A young American woman by the name Karen Ann Quinlan was left in a persistent vegetative state due to intoxication that left her with severe neurological damage. After 6 months with no improvements, her parents, with the aid of a Catholic priest decided to request the hospital remove the artificial respiratory aid. That way she may die in peace and dignity as, according to them, prior to this incident she had expressed a dislike of comatose patients or patients in a vegetative state being strapped to an artificial tube in order to maintain their life. The situation became serious enough that the parents took the hospital to court. The court sided with the hospital and disallowed her parents from trying to end her life. The court trial was once again held and it ended in the favour of the parents. The artificial respirator was removed, but Karen continued to live without it until she passed away in 1985.(Petra, S. A.)
The case of Karen was one of the first modern cases of euthanasia. It initiated debates about the morality of a physician assisting their patient with dying and whether this is something that can be ethically done. Many cases following this one and ones before this help us better understand what can be done. Many debates are still ongoing to this day about the ethics and morality of it all.
Origin
Euthanasia comes from the Greek word “eu” meaning good and “thanos” meaning death. Assisted suicide is different in the case that the patient is the one that injects the lethal dose to themself, while in euthanasia another person would usually be the one administering it. Both of them can not be done without full acceptance by the patient and with the relevant authorities notified and monitoring the situation. The patient mustn’t be coerced by his condition in life and euthanasia can only be done if the patient feels that they can not handle the severity of the suffering in which they are going through. Additionally, there are no other ways that they can be cured or their pain alleviated other than death. It is also allowed in the case that they are already nearing a certain death and experiencing great suffering in the times before it. If the death is to occur, it must be a painless one administered by the proper physicians.
History
Ancient Rome:
Most of the well known thinkers including Aristotle, Hippocrates, Pythagoras, and others condemned euthanasia. There were others though, such as Plato and Socrates, who believed that when necessary and in the case of a terrible quality of life it should be allowed. The amount of debate on this topic by these philosophers has made it clear to us that euthanasia was a common practice back in ancient Rome. In his book, The Republic, Plato states that those whose lives are ravaged by illnesses which are incurable should be left to die. Many seemed to have been quite divided on this topic as there were some who agreed with him while others, such as Hippocrates mentions that it is the job of the physician to ensure in all their power that all patients are receiving quality care whether the illness is terminal or not until the end of their lives.
Once the Catholic church was established and took over the majority rule and law of ancient Rome, the practices changed and euthanasia became outlawed. Euthanasia and assisted suicide were not taken lightly and anyone that ended his own life was shunned and disallowed from being buried underground. Their families also faced repercussions, sometimes even leading to the loss of property and exile.
Middle ages:
During this time, in the western world, Catholicism reigned over all disciplines of life and study. Everything from the arts to the sciences were viewed from the perspective of the Catholic church. Throughout this time euthanasia was completely outlawed and anyone who engaged in it would be separated from the Christian faith and forced to withdraw their rights to a funeral within the Catholic church. Christians at the time started viewing suffering as almost a form of worship. They saw suffering and pain as a way for God to remove one of sins, just as Jesus Christ suffered in order to take away the sins of humanity. To them, extreme, seemingly unending suffering no longer seemed like a heavy burden upon a person that would be an excuse with which to end a person’s life, but rather individuals saw it as a way for their sins to be wiped. They suppressed their desires to end their lives when things seemed to be going downhill, with also the threat of no longer being considered Christian and being denied a funeral and burial by the church. At the same time in battle, enemy soldiers who were badly wounded would be killed to end their suffering in a sort of “mercy killing”.
The enlightenment:
By the 18th century, following the french revolution, people started to get upset over the legal punishments imposed as a response to suicide. They believed that it was unnecessary and unruly. The body of the person that killed themself was dragged through the street and their property was forcefully taken away from their family. The masses believed that suicide was a matter between a person and themselves not the state. Multiple philosophers of the time published many papers on their detestation on the way suicide was handled. They believed suicide was a natural occurance and if one wishes they should have all authority to take their on life. Many of the enlightenment philosophers’ arguments paved the way for modern day thoughts and laws on euthanasia.
WWII:
By the end of the second world war around 200,000 people, in the name of euthanasia, had been killed due to Hitlers allowance of Nazi doctors to kill anyone who were apart of the physically or mentally ill, Jewish, and many other minority groups. All that in an effort to eradicate the human race of what the Nazis considered genetically inferior traits. Euthanasia in Germany began to be taken seriously around the late 19th century when eugenics and social Darwinism became more rampant. This ended up snowballing into the mass systematic killing of around 6 million Jews, schizophrenics, disabled babies and other minority groups that were deemed racially, mentally or physically inferior to the Germans.
Darwinism:
By the late 19th century Charles Darwin’s theory of evolution gained popularity. His theory essentially states that all species on earth are where they are now because of the strongest and fittest surviving harsh conditions throughout time. Nature selected those favourable genetics for the continuity of the species for centuries to come. His theory of the descent of man states that all humans descend from one original ancestor and all the abilities we gained were due to the timely process of evolution through natural selection. Darwin feared that due to the rapidly growing industries and innovations, human beings were no longer being challenged in the way that nature used to challenge us. He had become worried that we will no longer continue to evolve as there are no challenges before us that require only the fittest to survive, thus continuing the process of natural selection through their genetics.
Darwin was horrified as to how the supposedly fit people of society were reproducing less and the supposedly unfit were reproducing in large quantities frequently. He was worried that because of the comfort afforded to us by innovation the large quantities of the unfit individuals were going to overpower the fit in terms of population size. This will then spread their unfit genetics wider and future generations will evolve in degraded forms that are simply not ideal for survival.
Darwin had many supporters, like his cousin Fransic Galton, who also believed that the best humans were to reproduce in much larger quantities and continue on the bloodline of greatness. Galton heavily supported and advocated for a eugenics society where the unfit of society were to be stopped from reproducing and the fit encouraged. This belief of his would end by targeting the disabled terribly and anyone who Galton or the people in control considered unfit. Eugenics became globally accepted as the way of progressing the human race and measures started to be taken to prevent mental patients, disabled people, and others from reproducing. Marriage partners started being screened and immigrants assessed for any sign of an unfit gene. During WWII Hitler put eugenics principles into full practice and declared it law.
Religious perspectives
Judaism:
“No man has authority… over the day of death” (Ecclesiastes 8:8). As found in the old Christian testaments and Jewish scriptures, killing oneself is not something that the Jewish religion accepts as a way to alleviate suffering and pain. Suicide is considered unacceptable and allowing oneself to be killed was only accepted in the case of martyrdom across Jewish scriptures. Throughout Egypt, Syria, Rome and other areas in the Mediterranean, the Jewish beliefs on euthanasia were widespread the first couple of centuries into the common era.
Christianity:
In ancient Rome and Greece, Christianity systemized the laws against euthanasia. Though it had gained traction due to the Jewish beliefs before the revolt around 66 to 70 AD. Suicide was considered homicide making it both a sin and a crime in the Christian faith. Euthanasia and assisted death was not taken lightly and the Christians believed that killing oneself was trying to avoid the trials with which God, in his infinite wisdom, has imposed upon a person.
Hinduism:
Hinduism also doesn’t accept suicide as a way of alleviating suffering. People from the Hindu religion were only allowed to end their life as a way of self sacrifice to the religion. This can be seen in times that people were trying to achieve holiness and freedom would starve themselves to death and became widely respected. Sati, a Hindu tradition in which a widowed wife enters into the grave or funeral pyre of her deceased husband, was also practiced for centuries.
Buddhism:
Buddhists believe that killing any living thing including oneself is forbidden. Killing oneself to escape from suffering didn’t end the karmic cycle from bad deeds collected in previous lives, but rather follows the deceased into their death.
Islam:
Islam also accepts martyrdom as a form of self sacrifice for the religion. The martyrs are given direct entry into paradise. Suicide on the other hand is greatly condemned. According to the Islamic religion, the one who kills themself will enter into hell and suffer in their time there through repeated deaths in the same manner that they killed themselves.
Cases
In the 1990s, Nancy Cruzan suffered severe brain damage due to a car accident and was locked in a vegetative state. After a while of this persisting, her parents requested she be put out of her misery by cutting off her nutrient supply. The court first rejected this. But after providing evidence that Nancy would have agreed to euthanasia in the case of a persistent comatose or vegetative patient like herself, they agreed and she was removed from the supports keeping her alive.
Vincent Lambert, also like Nancy, suffered severe brain damage due to a car accident that left him in a vegetative state. His case went all the way to the European Court of Human Rights and when investigated was found that his family and the hospital did nothing wrong by withdrawing the treatment that kept him alive.
Paul Brophy, a firefighter, went into a coma due to a rupture of the basilar artery aneurysm. After countless attempts to help him recover fully, his family came to the conclusion that perhaps allowing him to die would be best for him. He earlier requested that, before he fell into a comatose state. The hospital refused, so they took the case to court which also was met with a refusal. The family then took it up to the state supreme court where they allowed Paul to be transferred to another medical facility that would allow them to finalize their decision.
Baby Doe was a small child with down syndrome who had a tracheoesophageal fistula and esophageal atresia. She unfortunately needed surgery nearly as soon as she was born, but because of the risk level an obstetrician recommended the family not to go through with surgery. The family took the advice and was met with disapproval from the hospital management who took the case to court. The court ruled that the family had the right to make the final decision. The case went public and many people offered to take the child in. Eventually, at only 6 days old, Baby Doe succumbed to her illnesses before the case was even able to make it to the supreme court.
Present perspectives
As of 2021, 10 states in the United states of America, Canada, Netherlands, and Province of Victoria in Australia allow euthanasia on the following conditions.
- Terminal stage disease
- No possibility of full recovery
- Left with unbearable pain or burdensome life as the direct consequences of the disease
- Voluntary and continuous request for death while the patient having the ability to make judgements
- It is impossible to terminate life of patient without assistance
- Consultations and prescriptions are only available at medical institutions
- Check whether the patient who is an adult has decision-making capability
- Check whether it is a voluntary decision made out of free will
- Provide documented explanation and consent thereof, and the explanation must include the details of palliative care
- Two or more medical professionals must confirm and sign
- Provide opportunity to withdraw request for euthanasia (Lee, M. A.)
Conclusion
Euthanasia and physician assisted suicide is a sensitive topic for good reason, as it deals with death. Once someone’s life is taken they cannot undo it, it is a decision that can weigh heavily on whoever makes that decision. Many people believe in bodily autonomy which includes allowing one to take their own life when they deem it necessary, such as when they are in unfathomable pain.
Legalizing euthanasia will have many implications. In the worst cases people will abuse their power. Physicians might start taking the lives of patients when they deem it necessary or acceptable with little to no consent and coercion of their patients. Many countries still do not accept euthanasia as a medical practice, but an increasing number of countries are starting to legalize it under strict circumstances and criteria. Euthanasia cannot be taken lightly and any and all decisions regarding it must go through a rigorous microscope of scrutiny, with the proper authorities and personnel included in the decision making.
Bibliography
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Lee, M. A. (2023). Ethical Issue of Physician-Assisted Suicide and Euthanasia.
Petra, S. A. (2024). Investigation of the ethical and legal issues of euthanasia and assisted suicide.
Picón-Jaimes, Y. A. Lozada-Martinez, I. D. Orozco-Chinome, J. E. Montaña-Gómez, L. M. Bolaño-Romero, M. P. Moscote-Salazar, L. R. Janjua, T. Rahman, S. (2022, February). Euthanasia and assisted suicide: An in-depth review of relevant historical aspects.
Dowbiggin, I. (2007, March 26). A concise history of euthanasia life, death, God, and medicine.
Cholbi, M. J. (2017, January 26). Euthanasia and Assisted Suicide: Global Views on Choosing to End Life.
