The Medical Shift
There is controversy as to whether a medical professional can or should help end the life of a terminally ill patient who desires that his or her life be ended. As a matter of social, official, and moral policy, euthanasia or in other term as “physician-assisted suicide” ought to be held as morally unacceptable. However, it is argued that euthanasia is not in conflict with the principle of nonmaleficence but is a service to individuals who are in great pain with “no more hope of improvement” and already had the moral right to commit suicide.
The mandate for health care professionals “first do no harm” which is called in ethics as “the principle of nonmaleficence” should be known and understood first and foremost (Beauchamp, 2006, p. 160). As stated by Beauchamp (2006), under the utilitarian theory of ethics, the duty of a medical professional not to cause harm through any intervention is interpreted to stress that any given intervention must result in more good than harm on a population basis. In medical practice, what the physician does for a patient should have a greater chance of benefiting than harming the patient. Thus, the moral principle of nonmaleficence espouses the belief of not inflicting harm on any individual (p. 120).
Euthanasia meaning “good death” is not considered killing. Killing, by definition, implies the taking of life against the will of the person who is to die. It should be noted that there are two types of euthanasia, passive and active. Passive euthanasia is considered to be the act of allowing a person to die without attempting any “heroic measures” to sustain the life of the individual. The act of passive euthanasia allows the individual to die naturally. On the other hand, active euthanasia involves the taking of positive steps to end the life of a terminally ill individual (Beauchamp, 2006).
According to Beauchamp (2006), circumstances that might lead to the withdrawal of life-sustaining treatments and the consideration of active or passive euthanasia is when treatments are considered medically futile, or the burdens of treatments may outweigh the benefits, and if the quality of the patient’s life is already poor. In these conditions, arranging for assistance to end a patient’s life is somehow permissible. Beauchamp (2006) believes that treatment is not obligatory when it offers no prospect of benefit to the patient because it is pointless. The maintenance of biological life thus should not automatically be considered a (net) benefit to the person who is in tremendous suffering.
Beauchamp (2006) states that nonmaleficence is different from and part of the principle of beneficence by its commitment to not inflict harm to an individual. He emphasized that beneficence involves positive acts of preventing harm, removing harm, and promoting good (pp. 121-123). On the other hand, the principle of nonmaleficence supports rules regarding prohibition of harmful actions – for example, “Don’t kill,” “Don’t cause pain,” “Don’t deprive of freedom of opportunity,” and “Don’t deprive of pleasure” (p. 125).
The principle of double effect, which is a part of the principle of nonmaleficence, provides for the understanding that good can come out of a bad act. “This principle has been invoked to support claims that an act having a harmful effect such as death does not always fall under moral prohibitions such as the rule against killing.” (Beauchamp, 2006, p. 127) However, death can be considered as a major harm to the human being. It could therefore be considered a conflict with the principle of nonmaleficence.
According to Beauchamp (2006), the morality of euthanasia could be justified by the moral principle of nonmaleficence even though there may appear to be dilemma with the principle of “doing no harm.” The act of euthanasia does not cause the dying individual harm because the harm to the individual is in the pain and or suffering of his or her continued life.
Beauchamp (2006) also expounds the condition of the double effect principle of nonmaleficence, wherein it states that “the good result must outweigh the evil permitted.”
The “evil” act of ending a patient’s life can be considered as a positive act, similar to the use of chemotherapy to eradicate cancer. Euthanasia relieves the pain and suffering of the patient’s life, similar to where chemotherapy potentially ends the suffering of cancer. Therefore, the supposedly “evil” act is somewhat good.
By practicing euthanasia, the physician is doing “good for the sick” by relieving the patient from his or her pain and suffering in this life. By relieving the individual of the pain from his or her illness, euthanasia is not inflicting evil or harm but is an act of nonmaleficence and beneficence towards the human being. However, it should also be considered that empowering a physician with “intentionally arranged deaths” not only dramatically changes the physician’s relationship with patients, but even more significantly, the physician’s own self-understanding about his profession. Now the physician, whose task was to cure and whose enemy was disease and death, finds a new self-description by engaging in the practice of assisting suicide or euthanasia, if it was acceptable for the patient to end his own life when recovery is no longer expected. We should remember that the primary duty of the health care professionals is to benefit the patients. Usually, this means attempting to preserve the patient’s life. Health care providers have the duty to do their best for the patient under any circumstances and not to harm the patient. Although Beauchamp (2006) has emphasized the moral consideration of the individual’s right of choice regarding his or her death by euthanasia as a non-violation of the moral principle of nonmaleficence, it is far better for a medical professional to follow a decision to simply withhold or withdraw any life-prolonging medical treatment “…which includes medication and artificially or technologically supplied respiration, nutrition, or hydration,” (p.177) then the patient will be allowed to go home. This act is a desire to end dying, to pass gently into the night without tubes running down the nose and a ventilator insistently inflating lungs that have already been exhausted from intense torment. Letting the patient die naturally, discharged from the hospital and cleared from any medical assistance, is more preferable to avoid conflicts between the patient’s request of ending his life and the codes of medical profession.
Reference
Beauchamp T.L. & Childress J.F. (2006) Principles of biomedical ethics. 6th ed. New York: Oxford University Press.