There is a lot of controversy surrounding the issue of people’s autonomy when it comes to the end of their lives. Why somebody would want to end their life prematurely is a question that puzzles people. So therefore is hard to comprehend why people should have autonomy over such a thing.
There has been an increase in the interest of euthanasia and assisted suicide for the terminally ill in recent years (Williams 1997). The most obvious reason for someone wanting to end their life is to end the suffering they are going through once the illness goes beyond being bearable.
Palliative care is an important part of treating a seriously ill patient. It provides a patient with care, support and any medical treatment they need including pain relief. But is this enough? A person that is extremely sick, for example, a terminally ill cancer patient, or a person that is paralysed from the neck down, or any person that is unable to do things for themselves – such as washing, eating etc., will need to depend on others to help them. This would involve somebody dressing them, washing them, feeding them – or having being fed via I.V., they would need help going to the toilet and may need to be lifted in and out of a bed.
These peoples quality of life would be very low. They may be depending on family members for these things or medical professionals that are strangers to them. Either way, this can be an embarrassing and upsetting for a person. They may feel like they have lost all sense of dignity and some might feel like they are just waiting to die. People in these situations may often decide that the best option for them is to end their physical and emotional pain. If a doctor cannot improve an individual’s quality of life and they make that decision to end their suffering, the patient should have right to have their wishes met. Those that request assistance in dying are usually very desperate and do not see any other option.
There are vast amounts of arguments against autonomy at the end of ones life too. Religious perspectives. consequences on family, friends and healthcare professionals. Is it ethical? Would it begin a slippery slope towards involuntary euthanasia? But are these arguments and opinions stronger than a person’s right to choose?
The subject of euthanasia is very controversial because there are very strong arguments at both ends of the spectrum. There are any justifications for and against the issue of one’s autonomy over their end of life decision.
Paterson (2008) states that religion plays a role in many people’s decisions against voluntarily ending one’s life. Most religions are strongly opposed to the idea that a person should want to end their own life and/or aid an individual in doing so. Other factors come into play such as conscience and morality. Some people see it as unlawful and more often than not, it is a very taboo subject that people would rather not discuss. (Paterson, 2008)
On the opposite end of the spectrum, one will argue that those who are terminally ill are going through unbearable suffering, they may need help going to the bathroom, eating and drinking and possibly feel like they have lost their dignity because of this. In an online article written for the Daily Mail, a man by the name of Tony Nicklinson describes his life as “miserable, demeaning and undignified” (Miller, 2012). The article describes how Nicklinson is mentally sound but physically paralysed from the neck down and took his plea for his right to die to the courts. This emphasises that euthanasia and assisted suicide can be a relief from pain and suffering, or in Tony Nicklinson’s case, an alternative to the quality of life he must struggle through on a daily basis. (Miller, 2012)
Many factors come into play when a person decides they no longer want to live. It is not a decision that is made lightly. It is one of desperation. Those opposed to the idea of assisted suicide and euthanasia will argue that a patient in severe pain and suffering in their daily living, will receive the appropriate palliative care thus, rendering euthanasia unnecessary (Anti-euthanasia arguments 2012) But surely palliative care is also a necessary element in figuring out whether or not a person would be deemed eligible if euthanasia were an option for them.
Palliative care also provides support for those closest to a patient. If a terminally ill patient of sound mind wishes to end their pain and suffering, does that mean that they and their close family and friends are no longer entitled to the same care and support as those patients that do not choose to end their lives earlier? Under the subtitle ‘Proper Palliative Care’, an article on the BBC website states “The key to successful palliative care is to treat the patient as a person, not as a set of symptoms, or medical problems.” (Anti-euthanasia arguments 2012)
If this is the case, the patient – as a person – should be given their dignity, respect and deserve to have their voice heard. “The judgement – as to whether a life, in the face of intractable pain and suffering, is worth living – can and should be determined by the conscience of the individual patient […]” (Paterson, 2008. p16)
An article for the Irish Times declares that the attitudes of the irish people towards euthanasia is rapidly changing. A study carried out by a Canadian student, Matthew Carere on final year medical students in UCC, reveals that the majority – almost 60% were in favour of euthanasia, with Carere stating that the reason for this was that patients are more informed these days to make their own decisions and that medical professionals have more respect for patient autonomy (Roseingrave, 2011).
Very often, deliberate decisions are made which results in the end of a life. For example, a person could be kept on life support, but instead, a family member or other significant person might choose to switch off the life support machine resulting in the official death of a patient. There is also the case that resuscitation of a patient may eventually prove to be trivial and a doctor might suggest just making the patient as comfortable as possible until their eventual passing. In the above situations, a medical professional’s decisions would not be questioned or doubted. It is conventional practice (Warnock and MacDonald 2008).
An organisation called Exit International was set up in 1997 by Dr. Philip Nitschke. They believe that people have the right to make an informed decision about when and how they will bring their life to an end. They provide information and support to those that need it on assisted suicide and voluntary euthanasia (About Exit International 2012) “Exit’s long term goal is responsible and ethical law reform. The Swiss model of decriminalising assisted suicide is the preferred model.”
(About Exit International 2012) At the moment the Netherlands is the only place in the world that one can legally take action should they decide it’s their time to go (Griffiths and Weyers 1998). It was legalised fully in the year 2000. Prior to this doctors could still be prosecuted by law. However, there are strict guidelines that must be met.
“1. Adult patients must be beyond any hope of recovery and face continuous unbearable pain. 2. The patient must make repeated, clear and reasoned requests to do so. 3. A second physician must be consulted. 4. The action must be carried out in a medically approved manner. 5. parental consent is required for patients under 16 years old.” (Legalized Euthanasia 2007) In Switzerland, active euthanasia is illegal but with specific consent, doctors may provide the drugs but the patient must be the one to take them voluntarily. (Legalized Euthanasia 2007) A person’s right to choose is very imminent. Considering the criteria that must be met in the Netherlands and Switzerland, it’s very obvious that it is only an option if it is in the very best interest of the patient. This makes sense if one considers prolonging the suffering of a patient both physically and mentally as cruel and unethical.
The term ‘suicide’ brings with it a lot of negative emotions. The idea that somebody would willingly want to end their lives is a distressing thought. It conjures up the idea that a person is depressed and in deep emotional pain. The idea of suicide is indeed scary. This, perhaps may be why people panic when they hear the term ‘assisted-suicide’ or when they think about euthanasia. What those opposed to the idea of prematurely ending a life do not think about though, is the physical as well as the emotional pain a terminally ill person is feeling. They can empathise but not fully understand, unless they are in the same or similar situation. So, who are they to deny a human being their free will and choice to end their suffering? How do they know that they would not feel the same way if they were the ones going through the unbearable pain and lack of dignity? “Furthermore it is argued, we ourselves have an obligation to relieve the suffering of our fellow human beings and to respect their dignity.” (Andre, Velasquez 2012)
People against the idea of assisted suicide and euthanasia will speak of the guilt of allowing a person to seek an end to their own lives. But where is their guilt in watching an individual, perhaps a loved one in relentless pain? Where is their compassion for the terminally ill patient? (Andre and Velasquez 2012) Thos people may also talk about a ‘slippery-slope’ to involuntary suicide. the legalisation of euthanasia and assisted suicide under certain circumstances, would mean legislation – criteria that needs to be met, similarly, if not the same as that of Netherlands. “…with safeguards, the law should permit it and people should be supplied with the means to take their own life or a doctor should be authorized to end their life provided the request is made before witnesses.” (Williams 1997)
People of sound mind should have autonomy over what they want to happen at the end of their life, they should have the choice. Williams (1997) suggests that if one rationally decides that they want to end their life, they must be prepared to discuss the pros and the cons of their decision and the reasons behind those decisions will be questioned. He writes that we all have a right to make a decision on our own life and once their unit of family and friends is taken into account, then it can be justifiable to deliberately end a life. This is completely understandable and logical. People would no longer have to endure excruciating pain and struggle through the end of their lives without dignity. If they have autonomy, they have the choice to end their suffering and pain.