Forced abandonment and euthanasia: a question from Katrina

Social Research, Spring, 2007 by Kenneth Kipnis

Euthanasia, as an ethical problem, has traditionally engendered debate on whether and, if so, when, killing another person can be justified or excused on the grounds that the person killed is benefited rather than harmed. Except in some European countries, euthanasia is a crime. Those who end the lives of the intractably suffering, even when they are following urgent requests, can expect to be charged with homicide. Should the law be changed to permit some beneficent killings?

Clearing the Ground

In examining euthanasia, three issues characteristically muddy the waters. First, "euthanasia" was the euphemism the Nazis used to sanitize their early extermination of those they deemed defective. The program quickly evolved to kill millions: Jews, Roma, homosexuals, communists, and so on. Treated as vermin, those who were involuntarily and secretly gassed in the concentration camps were not killed beneficently. Indeed "involuntary" euthanasia--"beneficently" killing another against his or her will--seems a contradiction in terms. While some fear that loosening the law of homicide will send us down the slippery slope to holocaust, such prognostications must be examined with care.

The second issue concerns what some still call "passive euthanasia": the discontinuation of life-prolonging measures, often the removal of a ventilator (a mechanical breathing device). When a patient or an authorized proxy withdraws consent to treatment, then the doctor, no longer at liberty to continue, can lawfully withdraw life support, causing death. It is sometimes urged that these patients die from their underlying diseases rather than from the doctor's action. But if death is a foreseeable consequence, then the clinical removal of a ventilator kills a patient (Brock, 1993) just as surely as the removal of a regulator kills a deeply submerged scuba diver. The law of homicide already includes this special exception for doctors, and much of the ethical and legal discussion of death and dying turns on the patient's legal and ethical power to refuse treatment, often through an advance directive and/ or a legally authorized representative. While suffering can sometimes be averted by withdrawing life-support, this strategy is often unavailable and, moreover, the deaths caused by abating treatment may not be as tolerable as those that are induced. Nonetheless, it is nearly everywhere unlawful to administer medications for that purpose. Should this be changed?

Life-supporting treatment can also be withdrawn on the grounds that it no longer constitutes a benefit for the patient or, while it may be beneficial in some ways (prolonging life for a few additional days for example), the treatment is disproportionally harmful in other ways (painful or costly, for example). Doctors may be permitted to withdraw life support, causing death, on the grounds that continuing treatment would either be futile or harmful on balance: that is, not "medically indicated." Here as well death is caused by the withdrawal of treatment.