Forced abandonment and euthanasia: a question from Katrina

Social Research, Spring, 2007 by Kenneth Kipnis

The third issue has to do with physician-assisted dying, now legalized in Oregon. In this case a doctor provides the means to end life: commonly a prescription with special instructions. Note that the doctor does not take the final life-ending step. While the reasons given for physician assistance are somewhat similar to the arguments for euthanasia (considered in Section II), I shall not explore them here.

I will now examine the active causation of death when it is done for the benefit of the one killed. Should the law of homicide be amended to permit some beneficent killings? I will consider two types of case where the defense of euthanasia is perhaps the strongest. The more familiar one arises in connection with intractable suffering. The argument from intractable suffering, together with some objections, will be explored in Section II. The second argument, in Section III, arises in connection with forced abandonment. It is, if perhaps not a novel argument, at least one that is less familiar. It is proposed that this second argument is sound and that, legally and ethically, such acts of euthanasia ought to be excused.

THE ARGUMENT FROM INTRACTABLE SUFFERING

The Standard Argument

Suffering commonly affects patients with a progressive illness--metastatic cancer, multiple sclerosis, Huntington's disease, for example. As Hippocrates put it, they are or soon will be "overmastered" by disease. While much of the euthanasia literature focuses on pain, the suffering brought on by severe illness comes in many flavors: dizziness, diarrhea, disfigurement, itching, insomnia, incontinence, exhaustion, strains upon relationships, shortness of breath, anxiety, cognitive impairment and dementia, debt, depression, disabilities of all kinds, dependency, loss of control, nausea, offensive odors, and the loss of dignity that can accompany these. Such conditions are familiar to those who provide hospice care. Sometimes--but not always--symptoms can be managed while preserving positive elements that give value and richness to a waning life: talking with loved ones, listening to music, enjoying a sunset. But residual abilities too can succumb, even as a patient retains sensitivities that can make life intolerable.

One strategy is "terminal sedation." Doctors can render a patient unconscious while withholding nutrition and hydration: death ensues in a matter of days. But not every patient would prefer such "care" to a timely passing. There is a broadly understood difference between having a life and being alive in the biological sense. It is the former--the life one has--that is often paramount for a patient. As with those trapped on 9/11, that life can come to an end before death occurs.

When a human life deteriorates to the point where one reasonably desires to end it, the argument for the permissibility of euthanasia can turn on autonomy: the ethical and legal power, within civic constraints, to chart the course of one's own life, especially in areas where the stakes that others have in the choice are not as great as one's own. The root political idea is that, provided there are no sound and proportional countervailing reasons, adults should enjoy the freedom to make their own decisions. (4) The presumption ought properly to be in favor of liberty: here the liberty of informed, suffering, competent individuals to choose the manner and time of their death. In the face of intractable suffering and an expressed and settled preference for death, there are strong arguments 1) that voluntary euthanasia should be permitted in these cases and 2) that it is cruel to prohibit or condemn charitable assistance to those who are relevantly similar to the 9/11 coworker in her wheelchair. Those who act out of courageous compassion in these cases are surely not the criminals we have in mind when we build prisons. Accordingly, public policy should regulate, but not prohibit, voluntary euthanasia.