Differences, Arguments and Cross-cultural Viewpoints

What are the differences between Suicide and Euthanasia? What are the arguments for and against it? How do viewpoints differ cross-culturally?

Euthanasia and physician assisted suicide are both contentious issues, with the heart of the argument lying at morality and legalization. The viewpoints mentioned below, for and against euthanasia, provide only a simple framework of the ethical concerns surrounding this topic. This post will not only delve deeper into the various types and differences of euthanasia and physician assisted suicide, but will also take a look at how viewpoints differ cross-culturally.

Physician assisted suicide and euthanasia tend to overlap. There have been many issues that have followed the creation and legalization of euthanasia and physician-assisted suicide. However, each of them also differs from the other. There are many different types of euthanasia and assisted-suicide and many different ways they can be administered. The traditional distinction states that it is passive whenever a physician allows a patient to die due to withholding or withdrawing their care. It is active whenever a physician administers lethal medicine, causing death to the patient. Voluntary euthanasia occurs whenever a person has euthanasia in their will as their desired course of treatment. However, involuntary occurs whenever a patient cannot make the decision for themselves and dies against their will. Physician-assisted suicide, however, a patient decides to end their own life with help from their physician. Active physician-assisted suicide occurs whenever the physician performs the act that leads to the death of the patient. In passive physician-assisted suicide, the physician provides the patient with the means of dying and the patient performs the act. As of right now, involuntary euthanasia is not legal and many medical practices have faced many controversies because of the expansion of voluntary active euthanasia and physician-assisted suicide.[1]

Many different countries have different medical and ethical opinions as well. The Belgian Integral Palliative Care Act states that high-quality palliative care, open to the act of advancing death, when suffering cannot be relieved and proves intolerable to the desolate dying patient. This ensures that patients will be treated as best as they should during their death. This act helps to set the medical standards of the care of people experiencing life-limiting illnesses and advancing death if they wish to do so. It is because of this that medical students are taught to be bright and sensitive and are obliged to provide their patients with autonomy. [2] In 2000, euthanasia was legalized in the Netherlands and in 2002, Belgium. In the United States, the state of Oregon legalized physician assisted suicide in 1997. Both of these countries are still continuing to develop their ideas about euthanasia and physician-assisted suicide. To address these issues, they asked questions at polls so they could be better prepared to address them.[3] In Britain, the medical origin of physician-assisted suicide and euthanasia was in 1901. Harry Haiselden was the first physician to publicly support assisted suicide as well as involuntary euthanasia. The increase in secularism and acceptance of Darwinism each allowed this idea to become more acceptable. However, still today, this is a very controversial topic. Since the Scientific Revolution, intellectuals have been testing the limits of science. Often, this causes scientists to push borders of the natural world without considering other spheres of knowledge. Earlier, the definition of euthanasia was providing pain relief to dying patients, but quickly transitioned to the hastening of death. It was even favored to kill people with disabilities. This happened in Germany in 1870 when Ernst Haeckel felt as if weak and sick people should not be able to reproduce. He believed this because people that were weak and sick caused a decreased chance in survival and inhibits adaptation. In America, this debate took off in 1915 Chicago. A case of a baby that who was severely deformed at birth was publicized. The family was talked out of a life-saving surgery and the baby died 5 days later. Harry Haiselden used this as his platform for passive euthanasia. [4] Whenever euthanasia and assisted suicide were introduced, they were only used for terminally ill patients. However, it was argued that non-terminally ill patients suffered just as bad and, in some cases, worse than patients that were terminally ill. They also suffered longer because their illness did not kill them, even if it was debilitating. In each act that has been passed in Oregon, California, and Washington, terminal diseases are defined as diseases that are incurable and irreversible, have been medically confirmed, and will cause death within six months. [1]

Right now, psychology is quickly becoming a field in which the effects of euthanasia and physician-assisted suicide are being evaluated. In Belgium and the Netherlands, psychiatric conditions that are resistant to treatment can be treated with euthanasia or physician-assisted suicide. The criteria include that the physician is convinced that the request is voluntary as well as well-thought out, the patient is currently suffering to an unbearable extent with no signs of improvement, and no other alternatives can be offered to relieve their symptoms. An independent physician must also be consulted and medical care and attention must be performed as the act is occurring. This is becoming increasingly popular because psychiatrists have begun arguing that suffering caused by psychiatric illnesses can be just as intense as suffering that comes with terminal illnesses. [5]

Euthanasia, sometimes referred to as a good death from the Greek meaning, and assisted suicide suggest a difference in the degree to which the doctor is involved. Physician assisted suicide (PAS) includes making lethal means available to the patient to be used at the time of the patient’s choosing, whereas euthanasia includes the physician taking the active role to carry out the patients request by delivering the lethal substance to the patient directly.[6]Both are considered the most controversial end of life decisions, causing much cultural debate on the fundamental issues of humanism.  PAS and euthanasia are legalized in four Western countries: the Netherlands, Belgium, Luxemburg, and Switzerland; one South American country: Columbia; and in two North American countries: Canada and the United States, in Oregon, Washington, Montana, and Vermont.  With the increase in population, the cases for chronic disease increases, as well, causing an increase in the number of PAS and euthanasia cases each year and an increase in the number of countries that legalize PAS and euthanasia.  Many countries, including Brazil and the United Kingdom, have not yet legalized PAS and euthanasia but the debate is timely to due this increase in chronic disease with the increase of population as a whole.[7] Not only do countries not want to legalize euthanasia and PAS because of the increase of chronic disease, but also because of religious beliefs within cultures.  Cross-culturally, PAS and euthanasia are both viewed as the same type of murder despite the many differences that they have.[8]

 

In this video, a Swiss lesbian theorist Michèle Causse who was suffering from a non-lethal bone disease chose to have assisted suicide. A medicine is given to her in liquid form and she drinks it. This is legal in Switzerland and two people are there with her and she is able to talk and eat as she is waiting for the medicine to activate. https://www.youtube.com/watch?v=l-_uEmdmSsY

 

Even though Euthanasia is banned in Denmark, it is still a contested topic. This film not only presents various ethical perspectives towards euthanasia, but gives the religious, philosophical and scientific evidence for individuals to have those viewpoints.

Both in the Eastern world and the Western world, religious beliefs, such as Islam, Judaism, and Catholicism, figure heavily into the acceptance of physician assisted suicide leading many people to believe that “only God should decide the time of death.”[9]Studies have shown that Muslims are most strongly opposed to euthanasia and PAS, followed by Catholics, Protestants, and those that have no religious affiliation, proving religion as a strong predictor of opposition to euthanasia and assisted suicide. Along with patient beliefs, the religious beliefs of healthcare workers also contribute significantly to their attitudes regarding PAS and euthanasia.  While ending the life of one suffering from a terminal illness, it is likely that this is becoming increasingly culturally sanctioned, with both physicians and patients struggle with cultural taboos on physician assisted suicide, euthanasia, and whether it is considered murder. In the United States, the general public seems to prefer that physicians perform the act, whereas physicians prefer the patient to do it, meaning that those that are involved with PAS and euthanasia are very reluctant to get involved and are sure that they are terminally ill and certain of this decision. [10]The result of heavy religious views in culture leads to the disappearance of distinct differences between the Western and Eastern parts of the world.[11]

An image taken by author and pastor, Paul Holt, who believes that all people should have the right to assisted suicide and to be able to determine when they would like to die. [12]
Intersect Project shows a video dealing with how Christians should think about the issue of assisted suicide and euthanasia in an interview with Erik Clary. [13]

The topics of euthanasia and assisted suicide are ones that are wrapped with much ethical discussion and debate. Advocates of euthanasia believe that the right to die is personal choice and that one whom is suffering should not have to be kept alive against the individual’s will. [14]On the other hand, euthanasia and PAS can be perceived to abuse autonomy and human rights. Kant and Mill [15]renowned philosophers, believe that the principle of autonomy prohibits the intentional ending of the conditions needed for autonomy—this includes ending one’s life. Additionally, it has been argued that euthanasia is seldom autonomous and sincerely a personal choice because terminally ill patients may not have the ability to express their rational mind.[16]

Individual’s against suicide may view suicide as an easy-way out for doctors because it could render the doctor as carefree and as one that does not want to address the patient’s’ problems. In terms of legalization, society often sees doctors as “healers” so when initiating suicide comes into play, there is controversy.  However, the caveat to this belief would be that a physician should heal until death is imminent then shift to healing to relieving suffering—in accordance to the patient’s wishes. Many view PAS and euthanasia as beneficent: ending one’s life is better than suffering unbearably.[17] Those against specifically active euthanasia and physician assisted suicide also may believe that it undermines the doctor-patient relationship by destroying trust built between the two. The doctor’s role in administering euthanasia “would compromise the objectives of the medical profession” 16—and thus diminish trust and confidence between the doctor and patient.

http://www.jamesrachels.org/ : James Rachels, a philosopher, who published one of the most salient articles on the euthanasia debate in the New England Journal of Medicine.

Based on a utilitarian argument by James Rachel, there is no difference between killing and letting die: this fundamentally makes active and passive euthanasia morally equivalent. Rachel also argues that active euthanasia is more humane than passive euthanasia due to active euthanasia’s “quick and painless” lethal injection. On the contrary, passive euthanasia can result in a “relatively slow and painful death.”[18]

Euthanasia and physician-assisted suicide are both very controversial topics that cause a lot of debate in many countries throughout the world. In societies around the world today, these topics have seemed to overlap and have become to greatly correlate with one other. It is within these certain societies that specific choices are made, in terms of these measures, either enabling certain patients to access to them or denying their access. These decisions are made based upon ethical, cultural, religious, or even scientific viewpoints of the leaders in these countries.

 

Prinal Patel, Breah Walker, Lindsey Farr

 

 

Endnotes:

[1] Varelius, Jukka. “Active and Passive Physician-Assisted Dying and the Terminal Disease Requirement”. Bioethics, 30(9), 2016. pp 663-671. Accessed April 1, 2019. https://onlinelibrary.wiley.com/doi/abs/10.1111/bioe.12282

[2] Boisvert, Marcel. “Physician-Assisted Suicide and Euthanasia”. The Permanente Journal, 16(2),(2012). pp 75-76. Accessed April 1, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383171/

[3]  Marcoux, Isabelle, Brian L. Mishara, and Claire Durand. 2007. “Confusion between Euthanasia and Other End-of-Life Decisions: Influences on Public Opinion Poll Results.” Canadian Journal of Public Health 98 (3), 2007. pp 235-239. https://www.ncbi.nlm.nih.gov/pubmed/17626391

[4] Weikart, Richard. “Does Science Sanction Euthanasia or Physician- Assisted Suicide?”. Human Life Review. 2016. Accessed April 1, 2019. https://search.proquest.com/docview/1797892576?pq-origsite=summon

[5] Steinbock, Bonnie. “Physician-Assisted Death and Severe, Treatment-Resistant Depression”. Hastings Center Report, 47(5), 2017. pp 30-42. Accessed April 1, 2019. https://doi.org/10.1002/hast.768

[6] Math, Suresh Bada, and Santosh K. Chaturvedi. “Euthanasia: Right to Life vs Right to Die.” The Indian Journal of Medical Research. December 2012. Accessed March 31, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612319/

[7] Castro, Mariana Parreiras Reis, Antunes, Guilherme Cafure, et al. June 13,2016. Accessed March 31, 2019. http://www.scielo.br/scielo.php?pid=S1983-80422016000200355&script=sci_arttext&tlng=en.

[8] Chowdhury, Rezawana. Summer 1012. Accessed March 31, 2019. https://stars.library.ucf.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=2323&context=honorstheses1990-2015

[9] Pierre, Joseph M. “Culturally Sanctioned Suicide: Euthanasia, Seppuku, and Terrorist Martyrdom.” World Journal of Psychiatry. March 22, 2015. Accessed March 31, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369548/.

[10] Pierre, Joseph M. World Journal of Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369548/.

[11] Nortje, Nico. “Cultural Perspective on Euthanasia.” Research in Psychology and Behavioral Sciences. January 23, 2013. Accessed March 31, 2019. http://pubs.sciepub.com/rpbs/1/5/3/index.html.

[12] Holt, Paul. “The Culture of Death Expands to Suicide.” Paul Holt Ministries. February 16th. Accessed March 24, 2019. http://www.paulholtministries.com/2015/02/26/the-culture-of-death-expands-to-assisted-suicide/

[13] Clary, Erik. “Physician Assisted Suicide: What Christians Need to Know.” Southeastern Baptist Theology Seminary. December 1, 2016. Accessed March 24, 2019.

[14] Irwin, Michael. “Euthanasia: The Right to Die Should Be a Matter of Personal Choice.” August 19, 2013. https://www.mirror.co.uk/news/uk-news/euthanasia-right-die-should-matter-2182127.

[15] Gwyther, Elizabeth, and Debbie Norval. “Ethical Decisions in End-of-Life Care.” CME 21, no. 5 (May 2003): 267-72. https://webcache.googleusercontent.com/search?q=cache:ZfJ6pw9rGnEJ:https://www.ajol.info/index.php/cme/article/download/43894/27413+&cd=1&hl=en&ct=clnk&gl=us&client=firefox-b-1-d

[16] Goldman, Lee, and Andrew Schafer. “Bioethics in the Practice of Medicine.” In Goldman’s Cecil Medicine, 4-9. 23rd ed. USA.

[17] Patterson, Rachael, and Katrina George. “Euthanasia and Assisted Suicide: A Liberal Approach versus the Traditional Moral View.” J Law Med 12, no. 4 (May 2005): 494-510. https://www.ncbi.nlm.nih.gov/pubmed/15957592

[18] Rachels, James. “Active and Passive Euthanasia.” New England Journal of Medicine 292, no. 2 (January 9, 1975): 78-80. https://webcache.googleusercontent.com/search?q=cache:XhNhdeBEDf4J:https://sites.ualberta.ca/~bleier/Rachels_Euthanasia.pdf+&cd=11&hl=en&ct=clnk&gl=us&client=firefox-b-1-d

2 Comments

  1. The arguments for the cultural and ethical perspectives are very well presented in this post. However, the part I enjoyed the most addressed arguments against PAS. There is a large disparity those who support PAS and those who are against it. This class appears to support the idea of PAS and even this post is more positive towards the legalization of death so I wish you expanded a little more on why people may be against it. For instance, the paragraph that caught my interest the most was about the “easy way out” given to a doctor when a patient chooses PAS. The intent of a doctor is addressed on a more case-by-case basis, however, there are other aspects of the medical business seeking the same “easy way out”. If this practice is legalized, insurance companies may advocate for patients to seek out PAS since it is usually cheaper than the alternative of seeking treatment. There seem to be many advantages to seeking an honorable death, however, when framed in the medical business of dying, allowing legal suicide may open up a Pandora’s Box that could inadvertently cause malicious companies to encourage death rather than treat it.

  2. This post does a good job of summarizing the various arguments and perspectives on a such a controversial topic such as physician assisted suicide and euthanasia. I found it interesting that religion was a common factor in polarizing the world to reject PAS and euthanasia, as opposed to dividing. A suggestion for this post would be to talk more about why that is, exploring more of how even with different religions and living in different cultures, people still argue against PAS and euthanasia. I would also appreciate more of a cross-cultural view that looked outside of religion.

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