Euthanasia

Euthanasia, also commonly known as mercy killing or assisted suicide, as defined by any lexicon, would refer to the act of intentionally killing a person in a painless or minimally painful manner so as to end that person’s suffering.

The word euthanasia was actually derived from two Greek words to wit: “eu” and “thanatos”, which mean good and death, respectively. Thus, euthanasia is also sometimes referred to as good death while in other references it is referred to as easy death.

Euthanasia or mercy killing is usually carried out for people who are terminally ill and would want to cut short their prolonged suffering from pain and or for those people who are placed in a situation wherein they have become incapable of making such request for themselves. This group of people would include those whose primary existence is being provided by a life support or vital medication.

There are actually various types of euthanasia. This would include active, passive and physician assisted suicide.

Active euthanasia, according to various references, would refer to that type of euthanasia wherein there is a direct action involved in causing an individual to die. To illustrate, let us take into consideration one of the most talked about film of the year, the Million Dollar Movie.

In the said film Ms. Maggie Fitzgerald (Hilary Swank) was placed in a situation wherein the only thing that enables her to thrive is by means of a life-support machine. Mr. Frankie Dunn (Clint Eastwood), who was Ms.

Fitzgerald’s trainer in the field of boxing, as a response to Ms. Fitzgerald’s request to help her end her suffering actually engaged oneself in committing the active type of euthanasia via injecting a substance which is alien to the Ms. Fitzgerald’s body, thus causing Ms. Fitzgerald’s death.

Passive euthanasia, on the other hand, is defined as that type of assisted suicide wherein the death of a person is hastened by deliberately altering available forms of life support and letting the individual experience the natural course of death.

To illustrate, Mr. Frankie Dunn also exhibited this type of euthanasia by means of taking out the life support machine of Ms. Fitzgerald, thus contributing to her hastened death.

Passive euthanasia may also be exhibited by stopping necessary and imperative medical procedures, medications, and the like. Likewise, by stopping food as well as water intake thus allowing the person or patient to dehydrate and or starve to death is also another manifestation of a passive type of euthanasia.

Physician assisted euthanasia, in contrast with the other two types mentioned, is that type of euthanasia wherein a professional in the field of medicine makes available to his or her patient the necessary information and or means to cut short the patient’s suffering or life.

Due to the fact that euthanasia involves an act that deviates from the natural way of dying, it became a precursor to various ethical, religious, and moral issues. Likewise, since there have been many medical cases that involved the act of mercy killing as well as existing and public policies that legalizes it, strong protests on its practice became prevalent. Should euthanasia be legalized despite the many intricacies and social implications it has created?

For the purpose of this paper, the author aims to discuss the nature of euthanasia and the claim of Mr. Robert Dworkin et al. in the compendium entitled “Assisted Suicide: The Philosopher’s Brief”. Likewise, it is also the objective of the author to make a stand on the legalization of euthanasia and support his claim by citing examples from the movie the Million Dollar Baby and other examples of even nature to critically examine Mr. Dworkin’s claim in his published essay.

The two-fold message of Babel, a film by Alejandro Gonzalez Inarritu, is human frailty and interconnectedness of lives. Most individuals tend to think that their actions are inconsequential, and often take people like family — along with other good things happening to them — for granted. In the least expected ways, people’s lives are intertwined. Usually, though, as a culture communicates itself to others, barriers arise, impeding a real connection.

The film likewise depicts that there are times when people behave irrationally, which may be part of human nature, and there will always be a point in time when people will experience Murphy’s Law, commonly understood as `Whatever can go wrong will go wrong, and at the worst possible time, in the worst possible way. ’ In such instances, people may be weighed down by misfortunes or tragedy, but in those instances, there are those who cling to each other for support.

Notwithstanding the trauma, individuals made up of sterner stuff rise to the challenge. Most people, in the end, also own up to their mistakes and take responsibility for their actions as well as for their closest of kin or alliances. Human beings are not infallible, and may sometimes have little control over circumstances unfolding in their lives.

Just as the Biblical meaning of the film’s title connotes (the Tower of Babel is referred to as a grandiose structure built by Noah’s descendants for their own glory, but divine intervention muddled up their tongue and they failed to understand one another’s speech, and ended up scattered across lands), Babel, the movie, features four interlocking stories where the characters experience some communicative barrier along with a sense of alienation from the rest of humanity, and are pushed to the edge.

Every obstacle that the characters encounter, however, is presented as an opportunity to improve on the human condition. As such, Babel showcases how the human spirit can prevail over critical challenges or life-changing hurdles. Hope as a universal thing is clearly expressed. On the other hand, chaos as a constant element in the world is also highlighted. The presence of a gun throughout the movie’s main plot and subplots shows how a shot can create a ripple effect, trigger untold pain, and change the lives of its victims forever.

It appears more like a symbolism of how guns can be misused. As each of the movie’s central characters embark on a journey of scars — in a remote setting in Morocco with its grazing lands and desolate tracts, and in another part of the world, Tokyo, with its resplendent yet lonely megalopolis — they see their lives unraveling, yet are unaware of the common thread running through them.

In essence, human frailty and disillusionment are exemplified by Babel’s central characters — a couple traveling in Morocco in order to emotionally reconnect; a Mexican nanny who brings their children across the US-Mexican border without the parents’ permission to attend her son’s wedding; a herdsman and his two young boys; and a teenage deaf- mute desperately seeking attention from her father and friends in Tokyo. As fate would have it, a rifle ends up in the possession of a local herdsman who delegates to his young sons the task of guarding the family’s herd from jackals.

While playfully testing the rifle’s capacity, the younger son of the herdsman accidentally shoots the lady-tourist, seriously injuring her. The ensuing events find the traveling couple’s nanny facing arrest and deportation for her unauthorized action; and the teenage deaf-mute enduring a dreary existence as social outcast. All these tormented souls attempt to soothe the pain and isolation they encounter as they wrestle with misfortunes and upheavals.

The parallel crises take place simultaneously, and as the families deal with their respective hurdles, they pay a high price – with their soul, dignity, freedom and life. Overall, it is a good movie that insightfully depicts the human condition and how people will go to great lengths to survive or find elusive happiness or meaning in an imperfect world where actions have impact on others. Reference Inarritu, A. G. (Producer/Director). (2006). Babel. US: Paramount Pictures Corporation.

“A dying man needs to die, as a sleepy man needs to sleep, and there comes a time when it is wrong, as well as useless to resist.” -Steward Alsop, Stay of Execution

Though no one has a choice in their own birth, should we be entitled to a choice when it comes to our death? Therefore, what is Euthanasia? Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering; sometimes called “mercy killing.” Euthanasia has been one of the most controversial issues in the medical field.

As of today, Euthanasia is only legal in three countries: namely Netherlands, Belgium and Luxembourg; and illegal in all countries remaining. Though it is illegal here in the Philippines, the researcher brought this topic out of curiosity with the issue.

Why the researcher chose this topic: The researcher chose this topic to gain and give knowledge on Euthanasia; to give enlightenment to people whether to accept or to oppose Euthanasia.

Statement of the problem

This study entitled “Perception of selected medical staff on Euthanasia”, will give enlightenment to the certain questions that arise: 1. What is Euthanasia?
2. What are the perceptions of selected medical staff on Euthanasia? 3. A right to life or a right to die?

Significance of the study

The significance of this study is to give enlightenment to the following people:

Respondents. Upon or during answering the questionnaire, they themselves will ponder on the issue at hand. Students. Since euthanasia may seem to be an unfamiliar word to most of the students, this study will impart them knowledge about euthanasia. Administration. This study will both impart them more knowledge and also let them ponder on their own thoughts about euthanasia. Citizens. As a whole, they will be gaining more insight and understanding on the issues from euthanasia.

Scope and delimitation

This study will only cover the professional medical opinion of doctors, and anyone in the medical field, and also the opinions of the society on Euthanasia. Definition of terms
Euthanasia – the practice of intentionally ending a life in order to relieve pain and suffering.

After being diagnosed with debilitating diseases, such as one of the multiple forms of cancer or being in a Persistent Vegetative State, (PVS), many consider euthanasia to end the suffering of that individual. Euthanasia is defined as “the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability” (Santrock, 2012). The whole idea of euthanasia is to end the pain and suffering of a person instead of letting them go through the rest of their life awaiting a slow, painful, and oftentimes, undignified death.

The act of euthanasia is separated into two main categories; passive and active, or “letting die” and “killing”, respectively, according to Ansari, A. , Sambo, A. O. , & Abdulkadir, A. B. (2012). Passive euthanasia is when a person is allowed to die by withholding available treatment, such as an individual not performing CPR on a person who suffers from cardiac arrest or taking a person off their artificial life support system, like a feeding tube or breathing machine.

Euthanasia can be considered active when a person actively or deliberately gives another person a lethal injection to end their life. Another way to differentiate between the two types of euthanasia would be to say that active euthanasia occurs when an something happens to cause death to a patient and passive euthanasia happens when an inaction causes the patient to die. Physician-assisted suicide is considered a type of active euthanasia, which takes place when a doctor gives a patient a prescription or other drugs to let them to commit suicide.

To further classify the term, euthanasia, it can also be categorized as voluntary or involuntary. Voluntary is when a mentally competent person makes the decision to die on their own without being coerced and made fully aware of the pertinent facts of their health. Involuntary euthanasia, (or non-voluntary) is done without the consent of the patient, such as when the patient is in a coma, and the wishes of that patient are unknown.

To combat any moral or ethical issues about a persons’ decision to partake in euthanasia, or not partake for that matter, that individual should discuss their advanced care planning, or planned preferences for end-of-life care (Santrock, 2012). By evaluating how a person wants to live out the rest of their life, they can establish an advanced directive, or living will, which would indicate whether or not they wanted life-sustaining procedures used to prolong their life if death were imminent.

Any living will should only be signed by an individual that is in a coherent state of mind and able to think clearly (Santrock, 2012). The ethical issue raised by active euthanasia is that it could be considered used as a way to rid society of elderly or terminally ill patients whether they want to die or not. Patients may begin to fear that if they go to the hospital for even routine exams, they might not leave because a person on the medical staff might deem them unable to recuperate from whatever reason brought them to the hospital in the first place.

Proponents however, say that people are autonomous, that they have the right to make their own decisions about important issues in their lives such as death. An ethical issue raised by passive euthanasia is that it causes a person die slowly and painfully, instead of giving them the opportunity to pass away comfortably and on their own terms. The laws in Arizona state that any contributor participating in euthanasia would be guilty of one of the subheadings of homicide, being manslaughter, a class 2 felony, or first or second degree murder, both being class 1 felonies.

The state of Arizona believes that life is very important and nobody should be able to take that right away from any individual, barring any medical emergency procedure. I believe that euthanasia has its place in society. While I do not condone murder, I believe if a person is dying from an incurable disease or is in a persistent vegetative state where there is no chance of recovery, allowing that person to die painlessly and with dignity is more moral than not doing so.

Although human life is a precious gift from God, I feel that it would be the duty of the patients’ family and doctors to take all the information about the health of the patient and make the best decision for their loved one, even if the end result means the death of that person. Euthanasia has many angles to evaluate before a person commits to such an ultimate and final act, whether for a loved one or their own ending. A person

Why would anyone consider Physician-Assisted Suicide (PAS)? It’s a scenario that’s seen all too often—a chronically ill woman is suffering in severe excruciating pain daily and feels like she’s become a burden to her family, a lonely man is suffering with a life-limiting illness and has no family to offer any care or support to him. These individuals have lost their independence and feel like they have no quality of life left to live. Great strides have been made to improve end-of-life care through palliative care and hospice programs, but sometimes that’s just not enough.

In America, the care that is offered to the elderly and the chronically ill is less than ideal. Statistics show that an estimated 40-70% of patients die in pain and another 50-60% die feeling shortness of breath. Ninety percent of the nursing homes where patients go to receive 24-hour nursing care are seriously understaffed. Patients who are home and have care provided by family often feel like they are a burden on their caregivers. The cost of hiring in-home caregivers support is not covered by Medicare or state and federal Medicaid systems. Caregivers often suffer from physical, emotional, financial, psychological and social strain. A person may feel as if they have lost all control of their life when they suffer from chronic and life-limiting illnesses. The body isn’t doing what it should and there is no way to stop it.

Therefore, a person my feel like they can regain some control through Physician-Assisted Suicide (PAS). If they can’t control the illness, they can at least control the way they die. Suffering has always been a part of human existence. Since the beginning of medicine there have been requests made to end this suffering by means of physician-assisted suicide.

Physician-assisted suicide is when a patient voluntarily choses to terminate their own life by the administration of a legal substance with the assistance of a physician either directly or indirectly. The patient is provided a medical means and/or knowledge to commit suicide by a physician. The life-ending act is performed by the patient and not the physician. Recent studies show that approximately 57% of physicians practicing today have received a request for physician-assisted suicide in some form or another.

There are many alternatives to PAS that exist. Unrelieved physical suffering may have been greater in the past, but now modern medicine has more knowledge and skills to relieve suffering than ever before. If all patients had access to careful assessment and optimal symptom control and supportive care, palliative care specialists believe that most patients with life-threatening illnesses suffering could be sufficiently reduced to eliminate their desire for a quick death. When the patient’s desire prevails, there are other available avenues to relieve the suffering and avoid prolonging life against their wishes. The driving force behind patients seeking physician-assisted suicide is quality of life.

In October 1997, physician-assisted suicide became legal in the state of Oregon. By the end of the year 2000, approximately 70 people had utilized the physician-assisted suicide law to end their lives. One hundred percent of these cases reported that individuals were not able to take care for themselves and make their own decisions and loss of autonomy. Eighty-six percent of these cases reported that individuals were suffering from loss of dignity and the ability to participate in enjoyable activities.

Currently, physician-assisted suicide is legal in Oregon, Washington, Vermont and Montana. Oregon was the first to pass the Death with Dignity Act in 1997. The requirements for attending/prescribing or consulting with a physician to write a prescription are listed in the following table. Washington followed suit passing the Death with Dignity Act in 2008, and Montana passed the Rights of Terminally III Act in 2009.

Table 1.
Safeguards and Guidelines in the Oregon Act

1. Requires the patient give a fully informed, voluntary decision. 2. Applies only to the last 6 months of the patient’s life. 3. Makes it mandatory that a second opinion by a qualified physician be given that the patient has fewer than 6 months to live. 4. Requires two oral requests by the patient.

5. Requires a written request by the patient.
6. Allows cancellation of the request at any time.
7. Makes it mandatory that a 15-day waiting period occurs after the first
oral request. 8. Makes it mandatory that 48-hours (2 days) elapse after the patient makes a written request to receive the medication. 9. Punishes anyone who uses coercion on a patient to use the Act. 10. Provides for psychological counseling if either of the patient’s physicians thinks the patient needs counseling. 11. Recommends the patient inform his/her next of kin.

12. Excludes nonresidents of Oregon from taking part.
13. Mandates participating physicians are licensed in Oregon. 14. Mandates Health Division Review.
15. Does not authorize mercy killing or active euthanasia.
Source: Compassion & Choices of Oregon, 2009b.

Physician-assisted suicide is illegal in Canada. In the Netherlands, it is legal under certain circumstances, and the right to choose physician-assisted suicide remains highly favored. Physician-assisted suicide is also illegal in the United Kingdom. They currently focus on palliative care. Under strictly defined regulations, physician-assisted suicide is legal in the following countries: Australia, Columbia, and Japan. The legalization of physician-assisted suicide remains controversial.

The topic periodically comes up for intense attention. Organized medicine agrees on two principles: 1. Physicians have an obligation to relieve pain and suffering and to promote the dignity of dying patients in their care. 2. The principle of patient bodily integrity requires that physicians must respect patients’ competent decisions to forgo life-sustaining treatment. There are four main points argued against the acceptance and legalization of physician-assisted suicide along with their counter argument. Improved Access to Hospice and Palliative Care

With quality end-of-life care being made available through hospice and palliative care programs, there is no reason for anyone to seek physician-assisted suicide. In the United States, there are over 4,500 hospice agencies. Millions of people don’t have access to the hospice agencies because of the restrictions on funding and the inflexibility of the Medicare Hospice Benefit requiring patients to have a life expectancy of six months or less. Counter argument: Rare cases of persistent and untreatable suffering will still exist even with improved access to quality end-of-life care. Hospice and palliative care aren’t always sufficient to treat severe suffering. Limits on Patient Autonomy

Physician-assisted suicide requires the assistance of another person. In the opinion of Bouvia vs. Superior Court, “the right to dies is an integral part of our right to control our own destinies so long as the rights of others are not affected,” was determined. Our society threatens physician-assisted suicide by worsening the value of human life. The sanctity of life is the responsibility of society to preserve it. Counter argument: Physicians who are requested to help to end a patients’ life have the right to decline on the basis of conscientious objection. The “Slippery Slope” to Social Depravity

There is concern to the opposition to physician-assisted suicide being allowed with euthanasia not too far behind. Without the consent of individuals in physical handicap, the elderly, the demented, the individuals with mental illness, and the homeless, there is a slippery slope toward euthanasia without the consent of the individuals is deemed “useless” by society. Counter argument: The “slippery slope” would not be allowed to happen within our highly cultured societies. Violation of the Hippocratic Oath

The Hippocratic Oath states that a physician’s obligation is primum non nocere, “first, do no harm.” The direct contrast to that is physician-assisted suicide, where killing a patient is deliberately regarded as harm. Counter argument: According to an individual patient’s needs, the Hippocratic Oath should not be interpreted. Alternatives to Physician-Assisted Suicide

Those opposing to physician-assisted suicide argue that there are legal and morally ethical alternatives to assisted death. Patients have the right to refuse any further medical treatments that may prolong the death, including the medications. Counter argument: Life-sustaining measures to live and still suffer are not relied on by some patients. Withholding life-sustaining treatments would only prolong suffering for these patients. Another argument is that patients can, and often do, decide to stop eating and drinking to speed up their death. Within one to three weeks afterwards, the death will usually occur, and it would be reported as a “good death.”

Counter argument: One to three weeks of intense suffering is too much for any one person to have to put up with. This debate has yet to see any final resolution. Physician-assisted suicide may become more of a reality in our society because of the undercurrent of public support. The United States Supreme Court handed down two cases central to physician-assisted suicide in 1997: Vacco vs. Quill and Gregoire vs. Glucksberg. In both case, it was determined that there was no constitutional right on the grounds of equal protection or personal liberty to the physician-assisted suicide. Both constitutional history and the Western Civilization trends were argued by the court and generally worked against reading the Constitution that way.

The court was sensitive in its decision to the prospect of unintended and unwanted consequences that might follow the recognition of a Constitutional right to physician-assisted suicide. However, it was never said that physician-assisted suicide would ever be legitimate. It was concluded that the states of the Union could decide the matter for themselves. Requests for physician-assisted suicide should be taken very seriously. Responses to these requests should be compassionate and immediate. There are six steps that should physicians should take when responding to requests for physician-assisted suicides: Step 1: Clarify the Request

Step 2: Determine the Root Causes
Step 3: Affirm Your Commitment to Care for the Patient
Step 4: Address the Root Causes of the Request
Step 5: Educate the Patient About Legal Alternatives for Comfort and Control Step 6: Seek Counseling from Trusted Colleagues and Advisors

Step 1: Clarify the Request

The physician should talk to the patient about what suffering means to them. Determine if their point of view can be defined. Listen carefully to their request paying specific attention to the nature of the request. Calmly ask questions to extract the specifics of their request and why they’re requesting such help. Ask directed and detailed questions to learn whether the patient is imagining an unlikely or preventable future. Listen to the patient’s answers with sympathy but not as if you’re endorsing their request to their perception of what they consider to be a worthless life. The physician must be fully aware of his or her own biases in order to effectively respond to the patient’s needs. If the idea of suicide is offensive to the physician, the patient may feel his or her disapprobation and worry about abandonment.

Step 2: Determine the Root Causes

The physician needs to assess the patient’s underlying causes for requesting physician-assisted suicide. The patient’s request may be a failure of the physician in addressing the needs of the patient. The attributes of suffering should be focused on: physical, psychological, social, spiritual, and practical concerns. The physician should evaluate to see if the patient is having some type of clinical depression or common fear about their future outlook. The patient may be worrying about suffering with pain or other symptoms, loss of control or independence, a sense of abandonment, loneliness, indignity, a loss of their self-image, or being a burden to someone.

Step 3: Affirm Your Commitment to Care for the Patient

The fear of abandonment is often felt in patients as they face the end-of-life. They want to be assured that someone will be with them at this time in their life. The physician should listen to and acknowledge the feelings and fears that the patient may express. They should commit to helping the patient find answers to their concerns. The physician should commit to the patient as well as the patient’s family and anyone who is close to the patient that they will continue to be the patient’s physician until their life has ended.

Step 4: Address the Root Causes of the Request

A patient’s request for a quick death is caused by some type of suffering on their behalf. They physician should discuss with the patient their health care preferences and goals. Alternative approaches or services should be discussed at this time with the patient. The physician should be able to determine if supportive counseling is needed for the patient.

Step 5: Educate the Patient about Legal Alternatives for Control and Comfort

Patients often have misconceptions about the benefits of requesting physician-assisted suicide. They may not be aware of the emotional effort that goes into planning for physician-assisted suicide. They also may not be aware of the emotional strain on family and friends. The physician should discuss the legal alternatives to physician-assisted suicide.

The legal alternatives include refusal of treatment, withdrawal of treatment, declining oral intake, and end-of-life sedation. The patient should be made aware that they have a right to decline or consent to any treatment or hospitalization, but that their declining of treatment will not affect their ability to receive high quality end-of-life care. The patient should also be made aware that they have the right to stop any treatment at any time including the stopping of any fluids or nutrition.

Patients suffering with unbearable and unmanageable pain may be approaching their last days or hours of life, and the only option available to them is end-of-life sedation. Before the end-of-life sedation should be considered for a patient, the attending physician and members of the health care team should know that all available therapies were tried. This option has to be agreed upon with the patient and their families with the patient have the final say so if they are capable of making the decision for themselves.

Step 6: Consult with Colleagues

Physician-assisted suicide requests are the most challenging situations that physicians have to face in their practice of medicine. The physicians often hesitate to involve others in these situations for reasons about personal issues being raised, convictions about the inappropriateness of talking about death and concerns about the legal implications of the situation. The personal, ethical and legal ramifications for physician-assisted suicides should be supported by a trusted colleague or advisor of the physician. The trusted colleague could be a mentor, peer, religious advisor, or ethics consultants.

Support may also come from nurses, social workers, chaplains, or other members involved in the care of the patient. Physician-assisted suicide requests should be a sign to the physician that a patient’s needs are not being met and that further evaluation is needed to identify the elements contributing to the patient’s suffering. Unfortunately, there is no easy answer to the question of physician-assisted suicide. Patients have the right to withhold and withdraw life-sustaining procedures. Patients also have the right to receive powerful medication for pain relief and sedation. Physicians who oppose physician-assisted suicide do not always have to prescribe lethal medication.

Death is one of the things humans have to understand in order to be able to live through life. Being born, growing up, learning to survive, and earning a living, these are all the milestones into becoming a statistic. Like dying, mercy is a fortunate circumstance that a person has in any situation towards a variety of offenders. Some say that mercy is a blessing resulting from a divine favor. In the story, “Of Mice and Men” by John Steinbeck, Lennie was euthanized by George, Lennie’s caretaker/ friend.

I believe that George, as a friend, only killed Lennie in grand admiration of Lennie’s already ill-fated continuance, like Candy’s dog. In the world of “Of Mice and Men”, Candy’s dog represents the fate awaiting anyone who has outlived his or her purpose. Quotes from Carlson, a ranch-hand, reveals this saying, “”Whyn’t you get Candy to shoot his old dog and give him one of the pups to raise up? ”, “I can smell that dog a mile away. ”, “Got no teeth, damn near blind, can’t eat. Candy feeds him milk. He can’t chew nothing else”, and “He’s all stiff with rheumatism.

He ain’t no good to you, Candy. An’ he ain’t no good to himself. ” After this scene, Candy finally lets Carlson euthanize his dog. Both Lennie and Candy’s dog would suffer if they lived. Candy’s dog relates to the reason why Lennie was killed by George. Candy’s dog wasn’t in good health and Lennie killed Curly’s wife and would be in trouble with the law. Although Carlson promises to kill the dog painlessly, his insistence that the old animal must die supports a cruel natural law that the strong will dispose of the weak.

Afterwards, Candy has regrets about the ordeal, and wishes he would have killed the dog himself instead. Like how Candy’s dog was euthanized, Lennie also was. He was killed with far greater compassion though. George loves his friend Lennie, whom he has looked after faithfully, and he doesn’t want Lennie to die horribly. He euthanized him out of love, therefore he is justified. Since Lennie unwittingly killed Curley’s wife, George knows that there is no way to save him now. Even if they do escape, Lennie will never be safe because he doesn’t know how to avoid getting into trouble.

Furthermore, if Curley gets his hands on Lennie, he will make his revenge be slow, terrifying, and painful. Therefore, George knows that the only way to protect Lennie is to shoot him. Lennie’s puppy is one of several symbols that also represent the victory of the strong over the weak. Lennie kills the puppy accidentally, as he has killed many mice before, by virtue of his failure to recognize his own strength. When Curley’s wife screamed, he didn’t know how to make her stop, except by force. Evidence supports that George must save his friend by mercifully killing him.

”Of Mice and Men” reflects upon many situations of mercy in many varieties. In this manner George is a divine favor over Lennie’s life bestowed upon him by Aunt Clara. As Lennie’s blessing, George had the god given right to distribute mercy upon his “other-half” in unfortunate circumstances. For this reason, Carlson and Curley represent the harsh conditions of a distinctly real world, a world in which the weak will always be vanquished by the strong and in which the rare, delicate bond between friends is not appropriately mourned because it is not understood.

Introduction

Frequently faced with decisions that impact on an individual’s quality of life, and with power over life or death, the healthcare profession encounters many ethical issues where the distinction between right and wrong is not always absolute. To ensure that the welfare of the patient is always of paramount importance, and to protect those involved with the patient’s care, healthcare organisations employ various ethical guidelines, committees, and procedures to handle these issues of morality.

The main motive of a healthcare professional, and therefore a primary ethical issue, is that of promoting patient welfare above all other concerns, or beneficence. Additionally, medical practitioners are compelled to consider three further important moral commitments. These are the patient’s right to choose their treatment, known as autonomy, non-maleficence (to first do no harm), and justice, ensuring the provision of fair and equal treatment for all patients (Gillion, 1994). An issue that creates conflict for decision-making in nearly all of these domains is euthanasia.

Euthanasia may also be referred to as mercy killing, and is the act of a deliberate intervention with the intention of ending an individual’s life with the purpose of relieving intractable pain and suffering (House of Lords Select Committee on Medical Ethics). Euthanasia has a variety of differing interpretations, being described as “Any action or omission intended to end the life of the patient on the grounds that his or her life is not worth living” by the Pro-life Society, and as a “Good death” by the Voluntary Euthanasia Society, who adopt the literal Greek translation “eu” and “thanatos” (British Broadcasting Corporation, 1999). Euthanasia has become a topic of increasing debate amongst medical professionals, journalists, and politicians, however remains illegal in the UK. There are several categories of euthanasia, and the classification depends on the level of patient consent. Voluntary euthanasia infers a request from the patient for premature death, whereas involuntary euthanasia is conducted without the request of the patient. Non-voluntary euthanasia is conducted where patients are not in the capacity to request premature death themselves. The ethical dilemmas encountered with euthanasia are the reason that the act is shrouded in such controversy. These will be discussed below, through the case study of Ramon Sampedro, who became quadriplegic after a swimming accident at the age of 25, and application of ethical theory.

Ramon Sampedro described himself as “a head attached to a corpse” (Euthanasia), and appealed to local and high courts for euthanasia as he was unable to commit suicide himself. Sampedro felt that his decision should be respected and he was being denied the right to suicide. There are several ethical and moral considerations as to whether Sampedro’s request should have been granted or not.

The sanctity of human life is expressed throughout religious scripture and moral rhetoric, and in the context of medical and healthcare ethics, manifests as a commitment to individuals’ right to health, to promote patient welfare and to do no harm (British Medical Association, 2007). The conflict between ending a life and non-maleficence is clear, however when considering the principle of beneficence, the definition of welfare comes under debate. Sampedro obviously felt his quality of life was so impaired that he would be better dead. Consider the case of Diane Pretty, a sufferer of motor neurone disease, a neurodegenerative disease that causes weakness and wasting of the muscles, creating difficulty walking, talking, eating, drinking, and breathing (Motor Neurone Disease Association). At the time of requesting her death, Mrs Pretty was paralysed from the neck down, virtually unable to speak, and being fed through a tube (Singer, 2002). Living a life plagued with problems and pain, and knowing that she would die a distressing and enduring death, Mrs Pretty’s welfare was evidently compromised. Wishing to die in a dignified and humane manner, Mrs Pretty took her case to the British courts, however requests for her husband to aid her death were rejected by the Convention for the Protection of Human Rights on the grounds of it being assisted suicide (Singer, 2002). The cases of Diane Pretty and Roman Sanpedro highlight a conflict between non-maleficence in which action would be taken to end human life, and promoting individual welfare and autonomy.

The outcomes of the above cases are in stark contrast to that of Mrs B. Mrs B was paralysed from the neck down, and kept alive by ventilator. Mrs B also professed a will to die, claiming her life was not worth living, and requested the ventilator be turned off (Singer, 2002). Due to her request for passive euthanasia, where treatment is withdrawn or not provided, the decision to turn off the ventilator and bring about her death was granted. In contrast, active euthanasia as with Pretty and Sampedro requires the implementation of a deliberate act to bring about death. Whilst all parties express the same will to die and implore an identical end result, only the autonomy of Mrs B was respected. The distinction between the two types of euthanasia lies in that of letting die versus actively killing, known as the acts/omission doctrine. Many medical professionals, ethicists and philosophers support this doctrine, illustrated by Clough (1968) who quotes; “Thou shalt not kill but needst not strive, officiously, to keep alive”. However, others have differences of opinion. In his interpretation of the acts/omission doctrine, Blackwell (1996) illustrates how an act which is considered ethically right may infer the same immoral consequence as an act considered ethically wrong; “Thus suppose I wish you dead, if I act to bring about your death I am a murderer, but if I happily discover you in danger of death, and fail to save you, I am not acting and therefore, according to the doctrine, I am not a murderer”. In this ironic depiction of the doctrine, Blackwell (1996) acknowledges the power of intent, action, and consequence as a whole when approaching an ethical issue.

The acts/omission doctrine follows a school of thought frequently referred to in medical ethics, that of Deontology, where the focus is on choice and whether these decisions should be permitted, forbidden, or are morally required (Larry & Moore, 2008). The morality of a decision is judged on its adherence to certain percepts, which include duties towards anyone, for example ‘do not lie’, and duties relating to one’s individual circumstance and relationships, such as ‘provide for your children’ (Lacewing, 2006). Deontological thought insists that if certain ethical principles are followed, behaviour is moral and just, regardless of the consequences. Conversely, even if the end result is good, if the means are immoral the act is unjustified. This infers that an end can never justify its means, for example; lying is always wrong even if it protects someone in the end. When considering the issue of euthanasia, a deontological approach proposes a thought process for decision-making, however does encounter moral conflict when considering whether euthanasia as a general principle is justified and ethically acceptable. A key percept of deontology when applied to clinical ethics is to heal (Pellegrino, 2005) therefore one can deduce that all forms of killing are wrong, and Sampedro should not be assisted in his death. However, if healing meant giving a patient medication with the intent of pain relief that would lead to their death, a deontological perspective would neglect the end consequence and permit the means. Deontology permits the duty of administering medication to relieve pain, however, if the same act were performed with the duty to kill, the act would be morally wrong and thus forbidden. This is an example of the rule of double effect, where outcomes that would be morally wrong if they were caused intentionally are admissible if they are foreseen but unintended (Quill, Dresser & Brock, 1997). By not intervening to relieve insufferable pain, the medical professional is inflicting harm on the patient, however to provide the dose of pain relief may hasten their death. The rule of double effect has been proposed to be ethically sound if several criteria are satisfied. These ensure that the physician did not intend maleficence either as a means or an end, that the nature of the choice is good, and that the good outweighs the bad (Marquis, 1991). The rule of double effect may enable physicians to overcome hesitations in providing pain relieving medications proportionally to their potential harmful effects (Quill, Dresser & Brock, 1997) and is a deontological principle that has potential for making some instances of euthanasia permissible. Despite this, intent is difficult to interpret and prove, which can elicit abuse of the notion, or create difficulties for those acting under good intent with inability to prove such. In the case of Sanpedro, he does not need medication, and any intervention with such would have been an immoral act as the means would only be to bring about death.

When considering the distinction between passive and active euthanasia, deontology places emphasis on the intrinsic features of individual’s actions and considers duties, principles, and the rights-claims of those involved (Candee & Puka, 1984). Therefore in accord with the principle of non-maleficence (ensuring patients’ right to be done no harm), and the duty of care that compels a healthcare professional, an intervention to directly cause death, or active euthanasia, would be considered immoral and strongly opposed by deontological principles. Alternatively, passive euthanasia is more in line with a deontological approach, which involves a decision based out of the respect for the patient’s wish, and with the aim of doing good. Passive euthanasia respects the patient’s right to refuse treatment regardless of the consequence.

A contrasting ethical approach is the utilitarian perspective, which postulates that morality judgement is dependent on a decision’s consequence, and that this consequence must be weighted for its utility. Classically, utility and well-being are determined by the presence of pleasure and the absence of pain (Bentham, 1823) however, this has expanded to consider knowledge, autonomy, friendship and economic value (Hooker, 1997). Consider the prospect of euthanasia in the instance of a patient experiencing severe and chronic pain, in a state of incapacity that prevents them from functioning without aid. A utilitarian philosophy would weigh the intense physiological and psychological suffering experienced by the patient against the patient’s autonomy and the relief that would come with death. The thought of death to this individual is pleasurable, and would provide happiness, whereas an individual living a fulfilling life is made unhappy by the thought of their death. With a utilitarian perspective, if Sampedro could provide adequate justification for his death, his request may be deemed permissible. Utilitarianism does not distinguish between active and passive euthanasia, as its focus is on the morality of the end consequence rather than the act by which it is brought about. A particular difficulty faced when approaching euthanasia with a utilitarian perspective is that of when the balance becomes tipped, deciding when it is that a person becomes better off dead than alive (Mitchell, 1995). It is important to acknowledge that happiness or unhappiness is not permanent and may be changed (Sheldon & Lyubomirsky, 2006). For some, pain, suffering and despair may be enduring, however for another, whilst unhappiness may be prominent in the initial throws of a terminal illness, as they adapt they may again begin to find fulfilment and enjoyment in life. The case of Joni Eareckson Tada poignantly illustrates this proposal. After suffering a diving accident at the age of 18, Joni became paralysed from the neck down, and during her rehabilitation experienced anger, depression and suicidal thoughts, and “begged my friends to aid me in suicide”. 38 years on, Jodi now professes “It concerns me deeply that now we live in a culture which capitalises on that depression and reinforces to people like myself that ‘you’re better off dead than disabled’. That is unfortunate, that’s sad, that is evil.” (Swanson).
Autonomy, the respect for an individual’s self-determination and responsibility for their own healthcare decision, is acknowledged in relation to both the means and consequence of euthanasia. This is something emphasised by the British Medical Association (2006). In the request for active euthanasia, patient autonomy conflicts with non-maleficence, where a doctor is required to cause harm to the patient, and in request for passive euthanasia, patient autonomy conflicts with beneficence, where a doctor cannot act to prevent harm. Again the definition of beneficence and non-maleficence depends greatly on the connotation of ‘harm’. For euthanasia to be justified, the harm of letting someone die must be less than the harm in keeping them alive. Patient autonomy also depends on the capacity to consent, where a patient must have the information necessary to understand the severity of any medical decision and the benefits and risks that will accompany the outcome (UCSF). In cases where patients are unable to make or comprehend decisions due to incapacity, difficulties arise where decisions must be made on their behalf. Sampedro evidently had a full informed understanding of his decision; however the maleficence caused by someone having to kill him would outweigh his wish.
The issue of capacity to consent highlights the importance of personhood with respect to euthanasia. Singer (1979) proposes that only humans with rationality are ‘persons’ and therefore deserving of rights and respect. Following the theories of Singer and other western bioethicists, it may be inferred that those who are not classified as persons, do not have the same rights and do not command the same dignity. Fletcher (1972) proposed that, amongst others, alcoholics, the mentally ill, those in a persistent vegetative state and the senile are not considered ‘persons’. If the lives of these individuals are not to be held with the same moral considerations, the impetus for euthanasia is greater, as justification comes from relieving societal expense and resources. The ecological validity of these theories is demonstrated as the definition of personhood is frequently raised with regard to decisions to terminate treatment at the end of life, and for those in vegetative states (Cranford & Randolph Smith, 1987). Whilst individuals lacking the consciousness do not command the same moral respect for autonomy, a rational and sentient person, such as Sampedro, demands moral obligation, and therefore the right to autonomy. This again highlights the conflict between the various moral duties resonant to euthanasia; if someone is deemed rational, should their wish to die not be respected?

The dilemma of euthanasia is likely to be a topic of contention for many years to come. Whilst both deontological and utilitarian philosophies provide moral grounds with which to approach the issue, each individual case and request owes its own appraisal and sweeping generalisations cannot be made. The British Medical Association (BMA) (2006) alludes to the dangers of these generalisations, stating that resulting pressures from scarcity of NHS resources, marginalisation of the inarticulate, and emotional, psychological and financial tensions can lead to poor decision making by the ill or disabled. These pressures may impinge on an individual’s rationality, affecting both the means behind their decision for euthanasia, and their perception of the consequences. Whilst someone may be happy living with disability, possibility of euthanasia opens up avenue for manipulation, where individuals are coerced into premature death to benefit or relieve family members. The BMA (2006) acknowledge the principles of autonomy (where a person’s wish for euthanasia should be valued) and beneficence (with respect to ending suffering) are compelling theories, however concern arises from how interpretation of these in society may lead to a change in perception of the chronically ill, disabled, or mentally impaired. The notion that these people have the right to premature death may mean that they are not considered as societal equals and creates implications for protection of the vulnerable.

Sampedro eventually died 29 years later as a result of poisoning. Despite the decision against active euthanasia, Sampedro still maintained his wish. This may highlight the validity of such wishes. However, in my opinion, and that of religious scripture, Sampedro’s death was the loss of a dignified and valuable human life equal to all others despite his disability. Life is given by God, and therefore only he should have the right to take it away. Enabling the poisoning of Sampedro meant that someone had interfered with this natural, spiritual process, and brought about the death of an innocent man which can only be deemed as murder, and morally unacceptable.

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