Differences Between Passive and Active Euthanasia

Abstract Euthanasia is one word that is part of a nationwide debate that is often wrought with resistance due to selective terms being used interchangeably to result in misunderstandings and mass confusion. These combinations of individual terms create for completely different meanings, meanings that have already been instilled into the minds of human society that contribute to misconceptions about euthanasia.

Euthanasia is defined as the intentional termination of life by another at the request of the person who is to receive their right to die, instead of dying naturally. There are many correlating synonyms of “eu” good and “thanatos” death: death with dignity, mercy killing, compassion in dying, and murder are some expressed by those who support as well as those against euthanasia.

One important objective that will be met is the clarification of all labels associated with euthanasia: voluntary, non-voluntary, involuntary, passive, active, and omission. It is through describing the differences between passive and active euthanasia that similarities will be unearthed while also including intent, refusal, and request.

Euthanasia has been linked to physician-assisted suicide (PAS), both of which are commonly debated due to being considered morally unethical. Advancements in medical technology are requiring alteration in traditional rules and fundamental concepts that will continue to promote the greatest life for the greatest amount of people possible. Legalization of voluntary active euthanasia requires weighing all possible consequences using the utilitarian hedonic calculus to best estimate as to whether this action will result in the highest level of pleasure.

DIFFERENCES BETWEEN PASSIVE AND ACTIVE EUTHANASIA Step 1: Identify the Problem The debate over euthanasia centers on the sanctity of human life and rights that are given to live that life. Supporters argue that the practice of euthanasia gives the means to die with dignity by receiving a good death. Those opposed to the idea of euthanasia support the passive form that is practiced daily as a means of ending life by withdrawing or withholding the use of life sustaining medical means such as ventilators, enteral nutrition, or allowing a patient to refuse medical treatment that will extend their time on earth.

Passive euthanasia, or “letting die”, occurs when there is an intent to hasten the death of a person and is considered acceptable for physicians to practice, patients to choose, and families to acquiesce (Life, 2011). Passive euthanasia delivers a painstakingly slow death due to omission of life sustaining means to a patient whereas active euthanasia via a lethal injection is fast and painless.

Active euthanasia is the intentional and direct form of “mercy killing” similar to physician-assisted suicide that ceases the life of an individual that had lived in fear, pain, and suffering. Supports believe that living in such means violates the quality of life. Jevon in 2009 identified additional factors that include whether an act is: 1. Voluntary: patient willingly, competently, and knowingly makes a request for euthanasia. 2. Non-voluntary: no request was made while the patient was capable and competent, or makes a request that is neither clear nor convincing. 3. Involuntary: a patient is euthanized in clear opposition to a request made when they were capable and competent.

A main component to note is that both intents equal end of life for the patients; passive and active euthanasia are similar in their consequences, but are achieved by different means. It can be argued that while passive euthanasia is the accepted form in society, it is crueler to the patient than active could ever be. This leads to believing active euthanasia should be more morally permissible as a means for an easy death, but cannot be due to the ethics of our social policies and practices. Physician-assisted suicide is akin to the active form due to a request made by a terminally ill and competent patient to be assisted in death, but unlike active euthanasia, it is the patient that takes their own life instead of the physician injecting the lethal dose.

The current problem is that voluntary active euthanasia has been legalized in the Netherlands and physician-assisted suicide has now entered the U.S. This is an issue of growing importance due to the increasing possibility of legalizing the voluntary active form within the United States borders. A study conducted by Frileux in 2003, provides statistics that the more repetitive requests to participants as they aged, the difference between euthanasia and PAS was decimated.

Should voluntary active euthanasia never become legal, there is a necessity for all age persons to obtain advanced directives, living wills, or assurance their family will know and uphold their wishes. Both means ensure correct measures are taken to uphold the patient’s rights and prevent the encouragement of physicians to have power over their life and death decisions. Step 2: Analyze the Context

Several contextual factors relevant to euthanasia include moral, ethical, legal, medical, political, and religious issues. Society places a negative point of view on active euthanasia is their moral definition of killing and their belief that it is morally worse than letting someone die (Rachels, 1975).

Should a physician let a patient die, it was still an “intentional termination of life of one human being by another”, be it for humane reasons or ending life preserving measures of apatient in a persistent vegetative state (PVS). It is the rule of action via murder or letting die and Rachels follows to say: “The important difference between active and passive euthanasia is that, in passive, the doctor does not do anything to bring about the patient’s death.

The doctor does nothing, and the patient dies of whatever ills already afflict him. In active, the doctor does something to bring about the patient’s death: he kills him. The doctor who gives the patient with cancer a lethal injection has himself caused his patient’s death; whereas if he merely ceases treatment, the cancer is the cause of death.” Economic factors and Healthcare Shortage

When considering the amount it costs for a patient in a PVS or coma that requires daily care and treatment may lead a person to insurmountable amounts of debt. In most countries, including the United States, there is a shortage of heath resources and health care providers as well as inadequate funding for palliative care and pain management. Access to speedy and cost effective methods is limited but what limited amount of resources we have are used for incurable or untreatable patients that may in fact prefer not to continue on (Ethics, 2012).

A sense of fear is created due to the cost of aid-in-dying being more affordable than seeking assistance to be treated; a fear that can turn to a fear of being a financial burden on loved ones (Life, 2011). Religious and Cultural Beliefs of Living and Dying

A large complication of religious factors is due to the intrinsic value of a life that is given by God with the view that any type of suicide or “cop out” may be deemed a sin. Such principles should not be acknowledged in order to dictate every person’s life (Duvnjak, 2012 ). Religions have emotions directly attached to a loved one or situation impairs an accurate means to evaluating such a concern.

Some coma patients are kept sustained in hopes of recovery, out of guilt, or selfishness of family that decides the patient’s wishes are wrong; others focus on letting the patient go in respect of their wishes. In Karen Quinlan’s case, a woman was in a coma with her breathing being maintained by the use of a respirator, her parents fought to “pull the plug” on the respirator. Joseph Quinlan, the father explains: “Let her pass through the hands of the Lord...if he wants her to live, he’ll create a miracle and she’ll live, if he wants her to die, she’ll die whenever he calls her.”

Fears expressed by those against active euthanasia is that doctors will pressure patients into accepting euthanasia as the means for death or will soon begin to play the role of God in deciding who lives and who dies; physicians have decided the fates of others since long ago. Problems occur due to the concern that physicians assist death but also interfere with Gods original plan; use of medical equipment that sustains or extends a person’s life. The American Medical Association expresses that a physician has obligations to preserve life and relieve suffering, but is not allowed to end that life no matter how much they are suffering. Legal and Medical issues

Physicians have to monitor their actions based on their own religion versus another’s and uphold the law. If doctors assist patients in active euthanasia they will face legal consequences as any further assist than a passive means is illegal. Physicians practice “judicious neglect” by deciding against reviving terminal patients experiencing a heart attack as it is unreasonable to save a person so that they can live in agony for a few more weeks (British Med., 2007). A key factor that begins most cases is that once any kind of extraordinary measure is implemented (medical treatment or life assisting measure), “pulling the plug” becomes the same as euthanasia.

Physicians have sworn by Hippocratic Oath that they are to protect life and not end it; means to enable physicians to follow this oath are through specifications and reclassification. Life support may be withdrawn so long as the patient is considered brain dead; enteral feeding can be discontinued as it is considered a medical treatment (Life, 2011;

Braddock, 1999). Within the government, keeping church and state separate as wells as personal emotions and judgments allows for rulings that aim for what is right and moral by law. With utmost care judges make rulings by not only interpreting the law, but making it; any misconstruction leads to action being taken for similar situations. Capital punishment was abolished due to the judgment that it endorses euthanasia contributing to uneasy feelings in the public as the state easily had the power to kill any member of society. The Slippery Slope Argument

Addressing legalization of voluntary active euthanasia is an issue met with reluctance for fear if found an acceptable means now it may later cumulate to slide into an unacceptable situation through a chain of events; practicing passive which shifts to practicing active which leads to involuntary or non-voluntary active euthanasia being practiced. This results in ending lives without requests or consent (Guido, 2009). Although these fears are important to address, it must be express that euthanasia cases are not murder cases; there is no unexpected, tragic end to a person’s life and all they may have ascertained to in the future.

Euthanasia cases involve already dying persons that ends their life as a life filled with suffering to them is not a valuable future (Volbrecht, 2002). These standards involve modifying of our concept of unjustified killing of innocent persons and understanding death is not always a “bad” thing; once accomplished people can consider that death at times a good thing. Step 3: Explore the Options

There are three viable options that can be considered in regards to this issue. First, the states can legalize voluntary active euthanasia to enable patients and physicians to work in a combined effort to secure the best options for their situation under the protection of the laws specific guidelines.

Second, passing a law that requires all persons that are United States citizens and eighteen plus years of age are to acquire documentation (advanced directive, living will) of their wants and wishes that are to be followed by anyone (physician, health provider, or family) in situations that they are unable to voice their wants. Lastly, legalizing physician-assisted suicide statewide is a viable option as it has already been approved and practiced in Oregon; since the Death With Dignity Act has passed 341 patients have died under terms of the law. Step 4: Apply Rule Ethics Decision Process:

The utilitarian theory is concerned with the principle of utility and what rules of action will are right in proportion to their tendency to promote the greatest good for the greatest number of persons affected by these rules. John Mill breaks down utilitarian theory to involve the intensity of pleasure or happiness derived by the action and its consequences. The action that maximizes utility is the action that will produce the most good (or least bad). Consequences are measured based on their intensity, duration, immediacy, fecundity, likelihood; then are followed by the extent and purity the action will produce. Accurately State the Rule to Be Evaluated

The rule to be evaluated in respect to this issue consists of the states legalizing voluntary active euthanasia to enable patient-physician relationships that are focused on securing the best care that pertains to their situation with the guidelines that provide protection to both beings. Identify All Those Who Are Directly and Indirectly Affected by the Rule

Those directly affected by this rule are the patient requesting the action and the physician receiving the request. Many people are indirectly affected by this rule; most significant is the family, health care, and society as a whole: any patients using life sustaining measures without previous arrangement for a will prior to their situation and family members of these patients. There really is not one person that will not be affected by this rule. People should expect insurers to change insurance plans in accordance to the ruling, affecting anyone paying for healthcare. Specify Consequences of the Rule and Their Likelihood of Occurring

Positive Consequences. A positive consequence of the rule includes preventing unnecessary elongation of patient suffering without pain control via use of narcotics that lead to unconsciousness or incoherence. Another is that patients will receive quick, painless, and merciful deaths; both these consequences have a hundred percent likelihood of occurring.

An increased in personal autonomy for the competent patient as sick and suffering individuals have freedom of choice and a sense of control over when their life will end and how it will end which is significantly important to those suffering diseases that end in a fairly traumatic sense; Diane Petty was to experience death when the muscles that enabled her to breathe would weaken until she would experience respiratory failure (Life, 2011).

Lastly, a significant and likely consequence will be the just increase in resource allocation, cost efficiency, and increase life expectancy. Focus is placed on persons with curable diseases, preventative medicines, and a better quality to life to those who may achieve more benefit. Autonomy, freedom of choice, beneficence, justice, and self-determination are all allowance of this rule.

Negative Consequences. The most significant and likely negative consequence is the potential for abuse, be it doctors on power trips or family members who assist in care and are responsible for the financial burden the ill person accrues. Due to an estimated sixty percent likelihood for abuse, this rule has significant damage potential. Second, a terminally ill diagnosis is made by a doctor who proceeds with euthanasia to later find it was a curable condition. Another consequence would be a suffering, terminally ill person who is euthanized, but a cure for that illness is brought into creation soon after.

These consequences would bring turmoil about wrongful deaths leading to distrust of the medical profession which would be a very serious situation. Yet, specifications and restrictions would be mandated in the law to protect from these instances. Waiting until a suffering, diseased individual is near the final stage that any new cure made (this would be very unlikely to change the course of the disease) and ensuring that person is correctly diagnosed before ending their life. Consider Whether There Is a Dominant Consideration

The dominant consideration that would occur based on a utilitarian perspective is that the suffering patient achieves being free from pain, in a manner of their choosing by respecting their autonomy and self-determination and beneficence occurred as the physician had done what the patient requested that most beneficial to them. This decision would bring the greatest amount of happiness to the greater amount of those directly (and increasing resources indirectly) affected. Summary of Consequences (Total Good and Bad Results)

It is clear that the positive consequences of allowing patients to maintain their right, whether to live or to die, and the promotion for the future health of society with more cost effective means outweighs the negative results of the rule. The rule is aimed specifically toward the patient but directly affects the society and in turn the nation while the negative consequences are more so possibilities that could have occurred without the proper safeguards in place. Alternative Rules

An alternative rule would be to pass a law requiring all United States eighteen plus years of age to acquire documentation (advanced directive, living will) of their wants and wishes that are to be followed by anyone in charge of their care in a situation where they are unable to voice their wishes. This would also be mandated in the event that voluntary euthanasia was legalized. Another would be to legalize physician-assisted suicide in the states, but this would not be the most plausible option. Results of the Alternative Rules

In any of the situations, it would be mandatory that any type of advanced directive be acquired, therefore eliminating the possibility of being euthanized or extraordinary measures are implemented against ones wishes. As stated previously, physician-assisted suicide is not plausible as the need for euthanasia is presented because of the disease processes effect on the body to a point where individuals are not able to end their life by themselves. Step 5: Implement the Plan and Evaluate the Results

Many important issues are associated with euthanasia that evoke strong responses from those who have experienced the death of a loved one that did not necessarily have the easiest or happiest of deaths. Euthanasia makes people reevaluate their beliefs and concerns should they ever be put in such a situation. This paper evaluated the ethical values and that if legalized, would enable health care professionals to free those that are suffering maintain their dignity and independence. Patients maintain the right to make competent decisions about their life as their being and best interests are placed at the center of all decisions.

This rule stresses the importance of informed consent to a patient that meets all requirements set as safeguards against abuse before allowing voluntary active euthanasia to be performed and that laws provide that all cases brought to attention are treated individually and without bias to promote desired values to enhance community utility.

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