In this article the author defines euthanasia and the different forms it can take based on distinctions that have been proposed as ethically relevant; explains important concepts in the current debate on euthanasia (proportionate or disproportionate means, principle of the double effect, argument of the slippery slope, quality or sanctity of life); puts forward some arguments for and against euthanasia practices for elder patients (ayuda a domicilio en barcelona); and reports on the different assessment that has been made of the current experiences of decriminalization.
In the currently predominant sense, euthanasia is the act or omission that allows, accelerates or causes the death of a terminal patient or a newborn with severe malformations, to avoid their suffering. The concept implies the intervention of an agent other than the patient and that it be carried out for the patient’s own good, moved by compassion.
Different opinions about euthanasia
There have been euthanasic proposals and practices in different eras and cultures. Sometimes it has been customary law that has determined when a sick or elderly person should die for the benefit of the group. On other occasions, it has been attributed to the role of the physician to encourage the death of those who are incurably ill or who have no social utility. Today, by appealing to the ethical principle of autonomy, authors and groups defend the legitimacy of helping an informed and competent patient who requests it to die or of accepting the decision of the person who represents the best interests of the patient if he or she cannot express the request.
Determining factors in the contemporary debate on euthanasia would be the inability of the medical profession to accept inevitable death and to limit the use of a technique capable of maintaining a purely biological life of the body for an indefinite period of time, when there is no longer any possibility of a truly human existence; the recognition of the patient as an autonomous moral agent and the affirmation of freedom as the supreme value of man; and an immanent conception of life, coupled with the rejection of suffering as a “purifying and meritorious” experience.
Euthanasia, which is broadly defined, can be classified from various points of view, and relevant distinctions can be made in the debate on its ethic:
Voluntary euthanasia: The decision is made by the patient directly or by others in accordance with the patient’s wishes expressed previously.
Non-voluntary euthanasia: The decision is made by a third party without there being any possibility of knowing the patient’s determination.
Involuntary euthanasia: The decision is made by a third party without seeking the consent of a patient who is able to express his or her choice or against his or her will.
Active (or positive) euthanasia: by action (e.g. administration of lethal substance).
Passive (or negative) euthanasia: by omission (abstention or withdrawal from therapy).
Direct euthanasia: the act or omission attempts to kill the patient.
Indirect euthanasia: the action or omission is not intended to result in the death of the patient, but it is recognized that it may occur as an unwanted side effect of the action or omission.
Action or omission?
The distinction between action and omission (active or passive euthanasia) points to the difference between killing and letting die, concepts that are susceptible to different moral values. In the first case, the patient dies as a direct consequence of the events initiated by the agent. In the second case, the patient dies because the agent does not intervene in a course of events (evolution of the disease) that are already underway and are not caused by him. Therefore, both not starting therapy and withdrawing it once it has been started would be omissions that allow for death (passive euthanasia).