A right to die: the moral perspective

A right to die: the moral perspective

Thursday 20 November 2014 - Ee Hsien Tan

It is perhaps highly ironic that with the advancement of medical science in areas of artificial life support and palliative care, issues regarding the appropriateness of terminating life have surfaced. Should it then be viewed as an egregious consideration that contradicts what is at the very heart of medical science: to prolong life and prevent death?

While the right to life is deemed to be an unquestionable, inalienable and fundamental human right, the same cannot be said of the converse.  The complexity of the discussion on euthanasia often reveals a vast spectrum of perspectives and an even wider range of moral issues at hand. The right to life is fervently enshrined and upheld, but the issue is whether the same can be said for the right to die.

It is first imperative to address the parameters of this discussion with reference to specific definitions of euthanasia. This is especially pertinent given the various forms of medical intervention by which accelerated dying can be effected. Euthanasia refers to the termination of life of a patient who is suffering from either an incurable illness or an irreversible coma by a positive act.

The difference between involuntary and voluntary euthanasia also has to be established before examining the moral issues brought to the fore. In the former, the life of a patient is ended without his or her consent. Such instances will not be considered within the scope of this discussion. A moral or legal basis for the right to choose medical intervention that causes one’s death rests on the assumption that one is indeed in the position to exercise this choice through consent. The prerequisite of choice is clearly not met in cases of involuntary euthanasia as the option of death is imposed rather than chosen by a patient.

Voluntary euthanasia refers to instances where a medical professional conducts an act that causes death following a patient’s consent. This is to be distinguished from assisted dying, where the patient is the one who conducts the final act that causes death. The distinction between the two highlights the difference in providing the resources for someone to commit an act and actually committing the act yourself. However, both instances may not be morally distinct. Ultimately, a patient is able to exercise his or her autonomy to give full and unqualified consent in both cases.

This leads us to the core of the discussion – is there a moral basis for a terminally ill individual to choose to accelerate his or her own death?

Opponents of voluntary euthanasia argue that the sanctity of life takes priority over individual autonomy. The sanctity of life recognises the intrinsic value of life; that life is of and in itself valuable. As such, it is morally reprehensible to diminish the intrinsic value of life through intentional killing. Lord Donaldson upheld this perspective in Re J, when he noted that ‘we all believe in and assert the sanctity of human life’. Indeed, the doctrine is one that resonates strongly among all audiences – both secular and religious.  Atheists champion the irrefutable dignity of each and every human life, while theists view the gift of life as sacred.

However, it is unclear whether this doctrine is something that should be upheld at all costs. Consider a patient who is suffering from a terminal, debilitating disease where painkillers fail to relieve him from the agony he experiences on a daily basis. Should the abstract notion of the intrinsic value of life still be blindly asserted? Is it worth prolonging the suffering and life of an individual who no longer values it? Should the choice to prolong life and conversely the option to accelerate death not lie in the hands of the very individual suffering from a painfully terminal illness?

Yet the discussion of an individual’s quality of life often lies on risky territory. The value each person places on his or her own life is subjective and self-determined. It differs based on perceptions and personal preferences. A terminally ill patient may find value in living his life till nature takes its course, enduring the pain he faces throughout the deteriorating stages of his condition. He may view this as testament to his will and determination. Another patient suffering from the same medical condition may view his life to be of less value if he is unable to carry out simple daily activities and is no longer in full possession of human cognitive abilities.

It would not be moral for society to place a value judgment on either of these preferences. It would be ethically unjust to decide that the opinion of one terminally ill patient is less valid than the other. Both individuals are entitled to hold their own opinions with regard to how they wish to live their own lives till their deaths. This brings us to the crux of argument for personal autonomy: a patient’s decision should be respected not because it is deemed to be a good choice; it should be respected because it was his or her choice.

When we assert that there is no moral basis for voluntary euthanasia, we inadvertently respect the choice of individuals who value their personal struggle in the face of illness. However, we neither respect nor protect the choice of those who view their suffering as a burden they do not wish to carry. Arguably, we should view life beyond biological terms. On the other hand, maybe we should look past the rise and fall reflected on a cardiac monitor by embracing an individual’s life in biographical terms of achievements, experiences and, most importantly, choices. It would then be patently clear that the attempt to draft yet another painful chapter is not up to society or a medically trained professional. The choice lies with the individual who faces the impending and inevitable possibility of death, regardless of what that choice may be.

Cover image: Flickr/Musesyndrome_ under Creative Common licence.

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Author: Ee Hsien Tan