When is euthanasia acceptable? Where do we draw the line ethically?
I recall recently seeing an article posted that was related to euthanasia, and I started thinking about the subject. I see both potential pros and potential cons associated with it. For example, there's the concern about family members or authority pressuring an ill person to opt for doctor-assisted suicide to ease financial burdens, for instance. There's also the benefit, on the other hand, of allowing someone who is terminally ill or guaranteed to live the rest of their life in excruciating pain the option to go out on their own terms. With proper oversight and ethical considerations, it generally seems to be an all-around ideal to provide an "opt-out" for those who would only continue to suffer and would rather not prolong it, as a merciful alternative to forcing them to live it out.
But then there are some trickier questions.
As a disclaimer, I spent nearly a couple of decades struggling through depression and have been surrounded (and still am surrounded) by people who struggle with their own mental illnesses. Because of this, I'm perfectly aware of the stigma and subpar treatment of mental illness in general. With that in mind, I completely recognize that there are certain conditions which are, at this time, completely untreatable and result in peoples' quality of life deteriorating to the point that they become perpetually miserable, particularly with certain neurodegenerative diseases.
Thus, the question occurred to me: wouldn't such a condition be the mental health equivalent of a terminal illness? Would it not be unethical to force someone to continue living under conditions in which their quality of life will only diminish? Shouldn't someone who has such a condition, and is either of sound enough mind or with a written statement of their wishes from a time when they were of sound enough mind, be able to make the same decision about whether or not to opt to go out on their own terms?
And yet, as reasonable as it sounds, for some reason the thought of it feels wrong.
Is there something fundamentally more wrong about euthanasia for mental health vs. euthanasia for physical health? Is it just a culturally-learned ideal?
More importantly, what makes euthanasia acceptable in some cases and not others? Which cases do you think exemplify the divide? Is there something more fundamental that we can latch onto? Is there a clear line we can draw? Is psychology itself just too young a field for us to be drawing that ethical line?
I'm genuinely not sure how to feel about this subject. I would be interested in hearing some other thoughts on the subject. The questions above don't necessarily have to be answered, but I thought they could be good priming points.
Just checking, but are you aware that euthanasia has already happened for people with long term psychological distress? Here's one example, but there are others: https://www.bbc.co.uk/news/stories-45117163
If someone has the capacity to make a decision they have the capacity to make an unwise decision. Obviously working this out is tricky if they have a mental illness that affects their ability to make choices about engaging in therapy or staying alive, but it's not impossible.
It's after 1am here, so I'm having a hard time continuing to concentrate, but I briefly glanced over the article and it seems like it'll be an interesting and relevant read. Thanks!
Look up Dignitas in Switzerland, they will kill you provided you meet their criteria. Don't know a lot about how they decide but it seems close to what what you described. And honestly if someone is so determined to die why should they not have the choice?
That's an excellent question. You could summarize my entire post by boiling it down to this. Why shouldn't they have the choice? What are the ethical implications of giving them that choice? When is that choice acceptable? I don't have the answers to these questions. That's why I'm curious about what others think.
Well I think they should I don't think that's too crazy - but deciding if they are in a position where such a desicion is truly theirs and not influenced by others around them or any mental health conditions they might have is difficult. How you would even go about testing for that I don't know.
Can you imagine being the person that gives the interviews at a place like Dignitas? I wonder if you would need a psychopath or someone with extreme compassion to cope with a job like that.
The issue as I see it is that it's just a huge messy conflict of interest in too many cases. Let's say person A is terminal and penniless but has a wealthy family. Let's say person B has vast riches, but a family deep in debt. On one hand, we would like to give both individuals the same framework by which to end their lives, but at the same time, are we really comfortable letting person B's family participate in that process? It also has the same problem as "right to try" laws in that it notionally creates a profit incentive for companies who will inevitably pop up to administer such procedures. How do we prevent a palliative care facility from implementing policies intended to "turn over beds" like some kind of shitty casual dining restaurant?
I just see no easy way around this issue when there are obvious conflicts involved. You'd have to do something like mandate that all assets of the deceased are placed in a trust for some period of time, but then we end up with the State controlling a bunch of these estates, which is a whole different can of worms. And that still doesn't completely address the conflicts involved. It just creates another step for vultures, who know their legal battle starts when their relative dies.
How is there a conflict? You talk as if person A's and person B's families have a say in whether those persons die or not. They don't. They absolutely do not. The only people who have a say in whether person A and person B die are person A and person B themselves. It's their bodies, it's their lives, it's their choice.
Of course, noone should pressure anyone to kill themself or to die. That's wrong. But if a person decides to die of their own free will, there is no conflict of interest involved.
The scenario I am imagining is a person who is of questionable mental capacity. Obviously there is less of a controversy if the person is mentally fit, but I foresee a lot of these cases playing out with people in various stages of dementia.
Get an independent expert to assess the person who's asking for euthanasia. Absolutely do not involve family members in this discussion.
That said, when my mother becomes non compos mentis, if she hasn't left a living will, I'm going to have to try to convince people that she's been telling me since I was a teenager that she wants someone to "pull the plug" when she's past it. I hope she has left a living will. It'll take that burden off me. Because, noone really knows that I'm telling the truth about our private conversations that only she and I were present for.
But, if they don't take my word for it, I'll understand. Hopefully, when the time comes, she'll be able to convince them of her wishes herself.
This is absolutely a conversation that you should have with her before she becomes, "non compos mentis". It's not morbid to talk about making sure your wishes are followed as your health declines, as it does for everyone, ever.
My mother and I barely speak. I have moved past hating her over the course of the past decade or so, but I certainly don't go out of my way to engage with her.
I'm just aware that, as the eldest child of this divorced elderly woman, I'm likely to be dragged in as her next-of-kin when the time comes. Even though she and my father are still in regular contact and are friends and he helps her out, he has no legal relationship with her since they divorced some years ago. It's going to be me.
Ahh, I see. Well, if you do get dragged in as the next of kin, without a POA or Living Will, your wishes will be hers. I hope it's as peaceful a process for you as such things can be.
My opinion about this is very simple (possibly too simple): anyone who wants to die for any reason has the right to kill themself. That's it. Suicide is not a crime.
We can put safety conditions in place for people who are unable to perfom the act themselves and have to ask others to help them. They have to sign (or otherwise authorise) a document saying they want to die. An independent witness has to confirm the person is of sound mind and not under any duress.
Maybe if they're suffering from depression without any terminal illness present, they have to talk to a psychiatrist a few times - if only so that the psych can convince them to take care of any loved ones they might be leaving behind.
But, ultimately, people are entitled to full autonomy over their body, including how and when they will die.
Essentially how I feel.
I touched on this previously, but in short and at the end of the day: I think it's unethical to force someone to continue living, at all. Our participation in creation is voluntary; we ought to have the right to close that book at any time, for any reason.
We can ethically try to convince somebody to stay—whether that takes the form of a discussion, therapy, or medical help—but one loses all ethical standing the moment they use tactics like emotional blackmail or physical restraint.
Autonomy is ultimate.
At one point in my life I would've killed myself if I could. Now I am enjoying my life much more, and would have regretted that decision. My worry is that plenty like me won't have a chance for life to get better if suicide is completely accessible.
I've been there, I get it.
I'm sure there are plenty of people who have taken their lives, who may regret their decision if they were able to be asked. However, I don't believe that potential for regret, and the potential for a chance of something getting better, is enough to remove ones sovereignty over themselves.
@Emerald_Knight, it sounds like we have some backstory in common. As I stated elsewhere, I find the resort to euthanasia for depression particularly problematic for two reasons.
First, depression arises from a feedback loop. Thoughts and experiences remodel brain architecture and biochemistry, changing perception (e.g. pain sensitivity), leading to more similar thoughts and experiences. There are underlying biochemical predispositions and disease events (infection, inflammation, prolonged pain) which may make it more likely for the loop to get reinforced, but depression is partly learning disorder and partly physiological disease. Treatment failures usually arise from failing to address the condition on both fronts.
The most treacherous learned frames in depressed mood are prevalence (everything is bad) and permanence (it's always going to be like this). The mere availability of legal euthanasia may validate and reinforce a depressed person's perception that it's never going to get better, even when this may be an untrue and transient cognitive distortion.
Second, depression is in many ways a selfish disease. I say this not as a moral judgment, but as a description of the inward-turned energies and dulled perceptions of others' pain, their empathetic suffering. Among the most difficult recovery tasks are mending all the neglected relationships and rebuilding the habits of self-care. As the basis of ethics, however much depressives try to self-isolate and reduce opportunities for both experiencing and causing pain, we remain tied to other lives. The choice of suicide is an irreparable wounding, a breach of the social trust and care that others invest us with. One suicide may trigger a cascade of others through sheer sympathy and demoralization. However painful it is to go on, however much we feel like our mere existence is a burden to others, there is an ethical duty to persist, even when it seems impossible.
I would like to clarify that depression wasn't the intent of my focus here, and I only mentioned my background to help clarify that I'm accustomed to mental illness and am not subtly advocating for allowing depressed people to commit suicide.
With that in mind, I appreciate your thoughtful reply on the subject of depression itself. It's definitely one of the more contentious subjects with regards to the topic at hand, and euthanasia as a concept itself does have some serious ethical implications, one of them being what you noted about reinforcing the perception of things never getting better, that the only way out is to opt out.
Thanks for the thread, though. For very strange reasons (the infamous Dr. Kevorkian was actually an acquaintance of my mother's, and they kept up a correspondence), the ethics of euthanasia were dinnertime conversation.
In the U.S., at least, the terminology is usually "assisted suicide", rather than "euthanasia", a term which has some nasty Holocaust-era history. Any medical assistance in voluntary death remains fully illegal here.
An interesting culture has arisen around hospice. American medical ethics and accepted practice in end-of-life care dictate that pain relief may be given even if the drugs compromise life expectancy. We have assisted death for terminal physical illness, in fact if not in name.
There are no objective medical exams to gauge the severity of mental illness (at least not like the ones we have for cancer, diabetes etc), making it very hard to determine the prognosis of depression. You could be euthanizing someone who was on the verge of improvement.
I'm a religious man, and in my view euthanasia is a crime against God (and, because Tildes doesn't have downvotes, I can openly state that. Isn't that great?). At the same time, I respect the right of all the people that don't think like me to make whatever medically justified decisions they deem appropriate regarding this subject. Because you know what? My religion, just like any religion, should not dictate public policy. And I'm fine with that.
You have the right to your beliefs, and I appreciate that you're gracious in allowing other people theirs.
I watched my father suffer horribly for two weeks, completely paralyzed from stroke except for excruciating muscle spasms, fully conscious, reduced to communicating with blinks, twitches, and groans, because a Catholic hospital refused to honor a clear living will and DNR.
He would have lingered in that state indefinitely if the doctors hadn't also followed the hospice guidelines on pain relief regardless of concern for health; he passed in a haze of gradually escalating morphine doses.
Again, I have nothing against your belief, but I'd ask that your co-religionists respect mine, and stop hijacking the ethics of medicine in service to their versions of faith.
I sympathize with your suffering. I fully understand the reasoning behind your decision, and I draw no judgment whatsoever. This is not just an empty discussion about abstract entities, we're talking about love here. And I respect that! You did what you did out of love. And you know what? Maybe my belief is wrong. I think that is a possibility, and I think every person that doesn't question its own beliefs is a fool.
When I say that I'm a religious man in venues like this one, most people (I'm assuming your north-American because most people on this kind of website is, sorry if I'm wrong) associate me with the common religious of their country, which are deeply intertwined with politics. This is not my case. Even in my country, there are movements trying to bend public policy to their private beliefs, but I'm not a part of those movements. I'm a christian, but a very particular kind of christian that is not very common in North-America. I won't try to describe it, because I'm sure it's gonna sound like some new-age thing. So I'll summarize for you:
(and spirits exist)
Yes, you're correct that I'm North American; there are many places here where religion is a fraught topic.
And there is plenty of contention about healthcare ethics in hospitals run by religious institutions, as well as other legal interventions by the overzealous. There's also more than a few liberal Christian denominationists here, though they don't get much press since they're generally out doing nicer things than meddling in how other people live, love or perish. Thank you for being one of the kind folk.
You're welcome, my friend! Greetings from Brazil!
"It's my funeral and I'll die if I want to..."
I think that voluntary euthanasia and suicide are always acceptable. Nobody asks to be born. Instead, we are thrown into existence without any consideration for our wishes. Since we have no choice about having been born, we should have a completely free choice about when and how we die, whether we choose to let nature take its course or end our lives as soon as we feel that life is no longer worth living.
What about parents? Do they not have an ethical obligation to a recently born child?
They already failed that child miserably by not using effective birth control.
Yes, they do have an ethical obligation to their child. But would they be fulfilling that ethical obligation if they raised that child in a home full of misery, depression, and resentment (for having to be alive when they don't want to be)? What if they gave the child up for adoption by a family that will love and welcome the child before killing themselves?
I think you may be onto something. It's not necessarily that it's a choice that the patient articulates, however, but that death is the result of their choice alone. For example, it doesn't "feel wrong" when someone with a terminal illness elects to die on their own terms because with or without their decision they're going to die soon anyway, but if it's a choice between a lifetime of pain and death to end it, it automatically feels more "wrong" somehow.
It's basically the difference between a perceived "merciful death" and a perceived "suicide", a subtle difference but an important one to consider.
Even in cases of mental health, if it's a neurodegenerative case like Alzheimer's it seems far more "acceptable" than when someone has depression or some extreme form of psychosis because in the case of Alzheimer's there's a clear understanding that the person is untreatable and is guaranteed to completely waste away.
It's probably not a perfect metric, but the inevitability of wasting away seems like a good starting place for understanding the psychology behind the perceived ethical boundary.
Here's another interesting case: two deaf twins who had lived together for a long time, found out they were going to go blind, and chose to opt for euthanasia
I think it's difficult, like you say. There's clear cases (dying a horrifically slow & painful death and choosing not to), there's murkier cases (mental illnesses, people not dying but still having a pretty terrible disease) and there's cases that are even murkier (there's a big debate in the netherlands about proposed "fulfilled life" cases, where someone can just say "i've done what I wanted to, and it's been good, but I won't get anything more out of life")
That last debate is a touuuuugh one to have, in my experience. Curious to see what you think about it.
I believe doctor-assisted suicide should be legal when the person chooses so and is terminally ill. Deseases of the mind like depression, borderline disorder et cetera. are more difficult to classify, as we have remedies against those, but they don't often work. If someone with such an illness has tried out every other possible remedy and they haven't found respite, then in my opinion, they should be allowed to choose suicide.
And if you're too physically incapacitated for that walk you'll exist in the prison of your body until the miracles of modern medicine fail. Depending on your current age this could subjectively be a maddeningly long time.
Is it weird that I think it would be a good idea to cryogenically freeze people like this with a terminal disease? At least then it gives them the slight chance to be revived in the future with a cure. I don't know. Euthanasia seems very extreme in my opinion
I work in aged care and am all for euthanasia / assisted suicide, whatching someone waste away to a shell of who they used to be is not fair in any shape of the word.
While studying we spent a decent amount of time on this and watched a two very moving documentaries, one was a Four corners episode (Australian news show) I wasn't able to find the episode itself but have the link to the episode run down http://www.abc.net.au/4corners/a-good-death/8952900
A few years back I also read an absolutely amazing article about a guy who helped 8 people with their assisted suicide. (https://torontolife.com/city/life/john-hofsess-assisted-suicide/)
Here in Australia we recently made the first steps towards euthanasia (November 2017) our parliament sat for 24 hours debating whether each state or territory could pass their own legislation.
Victoria (the state I live in) made it legal, but it will not come into effect until mid 2019. I was finishing my diploma when all this was happening and every class we had no matter what it was, this was all the talk having things finally move forward is such a huge and amazing step forward.
sorry I went off on a rant. if anyone with a long term illness, be it mental health or a degenerative disease and their quality of life will be next to nothing and they have met the conditions set in place ( I believe it's 3 different doctor's among other things. this might change country to country) then why can't they do what they feel must be done and go out with dignity.
Something that gets said between staff often is 'we don't let our pets suffer, yet a human doesn't have the same right'
again sorry for the rant at the start and I fail at hyperlinks