The Right To Die?

Do we have a right to die as much as we have a right to live? How much autonomy do we truly have over our bodies? “What I am saying is for me [is that] if I have a stroke that leaves me paralysed, leaves me brain dead, then I don't want to live like that, I don't and why should I?” shares one patient diagnosed with progressive multiple sclerosis [1].

Euthanasia — broadly described as the act of intentionally putting an end to a patient’s life, usually to end their suffering — is arguably one of the most controversial topics in healthcare and bioethics. When discussing euthanasia, there is a focus on active euthanasia — where a physician directly ends the patient’s life by injecting or prescribing a lethal amount of a drug. However, euthanasia can also be conducted passively, including limiting life-sustaining treatment or increasing the dose of pain-killing medication [3].

Involuntary euthanasia, which is conducted without patient consent, remains illegal in all countries and is generally considered as morally wrong due to its recognition as murder. However, the topic is divisive and there are many different-sided arguments in regards to voluntary euthanasia—where a person purposely seeks to terminate their life. In the United States, for example, physician-assisted suicide for terminally ill patients is legal in nine states plus Washington DC whereby physicians can legally assist the patient’s death by providing necessary resources and information [6]. In the Netherlands, both euthanasia and assisted suicide are legalized — accounting for 4.5% of all deaths in the country [4]. This can be requested in the case of an absence of other treatment options but only after the physician consults another physician [4]. Children as young as twelve years old may also request the procedure with parental consent when showing unbearable, prospect-less suffering.

Legalization of euthanasia was established on two grounding beliefs: compassion toward unbearable suffering and autonomy. Since the 1960’s, there has been an increase in the interpretation of autonomy over body/health choices as a fundamental right of a patient in health law. The European Convention for the Protection of Human Rights and the Dutch Constitution protect the right to privacy and right to bodily integrity, allowing patients to make informed decisions about their bodies and consent to medical treatment [4]. In the United States, the Constitution also ensures the right to bodily integrity, but the Supreme Court has concluded that prohibiting physician-assisted suicide does not violate the Consitution [8]. Arguments against euthanasia include possible distrust in relationships between physicians and patients — such as if the patient feels that too much power is put into the hands of physicians or whether or not the patients can look for other physicians who will perform the procedure. Moreover, the act of euthanasia may oppose the professional responsibilities and duty of healthcare professionals outlined by the Hippocratic Oath: to provide care for patients, restore their health, and “apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of over-treatment and therapeutic nihilism” [5]. There are also concerns surrounding the potential reduction of value of human life and advocacy for alternative options like palliative care. There are also concerns over the ability of patients to consent; patients may feel pressured to consent, and the use of euthanasia for psychiatric patients remains highly controversial [2].

However, euthanasia and assisted suicide are the most desirable options for some patients who seek to have control of their life and believe that they have the right to choose their death. Euthanasia can end their suffering and prevent a prolonged death. Palliative care and long-term life-sustaining treatment may also pose financial challenges to individuals and the US healthcare system [7]. A woman with metastatic kidney cancer who has witnessed her mother’s painful death explains, I just think that when you've come to that stage, only you know when that is, how bad that has to be, you don't need to go through the physical indignities of throwing up, being smelly, being incontinent, whatever it might be.” [1].

Ultimately, debates over the legalization of euthanasia are unlikely to resolve in the foreseeable future. However, the current focus on euthanasia allows us to question the power that governments should have in regards to the healthcare choice of its constituents. By questioning to what extent should the right to bodily integrity be applied, society can open the conversation into other issues in healthcare and bioethics, such as reproductive and abortion rights and transgender health access.

References:

1. Chapple, A., Ziebland, S., McPherson, A., & Herxheimer, A. (2006). What people close to death say about euthanasia and assisted suicide: a qualitative study. Journal of medical ethics, 32 (12), 706–710. https://doi.org/10.1136/jme.2006.015883

2. Denys, D. (2018). Is Euthanasia Psychiatric Treatment? The Struggle with Death on Request in the Netherlands. The American Journal of Psychiatry, 175(9), 822-23. https://doi.org/10.1176/appi.ajp.2018.18060725

3. Holland, K. (2019, May 31). Euthanasia: Understanding the Facts. Healthline. https://www.healthline.com/health/what-is-euthanasia

4. Kouwenhoven, P. S. C., Van Thiel, G. J. M. W., Van der Heide, A., Rietjens, J. A. C., Van Delden, J. J. M. (2019). Developments in euthanasia practice in the Netherlands: Balancing professional responsibility and the patient’s autonomy. European Journal of General Practice, 25(1), 44-48. https://www.tandfonline.com/doi/full/10.1080/13814788.2018.1517154

5. Marks, J. W. (2021, June 3). Medical Definition of Hippocratic Oath. Medicine Net. https://www.medicinenet.com/hippocratic_oath/definition.htm

6. ProCon. (2019). States with Legal Physician-Assisted Suicide. Britannica. https://euthanasia.procon.org/states-with-legal-physician-assisted-suicide/

7. Trachtenberg, A. J., & Manns, B. (2017). Cost analysis of medical assistance in dying in Canada. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 189(3), E101–E105. https://doi.org/10.1503/cmaj.160650

8. Washington v. Glucksberg. (n.d.). Oyez. Retrieved November 23, 2021, from https://www.oyez.org/cases/1996/96-110