Euthanasia, an ethical debate

David Albert a 60 year old man. He suffered from an incurable disease called motor neuron disease. David was diagnosed with this disease over 3 years ago and been able to manage his disease until now. In more recent times the disease has become much more severe and is taking a greater toll on his life. David spends a lot more of his time in and out of hospital and also requires daily care from a special carer from the HSC. Motor Neuron disease is part of a group of neurological disorders that selectively affect motor neurons which are the cells that control voluntary muscle activity including speaking, walking, breathing, swallowing and general movement of the body. This type of disorder progressively gets worse and worse as the disease progresses. There is no cure for this disease at present. David is a single man. His wife died many years ago after a long fight with cancer. She died aged 49. David has a long history of dealing with fatal illness. Both of Davids parents died from cancer, as his wife. David knows well the harsh and devastating effects of fatal illness and knows very well the struggle and great effort it takes to care for a person who is ill. David also knows more that anyone the pain and suffering felt by loved ones as they deal with the realisation that someone they love is dying before their eyes. David has one daughter, Laura. Laura is a pharmaceutical rep for a company is married and has 4 children. Laura is an only child and is extremely close to her father. As time progresses Davids condition gets worse and he has become unable to take care of himself. He is unable to live alone and requires 24hour care and assistance to complete even the most simple of tasks. David is also in financial strain. He had remortgaged his home in order that he could take care of his late wife and spent large sums of money on experimental drug trials in the past. David was struggling to afford the 24 care that he requires and although he had funding from the HSC he could not afford to keep the care going. As a solution Laura suggested that he move in with her and her family and that she would take care of him and provides him with all the care that he needs. Initially things seemed to be going well and David was getting the care that he needed. After time the stress and strain took its toll on her and her family and it was getting increasingly

difficult to care for her father and also to take care of her own family. David spoke to Laura at length about how he didnt want her to see him when the disease completely took over his life and he also expressed his wish that his grandchildren not remember him as a sick old man who was unable to even communicate with them. David asked Laura if she would help him to end his life peacefully and on his own terms. Laura, being a pharmaceutical rep had access to drugs that would end his life peacefully and safely. She was dead set against the idea at first but eventually over time she came round to his way of thinking. This was his last wish and Laura could see how much he wanted this to happen. She could also see how much he was suffering and eventually she agreed to help him to end his life. Laura knew the risks she was taking. David died from a drug overdose of medication aged 64. In this essay I will look at the case study above and analyse and evaluate the ethical issues involved. I will look at the story from an outside point of view and discuss the ethical issues that emerged from this case study. The principle issue that emerges is the topic of euthanasia. This is the term given to the act of helping a person to end their own life. Euthanasia is a very controversial topic. Many people are firm believers that this act is wrong and immoral. There are also those who believe in the right to die as a fundamental right and a part of the right to life. This topic has a firm set of believers who think that euthanasia should be available to all people. From a medical stance euthanasia is a controversial topic which again has a split reaction with some support and also some heavy resistance. I will discuss the ethical issues of this and through ethical theories and ethical studies I will portray, through the case study, how this topic may emerge in peoples lives and how often the act of euthanasia may seem to be a reasonable request and justifiable act. In ethics, normative theories propose some principle or principles for distinguishing right from wrong actions. (Shaw, 1993) Theories of ethics can be divides into two main branches: deontology which is duty based and consequentiality theory. In this essay I will examine both theses theories and apply them to the case study in order to form an ethical argument in relation to the right and wrong of the act of euthanasia.

The first theory that relates to the topic of euthanasia is the deontological theory. The word deontology comes from the Greek word deon which means study of duty. This theory operates on the basis that certain principles are worthy of upholding no matter the circumstances. The deontological theory operates on the basis that certain principles have intrinsic value. Certain actions are morally right or wrong in themselves (Seedhouse, 1998) The central point of this theory states that a moral person must always do his or her moral duty. A key element of this theory states that a person should perform certain duties with no exception. If one relates this theory to the case study then the deontological theory will state that to that to take a persons life is an act that is always morally wrong and ethically wrong. Can the principle of taking someones life be always wrong or can there be a time when the act can be right. Such principles are worth upholding for their own sake, even if the result of upholding such principles could lead to terrible consequences (Seedhouse, 1998). The question then asks can the act ever be justified. When we look at the case study we can see that Laura helps David to take his own life. She does this in accordance with his wishes and therefore the act or principle was sought after. Rule-deontology insists that rather than persons making moral choosing depending on how he or she sees a situation at the time, it should depend on, and decisions should be based upon, a set of rules and guidelines that should be followed no matter the outcome. Some people believe that the rules are good and that they should be followed no matter what the circumstances are and no matter what the outcome may be. This theory also portrays that not acting according to the rules would be undesirable. This rule-deontology portrays a basic and simple view on issues, stating that rules and guidelines should be in place and people should not have any ethical debate about what to do in a specific situation and instead should instinctively follow the rules from the outset. Rule-deontology does not allow for emotions are ones own thought to influence decision making. If we relate rule-deontology to our case study then we see how Laura, if she was to act or follow this theory should not partake in euthanasia as the rule would state this has been outlined as morally wrong and also that euthanasia has been developed to be wrong. This theory does not deal with the topic of euthanasia itself. This theory more outlines the standards or rules set out by society and for each society individually. Thus this theory would only apply to euthanasia with reference to how a society has classed euthanasia, wrong or right. Thus,

according to this theory, each member of this society has to follow the rules within the society and any breach of these standards or rules would be seen as a wrong act. The disadvantages of the rule-deontology is that if a rule or act is chosen and portrayed as the rule there will eventually come a time or situation where it would be better if the rule was broken. If a rule is chosen, it may seem to fit but sooner rather than latter it will clash and then the question is should people still follow the rule, still follow rule-deontology? Or should people not act or follow the guidelines and merely act on what they feel to be right and what will result in the best outcome or the best consequence. From this thought we look at the consequentiality theory. In contrast to the deontologists theory the consequentiality theory does not believe in upholding certain principles. This theory states that whether an action is right or wrong depends upon the consequences that come about as a result of an action. This theory holds that the rightness or wrongness of an act should be judges solely on whether its consequences produce more benefits then disadvantages.
The consequentiality theory operates on the basis that whether an action is morally right or wrong is depend upon the consequences that come about as a result of carrying out an action. Actions are right or wrong in themselves. (Seedhouse, 1998)

If we refer back to the case study and explore the conaequentialist theory can the act of helping David to take his own life still be seen as a morally wrong act or can it be justified. By follow this theory or principle there are no rules or guidelines to follow so the decision must be based on the outcome. This is different to the act-deontology in that the act will be judged by society based on the outcome of the situation as apposed to the following or obeying of pre-existing rules. For example in the case study the consequence of this act was that a man got to die peacefully and pain free and also in accordance with his wishes. In contrast to this, not performing the act would allow David to suffer a long and painful death, an outcome that he did not wish to experience. Thus, can the outcome justify the means? The question here is could the consequentiality theory justify the act. If we look at Immanuel Kants view we could examine the issue of one acting from a pure motive. Kant states that if a person acts or commits an act and was acting from a pure motive then should this act be seen as wrong? (Kant, 1997) An example of this that Kant uses to illustrate this point is that a shopkeeper did not overcharge a group of children for sweets. He did not overcharge them because it would be morally wrong, he did it because he was afraid that

people would find out and that it would affect his business. He did not act from pure motive or from a sense of duty. If we compare Kants view and Kants theory to the case study can the act of Laura be justified by the fact that she was acting with a pure motive. For example if David was a wealthy man who had left a lot of money to his daughter, she who would inherit all his possessions when he died, then if Laura agreed that she would help her father to commit suicide in order to get the money then she would not have a pure motive. She would be performing the act for her own gain. But as the case study shows Laura had pure motive. She realised that her father did not wish to grow old with this disease and that his true wish was to end his life. Thus can her act be justified and not seen as a wrong act due to the fact the she had pure motive. She just wanted to help her father. If we look at the theories of ethics with reference to deontology, we can examine utilitarianism. The utilitarianism theory is classically associated with the goal of happiness or pleasure. The utilitarian theory is different from deontological theory in that utilitarianism does not depend upon principles and commandments. This theory does not assume that there are right and wrong acts or principles, instead this theory implies that a person should perform an act which will result in the most amount of good or happiness.
a person ought always to act so as to produce the greatest balance of good over bad. (Seedhouse 1998).

If we take a look at our case study and put the utilitarian theory to the test, can it be possible to justify the means of an act or action? For example if we look at the act of utilitarianism as described by Seedhouse who stated that in any situation a person should, if he is to do the right thing asses which of the actions open to him is most likely to produce the greatest balance of good over evil. In our case study Laura can use this theory to justify her act. It is the request of David that he has the desire to end his life now and in Lauras eyes this would be providing good or happiness for her father. This theory states that Laura should ignore the deontologist theory and not follow a set of instructions or guidelines. Instead the utilitarianism act states that she would examine the situation and examine which would be better for everyone involved. She should ignore her own personal feelings and act according to the greater good or greater happiness, the utilitarianism theory. This theory states that if Laura were to act in a way that, in her opinion would bring the greatest amount of good or happiness then whatever the act it would be justified. This theory is in complete contrast to deontologist thinking.

Deontologist might think he has a moral duty to keep promise in all circumstances an actutilitarianism will not take this for granted, instead, in this light of the unique and specific prevailing conditions, he will weigh up the pros and cons of keeping the promise, always giving the fullest possible attention to a consideration of the likely outcome. If keeping the promise does not seem likely to produce a balance of good over evil then-according to act-utilitarianism he is justified in breaking it (Seedhouse, 1998)

When we look at the topic of euthanasia through the case study and indeed euthanasia in general the utilitarianism theory forms many of interesting opinions. For example if we examine the act of utilitarianism in relation to health workers been put forward by those who support the utilitarianism theory is in relation to euthanasia and in relation to the greater good. The actutilitarianism must asses in each and every case the likely ratio between good and bad, yet it is not practical to follow this word for word. For example old people occupying beds in a hospital that could be used to care for younger people. In utilitarianism it would be justified to say that in order for the greatest good and providing the greatest happiness those beds should be given to young children who are sick and in need of a bed. On a practical level however this is not possible.
Utilitarianism is the most significant consequentiality theory. The morally correct action for a utilitarian is that which produces the greatest good for the greatest number of people (Mill, 1993)

The act-utilitarianism, if we look at it from a personal stance we can see that individual responsibility is the main advantage of act-utilitarianism (Seedhouse 1988) if for example an old person who is in hospital due to fatal illness and who is occupying a bed. If this person too wished to die on his own terms and when he wanted. This individual also believes that his bed should be given to a sick child so he or she can get better. Act-utilitarianism states that any act by a person to provide the greatest amount of happiness should be justified. Then should the person be allowed to end his own life. Similarly in the case study if Laura performs the act of euthanasia on her father can the act be justified as both believed that they were providing the greatest amount of happiness to everyone involved? Should her act be justified if she was to act utilitarianism?

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Bibliography

Beauchamp, Tom L. (1991) Philosophical ethics: An introduction to moral philosophy. 2nd ed. New York, McGrow Hill. Kant, I. (1997) Groundwork of Metaphysics of morals. Ed and Trans, Cambridge Up, Cambridge. Seedhouse, D. (1998), Ethics: the heart of heath care.2nd ed. John Wiley, Chichester, John Wiley & Sons William, S. (1993) Social and personal ethics, California, Wadsworth. Mappes, T. & Defrazia, D. (2001) Biomedical Ethics. 5th ed. Boston, McGrow Hill.