Euthanization: Ethics vs. Legality

In the realm of medical ethics, few issues evoke as much moral controversy as the practice of euthanization. Euthanasia is the process in which medical professionals intentionally end a person’s life to relieve suffering. Whether this process is carried out actively or passively, medical professionals must receive consent from the patient or the patient’s legal guardian in cases when the patient is a minor or unconscious. In active euthanasia, medical professionals introduce drugs to cause death, specifically barbiturates and neuromuscular relaxants that calm the patient's body by lowering their heart rate and blood pressure and ultimately cause them to stop breathing. By comparison, in passive euthanasia, physicians withhold life-preserving treatments or supportive measures, such as disconnecting the ventilator of a patient who is unable to breathe on their own.

As medical advancements and new technologies allow those who would otherwise be unable to survive to live longer, society finds itself at a halt in cases where the patient’s morality conflicts with the medical professional’s sense of responsibility. The ethical dilemma surrounding euthanization raises questions about the importance of life in the face of chronic pain and suffering, the medical autonomy of individuals, and the obligations of medical professionals. The request to end one’s life prematurely not only introduces an ethical dilemma but also creates legal dilemmas for medical professionals, who are taught to do everything in their power to save their patient’s life—but only as long as the patient provides consent. Thus, debates about whether individuals should have the right to decide when and how they die—especially when facing unbearable pain—continue in full force.

Advocates for euthanization put great emphasis on the idea of the “right to die,” which refers to the ethical and legal concept that individuals have the autonomy to make decisions about their end-of-life care, including choosing when and how they will die. Supporters argue that respecting individuals’ decisions creates a progressive, patient-centered healthcare system where medical professionals respect patients’ wishes. Thus, the “right to die” is often framed in the context of providing relief to individuals experiencing unbearable physical or psychological suffering due to terminal illness. 

Some see euthanasia as an alternative that ensures a compassionate, dignified, and less painful death for those who request it in cases of unbearable suffering, terminal illness, or drastically impaired quality of life. For example, the Washington Death with Dignity Act, Initiative 1000, passed on November 4, 2008, allows some terminally ill patients to communicate their informed request and use lethal doses of medication from qualified medical providers as part of their end-of-life care, but only if they are diagnosed with an incurable and irreversible disease that will produce death within six months, are a Washington resident, and are 18 years of age or older. 

Outside of one’s personal belief system, other factors play a role in influencing the decision to agree with euthanization. One example is financial stability—for some patients from lower-income households, the familial financial burden of continued treatment that will prolong their life but not cure them feels like too great of a cost. For such individuals, euthanasia can feel like a way to honor the right to die with dignity without limiting their family’s future opportunities. Many view euthanization for financial and social stability as pivotal, especially considering that most euthanization petitions are filed by sufferers, family members, or caretakers. This is primarily due to the concept of the caregiver’s burden, where caregivers of patients suffering from drastically impaired health conditions endure various domains of financial, emotional, physical, and mental distress—a factor that can sometimes play a role in a patient’s choice to pursue euthanasia. 

On the other hand, those opposed to euthanization argue that the sanctity of life outweighs all of these concerns. Such individuals believe that providing suffering patients with the option of ending their lives creates a slippery slope that opens gateways for potential abuse. They argue that those abuses could result in people with terminal and extreme illnesses feeling pressure to remove themselves from society through euthanization and consequently a significant loss in population.

Just as advocates of euthanasia believe in the “right to die,” those opposed believe in the “right to live.” For example, Article 21 of the Constitution of India states that the “right to life” is a natural right, and suicide is an unnatural termination or extinction of life, making it incompatible with the “right to life”. Since euthanization is classified as physician-assisted suicide, it contradicts the Hippocratic Oath, the oath medical professionals take saying that the State must protect life, and the physician’s duty is to provide care and not harm patients. Furthermore, because suicide attempts are commonly seen in patients suffering from depression and schizophrenia, as well as substance users, it is essential to assess the mental status of the individual seeking euthanasia in case their mental state prevents them from making an informed decision and providing consent. Additionally, the concept of caregiver burden can be used against the advocates for euthanization; some advocate against the euthanization of minors or patients left unconscious by illness because they are not the ones able to provide consent, and their caregiver could be overwhelmed with the stress of the patient’s condition and make a rash decision.

There are various ongoing debates and ethical disputes in the medical world and society at large when it comes to euthanization. As a result, the procedure is more commonly performed on sick or injured animals and is illegal for humans in most of the United States. (The practice is legal in Washington D.C., California, Colorado, Oregon, Vermont, New Mexico, Maine, New Jersey, Hawaii, and Washington.) However, this is mainly due to a complex interplay of cultural, ethical, religious, legal, and other societal factors. The ethical and moral values of a society are a key factor and influence perspectives on the sanctity of life, individual autonomy, and the acceptability of intentionally hastening death. Religious beliefs also play a significant role, with some traditions opposing any form of assisted death based on moral principles. Likewise, legal traditions prioritizing personal freedoms—or in contrast, those that emphasize the protection of life—can determine if a country allows euthanization.

Some individuals argue that the modern-day Do-Not-Resuscitate (DNR) and Do-Not-Intubate (DNI) orders commonly employed across the United States are forms of passive euthanization that sufficiently protect patients’ ability to maintain autonomous end-of-life decision-making. In the case of DNRs, patients can opt out of life-saving cardiopulmonary resuscitation during cardiac arrest, while with DNIs, patients reject intubation in the event of respiratory arrest. These legal orders allow a patient to provide consent to medical professionals so as to not take life-saving measures in emergencies. However, some argue that patients are simultaneously asking physicians to violate the Hippocratic Oath’s emphasis on saving lives. However, DNR and DNI are legally recognized and accepted orders that overpower the Hippocratic Oath since, though they exhibit some commonalities with euthanization, they have different legal statuses.

Euthanization has stirred fierce ethical debates because the choice between life or death is a deeply personal decision, but the entities addressing this issue—like governments—are being asked to make all-encompassing decisions. It is possible that moral consensus around DNRs, DNIs, and—of course—euthanization will never reach a stage of full agreement. While a moral agreement is likely unachievable, clear outlines of legality or illegality are. With physician-assisted suicide legal in nine U.S. states and Washington D.C., it’s clear that the foundation of these jurisdictions regarding the legality of euthanization and its ethical concerns is each state’s decision.