Friday, August 3, 2018


Since the 1970s, health care policymakers in the U.S. have debated the morality and legality of  Euthanasia. Much of that debate stems from a conceptual framework that has been a critically adapted from ancient/medieval thought, especially Roman Catholicism.

The term "euthanasia" has it's origin in the Greek terms "eu" and "thanos," which means literally "good death." For most of us steeped in Western culture, "good death" seems self-contradictory. Most of us regard death as the supreme "objective harm" that all of us seek to avoid, unless we have a good reason to not avoid it. Other objective harms include pain, disability, and loss of pleasure. For a utilitarian, a "good death," is contextual, referring to the "least worst" alternative among those objective harmful consequences. Hence, one might argue that in at least some contexts, a quick painless death is preferable to a long life of intractable, excruciating pain; or a life of extreme disability. This raises an empirical question. Are there levels of pain and/or disability that are worse than death, and therefore, if given the choice, would most rational/competent adults choose death over suffering? If so, do other have a right or a duty to kill those persons?

For better or worse, the euthanasia debate in the US involves two issues: First, is the person requesting death a rational competent adult? Second, if it is morally acceptable (or morally required) to assist others in bringing about a painless is it better to actively kill that person or passively allow that person die, naturally? 

According to J.S. Mill (and other libertarians) rational competent adults "own their bodies" and therefore have a right to do whatever they want to do with those bodies, as long as they don't harm others.  However, the debate over euthanasia can also be framed in Kantian terms in the form of a "right to live," "right to die," and/or the "duty to live" and/or the "duty to die?" If all humans have a "right to life," then the rest of us have a perfect duty to "keep them alive" by providing provide food, clothing, shelter, and/or heath care. On the other hand, Roman Catholics argue that the "right to life" includes a self-regarding "duty to live," which suggests that, at least to a certain degree, we are morally responsible for staying alive and keeping others alive.

Theologically speaking, Catholicism argues that "life is a gift from God." Because, God is (by definition) "omnipresent, omniscient, omnipotent, and good," the gift of life is of infinite value. Therefore, choosing to die is tantamount to refusing that gift. Hence, the decision when and how to die, must be left to nature, which was created by God. Therefore, in all contexts, actively killing other persons is a priori wrong, including the active euthanasia, death penalty, and killing in war. However, Roman Catholicism also posits a right and a duty to defend yourself, therefore killing others in self defense is at least sometimes justified. At least some wars are just, and therefore killing others in a just war, is morally acceptable. In short, the "right to life" is contextual, and therefore, must include all forms of killing.

If euthanasia is justified, then the next question is: How to do it?" Active euthanasia says that "A kills B for beneficent reasons." Passive euthanasia says that "A allows B to die, for beneficent reasons." Today, passive euthanasia involves withholding life-saving treatment. Since, the 1970s a series of Supreme Court cases established that it is legally acceptable to withhold all forms of medical treatment, including respiratory technologies, food and hydration. Several states have legalized active euthanasia via various combinations of drugs...often the same drugs that are used in capital punishment.

There is also a third Roman Catholic alternative, called "double-effect euthanasia." It is based on the Catholic notion that it's always wrong to kill someone, however we also have a duty to minimize pain and suffering. Therefore, double-effect euthanasia occurs when you can foresee two effects of your actions, one is "good" (easing pain and suffering) and the other is "bad" (causal involvement in death). Roman Catholicism, therefore, argues that it is morally acceptable to give high doses of morphine to dying patients, knowing that that does will hasten their death... but only if your intention is to remove pain and not kill. Today, most people who die take pain-relieving drugs, even though everyone knows they will die earlier, as a consequence. 

In sum, over the years, the arguments for and against active euthanasia have remained, essentially, the same. Arguments in favor focus on liberty (informed consent), beneficence (remove harms), and utility (wasting health care resources). Arguments against focus on non-maleficence (Hippocratic Oath, "Do no Harm."), justice (killing poor sick people), and utility (slippery slope arguments, "Allow passive euthanasia and eventually we'll be killing people who can't afford treatment).

Finally, it is important to note that the drugs that are typically used to ease pain and suffering are highly addictive, and that the ongoing drug war now focuses on physicians that unnecessarily prescribe those drugs. Thus, one unanticipated consequence of the war on drugs, might be an increase in pain and suffering of patients.    

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