The debate on euthanasia and assisted suicide: moral contentions and legal implications

Article by Anna Wallace

Whilst there is an extensive existing body of literature regarding the moral, medical, and legal ethics of the practises of Euthanasia and assisted Suicide, this article will draw on philosophical claims to summarize some of the most prominent arguments.

Defining the terms:

Although there is little ethical distinction between assisted suicide and euthanasia, they are characteristically different and therefore require an understanding of their unique definitions:

Assisted suicide is the act of deliberately assisting another person with the necessary environment and means for that person to carry out their own suicide (thus the act is committed individually and not by a third party).  This assistance requires a clear and free request from the applicant without any defects.

Voluntary euthanasia is when an individual has the mental and physical capacity to seek help to die and asks for it.

Non voluntary euthanasia is when the individual no longer has the mental and physical capacity to seek help to die and it is not known what their will would have been.

A number of authors consider the terms ‘passive’ and ‘active’ forms of euthanasia to be unhelpful and misleading. But they are used in literature so do need to be discussed:

Active euthanasia takes place when deliberate steps are taken to end a patient’s life and Passive euthanasia is the withholding of treatments necessary for the continuance of life.

Limitation of treatment (LOT) is defined as: the withdrawal or non-implementation of a life support measure or any other intervention which, given the poor prognosis of the person in terms of future quantity and quality of life, constitutes, in the opinion of the healthcare providers involved, something futile, which merely contributes to prolonging a clinical situation that lacks reasonable expectations for improvement.

New legislation allowing assisted suicide in Austria:

In December of 2021 the Austrian parliament approved the new law allowing assisted suicide following a constitutional court order ruling on the issue.

Under its conditions, adults who are terminally ill or have a permanent, debilitating condition can opt to make provisions for an assisted death. The practise will be tightly regulated with each case being thoroughly assessed by two doctors, one of whom is required to be a palliative medicine expert. After gaining approval from two doctors, patients must wait 12 weeks to reflect on their decisions, or 2 weeks if they have a terminal illness, and then if they still wish to continue they can get the lethal drugs that are required, from a local pharmacy, after giving notification to a lawyer or notary.

Previously, under Austrian law, anyone who induced or helped someone to commit suicide faced up to 5 years in prison. However, an absolute ban on assisted dying was lifted by the federal court in 2020 which ruled that it ‘violated the right of self-determination’. This is reflective of libertarian ideas about the right to individual autonomy (an idea we will return to). Whilst Austria’s governing conservative Austrian People’s Party (ÖVP) partnered Greens supported the law un the National Council, along with the Social Democrats and the Liberal Neos Party, disagreement came from the far-right Freedom Party of Austria (FPÖ).

Ethical Debates:

Morality is defined as “performing an act that one believes to be right and beneficial to others, as opposed to wrong and harmful to individuals and society”.

The Libertarian argument about the right to self-determination:

 The libertarian argument is based upon the premise that in order to respect individual autonomy we need to respect autonomous decisions of people to die. Morality presupposes a respect for a person’s autonomy, which requires that they are allowed to act on the basis of their own desire.

However, this argument is steeped in contestation on the grounds that it is a reversal of primary medical ethics enshrined within the ‘Hippocratic Oath’: ‘do no harm’ or ‘non maleficence’. A key debate is thus whether respecting a patient’s autonomy should have priority over beneficence; whether respecting individuals’ autonomy should be prioritised against protecting them from the consequences of their own choice.

A Kantian perspective on the inherent value of life:

 This moral philosophy is based upon Kantian ideas about the inherent value of life as an end in itself rather than being used as a means of an end for fulfilment. This suggestion being that however reduced our condition, life is still deserving, hence why we all have equal human rights. This notion of inherent value is driven by claims that we are not only valuable through the means in which we contribute to the world, through work and the creation of capital etc, but rather there is dignity in human life itself.

Utilitarian claims:

Utility arguments directly respond to Kantian arguments as they suggest that ‘decisions’ should be based upon ideas around utility of outcome. Given that the annual NHS costs or cancer services are £5 billion, and the cost to society as a whole – including costs for loss of productivity – is £18.3 billion, a utilitarian would argue that a cancer patient wanting to undergo euthanasia should be allowed to ‘let die’, as this will be alleviate society from the economic incumbrances of their ongoing treatments.

Medical Implications:

Many gravely fear that the legalisation of euthanasia and assisted suicide may lead to disinvestment in healthcare working towards ‘Right to Life’. It also may discourage doctors working with seriously ill patients to promote the ethos of hope.

However, philosopher Peter Singer counters these fears by raising attention to the fact that, for example, only 3% of deaths in Netherlands are using euphanasia-97% of deaths not using euthanasia- so therefore medical progress will not be impaired. Others point out that medical advancements have extended human life well beyond limits that were ever supposed to be conceived, thus, the right to euthanasia amongst the elderly is not drastically ‘life shortening’.

Legal Implications:

Whilst the first purpose if law is to protect the innocent and vulnerable, thus protection from killing seemingly being the cornerstone of law, debates around euthanasia and assisted suicide have reconceptualised this notion of ‘protection’.

In the context of Europe; varying levels of euthanasia laws are extreme: Since 2001 euthanasia has been legal within the Netherlands, Belgium similarly followed suit and legalised the practise in 2002… whilst both euthanasia and assisted suicide are strictly illegal in the UK and in France whereby its practise is considered an act of premediated murder or poisoning ( see here for complete list euthanasia laws within Europe). Within France, despite the renewed euthanasia debate in France in the wake of  Rémy Salvat, 24 and Chantal Sébire, 52 appealing for the right to be ‘let to die’ under French law, the practise remains illegal.

Strident laws are often justified by arguments over ‘slippery slope’ theory. Studies have shown that the causes of death in the Dutch population reveal more than 400 citizens who have lost their lives to euthanasia without giving their consent.

In Belgium, despite euthanasia laws being legalised for adults only in 2001, by 2012 it was extended for children.

In the Netherlands, since the 2001 Act was passed, the annual number of reported deaths from euthanasia or assisted suicide has risen from 1882 (2002) to 6091 (2016).

This evidence reflects the very real ‘bracket creep’ that reflects the use of euthanasia as an instrument for an easier, cheaper and faster solution to death when faced with an illness. However, the extension of such laws to children have gathered considerable disagreement and suggest a possibly too liberal approach to euthanasia laws that undermine our trust in palliative care which should aim to install a sense of hope and sense of belonging into those who are faced with illness.

At the European level, the European Court of Human Rights has always been reticent about the debate on euthanasia, Considering Article 2 of the European Convention on Human Rights, explicitly indicating the right to live, the legalisation of the ‘right to a death’ has had difficulty being approved by many courts.

Therefore, despite ethical claims to the legalisation of euthanasia and assisted suicide, the recognition of the inherent right to life as a fundamental value of the legal system has generated a host of legal impracticalities that has hindered the implementation of many euthanasia laws.