Article ID: DE197-1 | By: J.P. Moreland
The following is an excerpt from article DE197-1 from the Christian Research Journal. The full article can be read by following the link below the excerpt.
What Is Euthanasia- The Definition of Euthanasia
There are two different uses of the term “euthanasia.” The first is sometimes called the “narrow construal of euthanasia.” On this view euthanasia is equivalent to mercy killing. Thus, if a physician injects a patient with a drug with the intent to kill the patient, that would be an act of euthanasia, but if the physician allows the patient to die by withholding some excessively burdensome treatment, that does not count as an example of euthanasia. The second view is sometimes called the “broad construal of euthanasia” and includes within its definition of “euthanasia” both killing (active euthanasia) and allowing to die (passive euthanasia). The broad construal is more widely used, so we will adopt it in this series.
What Is Euthanasia- The Active/Passive Distinction
The active/passive distinction amounts to this: Passive euthanasia (also called negative euthanasia) refers to the withholding or withdrawing of a life-sustaining treatment when certain justifiable conditions exist (see below) and allowing the patient to die. Active euthanasia (also called mercy killing or positive euthanasia) refers to the intentional and/or direct killing of an innocent human life either by that person (suicide) or by another (assisted suicide).
What Is Euthanasia- Withholding Vs. Withdrawing Treatment
The distinction of withholding vs. withdrawing treatment is fairly straightforward. If a treatment is withheld, that treatment is not started. If someone withdraws a treatment, then that person stops a treatment already begun. The basic difference lies in the mere fact that in the former, one refrains from moving body parts (e.g., I refrain from using my hands to start the respirator), and in the latter, body parts are moved (e.g., I move my hands to turn the respirator off). Emotionally, some people feel that it is morally preferable to withhold a treatment than it is to withdraw a treatment, perhaps because it seems more dramatic to stop something than it is to not start it in the first place. But ethically speaking, it is hard to see any relevant difference between the two. If it is morally permissible to withdraw a treatment, say, because the treatment is pointless, then it would have been permissible to withhold the treatment for the same reason, and vice versa. Some have argued that withholding treatment is more justifiable than withdrawing treatment because the latter involves an implicit promise to follow through with the treatment and it creates expectations of care from the treatment. But this argument is not a good one. The issue is not starting or stopping a treatment per se, but whether the treatment — considered in itself — is good or bad. When one begins a treatment, the implicit promise (and thus, patient expectation) only involves using that treatment until a point is reached when it becomes pointless and excessively burdensome.
What Is Euthanasia- The Voluntary/Nonvoluntary/Involuntary Distinction
Voluntary euthanasia occurs whenever a competent, informed patient autonomously requests it. Nonvoluntary euthanasia occurs whenever a person is incapable of forming a judgment or expressing a wish in the matter (e.g., a defective newborn or a comatose adult). Involuntary euthanasia occurs when the person expresses a wish to live but is nevertheless killed or allowed to die. This distinction combines with the active/passive distinction to form six different types of euthanasia: voluntary active, voluntary passive, nonvoluntary active, nonvoluntary passive, involuntary active, and involuntary passive.
What Is Euthanasia- The Ordinary/Extraordinary Distinction
Ethicists frequently distinguish ordinary means of treating a disease from extraordinary means. The term “ordinary” is the more basic of the two and “extraordinary” is defined in terms of “ordinary.” Ordinary means are all medicines, treatments, and operations that offer a reasonable hope of benefit without placing undue burdens on a patient (e.g., pain or other serious inconvenience). Extraordinary means (sometimes called heroic means) are those that are not ordinary; that is, those that involve excessive burdens on the patient and that do not offer reasonable hope of benefit. Two important points should be made regarding this distinction. First, it utilizes terms such as “reasonable hope” and “excessive” which change as medicine changes. What was excessive in medicine fifty years ago may be ordinary and routine today. Thus, the distinction between ordinary and extraordinary is relative to the current state of medical science; but this relativity is factual, not moral. Normally, we are obligated to offer ordinary treatment but not extraordinary treatment. Factually, what counts as ordinary or extraordinary depends on our medicine and technology. Second, the distinction between ordinary and extraordinary should not be made abstractly for kinds of treatments, but should be made in terms of kinds of treatments for specific persons in specific situations. The idea here is that what is excessively burdensome and offers little hope for one patient may be less burdensome and more hopeful for a second patient in a different state of health. The terms “ordinary” and “extraordinary” have been given different interpretations by different philosophers. For example, some take it to be the distinction between natural means of sustaining life (e.g., air, food, and water) and artificial means (e.g., respirators, artificial organs). A second, less adequate view treats the distinction as one between a (statistically) common versus an unusual means of care. Despite minor interpretive differences, the main point is this: the terms “ordinary” and “extraordinary” attempt to express moral intuitions as to when a treatment can be withheld or withdrawn from a person in a state of irreversible disease where death is imminent. The line between ordinary and extraordinary treatment is not always easy to draw, and such judgments should be made on a case by case basis and should involve the patient, the family, and the attending physician.7
What Is Euthanasia- Intentional Action and the Principle of Double Effect
When we evaluate the morality of someone’s action, we take into account the intention of the person who acted. If a person drives recklessly through a residential area and accidentally kills someone, that person is guilty of manslaughter. But if a person intentionally runs over someone, we consider that person even more culpable — namely, guilty of murder. Morally speaking, our intentions or lack thereof make a difference. When we evaluate the morality of someone’s action, we also take into account whether or not that person uses an immoral means to accomplish some end that may be either morally good or neutral. If a husband confronts his alcoholic wife with her problem in public, but he does so because he hates her and wants to embarrass her, then he may accomplish a good end (reformed behavior) by an evil means (a malicious act). But if he confronts her in public because he loves her and wants to help, he accomplishes that same good end by means of a good act. These two moral insights — the importance of intentions and the avoidance of using a bad means to accomplish a good or neutral end — have been expressed in what is called the principle of double effect. The principle states that when an action has good and bad consequences, then the action may be performed under the following circumstances: 1. The act is good or at least indifferent regarding the end that one directly intends. 2. The good and evil effects follow immediately from the act; that is, the good effect is not obtained by means of the evil effect. 3. One only intends the good effect and merely tolerates the bad effect, even if that bad effect was foreseen prior to the act. 4. There is a proportion between the good and bad effects; that is, the good must be at least equal to the bad. The principle of double effect expresses the importance of intentions and means to ends in moral actions. This is in keeping with a traditional understanding of the nature of a human moral action that treats intentions, motives, and means to ends as parts of actions. Since intentions, means to ends, and the nature of moral actions are all central to debates about euthanasia, it is important to be clear about how they are analyzed in the principle of double effect. An example may be helpful. Suppose that Patty, Sally, and Beth each have a grandmother who will leave behind a large inheritance. Each visits her grandmother on a Saturday afternoon and brings a cherry pie to her. Patty, motivated by respect for a relative, intends to love her grandmother by means of being with her for the afternoon and by giving her a cherry pie. Sally, motivated by greed, intends to secure a place in the will by means of being with her grandmother for the afternoon and by giving her a cherry pie. Beth, motivated by hate for her grandmother, intends to secure a place in the will by means of giving her grandmother a cherry pie with poison in it.Each woman had a motive, an intent, and a means to accomplish that intent. A motive is why one acts; an intent is what one is intending to do; and a means is how one acts — that is, the steps one takes to accomplish one’s intent. Patty had a good motive (respect for a relative), a good intent (to love her grandmother), and a good means to accomplish that intent (spending time with her and giving her a pie). Sally had a bad motive (greed), a bad intent (selfishly securing a place in the will), and a good means to that end (the same means Patty used). Beth had a bad motive (hate), a bad intent (the same as Sally’s), and a bad means to that end (killing her grandmother by giving her poisoned pie). This example shows that motives, intents, and means to ends are relevant in assessing the moral worth of an action, and the principle of double effect tries to capture these and other important issues. The principle of double effect also expresses the priority of intention for determining the nature and morality of an action.8