The New Jersey Supreme Court ruled in 1976, in re Quinlan, that it is legal for a guardian to direct a physician to discontinue all extraordinary procedures [Bioethics]. This asserts the rights of the patient over a physician's judgment.
This ultimately lead to the ethical issue of which medical treatments could be construed as optional: Is artificial nutrition, hydration, and all other medical advances under the same standards of evaluation? Legal branches joined with ethical literature and public interest formed a general rule. A passive 'letting die' at a patient's or family's request is acceptable, however the active hastening of death or killing is not acceptable [Bioethics]. To put it more clearly, a patient can REFUSE treatment, but has no right to request that their death be hastened intentionally.
However, questions have been raised about precisely what an individual has a right to decide and what an individual does not have a right to decide. The general rule stated above has evolved from a purely negative right against extraordinary procedures into a positive right to determination of one's own manner of death. Thus more and more control has been given to patients in the process of death. This has led to the question of whether the right to die includes the request of a physician's assistance. Many physicians fear that the expansion of patient's rights may lead to a physician obligation to assist in suicides [Bioethics]. This ultimately leads to patients having control over physicians.
The idea of euthanasia and physician assisted suicide is to benefit the patient. Some may argue that a patient cannot be benefited by death. However, the parallel question, 'Can a person be harmed through death even though death will result in a person no longer alive to suffer harm?'
Example> Andy is an accomplished tennis player. Had he not died so young, suppose he would have been an even greater tennis player. Due to tennis skills being valued as good, Andy had a less overall 'good life' than if he were to had lived longer.
Because Andy's life would have been better, his death is viewed as a negative occurrence. By excluding the achievements Andy could have made, his death harmed him.
Now suppose a person's life would only include pain and misery in the future, with no compensating 'good'. Living a shorter life with less pain and misery would benefit the person’s life [Bioethics]. By eliminating the pain and misery, the death benefits the individual, by preventing the worse life.
With that out of the way, is it ever morally permissible to benefit an individual via the hastening of death when requested?
Example> A doctor is treating a terminally ill patient in severe pain. Suppose the pain can only be treated with morphine, however by giving the patient morphine the doctor is essentially hastening the patient's death [Bioethics].
In this case the greater good for the patient is the relief of pain with the lesser evil being the loss of life. After all, the patient is terminally ill and is severe pain. The patient's life would end soon anyways, and is not of very good quality. The patient is then benefited from having a shorter pain-free life rather than a longer, more painful life. In this situation the doctor foresees that the morphine will end the patient's life. However, death is the side effect of the morphine, not the intended goal for giving the medication. Thus this situation is not a case of physician-assisted suicide. However, the physician did not simply let the patient die as a result of illness. The doctor administers a drug that causes death. In this case, many people view this as 'killing', even though death was not the goal. Just as a drunk driver does not intend the death of others, it is possible to kill without death being intended.
What if the morphine began to lose its effectiveness in reducing the pain for the patient, but administering more morphine would shorten the patient's life and limit the duration of the pain? Also, what if the patient began to request the morphine fully aware of the side effect of death? Now the goal of the morphine has changed from morphine for pain management to morphine for death [Bioethics]. Is it still ethically permissible from the doctor to administer the morphine?
Some people say that this is not allowable in this case. The greater good of less pain and lesser evil of death are still recognized. The problem some people have with this situation is that the doctor would not administer morphine if death were not expected. These people support the Doctrine of Double Effect [Bioethics]. According to this doctrine, there is a large moral difference between acting with the foresight that one's actions will cause some evil and acting with the intent of producing that same evil, even as a means of creating a greater good. Therefore, administering the morphine with the intention of death is not permissible.
Although the moral distinction between intending and foreseeing evil is evident, does it provide sufficient reason to refrain from euthanasia or physician assisted suicide? Many disagree. In many situations physicians intend the lesser evil to a patient in order to produce a greater good.
Example> To remove a cancerous tumor, a doctor may intentionally amputate a healthy leg in order to save a patient's life [Bioethics].
Example> A doctor may intentionally cause a patient pain, acting against the duty to relieve suffering, in order to save a patient's life.
In these cases, the duty to save a patient's life outweighs any other duty. The doctors in the above cases intend evil to cause a greater good. Why then is it impermissible and morally wrong to cause death, an evil, to cause a greater good, less suffering?
Many have come to these conclusions? Assuming patient consent>
A. We may cause death as a side effect if pain relief is the result. Death is sometimes the lesser evil and pain relief the greater good.
B. We may intend lesser evils to a patient for the sake of the greater good.
C. Therefore, when death is the lesser evil, it is morally acceptable to intend death with the reduction of pain as a result.
