Active and Passive Euthanasia: Differences in Morality

Posted: April 06, 2016

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Euthanasia, mercy killing or physician-assisted suicide is one of the issues faced by medical practitioners and by the public for quite some time. It has become one of the relevant issues in the medical ethics and in medical law. Relevant arguments is backed up by one of the Ten Commandments: “Thou shall not kill”. Killing another individual is indeed morally wrong. Based on the arguments, it is also true even for medical practitioners who have sworn the Hippocratic Oath, this they should oppose abortion and euthanasia (Turk, 2002).

The question about death and dying have been one of the favorite issue for debates among lawyers, health care professionals, theologians, philosophers and even by the common citizens. Is euthanasia morally and ethically upright? Or is it a murder? These are two of the controversial questions that require comprehensive analysis and thorough investigation.

This paper therefore investigates on the morality of euthanasia and on the legality of its implementation. The researcher is hopeful that by the investigations he had conducted, he can provide relevant material for the evaluation of the human death and of implementing mercy killing to those who are suffering from crucial pain due to severe illness. Moreover, this paper will also provide a reference for the rational, logical and convincing perspective on when to decide for mercy killing and when to consider death and dying.

In America, an alarming number of people suffering from chronic diseases have died in health institutions and this had caused public concern. This had even caused the public to question the dignity and credibility of the heath institutions in protecting life and taking care of the sick. It is a common knowledge that the medical institution is primarily responsible for improving the quality of life among those who are suffering or experiencing health problems (Pecorino, 2002). However, Vodiga (1974) also presented that the medical community is also responsible of providing a quality of end of life care for patients who are suffering severe pain caused by their illness. This can be illustrated through the freedom granted among physicians to provide appropriate and necessary medication in controlling pain and in some extent this may lead to the execution of euthanasia or physician-aided suicide (Somerville, 2008). However, the process of dying had been extended because of the intervention of new trends and advancement in technologies that make dying free from pain (Turk, 2002). Nevertheless, studies showed that majority of the population in the USA are expressing their oppositions to euthanasia and express their choice of just dying at home rather than ending one’s life using the current health facilities.

Euthanasia had been adopted by some people especially if the patient is suffering from severe pain due to the illness that he/she has. Though this had been accepted by some culture, but there are still majority of the population who questioned the legality and morality of mercy killing or ending one’s life. Vodiga (1974) cited the moral controversies of ending one’s life and emphasized the three conditions of opting euthanasia. Among these reasons include being diagnosed with terminal illness, experiencing excruciating pain and the desire of the patient or patient’s family of ending the life in order to get rid from the pain and to escape from lengthened suffering.

Euthanasia is categorized into two: active euthanasia and passive euthanasia. The active euthanasia is characterized by the deliberate action of the health professional or medical practitioner of ending the patient’s life (Turk, 2012). The passive euthanasia on the other hand, refers to the incident of ending the patient’s life because the health practitioner had not done the necessary things to prolong the life of the patient. Among those practices that can be categorized as passive euthanasia are switching off the life-support machine, disconnecting the feeding tube, refraining from doing the life-extending operation and refraining from giving the patients with drugs that can alleviate his/her condition (Pecorino, 2002).

Differentiating between passive and active euthanasia is indeed a crucial issue in medical ethics. Considering medical ethics, it is permissible to stop the treatment and just allow the patient to die however it is a questionable act to do any direct action that will kill the patient. This set of guidelines is indeed acceptable to some doctors and it is even endorsed and encouraged by the House of Delegates of the American Medical Association when the law was signed on December 4, 1973 (Vodiga, 1974). The deliberate act of ending one’s life of the human being or termed as mercy killing is opposite to what the medical professionals have sworn for and it is even opposing to the policies set by the AMA.

Deciding of whether to continue or stop the employment of the medication in order to extend the life of the patient when there is unquestionable evidence that the patient will die eventually is indeed a burden on the patient himself or to his immediate family (Percorino, 2002). Hence, the expert advice or judgment of the physician should be readily available. However, there are cases wherein this doctrine is being neglected and put aside and the doctors will undergo comprehensive review on the case and on the condition of the patient.

For instance, a patient who is suffering from terminal case of throat cancer definitely experiences terrible pain which cannot be alleviated by any form of medical treatment. It is certain that the patient will eventually die in the next few days given the medication. However, if the patient decides and chooses to not to live for those remaining days of his life because of the unbearable pain, then he may talk to the doctor about his decision and of course with the consent of the family. Suppose that the doctor agrees that the medication be withheld as mandated by the doctrine that he may give in to such decision. The doctor’s action will be justified on the fact that the patient is in agony and suffering unbearable pain and since he will die anyway then why let him suffer. It would be wrong letting the person in pain when in fact his death can be decide upon. However, consider this: if the treatment is withheld, it may take longer time before the patient dies and he suffer more pain than when the direct action of lethal injection is administered (Turk, 2002). This scenario can give reason of thinking whether passive euthanasia is better than active euthanasia and which is more morally upright. If the initial decision is not to prolong the agony then active euthanasia should be administered rather than the passive euthanasia. It is clear then to say that endorsing an option that can result to experiencing more suffering rather than less is indeed an opposition to humanitarian impulse which should hasten the decision of not prolonging one’s life (Somerville, 2008).

The point is in passive euthanasia the patient is allowed to die in a relatively slow manner and he may suffer severe pain however in the administration of lethal injection or active euthanasia the patient dies quickly in a painless manner (Turk, 2002). Let us look into this example. In the studies conducted, it was found out that one in every 600 babies is diagnosed with Down’s syndrome. Most of them are healthy and if given with proper pediatric care they will have a normal infancy (Pecorino, 2002). However, there are those babies suffering from congenital disease like intestinal obstruction that severely needs operation so that they will live. There are cases wherein the patient’s family opted that the baby will not be operated upon and just let him/her die. This case indeed as some doctors had recounted is emotionally draining to their part especially that they know that there are possible means that can prolong the life of the infant. At one point it is understandable why there are those who opposed all form of euthanasia and insist that the infant be allowed to live despite the consequences and health condition that the baby may suffer. Thinking of those parents who favored ceasing the baby’s life quickly so that he/she may not experience more pain is rational. However, there are also those parents who want to bet everything just to prolong the life of the infant yet eventually let the baby wither and dehydrate to death. The medical doctrine mandate that an infant must be allowed to dehydrate and wither however giving any form of injection that could definitely end the life and the suffering of a small human body is not allowed and thereby needs no further refutation. (Turk, 2002).

The Moral Difference between Killing and Letting Die

Most people would make a difference between active and passive euthanasia. Some think that withholding the treatment and just letting the patient die is more acceptable; however isn’t it morally wrong to deliberately kill a human being? There are medical practitioners who favored providing the patient that death he wished for and eliminating the instances of dealing with the moral issues they faced when they killed the person by active euthanasia. However, if it is taken seriously, the distinction between passive and active euthanasia is nonsense. Stopping the medication is indeed a deliberate act and the same is true with not continuing a certain medication (Somerville, 2008). Turning off the respirator needs someone to do such action. If the patient’s life is ended because the doctor or any medical practitioner has turned off the respirator even if the patient is suffering from a deadly illness and there is certainty that he will die eventually because of the illness, however it will come out that the immediate cause of the death is the switching off of the breathing machine, then it is still a moral issue and definitely the act of killing someone is immoral. Both cases, active and passive mercy killing, the doctor deliberately ended one’s life. In active euthanasia, the doctor conducted an action that cause the death of the patient while in passive euthanasia the medical practitioners just let the patient die without doing something (Vodiga, 1974). Whatever the means implemented, it has just one result and that is ending someone else’s life, and killing is not a moral thing to do. Both actions have the same result and that is killing a human being because of humanitarian reasons. Thus, one may say that shutting off the breathing support machine is just as deliberate with injecting the patient with lethal injection (Turk, 2002).

Several people may believe that there is moral difference between active and passive euthanasia due to the thought that killing a person is morally better than just letting the person die (Pecorino, 2002). However, is this true? Is the case of killing better than just letting the person die? In answering these questions, let us consider two cases: the case of Smith and of that of Jones. Smith will have a large inheritance if something bad will happen to his nephew who is just six years old. So one night while the child is taking a bath he sneaked into the bathroom and drowned the child and arranged things so that it seems to be an accident. In the case of Jones, similarly he will have the inheritance if ever something bad will happen to the six-year old child. Just like Smith, Jones carried out a plan of drowning the child however, when he entered the bathroom, he saw that the child has slipped and hit his head and was facing down the water, dead. Jones was amazed with what he saw because the child was drowned accidentally and he does not require carrying out his plans anymore. Looking at the two situations, it is clear that Smith drowned the child while Jones simply let the child dies. That is the only difference in the two cases, thus, from a moral perspective, did any man behave better? 

Considering the moral perspective, the two incidents are both not right. However, it is then right to say that passive euthanasia is better than the active euthanasia. Watching the person die is more acceptable than killing that person. When the doctor decided to terminate the medication and just let the patient die, he did not do anything to end the person’s life but rather just let the illness inflict death on the patient. If the doctor gives lethal injection to the suffering patient, literally there is the act of killing. Then it is safe to say that in active euthanasia, the doctor is the cause why the person died but in passive euthanasia it is the illness that deliberately caused the person to die. Hence, it is just right to say that passive euthanasia is morally better than active euthanasia.

References

Pecorino, P. A (2002). Active and Passive Euthanasia. Journal of Medicine. Vol. 292. 78-80.

Somerville, M. (2008). Death Talk in a secular age. 

Turk, T. (2002). On the Moral and Social Implications of Legalized Euthanasia: An Argument for the Moral Permissibility of Euthanasia and an Evaluation of the Leading Moral and Social. Objections to Legalized Euthanasia in Support of the Continuation of Death with Dignity Initiatives. Wisconsin: Lawrence University. 

Vodiga, B. (1974). Euthanasia and the Right to Die- Moral, Ethical and Legal Perspectives. Chicago- Kent Law Review. Vol. 51. 1.

 

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