“O, let him pass. He hates him
That would upon the rack of this tough world
Stretch him out longer.” (Shakespeare, King Lear)
The subject of euthanasia has been highly controversial in society for hundreds of years. The very word itself originates from ancient Greek, “eu” and “thanatos,” meaning “good death.” (Miriam-webster.com). It is a very important topic, with historical, cultural, spiritual, and medical influences considered from both advocates and opponents alike. With advances in medical technology, it is becoming more complicated for patients and their loved ones to make end-of-life decisions as the line between preserving life and ending suffering becomes blurred.
This subject is one that cannot be ignored, as every human faces death; it is important to understand that dignity needs to remain intact throughout the death and dying process, whatever the case may be.
Euthanasia: The Four Types
- Active—Purposefully, directly causing death (such as a medication overdose “mercy killing”)
- Passive—Withholding interventions (such as withdrawing life support and “letting the patient go”)
- Voluntary—the patient actively consents and participates in death (think Dr. Kevorkian)
- Involuntary—the patient is unable to consent (on life support, comatose)
There have been many arguments that there is no moral distinction between active and passive euthanasia—between “mercy killing” and “letting die.” But when it comes down to legalities, medical professionals and patients alike need a clear definition between the two, for protection and permissibility.
The American Medical Association has provided a policy that makes a distinction between the two: “The intentional termination of the life of one human being by another—mercy killing—is contrary to that which the medical profession stands and is contrary to the policy of the American Medical Association.”
“The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or immediate family.”
In other words, active euthanasia is not legally or ethically permissible, but passive euthanasia is both permissible and ethical for medical professionals.
Withdrawing life support and heroic measures is okay. Helping someone commit suicide is not.
As a nurse, I find this distinction quite helpful as I am frequently asked to educate patients and their caregivers about legality and euthanasia.
As compassionate human beings, I am quite confident that when faced with the serious illness of self or a loved one, each individual would want suffering to be minimal, if nonexistent. Modern medicine allows us the power to extend life, but it also allows us the power to comfort the dying. In doing so, if the measures we take hasten death, we are still acting within the moral spectrum; our intent is to relieve suffering, not to cause death. I have witnessed thousands of deaths in my career—most of them “good deaths”, but not all. I have seen the difference between dying with dignity and suffering an agonizing death. Euthanasia (passive) is “good death.” There are many opinions and viewpoints surrounding this controversial issue; and a person cannot truly say with certainty what he or she would do unless faced with the situation. Death brings about a lot of fear and anxiety for most people, and the last few months, days, even hours of a person’s life should be lived in comfort, as pain-free as possible, so that he or she may leave this earth peacefully…with a “good death.”