Question

Present in depth the ethical issue of Euthansia. How might medical ethics principles (principles of the Normative Basis) be applied to this issue?

Answer 1

Euthanasia is one of the issues that has been the subject of intense debate over time. It has been a pertinent issue in human rights discourse as it also affects ethical and legal issues pertaining to patients and health care providers. This paper discusses the legal and ethical debates concerning both types of euthanasia.

Four commonly accepted principles of health care ethics, excerpted from Beauchamp and Childress (2008), include the:

• Principle of respect for autonomy,
• Principle of nonmaleficence,
• Principle of beneficence, and.
• Principle of justice.

Physician-assisted death is one of the most stringent debates of modern societies. Although different countries have particular social and religious backgrounds, most developed societies are progressively engaging in such debate. The rapid change of the sociological environment all over the world anticipates that the legalisation of voluntary euthanasia will take place in more countries in the near future. As Quill suggests, there are several things that should previously be cleared before legalising euthanasia and physician- assisted suicide.First of all, palliative care is the standard of assistance for addressing the suffering of seriously ill patients.This follows that public policies should address the issue of improving the access and delivery of palliative care. Secondly, and despite of state-of-the-art of palliative measures, there will always remain some patients whose suffering is insufficiently relieved. Several “last resort” options could address many of these cases Aggressive pain management, forgoing life-sustaining therapies and sedation to unconsciousness are a common practice to relieve suffering, even if death is hastened.
Also, self-determination at the end of life should be promoted. For example-legalising the living will to allow an easier withdrawal or withholding of futile treatments gives a sense of control that is usually felt as an opportunity to alleviate pain and suffering. In this vein, Tolle et al. have suggested that the availability of such an escape, as euthanasia, may be much more important to many individuals than its actual use.Moreover, evidence shows that the legalisation of euthanasia and physician.assisted suicide enhances rather than undermines other aspects of palliative and end-of-life care. For
instance, according to Jan Bernheim “In what has become known as the Belgian model of integral end-of-life care, euthanasia is an available option, also at the end of a palliative care pathway. This approach became the majority’s view among the wider Belgian public, palliative care workers, other health professionals and legislators. The legal regulation of euthanasia in 2002 was preceded and followed by a considerable expansion of palliative care services”.
In this global context, medical ethics should have the insight to evolve accordingly and to promote true universal values in death and dying. If some practices are universally considered as consensual one’s such as withholding or withdrawing futile treatments, the living will or even palliative sedation-euthanasia and physician-assisted suicide are ethically disruptive, even from the medical ethics point of view. Only by letting physicians abide to their conscience will medical ethics be allowed to remain universally unquestioned.
Indeed, the goal is not to reach the lowest common denominator but only to allow some responsiveness of medical ethics, so it can adapt to specific cultural settings. Of course there are some values that are indisputable, such as respect for personal autonomy, medical integrity, or protection of vulnerable people and populations. But ethics in medicine cannot stay completely static because social values evolve steadily by themselves. Probably the best strategy will be to resort to some kind of “glocalisation” of medical ethics so that consensual universal principles do not contend with particular ethical views of medical practice.
In the absence of such strategy, and if the actual global code of medical ethics is ignored in some countries and cultures, medical ethics might be severely undermined in the near future. This new role for a global ethics is dependent of the existence of practical ways to implement and to divulge these universal ethical principles. And it also implies a fair way to determine the consensus. Tristram Engelhardt Jr. speaks of reaching a consensus in ethics by mutual consent.It follows that in a medical ethics perspective public deliberation, meaning medical deliberation, could be a solution. This kind of method is particularly appealing when there are apparently irreconcilable moral perspectives-for instance with regard to euthanasia-nevertheless, there is a common will to reach a consensus.By consensus it is meant not the consensual resolution of a particular ethical dilemma but a consensus regarding the way physicians should individually deliberate and decide. Consensus also implies some degree of compromise between different views of a good life.