Euthanasia: issues and ethics

Euthanasia (literally, "a good death") refers to cases where death is brought about or allowed because death is thought to be in that individual's interest, normally because the patient is suffering from an incurable and terminal illness. In these cases the ethical justification may be summarised colloquially as "he (or she) is better off dead". It is therefore inaccurate to associate the term "euthanasia" with the extermination camps of Nazi Germany or with ideas of killing off the so-called useless or undesirable members of society. For instance, to kill someone merely because some other person decided they were too old could not count as euthanasia. Therefore, there is little virtue in the argument against euthanasia on alarmist "slippery slope" grounds; nonetheless, as previous discussion about values illustrated, caution over the social consequences of instituting euthanasia as a medical practice may be justified.

Overall, it is not inconsistent with an ethic of response to argue that, in certain cases, euthanasia, even "active involuntary situations", is justifiable as morally fitting. However, should, or how can, that conclusion be translated into law and social policy? There are certainly major objections to the legalisation or decriminalisation of euthanasia to be considered:

• is there not a danger that legalised euthanasia will put undue pressures on medical practitioners and nurses, subtly altering their duty to care?
• is it possible to devise a law which is not open to abuse?
• is it not conceivable that carefully framed laws might later be amended or extended by regulation, bypassing public debate?
• might not legalised euthanasia open the door for elderly people to be quietly disposed of against their will?
• if euthanasia is legal, might not an old person feel pressured to die because they are a burden to their relatives?

The ethic of response with its concern for social justice, universality, accountability and social solidarity also infers that a major consideration for particular, individual cases of euthanasia is the broader social impact of the ethical decision.

Euthanasia policy is also likely to be influenced by two contemporary developments. The first, developments in palliative care, represents part of the case that there are positive alternatives to euthanasia in a "bad dying" process. The claim is that through more sophisticated pain relief measures and the caring of the hospice movement support for a "good death", without active termination of life, is possible.

The other development is what is claimed to be the complex social cost of an ageing population. Can societies afford the escalating costs of keeping people alive to an advanced age especially when a large proportion of limited resources are devoted to the terminally ill? This utilitarian consideration is arguably unfair and disrespectful of persons, and needs further factual substantiation. However, it is on the community agenda and rightly or wrongly, may subtly influence social policy with respect to euthanasia.

In the community debate over euthanasia, religious believers represented by Christian churches are officially cautious, even hostile, though it must be added that many individual Christians have another view and are even active in groups such as the Voluntary Euthanasia Society. The major churches in Australia have expressed concern about the moves to legalise euthanasia.

Undoubtedly, one's beliefs influence how one approaches life-and-death dilemmas, especially euthanasia. Some simply claim that only God can take an individual's life. Other critical questions relate to one's beliefs about suffering: might not suffering be redemptive and purposeful? Does it make any difference that it is the suffering of dying? Might we not cheat ourselves of something life has to offer when we terminate life prematurely? On these questions, Elizabeth Hepburn offers a fitting observation with which to conclude this brief discussion:

"A philosophy which sees suffering as absurd will lead us to seek relief in the form of euthanasia. We must decide whether we will interpret the dispossession we experience in the face of suffering as absurdity or mystery. If we opt for mystery will be committed to living life to the full in both ecstasy and sorrow."