The main reason why this moral question arises is that many people think that killing someone is morally worse than allowing or purposely letting someone die. Especially in the medicine, where Hippocrates’ Oath laid the foundation for the ethical ideals, it is difficult to answer this moral question (, 2004). Physicians and all health professionals promised, under oath or not, only to heal life and not to take it. To make a decision if euthanasia is morally tolerable or not or whether it is a “good thing” or a “bad thing” to do is very complicated for health professionals, particularly under consideration of the patients rights, which are in the foreground.
Autonomy plays a significant role in patients’ rights, especially in end-of-life decision-making.
A person that has the capacity to choose freely and make decisions about one’s own life without being forced by others is said to have personal autonomy (Pence, 1998). It is also the ability for self-determination and freedom of choice (Charlesworth, 1993).
In modern medical ethics, autonomy means that the patient has the right to make his or her own decision about his or her body, including dying (Pence, 1998). So, if one requests to die because the own value of life is lost, than it should be accepted and permitted, if the personal autonomy of this person is respected. A liberal society encourages its citizens to exercise autonomy but only if it does not harm or affect the rights of others (Charlesworth, 1993).
Although Australia is a liberal society that “emphasizes the importance of individual freedoms and responsibilities, and the relevance of values and obligations in securing outcomes in the national interest” (The Hon. Prime Minister Mr John Howard, 1997), it still involves some paternalism, which includes state policies. Prime Minister John Howard expressed the importance of paternalism in a liberal society in his speech “My Government has a presumption against intervention by the state in favour of the rights and role of the individual…we fully recognize the responsibility of the state to protect the interests of its citizens. The state must intervene if community interest is at risk" (The Hon. Prime Minister Mr John Howard, 1997). In the case of voluntary active euthanasia, the state protects the society in prohibiting this form of euthanasia. In doing so, citizens cannot coerce others to comply with a command for active voluntary euthanasia, because the implication to do so might damage the security of vulnerable and elderly people and thus impinges upon their rights (British Medical Association, 1993).
There are numerous reasons why active voluntary euthanasia is prohibited and judged by many people as morally wrong. One of the main reasons, as often stated in topic related books, is the anxiety that the security of vulnerable and elderly people could be damaged (Pence, 1998).
According to the British Medical Association, security of especially elderly people could be damaged due to increasing aging population and the imbalance between financial providers and financial dependants (British Medical Association, 1993, p. 151).
This brings with it the common “slippery slope” argument which argues that if voluntary euthanasia were legal for the terminally ill person, than it would eventually expand the cases where euthanasia is applied and therefore could affect the vulnerable, elderly and disabled in killing them through involuntary euthanasia against their will (Kerridge, Lowe and McPhee, 1998).
Basically, “slippery slope” means slipping from voluntary euthanasia into involuntary euthanasia. In relation to this argument, it is important to know that not all people have personal autonomy, inborn or achieved, due to certain circumstances. A person that is able to have autonomy must usually be an adult and of soundmind and morally independent (British Medical Association, 1993). For example, a patient with severe cerebral palsy is not of soundmind and therefore cannot have autonomy. This is important for the “slippery slope” argument, because other people have to act on the patient’s behalves and may use euthanasia against him or her. Other issues, like mental illness or drug addiction can limit the exercise of autonomy (British Medical Association, 1993).
Another concern that arises in permitting euthanasia is the incompatibility of the physicians “fundamental moral” and “professional commitment” to heal people and to protect their life (Pence, 1998, p. 56). Common euthanasia practice by physicians would also lead to distrust between patient and physician, because patients would have to fear that a treatment was intended to kill them not to cure. The control of high health care costs lead to a pressured budget, which could use euthanasia as an alternative option to sufficient treatment and care (Keown, 1996).
However, surveys showed that many people from different societies all over the world would welcome the legalisation of active voluntary euthanasia.
A survey in Australia showed that ca. three quarters of Australians would welcome voluntary euthanasia and that people from a church background had more supporters for euthanasia than opponents (South Australian Voluntary Euthanasia Society, 2004).
There are as many reasons to legalise euthanasia as there are for keeping it prohibited. Mercy is one of the strongest arguments for euthanasia. A person should be allowed to be released from suffering and pain if there is no hope for cure but only death. Another good consequence of legalising euthanasia would be the possibility to respect personal autonomy and self-determination of patients that request euthanasia (Kerridge, Lowe and McPhee, 1998).
The right to “die with dignity” is a major argument for euthanasia. Many people are afraid of their last days, and this does not count for only terminally ill people but also for every other person. For example, people are frightened of becoming old and loosing their continence or not being able to feed themselves. These facts do not need to arise from a terminal illness; a healthy old person can loose those abilities as well. For some people, this would be a loss of dignity and they may choose to be euthanased (Pence, 1998). Other people may want their families to remember them as they were in the “good” days.
As the reader discovered, there are many pros and contras related to euthanasia. Community viewpoints can differ greatly, depending on the beliefs of the community members. In Australia, major groups of opponents are Aboriginals and Torres Strait Islanders. Their religious beliefs and concerns about discrimination and distrust in medical care play a key role in rejecting euthanasia (Kerridge, Lowe and McPhee, 1998). Many disabled people are against the legalisation of euthanasia.
This could have its roots in former Nazi Germany, where thousands of disabled people were involuntary euthanased because they were considered “not worth living” (Keown, 1996).
However, the majority of a liberal community would welcome the legalisation of active voluntary euthanasia, because personal autonomy and self-determination are of great importance for these groups.
In a community, where paternalism rules, people would do what they expected to do and what is “good”. Those communities are mainly strong religious or traditional groups (Charlesworth, 1993).
The fact is that active voluntary euthanasia is illegal in Australia, though the Northern Territory legalised it under “The Rights for the Terminally Ill Act 1995” and was the first jurisdiction worldwide. However, the Act was revoked by the federal parliament in march 1997. The only countries that legally provide euthanasia today are the Netherlands and Belgium (Australian Voluntary Euthanasia Society, 2004).
At the very beginning of this essay, the reader was introduced to passive voluntary euthanasia, another form of bringing about death, although it is different from the legal and ethical view. Passive voluntary euthanasia refers to withholding or withdrawing life-sustaining treatment, which leads to a hastened death of the patient at his or her request. The patient with a terminal illness is allowed to die. As discussed earlier, this form of euthanasia is seen by many people as morally tolerable. Australian Law tolerates passive voluntary euthanasia under certain circumstances (Kerridge, Lowe and McPhee, 1998).
A common-law right exists that enables all patients of legal capacity to refuse medical treatment and therefore gives the ability of requesting withholds or withdrawals of life-sustaining treatment that can hasten death. Certain criteria must be met to participate in such an act.
The Northern Territories “Natural Death Act 1988” is such a law, where terminally ill patients that meet the requirements of the act, can refuse treatment and therefore the prolongation of their life (Staunton and Chiarella, 2003). The patient that meets all the criteria has full personal autonomy and no one can interfere in his or her decision.
Surveys all over the world showed that many people, including health professionals, think positively of euthanasia and they would like to see changes in the government legislature that legalise euthanasia (Australian Voluntary Euthanasia Society, 2004). This result leads to an emerging ethical role of the nurse. More and more patients are aware of the meanings of euthanasia and that there are other ways to achieve death, such as “double effect” (Kerridge, Lowe and McPhee, 1998). The nurse will be more and more involved in the decision-making and has to make moral decisions herself. A nurse needs to remember that, even if a patient is very sick and in severe pain without hope of cure, begging to die, there is nothing she can do, but reassure him or her and to give comfort.
It is also important for a nurse to act as outlined in the four major ethical principles, which are autonomy, non-maleficence, beneficence and justice. Non-maleficence emphasizes the principle of “above all, do no harm”. This has to be considered and remembered when terminally ill patients beg for mercy. Beneficence refers to “above all, do good” (Staunton and Chiarella, 2003). This principle can be controversial, especially in relation to a terminally ill patient. Nurses from a particular cultural background could experience great difficulties in “allowing a patient to die” and withholding treatment, because their beliefs are against death. Furthermore, personal relationships, thoughts and certain attitudes can play an important role in moral decision-making for the nurse. However, The Australian Nursing Council’s Code of ethics includes the four ethical principles and a nurse should act in moral decision-making under this code (Staunton and Chiarella, 2003).
Issues of euthanasia are very controversial and confusing. Hopefully the reader was able to penetrate the fog of confusion and gain some understanding of the issues accompanying euthanasia. The rights of the patients and autonomy in a liberal society have been outlined and need to be considered frequently, because of their enormous importance in professional health care. Pros and contras have also been discussed. However, every person is unique and has their own value of life; therefore, every person might think differently about the issues related to euthanasia. The ability to think differently is another form of autonomy that one can exercise in a liberal society like Australia.
Bibliography:
Charlsworth, M. (1993) Autonomy and the liberal ideal: Bioethics in a liberal society, Cambridge University Press, Melbourne
Hawley, R., King, J. & Weller, B. F. (2003) Australian Nurses’Dictionary, 3rd edn. Bailliere Tindall, Sydney
Keown, J. (1996) Euthanasia Examined, Cambridge University Press, Great Britain
Kerridge, I, Lowe, M & McPhee, J. (1998) Euthanasia: Ethics and law for health professions, Social Science Press, Australia
Pence, G. E. (1998) Classic works in medical ethics, McGraw Hill, Boston
British Medical Association (1993) Medical Ethics today: Its practice and philosophy, British Medical Association, Plymouth
(2004)
(Online, accessed 20.05.2004)
Staunton P. & Chiarella, M. (2003) Nursing and the Law, 5th edn. Churchill Livingston, Sydney
The Hon. Prime Minister Mr John Howard (1997) Sir Robert Menzies Memorial lecture: Australia in the world, University of London
http://home.vicnet.net.au/~victorp/liberals/nsw/Howard.html
(Online, accessed 23.05.2004)
NUR 111 Health and Health Professions Bioethics
