Some Arguments Against Voluntary Active Euthanasia
Germain Grisez and Joseph M. Boyle, Jr., authors of Life and Death with Liberty and Justice (University of Notre Dame Press, 1979, pp. 149-170), offered the following objections to legalizing voluntary active euthanasia:
- Patients will have to be told the full extent of the pain, suffering and hopelessness of their medical condition all at once rather than in gradual, tolerable stages, in order to safeguard the legal requirements of informed consent needed for truly voluntary euthanasia.
- Patients not wanting euthanasia would inevitably hear about their dreadful prognosis from other patients with similar medical conditions, relatives and so on, and have to bear the burden of such unwanted information.
- It will cause conflict for people who are morally opposed to euthanasia but who might be tempted to accept it anyway to avoid the burden of suffering. This will add a second burden of feeling guilty for having violated their consciences.
- Patients may be tempted to choose euthanasia from altruistic motives, even though morally or otherwise opposed, so as not to be a “burden” or from a feeling of guilt for using scarce medical and economic resources.
- No matter what the safeguards, patients not wanting euthanasia may become anxious that they will be included as victims. Very sick or debilitated people in hospitals or nursing homes are often confused, anxious and not too reasonable. Emotional regression is common. Just knowing that people around them are being killed could arouse in them tremendous apprehension that all the reassurance in the world will not ease.
- The family or loved ones of a patient choosing euthanasia may find it morally repugnant (as with suicide) and suffer much more grief than if it were a natural death.
Most of the objections concern the harmful effects of legalizing euthanasia on those who are opposed to euthanasia. Grisez and Boyle argued, “From the point of view of sound jurisprudence, the self-interest of the opponents of euthanasia can no more be excluded from consideration than the self-interest of its proponents.” They stated that legalizing voluntary euthanasia would serve no public interest but only the personal, private interest of those demanding legalization.
Justice and Liberty
The authors believe that the most decisive argument against legalization is the one based on the “jurisprudential principles of justice and liberty.” The argument is as follows:
“If voluntary active euthanasia is legalized without regulation, those who do not wish to be killed are likely to become its unwilling victims; this would deny them the protection they presently enjoy of the law of homicide. And since the denial is to serve a private interest, it will be an injustice.
“If voluntary active euthanasia is legalized with close regulation, which will involve the government in killing, those who abhor such killing will be involved against their wishes, at least to the extent that the government and institutions will be utilized for this purpose.
“Since the government’s involvement will be required only as a means to the promotion of a private interest, this state action will unjustly infringe the liberty of all who do not consent to mercy killing as a good to whose promotion state action might legitimately be directed.
“A solution involving a compromise between legalization of voluntary active euthanasia without regulation of the practice and legalization with close regulation, which will involve the government in mercy killing, would mean some degree of lessened protection together with some degree of government involvement, a situation which will result in injustice partly due to the reduced protection of the lives of those who do not wish to be killed and partly due to the unwilling involvement of those who do not wish to kill.
“Since the stated conditions are all the possible conditions under which voluntary active euthanasia could be legalized, legalization is impossible without injustice.
“Therefore, the legalization of voluntary active euthanasia must be excluded” (p. 153).
On these points, the authors further argued that:
“The public has a liberty to stand aloof from the killing of human beings. This consideration, together with the already well-argued point that even voluntary euthanasia cannot be legalized without undue danger or extensive public involvement, poses a very serious dilemma for proponents of legalization. . . . Nor will it do to say that the liberty of those who abhor mercy killing to stand aloof would only be slightly infringed by governmental involvement in this practice. Reading a few Bible verses each day in the public schools is only a little establishment of religion. But that little is too much for those who take conscientious objection to it” (pp. 169, 170).
The psychological burden of having to make such a decision rests on an already overburdened patient. Most of us find making major decisions very difficult. We are often filled with conflict, ambivalence and anxiety and would be over the enormous consequences of that choice.
If we were asked to choose regarding euthanasia, which conflicts with our instinct for self-preservation, the pain of having to choose could put an unbearable pressure on most people.
If we choose death, there is no undoing the choice and no way of knowing from experiences of others who have made that choice if it is a good one or a bad one, because those who have made it are no longer alive to advise us.
It is also relatively rare to find a patient with a fixed and enduring wish to die. What we claim we would do while in good health and under no threat is not an indicator at all.
Avery Weisman, M.D., of the department of psychiatry at Harvard Medical School, brought up this point in his book On Dying and Denying:
When healthy people are asked what they would do should they be found to have an incurable illness, many promptly declare they would commit suicide. Actually, evidence indicates suicide is rather infrequent among cancer patients. . . .
The intention to take one’s own life rather than submit to fatal illness is rarely implemented. . . . The option to destroy oneself is not an expression of freedom, but one of despair . . . (pp. 25-38).
Elisabeth Kubler Ross, M.D., who has done extensive studies involving dying patients, stated in Attitudes Towards Euthanasia (publication of the Third Euthanasia Conference), “
Our interviews have shown that all patients have kept a door open to continued existence and not one of them has at all times maintained that there is no wish to live at all.
Euthanasia portends harmful effects on good medical care. Alfred Jatetzki, M.D., associate professor of surgery at Columbia-Presbyterian Medical School, stated in Dilemmas of Euthanasia (publication of the Fourth Euthanasia Conference), that it was hard to be certain a patient was really dying in many cases.
He cautioned that many doctors have had patients whom they thought hopeless recover, and stated, “
As the medical sciences progress, it becomes more and more of a problem . . .
“If we … are thinking of ten patients who were put through a great ordeal and only one or two or three benefit from it, then this becomes a major moral issue. . . . The doctors cannot help but be influenced by maybe even those two or three . . .”
Lawrence V. Foye, M.D., in his statement before the Senate Special Committee on Aging, August 7, 1972 (as reported in the AARP News Bulletin, September 1972), expressed a similar concern:
“If a physician withholds maximum efforts from patients he considers hopelessly ill, he will unavoidably withhold maximum effort from the occasional patient who could have been saved.” He reasoned that the only way to be sure a case is hopeless is to try all available therapies and find them of no avail.
Jonathan H. Pincus, M.D., associate professor of neurology at Yale University School of Medicine, declared in a New York Times letter on January 24, 1973,
Many patients who could have been allowed to die are alive and doing well because of some new advance in therapeutics which occurred during the course of their illness . . . when a doctor is considering possible therapeutic courses of action for his patient, homicide would not be among them!
Another of his concerns was that fewer health care resources would be allocated to those considered “better off dead.”
A Dr. Lebensohn spoke at the Third Euthanasia Conference, according to Attitudes Towards Euthanasia:
His [the physician’s] mere presence in the room is a symbol of hope. . . . If he is associated in the mind of the patient or of the public with being also the terminator of life . . . there is going to be a great conflict, fear and distrust, similar to that which occurred in the time of Rome, where the poisoners were very prevalent.
There are the subtle but nonetheless powerful pressures exerted by those who are involved in the care of the hopelessly ill. If the patient decides to hang on to life rather than choose to be put to death, hard-pressed medical personnel and economically and emotionally exhausted families may become less tolerant of these “better-off-dead” patients.
Their feelings could be expressed in countless unspoken and even spoken ways, exerting pressure on the patient to choose death against his own real wishes or making him feel unloved and unwanted while he remains alive. Perhaps those few who would truly choose euthanasia if it were legal might find a meaning in their suffering, knowing that a liberty for themselves is a liberty worth rejecting if it would cause great harm to many others.
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