Euthanasia and Ethics

Student Number: Z5059296

Course: Ageing and Endings A
Course Code: MFAC 1525
Word Count: 2193

Contents:

Pag
e

Introduction
3
Euthanasia Definitions

Euthanasia Laws and Clinical Relevance

4
Arguments For and Against Euthanasia

Should Euthanasia be Legalised?

9
Conclusion

10

Reflection
10
References

12

Introduction:
The debate surrounding euthanasia is multifaceted in nature;
ethically ambiguous and attracting the contrasting opinions of
various contemporary bioethicists. Euthanasia is currently illegal in
Australia and in most of the world, although there are some
countries that have legalised it in certain circumstances. This report
will define relevant terms in relation to euthanasia, providing a
framework to examine the arguments of those propagating its
legalization and those opposing it. Furthermore, it will assess the
clinical relevance of current laws, and provide an opinion on whether
or not euthanasia should be legalised.

1.1 Defining Euthanasia:

The term Euthanasia is derived from Greek, with the literal
translation being Good Death (Ebrahimi, 2012). It is used
commonly to refer to the practice of ending a patients life in order
to alleviate them from suffering, usually from a terminal or incurable
condition, and thus is also referred to as mercy killing.
There are various types of euthanasia recognized in clinical practice.
Active euthanasia refers to the act of performing deliberate action in
order to end a terminally ill patients life, such as administering a
lethal injection (Ebrahimi, 2012). Passive euthanasia is the term
used to describe the withholding of actions or processes that are
keeping the patient alive (Quill, Lo, & Brock, 1997). In many
countries, including Australia, this practice is not considered a form
of euthanasia, and according to legal and medical practitioners,
withholding or ceasing life-prolonging medication or treatment in
the best interests of the patient, or at the patient or a surrogate
representatives request, has become an established part of
medical practice and is relatively uncontroversial. (Bartels &
Otlowski, 2010)

Further categorization of euthanasia can be made Voluntary,

Involuntary and Non-voluntary. Voluntary euthanasia refers to the
circumstance in which a patient or their surrogate representative
requests euthanasia to be performed. Involuntary occurs when
euthanasia is performed without the patients request, with the
intention of relieving suffering. Non-voluntary occurs when
euthanasia is administered in the situation in which the patient is
incapable of consenting. (Wilkinson, 1990) The debate surrounding
the propagation of euthanasia refers to Active Voluntary euthanasia,
which entails performing deliberate actions in order to end a
Euthanasia has further been linked with the Principle of double
effect; an ethical doctrine declaring that the attainment of a
beneficial outcome may render certain bad side effects permissible if
they are inevitable and intrinsically linked to the beneficial outcome
(Krakauer et al., 2000). This is demonstrated clinically as various
medications have bad side effects, however are still administered
due to the overall positive effect. With regards to euthanasia, this
refers to the alleviation of distressing symptoms with the death of
the patient being an unintentional consequence. (Williams, 2001)
terminally ill patients life at their request. A further term,
physician-assisted suicide refers to the voluntary termination of
ones own life with the physician providing the necessary means. In
this scenario, the patient is able to end their life at a time of their
choosing, with the physician providing the necessary means but not
performing any positive actions. (Quill et al., 1997)

1.2 Legislation and Practical Implications: (Note

Euthanasia refers to Active Voluntary Euthanasia in this
section)
In Australia, any deliberate action that results in the death of
another person is illegal and defined as murder. Thus, both active
voluntary euthanasia and physician-assisted suicide are illegal, even

if the act is committed in compassion. Briefly, in Northern Territory,

euthanasia was made legal under the Rights of the Terminally Ill
Act, however this was voided by the Euthanasia Laws Act 1997,
which was introduced in order to remove the power of individual
states to legalise euthanasia (Otlowski, 1997). Although illegal,
prosecution has rarely occurred for various cases of documented
euthanasia (Justins V Regina, 2010). In efforts to combat this, the
Government introduced the Criminal Code Amendment (Suicide
Related Materials Offences) Bill of 2004. The Australian Medical
Association also endorses the view that euthanasia remains illegal,
along with assisted-suicide.
In Belgium, Euthanasia was legalised on 28th May, 2002 under the
Act Concerning Euthanasia. It was only the second country to do so,
after the Netherlands. Previously, this was only for patients over the
age of 18, but since 2013, the act has been extended to include
children. Several conditions must be met for euthanasia to be
administered:
-

The patient must be conscious of their decision

Their illness must be terminal
They must be in great pain, with no available treatment to

alleviate their distress

A psychologist must also determine the integrity of the
patients decision

The broad scope of these criteria also allows patients with mental
diseases to receive euthanasia, although the majority of cases are
young, male cancer patients (Deliens & Van der Wal, 2003). On
average, approximately 1400 euthanasia cases are recorded in
Belgium every year. (Smets, Bilsen, Cohen, Rurup, & Deliens, 2010)
In a clinical setting, Australian legislations prohibit any form of
active euthanasia from occurring, and thus practitioners are legally
unable to engage in any form of euthanasia or assisted suicide.

Instead, palliative care and alternative approaches in improving life

quality by treating psychological distress and providing satisfactory
relief from suffering have been propagated. However, passive
euthanasia, if requested and in the best interests of the patient, is a
relatively common practice in the present clinical setting (Bartels &
Otlowski, 2010). This catalyses a spectrum of ethical and moral
discrepancies between action and inaction; for is there difference
between the two if the intention and outcome are the same?
(Rachels, 1997)

2. Arguments For and Against Euthanasia:

2.1 For:
Autonomy
Patient autonomy dictates that individuals should have complete
power over choices that involve themselves if the choice does not
harm others. Current legislations on euthanasia limit the individuals
scope for controlling the end of their life. Various bioethicists have
argued for the legalization of euthanasia on request in carefully
circumscribed situations, utilising the value of patient autonomy to
support this. Peter Singer, a contemporary bioethicist, states that
current laws make it impossible to respect the value of autonomy,
when there is no capacity for it.(Singer, 1993) Furthermore, as the
way in which individuals die is intrinsically linked to their unique
awareness and understanding of their existence, the importance of
being able to influence the occurrence of ones death is very
significant, especially within the contemporary society, which
propagates values of free will in letting individuals determine their

lives themselves with their own values (The Danish Council of

Ethics, 2006).

Passive vs Active Euthanasia

The distinction between active and passive euthanasia is one that
plays a critical role in the debate over its legalization. This debate is
critical, as currently in Australia, in many cases it is permissible to
withhold treatment and allow a patient to die, whilst it is illegal to
actively euthanize or perform a direct action to kill a patient. As
moral responsibility may accrue from inaction as well as action, the
notion that withholding treatment and letting a patient die is
permissible, whilst taking direct action is not, is a moral paradox as
they harbor the same intention. The contemporary bioethicist James
Rachels argues this point, proposing that active euthanasia is more
humane as it allows patients to undergo a fast and painless death
(Rachels, 1997). He illustrates the moral equivalence of the two by
employing hypothetically scenarios. In the first, an individual will
inherit a fortune if his nephew dies, and so he plans to drown him

in the bath and carries out the act. In the second, he plans to drown
the nephew, but upon entering the bathroom, he sees his nephew
drowning but does nothing to help him. Rachels questions the moral
responsibility of both men, Did either man behave better, from a
moral point of view? As both men acted with the same motive, same
view and same end result, it can be said their actions and inactions
are equivalent (Rachels, 1997). However, this scenario does not
accurately depict the choice of euthanasia as both individuals are
acting out of selfish gain, whilst euthanasia can be argued to have a

Beneficence
Proponents of euthanasia argue that no individual should have to
experience unbearable suffering, and that ending ones life
7

painlessly in certain situations does more good than harm (Norval &
Gwyther, 2003). Values of compassion and humanity dictate the
alleviation of such suffering is a permissible act.

2.2 Against:
Palliative care
With the development of palliative care, defined as an approach
improving the quality of life of terminally ill patients, providing relief
from pain and other distressing symptoms (WHO, 2015), improved
life quality can be ascertained after diagnosis of terminal conditions,
rendering euthanasia redundant. Studies have demonstrated a
decrease in euthanasia requests in lieu of proper palliative care
(Norval & Gwyther, 2003).

Pro-Life
The doctrine of the sanctity of life states that all human life is of
equal intrinsic value, and thus it is wrong to take life in any
circumstance, other than self-defence (Perrett, 1996). This is a
crucial argument against euthanasia, as it has both religious and
societal roots.
Christianity believes life should be cherished as it is a gift from God,
and that it should be valued as it is a basic good. Furthermore God is
seen as the only arbiter of life and death. Euthanasia directly
contradicts these values as it forces the physician to end life, and
irrespective of the circumstance, this is considered taboo.(Keown &
Keown, 1995)
Buddhism differs in that its respect for life comes not from a divine
being, but its spiritual destiny a perfect afterlife state known as
nirvana. Any attempt to intentionally reach this state is forbidden
(Keown & Keown, 1995). Analogous to Christianity, the values of

Buddhism are against use of Euthanasia, with the fundamental

precept forbidding killing a human and seeking assistance in dying.
(Gombrich, 1990)

Bracket creep
Studies have demonstrated that over time, laws are interpreted
more liberally (Australasian Scientist, 2014). With specific regard to
euthanasia, bracket creep refers to the pressure to extend the right
to new classes of individuals, such as mentally ill, children and
infants. Furthermore, terms such as suffering or pain which would
be part of the criteria, are subjective and ambivalent, and could
possibly be manipulated. Archbishop Anthony Fisher argues this
view, utilising Belgiums extension of the law to include children, a
path referred to as a slippery slope. This is because when one
accepts some people are better off dead, a moral line is crossed.
(Fisher, 1997)

3. Should Euthanasia be Legalised in Australia?

I believe active voluntary euthanasia should be legalised in
Australia. In researching moral and practical arguments for and
against euthanasia, I was exposed to varying secular and religious
perspectives, which augmented my perception of this issue. As with
any contemporary medical issue, the arguments for each side are
complex and based on a variety of moral and ethical considerations.
My reasoning for agreeing with those who advocate for the
legalisation of euthanasia builds off the foundations of all their
arguments; humanity. If one is suffering and in unbearable pain as a
result of a terminal illness, with no chance of recovery and will

continue to suffer until their death, then it is only humane that

euthanasia be considered. There is no point in letting them suffer.
However, I believe that this would need to be an extremely tightly
regulated system and each case should be treated individually and
assessed with strict criteria.
Building off my fundamental reasoning of beneficence, I believe that
active euthanasia and passive euthanasia are morally equivalent
and that if passive euthanasia is permissible in some situations,
then active should also be considered. However, for the physician
performing either, this may be a completely different scenario.
Verbally agreeing to an act of such magnitude is utterly unlike when
you are the one performing it. Furthermore, the patients family will
also be involved in the process, and they may not want the patient
to undergo euthanasia, complicating matters. Therefore, if
euthanasia is legalised, I believe there should also be training and
support dedicated to physicians who are performing it, as well as
adequate information and support for families who will have to
endure the loss of their loved ones.
Overall, although I agree with religious views that life is sacred and
that proper palliative care has the potential to eradicate suffering, in
certain circumstances where the patient is experiencing suffering as
a result of a terminal condition with a potentially painful death, and
has requested euthanasia, I definitely believe it should be
considered as a compassionate and humane solution.

Conclusion:
The many perspectives on euthanasia demarcate it as a complex
and intricate issue, both morally and practically. In the
contemporary medicine, it remains illegal in most countries around
the world, with only a few countries choosing to legalise it, and even
then, in selective circumstances. The ethical complexity is such that
on one end, it has the ability to cease the suffering of terminally ill

10

patients, however, on the other, it transgresses natural and human

boundaries in taking away the sanctity of life. The handful of issues
highlighted represents but a shade of the plethora of perspectives
put forward by current bioethicists, further illustrating the complex
nature of this controversial debate.

Reflection:
Initially before this assignment, I was unsure about my position on
euthanasia. My dog of 11 years was put down in the week before the
start of AEA he had a large, undetected tumour in his spleen which
ruptured and haemorrhaged into his abdominal cavity. At the vet, my
family and I were talked through the process of euthanasia painless
and merciful, as it would save him the agony of internally bleeding
out. Not knowing what else to say, I had tearfully agreed to the
procedure, however I could not bring myself to watch. As a result, I
chose this assignment to explore the perspectives of euthanasia on
human patients. Initially, my outlook was rather oversimplified on
one end, you could stop someones suffering, but on the other,
taking a life is never justified. After researching the practical and
moral arguments, my perception of the issue has become a lot more
complex not only must one consider the patient, but also the
physician and family, and additionally, what legalising euthanasia
In completing the assignment, I found it difficult initially to condense
the information down into the word limit, as many of the sources
offered a wealth of information which I had to interpret in a succinct
manner. Furthermore, some of these sources were quite old (19801990s), and reflected a slightly stale zeitgeist of euthanasia, before
it was legalised in various countries and states around the world.
In order to condense my assignment, I chose three positive and
negative arguments of euthanasia instead of my plan of four. This
allowed me to explore them in a little more depth and facilitated a
deeper understanding of their concepts. To eliminate out-dated
11

information, I made sure to research whether certain laws were still

in place or had been overruled.
Overall, through completing this assignment, I have gained
meaningful insight into a prominent debate in contemporary
medicine. Initially coming from a stance which neither supported or
rejected euthanasia, I now believe that in certain circumscribed
situations, euthanasia would be appropriate as it ceases needless
suffering. However, I also believe that if legalised, euthanasia would
need to be strictly regulated in order to avoid bracket creep and
regretful decisions.

References:
Australasian Scientist. (2014). Euthanasia and Assisted Suicide. from
http://www.issuesmagazine.com.au/article/issue-september2014/euthanasia-and-assisted-suicide.html

12

Bartels, L., & Otlowski, M. (2010). A right to die? Euthanasia and the
law in Australia. Journal of law and medicine(17), 532-555.
Deliens, L., & Van der Wal, G. (2003). The euthanasia law in Belgium
and the Netherlands. The Lancet, 362(9391), 1239-1240.
Ebrahimi, N. (2012). The ethics of euthanasia. Aust Med Stud J, 3,
73-75.
Fisher, A. (1997). Theological aspects of euthanasia. Euthanasia
examined: Ethical, clinical and legal perspectives, 315-332.
Gombrich, R. (1990). How the Mahayana began. Paper presented at
the The Buddhist Forum.
Keown, D., & Keown, J. (1995). Killing, karma and caring: euthanasia
in Buddhism and Christianity. Journal of medical ethics, 21(5),
265-269.
Krakauer, E. L., Penson, R. T., Truog, R. D., King, L. A., Chabner, B. A.,
& Lynch, T. J. (2000). Sedation for intractable distress of a
dying patient: acute palliative care and the principle of double
effect. The Oncologist, 5(1), 53-62.
Norval, D., & Gwyther, E. (2003). Ethical decisions in endof-life care.
Continuing Medical Education, 21(5).
Otlowski, M. (1997). Voluntary euthanasia and the common law:
Oxford University Press.
Perrett, R. W. (1996). Buddhism, euthanasia and the sanctity of life.
Journal of medical ethics, 22(5), 309-313.
Quill, T. E., Lo, B., & Brock, D. W. (1997). Palliative options of last
resort: a comparison of voluntarily stopping eating and
drinking, terminal sedation, physician-assisted suicide, and
voluntary active euthanasia. Jama, 278(23), 2099-2104.
Rachels, J. (1997). Active and passive euthanasia. Bioethics: An
Introduction to the History, Methods, and Practice, 77-82.
Singer, P. (1993). Taking life: humans. Practical Ethics, 175-217.
Singer, P. (2003). Voluntary euthanasia: a utilitarian perspective.
Bioethics, 17, 526-541.

13

Smets, T., Bilsen, J., Cohen, J., Rurup, M. L., & Deliens, L. (2010).
Legal euthanasia in Belgium: characteristics of all reported
euthanasia cases. Medical care, 48(2), 187-192.
The Danish Council of Ethics. (2006). from
http://etiskraad.dk/upload/publications-en/euthanasia-andconditions-of-the-dying/end-of-life/kap3_3.htm
WHO. (2015). from
http://www.who.int/cancer/palliative/definition/en/
Wilkinson, J. (1990). The ethics of euthanasia. Palliative medicine,
4(2), 81-86.
Williams, G. (2001). The principle of double effect and terminal
sedation. Medical Law Review, 9(1), 41-53.

14