The Last Right by Marianne Thamm (best ebook for manga TXT) 📕

pain or distress (anxiety). The argument from suffering is premised on the value of human well-being.

Life, the good that makes all other goods possible, may become a burden or worthless on account of suffering pain, or suffering distress at the loss of control and dignity. Death may become the only deliverance.

Judging another’s well-being, or whether life is worth living, or death desirable, is not merely a matter of considering objective facts, such as medical information about diagnosis and prognosis.

It also requires considering the subjective values, projects, preferences and experiences of the person whose life and well-being is at issue.

Consequently, if a competent person freely judges that death is the only escape from suffering, then assisting that person to die would not wrong or harm them but be in their interest. On the contrary, refusing to help would harm them by frustrating their projects and preferences, and would be crueller and less merciful than assisting them with a gentler, more dignified, death.

The counter-argument usually maintains that the suffering caused by pain or distress is controllable by means of comfort care. Again to maintain that pain medication, coupled with a conventional dosage of sedative, would keep patients asleep until they die naturally ignores their legitimate preferences not to die in a state of palliative or terminal sedation. And it does not address suffering induced by distress at the loss of dignity.

Another counter-argument contends, from a religious point of view, that God has a purpose with suffering and that we would frustrate his will when we remove suffering by hastening death. Not all religious believers would accept this interpretation of God’s will.

Moreover, for what sound ethical reason would we wish to relieve others’ suffering throughout their lives, but retreat if suffering occurs when death is imminent and relief of suffering may hasten death?

Moral Equivalence

There is a strong argument for assistance with dying premised on the moral equivalence of assistance with dying (assisted suicide and voluntary euthanasia), on one hand, and withholding and withdrawal of life-sustaining treatment, on the other.

If the latter are ethically justified healthcare practices, so should be the former, since there are no relevant moral differences between the two.

The mere fact that one action is an omission or “passive”, while the other is an act or “active”, does not in itself render the former morally acceptable and the latter morally objectionable.

All these practices involve deliberation about the patient’s condition, intention, benevolent motive, and consequences – directly for the patient who dies, and indirectly for family, friends, healthcare workers, other interested parties, and state interest.

The only difference is the means whereby death is caused: withholding or withdrawal of life-sustaining treatment involves an omission of treatment, whereas assisted dying requires an act. This, however, is not a morally relevant difference because we are (morally and legally) responsible for both acts and omissions.

In short, there is no one set of distinctions or differences that attach only to either acts or omissions.

Ethical Arguments against Assisted Dying

There are three significant ethical arguments against assisted dying: it is wrong to “play God”; the responsibilities of healthcare workers should never include killing people; and “slippery slope” undesirable consequences, including abuse, will follow or are likely to follow.

Playing God

The doctrine of the sanctity – or special moral value – of human life means, among others, that only God should determine the time and manner of our death. It is therefore wrong to “play God” by shortening our lives, even if suffering is intractable and unbearable.

Clearly, people have different views about the existence of God, and divergent interpretations of coming to know His will. For some, He is authoritarian and inscrutable, giving us orders and instructions, for example, in the form of a Bible text or some personal revelation. For others, He is merciful and understanding, and confers upon us autonomy and responsibility to do our best through rational and compassionate decisions in situations of great tragedy and ambivalence.

But even if we accept an authoritarian conception of God, His orders or instructions still need to be interpreted. For example, if God prohibits us from usurping His authority by making decisions that alter (hasten) the time of our death, then surely we likewise “play God” when we shorten our lives with bad eating habits, or lengthen our lives with antibiotics or surgery. Which, then, is acceptable in the eyes of God, and which not?

In essence: the “playing God” argument is weak since it is impossible to make a non-arbitrary distinction between practices of which God approves and those of which He disapproves. Something is not right because God says so; God says so because it is right. Irrespective of our religious convictions, we need to use our reason and compassion to come to know what course of action ethical values demand of us.

Professional Responsibilities

A second anti-assistance with dying argument contends that healthcare professionals have responsibilities that are incommensurable with killing or shortening life, namely, general moral obligations as human beings to prevent harm (non-maleficence) and do good (beneficence), and specific professional and institutional duties to care, heal, extend life, or preserve life.

Assisted dying would undermine these responsibilities and commitments, thus eroding the trust patients have in healthcare professionals to act in their best interest. These practices are forms of killing, and killing is not what healthcare professionals do, or ought to do. And this professional prohibition against killing goes right back to the Hippocratic Oath.

This argument fails to take adequate account of non-curative healthcare of terminally ill persons whose death is imminent. Life is finite, and all humans eventually die of natural causes unless some unnatural cause intervenes.

Tragically, a natural death, for some, may be infused with intractable or unbearable suffering, and death may be preferable to a life that is no longer worth living. It follows that the ethical responsibilities of healthcare professionals cannot, in all circumstances, be to save life, or to heal.

Healthcare professionals, or others, who assist with dying would be morally blameworthy only if death is the enemy in all circumstances, and