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When a loved one is in the pain of death, what weight do arguments and words carry? If individuals were sure about a dignified and painless death and the capacity to determine the manner and time of their death, should they not be spared of the nonsensical anguish and degradation? Should it not be necessary that the genuine respect that individuals do accord themselves and others need some form of stoical, medicalized control over their final moments, some kind of euthanasia, either voluntary or so presumed, if they are not in a position to negotiate their wishes? Individuals whose conditions force them to ask these questions appear to be trapped between oversensitivity and under sensitivity, shortsighted emotions and impossible logicality (Narveson, 1999). Simply states, the question of legalizing euthanasia is a question of whether it is murder or a final care measure. Arguing logically and arranging words meticulously is the least that individuals in extreme pain can be owed. I will first attempt to consider the various positions before assessing the arguments.
The two major opposing conceptions emerge right from the definition of euthanasia. There are five possible options in situations where an individual is in extreme pain: administration of analgesics in doses that can lead to death; restricting or suspending treatment; withdrawing artificial maintenance of life; assisted suicide; and injecting a lethal substance. A radical difference is seen by advocates of palliative care between the first three measures which are care measures, and the last two which encompasses a decision to end life (Callahan, 1992). The proponents of euthanasia on the other hand argue that all the options involve euthanasia with the first three being passive and the last three being active considering that the care provider is conscious of the outcome and proceeds to act. The advocates of palliative care base their view on the conscious distinctions between the two effects, that is, the desired effect which is the alleviation of pain, and the undesired effect which is death. The proponents of euthanasia on the other hand consider these differences as ,artificial in the sense that there is no difference in whatever is being done, be it withdrawing treatment or offering an injection. What method can use to decide between two conceptions that do not agree terminologically about what one side wants legalized while the other side wants prohibited?
The actual issue with the five options is the place to demarcate the line. Stressing on the actual action and avoiding to distinguish conscious intent does not offer any help. Is it one’s intention to stop a dying individual’s unbearable suffering (and for whom is it unbearable) or to make his pain more bearable without the knowledge of when death will come, and maintaining as much as could be done the little life that remains? Only intent can provide a distinction between a heavily sedative injection or a lethal one. For the purpose of demarcation, the care provider requires a definition based on distinguishing between actual intention. The classic definition of euthanasia as an act of omission basically meant to end the suffering of a patient through death offers a simple criterion, that euthanasia is an imposed death as opposed to a natural death. This definition makes it possible for individuals to assess their intentions and is thus a liberating definition. However, the question is whether the intentional employment of euthanasia and the non use of euthanasia possess equal justification.
There are three concepts that are mainly used in accepting or rejecting the employment of euthanasia. These are respect, consciousness and universality. However, can their validity be proven? Thomas Aquinas offers a classical conception of the dual effect argument in relation to permission to kill in self defense. He holds that nothing stops an action from having double effects, one of which is intended while the other is beside the intention. According to him, moral acts adopt their species depending on what is intended and not according to what is beside the intent since it is accidental. The act of self defense may possess two effects, one of which being saving ones life and the other being killing the aggressor. Because an individual’s intention is to save life, this act is not unlawful considering that it is natural to every conceivable thing to keep itself distant. However, as much as it precedes from good intent, according to Aquinas, an act may be deemed unlawful if it is out of proportion with the end. As such, if an individual employs more violence than necessary in self defense, the act should be considered unlawful. On the other hand, if he counters the force with moderation, the defense will be lawful. In order for it to be applicable, the dual effect argument encompasses very strict requirements.
The action has to be good in itself and the negative effect must not be willed even if it is envisioned. The negative effect should not be employed a a means of achieving the good effect neither should it be worse that the good effect. Finally, there should not exist another course of action. When this reasoning is applied to analgesics, it can be said that such a use is in itself unobjectionable as opposed to injection of a lethal substance, that death is envisioned but is not desired, that death is not the means through which the absence of pain is being achieved and that it is not worse than than the desired goal which is the absence of pain considering that the illness will result in pain in any case (Rachels, 1986). Finally, possessing no other possible course of actions includes not using analgesics that are dangerous if the harmless ones are accessible. Thus, seeking to aid an individual does not involve seeking to harm him. Alleviating pain at the risk of an individual dying is not the same as causing death so as to end pain.
The acceptance or rejection of the dual effect argument lies on how much confidence is held with regard to the concept of consciousness. For some people, the dual effect argument is a social invention, an illusion and myth (Krutsen, 2008). It is either the case that the ability of humans to stand back from their actions is an illusion which does not possess its own knowledge on particular determinants, and being an illusion, cannot access the real nature of actions. In the situation of euthanasia, the uncertainty would seem not to have much weight on the balance than the risk of ending the life of an individual who may have asked for death but does not necessarily desire it. To mark the distinction, consciousness is a convenient concept which offers a clue on actuality an makes the identification of priorities in our actions possible. The dual effect argument therefore becomes a tool for measuring the intentions and priorities which an individual sets for his actions. However, this dual effect argument has no validity for determinists.
If this argument appear suspect, can it then be said that arguments based on respect are more valid? Respect for human beings have been employed by philosophers in two ways which are distinct by alike in some respects. An individual has to place himself in another’s position if he is pass fair judgment. According to Leibniz, this takes into consideration both individual standpoint and the rational scheme designed by God (in. Humphrey & Wickett, 1990). This standpoint is neither subjective nor limited. The truth that it reveals is a complete truth which offers the standpoint universality. The concept of universal does not depend on the belief in God but in the belief in holistic human rationality (ibid. 23). According to Kant, the only way of evading a morality plagued by sensitivities that exist in the concept of happiness is to provide it with universal form. As such, our actions must be guided by rules that are universally uncontradictable. Respect is a supra-sensitive identification of the moral law as a universal imperative which is unconditional. Regardless of whether the universal is an unconditional absolute as seen by Kant or Leibniz’s sum total of determining factors, it function is the same; to overcome introversion and broaden the scope of human thought so as to include all human beings. However, does respect have any scope in the medical context of human life’s final stages and is it relative or universal?
The care provider who is concerned with the wellbeing of the patient may be subjected to draw a difference between respect for the wishes of the patient and respect for the patient’s organism (Keown, 1997). This leads to three possible situations, the first one being that the patient may request for the termination of his life, desiring not to live in his present condition. The second situation is where an individual who cannot express his present wishes has asked explicitly that his past wishes be acted upon and finally, a situation where there is no expressed wishes. In all these case, respect is practically not respect for an individual’s expressed wishes but for the body since it is the body which is the first and last receptacle of the will to live. Respect should be practically broad in scope, encompassing respect for the body right to the end.
This respect consist in preserving the patient from the chains of pain so that his desire to die broadens into his desire to live rather than giving life to someone who does not wish to live. Pain and euthanasia have equal abilities to imprison and countering pain is more precautionary than taking away life. However, can all invasive and unbearable pain make it legal to kill an individual if this alone will lead to overcoming pain? In other words, is it necessary sometimes to end life so as to end suffering? Logicians often make a distinction between a subject and its predicates. For instance, if one says that “John is in pain”, the subject cannot be reduced to its predicate but the predicate can be replaced by another. However, if the subject is taken away, then no predicate ,can be attached to it.
From this point of view, it does not make much sense doing away with John so as to do away with his pain since doing away with John invariably means that the pain no longer exist. Instead of doing away with John’s life, it is always a better option to end John’s pain by employing appropriate means of treatment. However, can the argument that John’s pain is so inseparable from him to such an extent that it would be impossible to attack the pain without attacking John himself be adopted so that logic should be ignored and John’s suffering be ended by ending his life? One’s a person is dead, he is dead. If logic is ignored on the pretext of dire suffering, the suffering is left to take precedence over the individual. As such, sedation is more respectable than lethal injection and therefore, it appears there does not exist any logical argument for euthanasia.