Open Access Research Article
EXPLORING THE ETHICAL CONSIDERATIONS OF EUTHANASIA: BALANCING AUTONOMY AND REGULATION IN END-OF-LIFE CHOICES BY: ISHAN MISHRA & DR. REKHA VERMA
Published Paper
Article Details
EXPLORING THE ETHICAL
CONSIDERATIONS OF EUTHANASIA: BALANCING AUTONOMY AND REGULATION IN END-OF-LIFE
CHOICES
BA.LLB(H), Amity
University, Noida, India
CO AUTHOR:
DR. REKHA VERMA
The ongoing discussion around euthanasia is a multi-faceted and
emotionally charged topic that gives rise to deep moral, legal, and social
disputes. From a multidisciplinary
vantage point, this research
delves at the origins of euthanasia as well as its ethical and legal aspects,
as well as public views, healthcare
provider consequences, and potential future developments. The research examines the reasons for and
against euthanasia, drawing on ideas from a variety of disciplines including ethics, sociology, law, medicine, and
philosophy to weigh the pros and downsides
of the practice. Also included are the variables that influence legislation and
policy on end-of-life care, as well as
an
examination of the various legal systems across
the globe that regulate
euthanasia. We take a look at how people in different parts of the world feel
about euthanasia, and how
demographic, cultural, and religious variables play a role in shaping public discourse and policy discussions. This
article explores the ethical, legal, and psychological difficulties encountered by frontline caregivers in responding
to euthanasia requests, with an emphasis on the ramifications of euthanasia on healthcare providers. Efforts to develop palliative care, advance care planning,
treat psychological and spiritual needs, encourage advocacy, and public education are some of the future paths that
are being considered in the discussion
over euthanasia. The development of end-of-life care practices that are more compassionate, patient-centered, or morally responsible may be achieved
via educated discourse, ethical reflection, & evidence-based legislation.
Keywords:
Euthanasia, end-of-life care, ethics, legal frameworks, societal perspectives, healthcare professionals.
CHAPTER-1 INTRODUCTION
For decades, ethical, legal, and social conversations have revolved
around the controversial topic of
euthanasia, sometimes known as assisted dying. Invoking deep moral quandaries
and problems
about individual autonomy vs society
control, euthanasia is defined as the intentional end of a person's life with the purpose of alleviating
suffering. How should the government handle questions
of when and
how people die? Should people
have complete autonomy
in these issues, or should they be heavily
regulated? Examining the reasons for and against euthanasia as
well as current legislation and acronyms relevant to this controversial topic, this article dives into the
ethical intricacies surrounding this controversial practice.
The legalization of assisted suicide has been a hotly contested issue in several nations
in recent years. A kind and individualistic display, according to proponents, would be to provide terminally sick individuals the option of a peaceful death1.
Proponents of assisted suicide often
bring up the concept of autonomy, stressing that people should have the
freedom to decide for themselves
what to do with their life, including whether or not to end their pain and
suffering. They contend that it is
a breach of fundamental human rights to subject people to intolerable suffering
and pain against their will.
Also, many who support euthanasia argue that it may be better regulated
and legalized if it is neither
illegal or badly executed2. Some people think that the hazards of
euthanasia may be reduced if certain
rules and protections are put in place, such making people provide their informed
permission and having
doctors oversee the procedure. Euthanasia proponents cite
1Encyclopædia
Britannica. (n.d.). Euthanasia.
Encyclopædia Britannica. Retrieved from https://www.britannica.com/topic/euthanasia
2 Byars, S. M., & Stanberry, K. (2019). Business ethics.
Houston, TX: OpenStax College, Rice University.
countries like the Netherlands, Belgium, & several states in the US
where the practice is legal and heavily
regulated to guarantee responsible and ethical execution of the operation.
But there are serious moral and pragmatic issues raised by those who are
against euthanasia. The elderly, the crippled, and the mentally ill are among the most likely to be victims
of abuse, compulsion, and
prejudice if euthanasia becomes legal, according to those who fear it would desecrate the sacredness of human life.
They express concern about the potential expansion of euthanasia to cases
when the patient's permission is uncertain or when there are other methods of pain relief
and palliative care, arguing with the slippery slope argument.
CHAPTER-2
LITERARURE REVIEW
Ethical considerations in the regulation of euthanasia and physician-assisted death in Canada. Health policy, Kekewich,
M. (2015)
Upholding a lower court's ruling that
Canada's current ban on physician-assisted dying violates the s. 7 [Charter of Rights while
Freedoms] rights of mentally competent adults whose illness causes intolerable suffering, the Supreme
Court of Canada (SCC) published its ruling on
February 6, 2015, in the case of
Carter v Canada (Attorney General). This post aims to provide a
concise overview of the rules in place in three countries that have legalized physician-assisted dying and/or euthanasia: Oregon (USA),
Belgium, & the Netherlands. It also discusses the recent passage of Bill-52, "An Act Respecting End-of-Life
Care," in the province of Quebec3. Patient and provider
autonomy, finding an applicable
decision-making norm in practice, explaining difficulties with the SCC
eligibility criteria for assisted-death, reviewing assisted- death cases, and taking into account the
provision for assisted-death are all important ethical considerations that should be taken into account when policies
and regulations are developed across
Canada in response to this Supreme Court decision.
[This paper aims to stimulate and steer the debates in these areas by policy makers,
professional organizations,
and regulators—it does not cover all concerns connected to the regulation & policy development regarding
euthanasia and assisted dying in Canada.]
In the case of Carter v. Canada (Attorney General), the Supreme Court of
Canada (SCC) affirmed a lower court's ruling that the long-standing "prohibition of physician-assisted dying
3 Kekewich, M. (2015). Ethical
considerations in the regulation of euthanasia and physician-assisted death
in Canada. Health
Policy.
violates the section 7 [Charter of Rights and Freedoms] rights of
competent adults who are suffering
intolerably as a result of a grievous and irremediable medical condition"
(SCC, February 6, 2015). Section 14 of the Criminal Code prohibits "[n]o person is entitled
to consent to have death
inflicted on him, and such consent does not affect the criminal responsibility
of any person by whom death may be
inflicted on the person by whom consent is given" (pg. 3), and the Supreme Court understood this and
upheld the prohibition. An unreasonable restriction on the right person life,
liberty, and security is said to
exist in Section 241 (b), which states that one is guilty of a
criminal conduct if they "aid or abet an individual to commit
suicide" (pp. 5). This
decision overturned the criminal code provisions that forbid physician-assisted
suicide in two cases:(1)
when the patient is an adult and gives clear consent to end their life, and (2) when the patient has a severe and
irreversible medical condition (such as a disease, disability, or illness)
that causes unbearable suffering given their condition.
(74th page)
To give Parliament, provincial governments, professional groups, and
regulatory colleges a chance to think about how they might decriminalize and regulate physician-assisted dying,
both in theory and in reality, this declaration of invalidity was put on hold for twelve
months.
The SCC's ruling accepted the criteria provided by the Canadian Medical
Association rather than attempting to
define physician-assisted death and euthanasia directly. It is reasonable to assume
that euthanasia and physician-assisted dying, in its generally
recognized forms, should be legalized
as they have deemed Section
14 and Section 241 (b) as unacceptable violations of a competent individual's Section 7 rights.
In accordance with the definition offered by the Canadian medical organization,
euthanasia is defined as the following: the individual in question has an incurable
disease; the agent is aware
of the person's condition; the act is committed
with the main intention
for ending the life of the person;
and the act is carried out with
empathy and compassion, without seeking personal gain, in order to bring
about this end. This can be done with or without consent.
page two the third
"A physician knows and intentionally provides a person with the
knowledge or means or both required
to end their own lives, including counseling about lethal doses of drugs,
prescribing such lethal doses or
supplying the drugs." This is what's known as physician-assisted dying. page two
the third.
In view of the recent Carter v.
Canada decision4, this article
will take a cursory look at the laws in place in three countries that allow
physician-assisted death and/or euthanasia: Oregon, Belgium, and the Netherlands.
It will also take a look at a newly-created bill in Quebec. Finally, it
will present some ethical considerations that would be relevant in the creation
of laws across Canada. For
our research, we selected Oregon, Belgium, and the Netherlands as typical jurisdictions due to their
well-established and generally effective rules. On the other hand, we picked Quebec to give light on Canada's
current situation before
the SCC judgment.
Readers uninitiated with Canada's healthcare system may find it strange
that the writers
of this piece
choose to investigate potential national regulations for assisted suicide
considering much progress
has been made in this domain in Quebec. Despite assurances that health care in Canada would be accessible, portable, and
universal, the system is actually governed at the provincial and territorial levels. This is why, while
Quebec is in a good position to establish regulations, the other nine provinces & three territories have only recently started
talking about it. We do a lot of talking about Canada in general, but we'll be using examples
and questions from our time in
Ontario to illustrate our points. We think the other provinces and territories
can learn from these models when they draft their own legislation.
4 Library of Parliament. (n.d.). Physician-Assisted Dying in Canada: Legal and Ethical Considerations.
Retrieved from https://lop.parl.ca/sites/PublicWebsite/default/en_CA/ResearchPublications/201943E#:~:text=In%20February
CHAPTER-3
ETHICAL CONSIDERATIONS SURROUNDING EUTHANASIA
Along with the
right to life, does a man also have the right to die? I want to know whether he has the right to die with honor. Is it a
criminal or an unpunishable deed to take a life from a mercy case? How each nation responds to these issues is unique. The first and foremost concern is, why would a state choose to authorize this kind of life-depriving treatment? When lawmakers have the opposing
opinion, however, the same dilemma
arises. Consequently, there is
an endless well of literature on euthanasia and, more recently,
physician-assisted suicide, covering all the bases from a moral and
philosophical perspective; some have even ranked this debate as one of the ten most
contentious moral issues, and it certainly ranks among the most pressing
issues affecting both national and
international health policies. For the sake of brevity, let's just say that physician-assisted
suicide (PAS) occurs when a doctor gives a patient medication to end their life,
and direct active euthanasia (ADE) refers to a medical act that aims to deprive a person of their life.
When exactly the guy first considered
euthanasia is unclear. The 1906 effort by Ohio to legalize euthanasia was the culmination of
long-running debates in the US and UK . Over the last several decades, there have been efforts to legalize both the ADE and PAS. However, lawmakers across the globe have been more
willing to decriminalize PAS because they see it as a less severe type of life deprivation. This is most clearly shown in the United States,
where certain states
have decriminalized PAS notwithstanding the Supreme Court's ruling that neither the right nor the prohibition of ADE nor
PAS exists in the Constitution. At
the same time, there
are strong objections to these measures, the end goal of which is to make
it a crime to help a terminally sick patient have his life taken from
him . By way of illustration, consider England: the 5British
Medical Association or the Royal College of Physicians' stances on assisted suicide
are in a perpetual state of flux, shifting from outright opposition to a
neutral stance and back again).
Legislative handling of these two
concerns has varied between nations owing to
differing opinions, but solutions
are continuously examined due to the abundance of activity in this field. For instance, Belgium
moved swiftly in 2014 to legalize ADE for minors,
reasoning that they were mature enough to make such a
choice. Although these treatments are considered illegal in most nations, they are
really rather common.
CHAPTER-4
LEGAL
FRAMEWORKS GOVERNING EUTHANASIA
Society has been profoundly affected
by the tremendous technological and medical advancements. Because of them, problems
that are changing people's lifestyles and society values have come to light. Concurrent with these shifts, there has been a spike in the promotion of
individual agency, autonomy, and
choice. In light of these problems, we must reconsider the foundations of our beliefs
in
medical and social ethics6. Of particular importance in recent years has been the study and treatment of palliative care and quality
of life concerns
in terminally ill patients,
particularly those with advanced cancer & acquired immune deficiency
syndrome (AIDS). A lot of work has
gone into expanding the scope of palliative care and quality of life research to include cancer patients'
clinical problems, particularly those pertaining to mental health, like neuropsychiatric syndromes or
psychological symptoms in terminally ill patients. But the most interesting and
clinically significant mental health concerns
in palliative care right now are about depression, physician-assisted suicide (PAS), and the
desire to die.
Many connected phenomena, such as suicide and suicidal thoughts, interest
in physician- assisted suicide (PAS),
and requests for PAS or euthanasia, have been theorized to revolve around a desire for death. This concept,
first put forth by Brown & colleagues & refined by Chochinov et al., centers on how much one
wants their life may end sooner. It varies from having no wish to die at all to having suicidal purpose,
which is the urge to terminate one's life
6
Euthanasia in India. (n.d.). National Medical Journal of India, 25(2), 120–122. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440914/#:~:text=In%20India%2C%20euthanasia%20is%20a,t he%20help%20of%20family%20members.
quickly. Following the high-profile examples
of Drs. Jack Kevorkian, Timothy
Quill, & Aruna
Shanbaug, advocates for patient autonomy in dying have become louder in
recent years. The suffering of terminally sick people has been at the
heart of many instances.
In all the legalese and political wheeling
and dealing, the role of medical, social,
& psychological elements
(such as depression) that may exacerbate terminally sick patients' thoughts
of suicide, desires
for a quick death, and requests for PAS has been largely
disregarded.
"Euthanasia" was first used in the early 17th century by the
British philosopher Sir Francis Bacon.
A "good" or "easy" death was originally meant by the Greek
words eu—"good"—and thanatos—"death."
This is where the English term "euthanasia" gets its origin.the
third. The practice of euthanasia
involves another person knowingly and willingly administering a fatal substance
to a patient in order to end the patient's unbearable and incurable
suffering7. In most
cases, the physician's goal is to alleviate pain and suffering out of
mercy. Both "active" and "passive"
euthanasia, in which doctors carry out the procedure, are in use today.
"Active euthanasia" means that the doctor
is taking intentional measures to kill the patient. The practice of delaying or discontinuing life-sustaining
care is known as passive euthanasia. Active euthanasia
may be categorized into three main forms. A kind of active euthanasia,
voluntary euthanasia is carried out
when the patient requests it. The practice of involuntary euthanasia, often called "mercy killing," is ending a patient's life for the purpose of alleviating his suffering and alleviating his pain without his
explicit consent. Nonvoluntary euthanasia is carrying out the procedure regardless of whether the patient is competent
to provide consent or not.
CHAPTER-5 CONCLUSION
Euthanasia is a contentious and divisive topic
because it raises profound and personal concerns about human worth, dignity, life, and death. We have examined
euthanasia from a variety of angles, including its social, legal, and ethical implications, as well
as its advocates' and detractors' arguments. We have seen that euthanasia poses serious moral questions and problems for people, groups,
and governments as we wrap up our subject. Autonomy,
beneficence, non-maleficence, &
fairness are only a few of the ethical concepts and values that we are forced to confront while
discussing euthanasia. An argument in favor of euthanasia is that it respects people's autonomy and
provides a humane solution to intolerable pain and suffering. Respecting the
liberty of individuals and alleviating the agony and suffering of those with terminal illnesses are two of their
main points. Opponents, on the other hand, bring up issues such medical ethics, the possibility of abuses, and the
value of human life. They warn that euthanasia
is becoming too common and stress the need to protect vulnerable people from abuse and exploitation. Cultural,
religious, & political views on end-of-life care are reflected in the
varying legislative frameworks allowing euthanasia throughout different countries. Some states in the US, like with the
Netherlands and Belgium, have made euthanasia legal under certain circumstances; however, there are
many checks and balances in place to make sure it's done in a responsible and ethical manner. On the other hand, patients in nations where euthanasia
is still illegal or heavily regulated may have trouble getting the
end-of-life care they need, which might prolong their suffering.
Many things impact how society views euthanasia. These include
demographics, religious views, and
cultural standards. Some members of the public are strongly in favor of
legalizing euthanasia, while others have concerns or are completely opposed to the practice.
It is crucial
to have well-informed conversations and be courteous while discussing
euthanasia because of the powerful
influence of media portrayals, public debate, and lobbying activities on social views towards the practice. The ethical and legal
dilemmas that arise while caring for terminally sick patients in the face of
euthanasia have far-reaching consequences for the medical community. When faced with euthanasia requests,
healthcare providers may have competing moral and professional responsibilities; they may benefit from education, community, and direction as they work
through these difficult circumstances. In debates on euthanasia policy and
practice, the opinions and experiences of healthcare providers, who play an essential role in helping patients make end-of-life decisions, must be included.
REFERENCES
Askitopoulou, H., & Vgontzas, A. N. (2018). The relevance of the
Hippocratic Oath to the ethical and
moral values of contemporary medicine. Part II: interpretation of the
Hippocratic Oath—today’s perspective. European Spine Journal,
27(7), 1491–1500. https://doi.org/10.1007/s00586-018-5615-z
Byars, S. M., & Stanberry, K. (2019). Business ethics. Houston, TX:
OpenStax College, Rice University.
Esikot, I. F.,
Bessong, P. K., & Ette, E. E. (2019). An Examination of Spinoza’s Moral Philosophy. GNOSI: An Interdisciplinary Journal
of Human Theory
and Praxis, 2(1), 10-19.
Hurst, S. A.,
& Mauron, A. (2003). Assisted suicide and euthanasia in Switzerland. BMJ, 327(7405), 52–53. https://doi.org/10.1136/bmj.327.7405.52-c
Lorenzl, S., Butzhammer, L., & Nübling,
G. (2017). Assisted
Suicide of patients
with parkinsonian syndromes in
Switzerland – the need of early and continuous integration of palliative care and dignitiy therapy. Movement Disorders, 32(suppl
2).
Ogar, T. E., & Ogar, J. N. (2018). Globalization in Africa and
Beyond: The Quest for Global Ethics. GNOSI:
An Interdisciplinary Journal
of Human Theory
and Praxis, 1(2), 38-47.
Tarabeih, M., Bokek-Cohen, Y., Abu Rakia, R., Nir, T., Coolidge, N. E.,
& Azuri, P. (2020). Religious observance and perceptions of end-of-life care. Nursing Inquiry,
27(3). https://doi.org/10.1111/nin.12347
Glenn, R. A. (2003). The right to privacy:
Rights and liberties
under the law. Abc-Clio.
Young, R. (2007).
Medically assisted death. Cambridge
University Press.
Pojman,
L. P. (2000). Life and death: a reader
in
moral problems. Wadsworth Publishing.
Hockey, L. (1987).
The End of Life:
Euthanasia and Morality.
Journal of Medical Ethics, 13(1), 50.
Article Information
EXPLORING THE ETHICAL CONSIDERATIONS OF EUTHANASIA: BALANCING AUTONOMY AND REGULATION IN END-OF-LIFE CHOICES BY: ISHAN MISHRA & DR. REKHA VERMA
Authors: ISHAN MISHRA, DR. REKHA VERMA
- Journal IJLRA
- ISSN 2582-6433
- Published 2024/04/24
- Issue 7
About Journal
International Journal for Legal Research and Analysis
- Abbreviation IJLRA
- ISSN 2582-6433
- Access Open Access
- License CC 4.0
All research articles published in International Journal for Legal Research and Analysis are open access and available to read, download and share, subject to proper citation of the original work.
Disclaimer: The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of International Journal for Legal Research and Analysis.