There are few more urgent and important socio-moral questions than the question whether voluntary euthanasia

and/or physician-assisted suicide should be decriminalized. The question continues to generate intense and widespread debate. Regrettably, the quality of that debate fails to do justice to the importance of the question. The case for decriminalization is too often assumed rather than argued. This is particularly evident in the treatment of the question by the mass media which, generally, seem largely to assume the case for decriminalization. Their coverage of the issue often consists of milking viewers' emotions in favor of decriminalization and implying that any opposition must rest solely on religious belief, particularly of a "fundamentalist" stripe. This paper aims to promote a more accurate and informed understanding of the issues. It sets out seven arguments which are commonly advanced by advocates of decriminalization and offers corresponding counter-arguments. The arguments for decriminalization undoubtedly merit a reply. However, as will become apparent, cogent replies are available. Moreover, these replies need rest on no religious basis, "fundamentalist" or otherwise. The aim of the paper is to provide anyone interested in this pressing debate with a clear overview of the arguments, and to suggest that the case for decriminalization is far less persuasive than is often thought. It concludes that relaxing the law would be a serious mistake which would hinder rather than help the urgent task of improving care for the sick and the dying. Definitions "Euthanasia" Before tackling the arguments, it is important to consider definitions. In the contemporary debate there is no universally agreed definition of "euthanasia." The word is often used to mean different things and this can produce serious confusion. The word "euthanasia" is derived from the Greek for a "good death." In this paper the word will be used to mean the intentional killing of a patient by a doctor because death is thought to benefit the patient . There are three significant points about this definition.

Euthanasia refers to intentional killing, where it is the doctor's aim to end life. It does not include cases where the doctor merely foresees that the patient's life will be shortened. Thus, it is not euthanasia for a doctor to administer palliative drugs to ease a dying patient's pain, even if the doctor foresees that as a side-effect the patient's life will be shortened. 1 Nor is it euthanasia for a doctor to withhold or withdraw treatment because it is futile or too burdensome, even if the doctor foresees that the patient will, as a result, die sooner. Advocates of euthanasia typically argue that the law should be relaxed to permit doctors , not lay people, to kill patients. The definition used in this paper is therefore confined to medical practitioners.

Euthanasia advocates argue that benefit to the patient is central to euthanasia. Their case is that euthanasia should be permitted because, in certain circumstances, the patient would be better off dead . It is this alleged benefit to the patient that, they claim, distinguishes euthanasia from killing out of selfish motives.

"Active" and "Passive" Euthanasia may be "active" or "passive." A doctor may kill a patient by an act (such as injecting potassium chloride) or by omission (such as disconnecting a ventilator.) If, in either case, the doctor's aim is to kill, then the doctor commits euthanasia. (A doctor's aim in disconnecting a ventilator need not, of course, to be to kill but may solely be to withdraw a treatment which has proved futile or which has become too burdensome to the patient. The patient's death is then merely foreseen, not intended.) This paper will be concerned mainly with active euthanasia since the target of euthanasia campaigners is the current law which bars active intentional killing. "Voluntary," "Non-voluntary," "Involuntary" Euthanasia may be "voluntary," "non-voluntary" or "involuntary." It is

voluntary when a competent patient (that is, a patient who has sufficient understanding) requests it; non-voluntary when it is performed on a patient who cannot request it (such as a baby or a person with advanced Alzheimer's) and involuntary when carried out on a competent person who does not want it.

In Anglo-American criminal law the active intentional killing of a patient is murder, irrespective of the patient's wishes or condition. "Physician-assisted Suicide" "Physician-assisted suicide" occurs when a physician intentionally assists a patient to commit suicide, as by providing means, advice or encouragement. Unlike euthanasia, the final act which causes the patient's death is performed by the patient rather than the doctor. In Anglo-American law, physicianassisted suicide is, generally, illegal. The Arguments and Counter-Arguments The campaign for relaxation of the law is currently pressing for the decriminalization of voluntary, active euthanasia (VAE) and/or physicianassisted suicide (PAS) . They will, therefore, be the focus of this paper. Seven arguments for decriminalization will be set out in italics, followed in turn by one or more counter-arguments.

Choice We should respect the choice of a patient who wants VAE/PAS. We human beings are, in general, autonomous beings. Unlike mice, we have the capacity to make choices and shape our own lives. Respect for this capacity is one of the most important and widely-accepted moral principles in the Western world. And the choice of when and how to die is one of the most personal and private decisions we can make. Who are we to deny a patient's request to die sooner rather than later? Whose life (and death) is it anyway? This line of argument is by itself sufficient to persuade many that the law should be changed to permit VAE/PAS. On the surface, it glistens with attraction. On closer inspection, however, it looks more like "fool's gold." Why? (i) A Right to Choose or Choosing What is Right? Our capacity to make choices is indeed an important capacity. Our autonomy is important because our choices have effects both on other people and on ourselves. Our choices shape our lives and the lives of those around us. Choices which promote our well-being and the well-being of others are undoubtedly worthy of respect. But is just any choice worthy of respect? Of course not. We would do well to recall the saying "Be careful what you want because you might get it" as well as the salutary tale of King Midas. The mere fact that I have chosen something cannot justify what I have chosen. Our laws have long illustrated this truth. For example, they prohibit a range of choices to harm others, from murder to assault. Does the fact that the murderer or mugger wants to commit these crimes afford them any shred of justification? And even if the victim consented would that justify the conduct? Would it be right, for example, for a person to kill someone who volunteered to be the victim in a "snuff" movie or to be eaten for dinner? Further, our laws prohibit not only choices which harm or risk harming others: they sometimes also prohibit choices to harm or risk harming ourselves, such as by snorting cocaine or driving without a seatbelt, as well as conduct which may involve no risk of physical harm to oneself or another, such as incest and bestiality. Are these acts justified by the mere desire to commit them? If individual choice were to be the touchstone of what was right or what the law should permit then we should surely have to repeal many laws which are widely and rightly accepted as just. In short, it is not enough for advocates of VAE/PAS simply to trot out "respect for autonomy" as if it were a knock-down argument for decriminalization. There cannot be a right to do wrong, so the prior question is whether VAE/PAS are wrong. The laws against VAE/PAS reflect the historic principle of the sanctity/inviolability of innocent human life, a principle which has been enshrined for centuries in Western criminal law and for over two thousand years (since the Hippocratic Oath) in Western medical ethics. Our laws and medical ethics have long held that it is a grave wrong for doctors intentionally to kill patients, even at their request. Life is a basic good, with intrinsic and

ineradicable value. The value of the patient's life does not depend on the patient's subjective appreciation of it. The fact that a patient may have lost sight of the value of his or her life, through depression or other cause, is no warrant for endorsing that tragically misguided judgment and for assisting that patient to end his or her life. Doctors should no more grant patients' requests for a lethal dose than they should help them jump off a bridge. In short, a request for VAE/PAS is not one that merits respect: it is always wrong to choose to end an innocent life. And, in any event, even if autonomy were more important than life, this would hardly be a persuasive argument for VAE/PAS. On the contrary, if autonomy were so important, why should we help someone destroy it by putting an end to their life?

Studies using systematic assessments in terminally ill patients have clearly shown that depression is strongly associated with the desire for a hastened death, including the wish for PAS or euthanasia. 2 It noted: In persons suffering with painful, disabling and terminal illnesses, depression is very common. Depression, pain and desperation generally underlie suicidal thoughts, which can generally be relieved by appropriate support and by effective treatments for depression in the terminally ill, including antidepressants, anxiolytics, psychostimulants, electroconvulsive therapy and psychotherapy ... and relief of pain by diamorphine often lifts depressive ideation. 3 Further: Once a person's depression is treated effectively most (98-99 [percent]) will subsequently change their minds about wanting to die. ... 4 The Royal College also cautioned: Many doctors do not recogni[z]e depression or know how to assess for its presence in terminally ill patients. ... Even when recogni[z]ed, doctors often take the view that "understandable depression" cannot be treated, does not count or is in some way not real depression. So in terminally ill patients, depression often goes untreated and in some cases PAS or euthanasia is provided anyway. 5

(i) Is Death a "Benefit"? It is true that we sometimes have a duty to benefit others. Parents, for example, clearly have a duty to feed their children. But there are limits to our duty to benefit others. Chris has a duty to feed his children but not to feed Edmund's. And the duty to benefit others must be understood in light of our other moral duties. Chris may not kill Edmund's children and feed them to his

own. Similarly, the duty of doctors and nurses to benefit their patients is not a duty to end their suffering at any price. Doctors and nurses have for centuries recognized an absolute duty not to intentionally kill their patients. Moreover, how can putting an end to someone's existence be a benefit to them? Not only are they no longer there to experience any supposed "benefit" but they are being deprived of the basic good of life. The fact that the pain and suffering experienced by patients is bad does not mean that their lives are bad. What is bad about a dying person's cancer is the cancer, not the person. Western law and medical ethics have historically rejected the view that patients can be divided into two categories: those with lives "worth living" and those with lives "not worth living." And rightly so: the lives of all patients are worthwhile. Although terminal illnesses such as cancer can reduce a person to experiencing undignified circumstances (such as incontinence) this does not mean that the person loses their inherent dignity or worth. Even if we have sometimes to endure undignified circumstances we never lose our inherent dignity. Were it otherwise, and were we to lose our dignity whenever we found ourselves in undignified circumstances, then our human rights would be merely provisional. They would come and go. And they would go precisely when we needed them most. The person of color enslaved and set to work on a plantation; the woman regularly battered in an abusive relationship; the baby born of a crack-addicted mother into abject poverty; the tourist thrown into a foul, foreign jail - have they lost their dignity because of the undignified circumstances in which they find themselves? Indeed, it is precisely because they retain their human dignity that we have a moral duty to do what we reasonably can to put an end not to them but to their undignified circumstances. Although we never lose our inherent human dignity we can lose sight of it. This is especially so when those around us tell us, directly or indirectly, by unfeeling word or cold indifference, that our life is no longer worth living. How we see ourselves is often influenced, often greatly, by how others see us. And by legalizing VAE/PAS, society would be telling patients who "qualified" for it that their lives were indeed no longer worth living, that they would be better off dead. VAE/PAS undermine human dignity and corrode the bonds of human solidarity. But aren't VAE/PAS a compassionate response to human suffering? Compassion (which means to "suffer with") is of course a laudable emotion. But a laudable emotion cannot justify immoral actions. Compassion for the sick no more justifies killing them than compassion for the poor justifies robbing banks to redistribute wealth. And, in any event, how often would our compassion for the terminally ill turn out, on closer analysis, to be counterfeit: a desire not to put them out of their misery but to put them out of our misery? True compassion respects the equality-in-dignity of all patients and seeks to alleviate their suffering in ways that respect their dignity and, where suffering cannot be further alleviated, to show solidarity with them by standing by them and furnishing what support we can. We do not respect the dignity of the sick by eliminating them. Killing is the ultimate abandonment. 8

The fact that all human beings possess an inalienable dignity and that it is wrong intentionally to kill them does not, on the other hand, mean we have a duty to squeeze every possible minute out of our lives. The principle of the sanctity/inviolability of life holds that it is wrong intentionally to kill the innocent; it does not require that we preserve life at all costs. This is an important distinction that is often overlooked by advocates (and sometimes even by opponents) of VAE/PAS. Patients have every right to refuse medical treatment, even life-prolonging treatment, if it would be futile or would prove too burdensome. Sometimes the treatment can be worse than the disease. It is often, therefore, right for us to refuse treatment, and for doctors to withhold or withdraw it, even if we and the doctors foresee that we will as a result die sooner rather than later. All human lives are worthwhile but not all medical treatments are worthwhile. Moral Hypocrisy The criminal law and traditional medical ethics are hypocritical. They allow a doctor to administer palliative drugs even though the doctor foresees that they will suppress the patient's breathing and thereby hasten the patient's death. This is morally no different from VAE. They also allow a doctor to switch off a life-support machine at the patient's request even though the doctor foresees that the patient's death will be hastened. This is morally the same as PAS. The administration of palliative drugs like morphine need not involve VAE. Palliative drugs do not, if properly titrated, accelerate death; if anything, they prolong life by making the patient more comfortable. 14 Even if the mistaken belief were true, however, it would not follow that administering morphine, foreseeing that it hastened the patient's death, would morally be the same as VAE. As we also noted above 15 VAE involves the intentional not merely foreseen hastening of death by a doctor. A doctor whose purpose in administering morphine is to alleviate the patient's pain need have no intention to shorten the patient's life. Similarly, a doctor who disconnects a patient's life-support machine need have no intention to hasten the patient's death: it may simply be the purpose of the doctor (and of the patient) to put a stop to a treatment which is futile or too burdensome. No one is morally or legally obliged to undergo a treatment which offers no reasonable prospect of therapeutic benefit or which involves excessive burdens. Moreover, a doctor who administers drugs to palliate pain or switches off a life-support machine does not necessarily cause (in any morally relevant sense of the word) the death of the patient. The patient's death may be attributable solely to the patient's underlying pathology. If your 90 year old grandfather was 12 hours away from death from lung cancer, and his doctor declined to extend his life-expectancy to 18 hours by hooking him up to a ventilator because doing so would merely prolong the dying process, would the doctor have caused your grandfather's death? 16

Firstly, i bet all of you are wondering what on earth is euthanasia.Well for those of you who don't know euthanasia is defined as the intentional termination of life by another through the explicit request of the person who whiches to die. Now as you all know euthanasia as been legalized in several parts of the world such as Oregon, US and in the Netherlands. However, now these countries are now facing the negative side effects of legalizng euthanasia. For example in Oregon, the oregonians are now facing a decrease in the standards of health care. A report card issued by the Last Acts Organization proves my point as the report card stated clearly that Oregon has received a 'D' grade for hospice and an 'E' grade for pallilative care programs. Another drawback that the oregonians are facing is that there is now an increase in medical cost. The Oregon Health Plan that normally subsidies for patients who can't afford treatment recently cut off 10000 poor people from the plan in 2003. In 2004 and the first half of the year an additional 75000 people were cut from the plan yet again. The dutch are facing a different situation. Firstly, they are facing an inhibition in medical advancement. This is due to the fact that euthanasia has become a norm. So doctors normally just euthanize patients especially when they face any puzzling medical problems.Another negative side effects that the Dutch now face is that many of their patients are being euthanized without consent. A study released by the Dutch government showed that 9.1% of the deaths that occur in the Netherlands annuallyis due to euthanaisa. In other words this means that approximately 1040 people which means 3 people per day are euthanized. The similar results were produced 5 years later. Now let us look at the advantages of euthanasia. Firstly, euthanaisa helps reduce the pain suffered by patients. As patients normally suffer the worst kind of pains during the last few months of their life. They will exprience both physical and physiological pain. Euthanasia can prevent all of this from happening. Another advantage of euthanasia is that the patients loved ones will suffer emotional pains as sometimes they too suffer as much or even more pain than the patient themselves as they have stressed for a long period of time. However, euthanasia has some disadvantages. One of them is that it violates the hippocratic oath. When a physicians takes the oath,

he or she is actually promising or swearing to never ever prescribe a deadly drug to any patient no matter what the circumstances are. So by legalizing euthanasia we are actually allowing physicians to help their patients commit suicide. This in turn violates the hipprocratic oath and weakens the doctor-patient trust. Secondly, euthanasia gives patients and doctors a chance to give up on recovery a little bit too early. As some patients may decide to give up on treatment early. This gives absolutely no chance of recovery as for all you know the doctor might have made a mistake in the diagnosis. In the netherlands this is true as many dutch patients actually decline any type of treatments when they know their about to die. In conclusion, euthanasia should never ever be legalized in Malaysia because it has shown to have negative side effects in places where it has already been legalized. Other then that it will also be abused as doctors will be given the power to decide who gets to go on the road to recovery and who goes onto the road of the afterlife.

YES # Euthanasia is different from suicide as it is only allowed in the cases where death is impending and one can not do anything except wait for his end, and suffer in between. # Limited hospital beds could be used for people whose lives could be saved instead of continuing the life of those who want to die which increases the general quality of care and shortens hospital waiting lists. It is a burden to keep people alive past the point they can contribute to society. NO # The care of human life and happiness and not their destruction is the first and only legitimate object of good government. # Euthanasia is a violation of the sanctity of human life that unduly compromises the professional roles of health care employees, especially doctors.

The question, should euthanasia be legalized can be put into a category with should we go to war with Iraq? Or should we continue to use capital punishment? Only an individual can answer these very emotional questions for himself or herself based on whatever factors he or she chooses to use. I feel life is very sacred and should not be taken lightly, but I also understand life is different for every person. It can be painful beyond belief; it can be extremely depressing; therefore, I believe people should have the choice to end life, under certain guidelines. If euthanasia were to be legalized there must be laws to regulate the use of it. A main part in the process of getting euthanized would be the determination of why the person wants to be euthanized. This determination would be made by a group of physicians and psychologists, to determine if the person wanting the euthanasia procedure is terminally ill or in great pain. They would also have to determine if the person is of sound mind to make this decision. In addition, I dont think regular doctors should be the ones using euthanasia on people. There should be specially trained individuals working at some sort of euthanasia clinic. They would be highly trained doctors who would take a new oath to help end the suffering of people in need. These doctors and psychologists would be required by law to make sure a person knew about any alternatives to relieve the pain of their sickness and the chances of recovery. These doctors and psychologists would also be required by law to make the person understand the consequences of their actions. I dont say this because I am uncertain on my position of euthanasia. I just feel people need to be aware of what euthanasia is and what obvious effects it will have on them and their families. Another benefit of euthanasia clinics would be the relief of pressure on doctors who dont want to perform euthanasia. Some doctors wouldnt want to actively or passively kill anyone, and thats understandable. Also some people Im assuming would complain about being treated by someone who takes life instead of preserving it. More laws would be made on the different distinctions of euthanasia, voluntary, involuntary, nonvouluntary and passive or active euthanasia; assisted suicide would also need laws to regulate it. Through my research I found three types of consent for euthanasia. Voluntary is when a person wants to be euthanized; involuntary is when a person doesnt want to be euthanized, and nonvoluntary is when the person is unable to consent to euthanasia, so others such as family

consent for him or her. When a person volunteers to be euthanized and fits in the correct protocol, i.e. has a terminal illness or is incurably depressed in some cases which I talk about later, then that person should be granted the right to end his or her life because it belongs to that person. With regards to involuntary euthanasia, a person should never be euthanized against their will no matter what the circumstances. An example of involuntary euthanasia can be found in the case of Christine Malevre (Skynews), a French nurse, who helped six terminally ill patients die. The problem is that it isnt clear whether the people wanted to be euthanized or not. The victims families even said the victims had never spoken about wanting to be euthanized before. However I do agree with nonvoluntary euthanasia in some cases like in the article The complex Issue of Euthanasia by Washburn (Washburn 258). He gives an example of Baby Boy Houle, a boy who was very deformed and not expected to live. In this case, the parents of the baby involuntarily decided to end its life. This in my eyes was the right thing to do, and they should have the choice to do it. But the doctors in this case decided to take the case to court and get an order to try and save the baby. They won the court decision and worked hard to save the babys life, but in the end no miracle was performed and as predicted the baby died, after what must have been 15 very painful days of life. I agree with the parents decision to end the babys life because there was proof this baby would not live long and for the time it did live in would be in great pain. While I do agree with nonvoluntary euthanasia in cases like Baby Boy Houle, I dont agree with nonvouluntary euthanasia in cases where people dont specify that they want to be killed i.e. no living will. And arent in a position to make the determination. The reason I agree with the parents decision in Baby Boy Houles case and not a family member giving permission to say a 35 year old man who is brain dead from a car accident, is mainly the fact that it was proven after this child was born he wouldnt live long even if they did fix some of his problems. The way it was explained seemed he was already dead; it was just a matter of time. Whereas the 35 year old man had time to have his wishes expressed, and maybe he wanted to hope he would recover; Baby boy never had the ability to make that choice, and therefore it was correct for his parents to do so for him.

I dont think there is much difference between active and passive euthanasia. If a doctor feels comfortable in directly ending someones life, then that is fine; if a doctor doesnt, I dont think it should be a requirement. And most likely, if euthanasia was legalized, there would likely be euthanasia clinics created to deal specifically with euthnizing patients. Passive euthanasia seems much like active. What is the real difference between giving a lethal injection or withholding a life sustaining one? Passive seems to be the way most doctors choose to help their patients end their lives. I think assisted suicide should follow the same laws as euthanasia. There is a problem that people who want assisted suicides arent always terminally ill. They could just be in great amounts of pain or even very depressed and unhappy about life. I remember watching a video about Dr. Jack Kevorkian where he helped a woman die who wasnt terminally ill or in great physical pain. She suffered from severe depression for which there was no medical treatment available (The Kevorkian file). For along time I wondered if it was right for Kevorkian to help her commit suicide. The article by Phil Washburn called Hedonism (Washburn 189) Washburn defines Hedonism in these words, Hedonism rests on two beliefs. First, pleasure is good. And second, pleasure is the only good. And I find that statement to be true in my life. Therefore I believe in the case of Kevorkian helping a mentally disturbed woman, who finds no happiness in life, and cannot be helped to get over this depression. It is just as valid to help her commit suicide as to help someone who is in physical pain. I feel the laws for assisted suicide should be very similar to the laws for euthanasia with the exception that a person doesnt need to be terminally ill or in great physical pain. If a person is showing signs they are suffering in a way that makes them want to end their life; they should have the option to get help in their death. The choice is theirs. The term agnostic does a good job explaining how I feel about a higher power (I think there must be a higher power something more powerful than humans). In addition to that belief Ive also learned from Philosophical Dilemmas by Phil Washburn that I agree with the moral theory of Utilitarianism (Washburn 227). The way it is described in the book seems to agree with how I feel about whats right and wrong. And that is to say If you want to do the right thing in any situation, you should ask what would lead to the greatest happiness for all concerned, and do that. These factors have shaped my idea on euthanasia so that, I dont believe in any specific god or that my higher power would care if

someone ended their life when they saw fit. And I believe morally people should do what brings the most happiness to those concerned, and the only people of any real concern when dealing with euthanasia is the person considering dieing. As I stated before, euthanasia is a very sensitive subject that when sparked can ignite great discussion. These are just my ideas based on what I know and feel to be right. They are fueled by the concept that if I was in a situation where I was in great pain or terminally ill, I would want the option of euthanasia; I find it a better way to die than many others. I feel similar about assisted suicide even though I have never contemplated a suicidal act; a person should be able to end their life when they want. And if they want help in the act they should not be alone. It all comes down to having the freedom to choose where you want your life to go.