The Right to Die: Euthanasia and Suicide
Suicide in its many forms is a divisive topic to say the least. The concept of life and death are the foundation on which we build our lives, develop our world views and perceive, or at least attempt to perceive good and evil. Therefore, the right to die has become central to the debate which surrounds the place of humans in this world. Prompted by a suggestion from a close friend regarding Physician Assisted Suicide, I embarked on a journey to try and comprehend how life and death are legislated and philosophised throughout the world. In the end it has brought me to attempt to lay out humanities interaction with death, our perception of it and what justifications there are for the intrinsic value of human life.
Euthanasia is the easier concept to talk about. It is largely documented, mostly backed by some sort of justification usually under the recommendations of physicians. Euthanasia has slowly seen acceptance under different terminologies. For example, Physician Assisted Suicide is a name attributed to Euthanasia, under this name it is legalised in nations such as the Netherlands, Belgium, Canada and in certain states in the US.
Euthanasia is generally split into four classifications:
Voluntary: Voluntary Euthanasia is perhaps the most acceptable form of Euthanasia, being termed as Physician Assisted Suicide in some nations. Legalised in both its active and passive form in many nations this form of euthanasia is backed by the consent of the patient or their family.
Non-Voluntary: Non-Voluntary Euthanasia is exercised in cases wherein the person is unable to give their consent to euthanasia (for example in the case of children). This form of Euthanasia faces severe opposition, many citing this as the outcome of a slippery slope in regards to euthanasia. This form of Euthanasia (specifically for children) is permitted in only one nation, the Netherlands. There a controversial medical protocol known as the Groningen Protocol provides some protection to physicians to euthanise children below the age of 12 under the express condition of the parents.
Involuntary: Involuntary Euthanasia is the poster boy for anti-euthanasia groups, followed most infamously by the Nazi Regime in Germany on people considered too ill, mentally unsound. The research used on the euthanasia of these people was put to work in the Final Solution concentration camps as the killing and disposal of undesirables was mechanised. This form of euthanasia has contributed to the overall negative public image of euthanasia in general and has also gained the proponents of euthanasia comparisons to Nazis.
Active and Passive: The above types of euthanasia are further divided by whether the process of euthanasia was active or passive. Active euthanasia refers to the practice of administering lethal substances. There is a slight controversy as to what constitutes active or passive (example toxic doses of painkillers). Passive euthanasia is simply withholding treatment. In this case active euthanasia is more controversial, often equated to homicide, or abetment to suicide.
These four classifications of euthanasia however are just technical terms. The more important factor is the history of Euthanasia and the justifications behind it.
History of Euthanasia:
The concept of euthanasia is ancient, as ancient as the concept of death itself. The term euthanasia however first originated in the works of English philosopher Francis Bacon. He termed it as Euthanasia Medica and claimed that it was the physician’s duty to prepare the patient for death both emotionally (Euthanasia Interior) and physically by dulling the senses (Euthanasia Exterior). However, at this stage the term wasn’t used in its modern sense. Francis Bacon had meant that when death is inevitable a physician must comfort the patient and attempt to make the end as painless as possible.
The modern definition comes from German philosopher Karl Friedrich Heinrich Marx who argued in his works for the alleviation of death by physicians. At the time his ideas were heavily contested by both philosophers and theologians. In Christian thought, especially of the highly dogmatic form which was heavily rooted in Europe at the time, suicide and assisted suicide were considered sins equivalent to murder.
The theological backing came from the “thou shalt not kill” commandment as well as certain bible passages which associate the act with wicked individuals. However, it is to be noted that there is no explicit condemnation of suicide in the Bible, this will be discussed further. Philosophically, the idea was attacked for it was thought to be contradictory to the human instinct for survival. Regardless the concept was and still is extremely divisive. In the Renaissance, as the philosophy of individual rights was developed and accepted the voices for euthanasia increased dramatically.
The question was again hotly contested in the aftermath of a speech delivered by school teacher Samuel Williams in 1870. Thereafter many famous philosophers began to debate the idea but the concept remained mostly limited to the discussions of philosophers with physicians not taking a side. The use of Chloroform and Morphine were recommended to hasten the process of death. Annie Besant, famous in India for her support for the Indian Home Rule movement also argued in favour of euthanasia.
The establishment of pro-euthanasia groups in the UK and the US hastened the process of legalisation as legislative bodies debated on the issue. However, as the 20th century progressed we entered into the darkest period for euthanasia. In Nazi Germany, under the codename Action T4 and the justification of eugenics, racial cleansing and overall purity of genes the regime began a systematic massacre that targeted homosexuals, the mentally ill, children with developmental defects etc.
The number of victims varies wildly from 70,000 to 300,000 depending on the records cited. There is speculation that the number is even higher. This project would lay the groundwork for the holocaust with many of its architects being involved here as well. This has left a permanent stain on euthanasia as process with many opposition voices terming it to be eugenics in action regardless of context. Since then the acceptance and legalisation of euthanasia has been haunted by this event.
The history of euthanasia covered we can now go forward to the arguments for it and against it. In this section I’ll be looking at three main groups and their opposition/support for euthanasia.
The philosophical community has argued both for and against euthanasia with many of their arguments being similar to if not an extension of their arguments for and against suicide. Kant believed in the idea of humanity being of inherent value and that self-preservation was the ultimate goal of any rational with his arguments appearing to be very similar to those of Thomas Aquinas a theologian and philosopher.
More recently Jordan Peterson has referenced his opposition to euthanasia as well as anti-natalism. On the other hand, the late Stephen Hawking had long held that the right to die had to be given to individuals.
Physicians themselves are divided as to the validity of euthanasia and physician assisted suicide with surveys conducted by the Royal College of Physicians in the UK showing that the majority of physicians polled did not support the extension of euthanasia laws. Another issue was the perceived psychological pressure that extensive incidents of physician assisted deaths would have on doctors themselves. The Future Health Journal article stated that “Some physicians feel that death is synonymous with failure”. There were also concerns regarding the validity of the idea of passive euthanasia. The European Association of Palliative Care termed that Passive Euthanasia was a contradiction in itself and called for greater dialogue for issues like physician assisted suicide.
Multiple studies have taken place to gauge the reception of physician assisted suicide and euthanasia by the patients themselves. According to certain reports a majority (60 percent) of patients supported the creation of euthanasia laws. Moreover, another report pinpointed that control of manner and time of death played a central role in the request of euthanasia. Even hospice care, which has been previously cited to lessen the probability of patients and their families requesting euthanasia failed to convince a sizable minority of patients. This proves that those under circumstances of chronic pain, the possibility of a slow and gruelling death and extended periods of emotional and psychological distress would prefer to be able to control their deaths.
The debate around euthanasia in terms of governmental and political implications seems to once again boil down to an argument between individual liberty and a slippery slope. Governments and politicians have cited the case of the Netherlands which has seen a gradual extension of euthanasia rights all the way to granting euthanasia to those above the age of 70 who were “tired of living”. A lot of the hesitation regarding legalisation of euthanasia comes from the treatment of the mentally ill. The Resistance Charter of 2010 for example said the following:
Disabled and terminally ill people fear that calls to legalise assisted suicide and euthanasia are likely to intensify. Our concerns are heightened by the current economic climate and calls from politicians from all parties for cuts in public services.
"We, and our families, rely upon such services to live with dignity.... We face a bleak situation as calls for assisted suicide to be lawful are renewed, whilst vital services are being withdrawn or denied."
Thus, fears for the safety and level of care afforded to these patients has blockaded the extension of euthanasia rights. This and a level of discomfort afforded to the idea due to its association with the Nazi regime has made politicians skittish around the topic.
Suicide is perhaps even more controversial than euthanasia mostly due to its association with irrationality, emotional distress and the flights and fancies of the youth. The cultural perception of suicide has many times been related to ideas of failed romance (Romeo and Juliet) and lost glory (Arjun during the Mahabharat). As the age of information has advanced newer reasons have been associated with suicide ranging from social media woes to obscure ritualistic and occult games.
History of Suicide:
In the Greek Antiquity suicide was a divisive practice. Philosophers like Aristotle thought it to be a shameful practice yet Socrates famously died by drinking hemlock (though a State mandated punishment it was still a voluntary act especially if one reads the scene of Socrates’ death). Under the Roman Republic it was an appropriate act under certain circumstances such as gladiatorial defeat or military defeat. In the East suicide was looked on with nobility with multiple instances of suicide or suicidal threats and vows being recorded in Indian epics. The Japanese Bushido culture considered suicide by Seppuku a more noble alternative to capture by the enemy.
In Europe as Christianity spread under the auspices of a resurgent Roman Empire the stance towards suicide hardened due to various theological reasons. The act of suicide became sin and lost most of the romanticism that had been previously linked to it.
Again, it was under the era of Enlightenment and the Renaissance that the perception of suicide shifted. The greatest influence at the time was Hume who concluded in his Essays on Suicide that suicide
“may be free of imputation of guilt and blame”
The media also softened its stance towards suicide egged on by newer philosophical ideals such as Utilitarianism (which Hume based his arguments on).
In the modern era the approach towards suicide has been two-fold. During the Second World War suicide became a weaponised ideal under the Japanese who launched Kamikaze attacks against enemy ships and installations. When news of his son’s capture reached Stalin, he is said to have remarked that he should have killed himself rather than become a pawn in Nazi hands. Similarly, Hitler ranted against reports of the surrender of his troops claiming that their last bullets should have been used on themselves. Therefore, a military tradition of suicide over capture seems to have prevailed in many nations during the era.
However, in the aftermath of the Cold War as American values imploded resulting in the emergence of the Red Scare and the Evangelical movement of Christianity the perception of suicide again changed. Suicide though legalised in much of the Western world today carries a social stigma. Those related to the incident are often termed as negligent and religious beliefs continue to paint the practice as sin and all attempts at suicide as sinful activities.
The Right to Die:
The Right to Die is the philosophical notion through which today we can source our arguments for euthanasia and the de-criminalisation and de-stigmatisation of suicide. The Right to Die supposes that humans have the right to terminate their life on their own terms and will. The origination of the idea itself is tricky but most accounts seem to pinpoint the libertarian awakening in the Renaissance as the idea of individualism and individual liberty were on the rise.
Regardless since its formulation the idea has not only maintained a controversial stance but has been addressed in almost all major philosophical schools of thought. Currently the Right to Die isn’t a universally accepted maxim. Even in nations where the Right to Die is recognized it is usually under strict circumstances and conditions. Therefore, regardless of philosophical arguments and rhetoric surrounding the idea the political and social acceptance of it has been lackluster at best.
Moving on let us now analyse the philosophical arguments that surround the Right to Die and how they fall within different schools of thought.
Under the Libertarian school of thought life is the property of the individual. Therefore, it is the individual’s prerogative to decide their death and if they wish to end their life, the decision cannot be scrutinised by governments or society.
There is an assertion of suicide being exercised under the Right of Non-Interference stating that others have no moral basis for interfering in the process of suicide or even in suicidal tendencies. Another stronger claim is the body being property and therefore the relationship between the body and the individual is similar to that of the individual and his/her items. Thus, bodily autonomy is sacrosanct. The right to suicide follows from a deeper right to self-determination, a right to shape the circumstances of our lives so long as we do not harm or imperil others. Under the Libertarian school of thought suicide is not only legal but also not moral (not immoral) as in it is detached from the moral sphere similar to how our treatment of our items is detached from morality.
Under the Utilitarian school of thought the act of suicide affects the well being of the society around the individual. Therefore, the duty to contribute towards the state or society under Utilitarian thought is clearly violated by the act of suicide. The idea of reciprocity to society is also under threat by the legalisation and acceptance of suicide. There is also a counter argument under Utilitarianism which supposes that the reciprocity of society if violated by society itself frees an individual from his/her moral duty towards the state. Hence, if a society fails to fulfil its obligations under the contract, namely to provide individuals with the goods needed for a decent quality of life, then the individual is not morally required to live.
Nihilistic thought is often characterised by a lack of belief in objective morality. In some forms Nihilism espouses the lack of any morality (objective or subjective) and thus under such a condition suicide is a process that occurs outside the sphere of morality. However, such a myopic view on Nihilism is not only reckless but also misinformed. For example, Nietzsche though usually characterised as a Nihilist usually spent most of his life countering Nihilistic thought. Therefore, Nihilism is not the abject apathy of life or an acceptance of it.
Take the example of Kierkegaard who once famously said:
“Marry, and you will regret it; don’t marry, you will also regret it; marry or don’t marry, you will regret it either way. Laugh at the world’s foolishness, you will regret it; weep over it, you will regret that too; laugh at the world’s foolishness or weep over it, you will regret both. Believe a woman, you will regret it; believe her not, you will also regret it… Hang yourself, you will regret it; do not hang yourself, and you will regret that too; hang yourself or don’t hang yourself, you’ll regret it either way; whether you hang yourself or do not hang yourself, you will regret both. This, gentlemen, is the essence of all philosophy.”
Hence under different Nihilistic approaches suicide becomes moral, immoral or simply outside the moral purview. Under Kierkegaard suicide is just as banal and useless as existence therefore the stereotypical view of Nihilism advocating Nihilism is false. Mostly however, under Nihilism suicide isn’t to be considered illegal or immoral and is to be viewed as simply another desperate act by mankind to establish their place in the world.
Absurdism prescribes to the idea of suicide being a negative attempt at freeing oneself from the absurdity of life. Camus author of the Stranger and the Plague, used the example of the Greek character of Sisyphus, condemned by the Fates to push a boulder up a hill only to have it roll down just as the peak is reached. Camus cites Sisyphus and his perseverance as a positive example of continuing to struggle against an otherwise chaotic, godless and meaningless world.
Religious philosophy towards suicide changes from one religion to the other. Hinduism for example embraces non-violent forms of suicide such as fasts to death. Philosophically the Hindu faith advocates for an absurdist and ascetic view to be adopted in the later quadrants of life. Therefore, the Hindu faith treats suicide as a person’s choice that can be utilised both for positive and negative reasons.
The Abrahamic religions however have a much different view. As mentioned earlier while the Bible does not have an explicit condemnation of suicide in the subsequent theological conferences suicide was held to be a sin. This view was upheld by leading theologians of the time on the basis of suicide being a rejection of God’s gift of life as well as a violation of the Ten Commandments. The objection to suicide is also found in the teleological viewpoint which states that since the preservation of one’s life is natural amongst all of God’s creatures, suicide is unnatural.
In Islam the act of suicide is considered sin, against the will of Allah. However, to be perfectly clear the acts of suicide bombers who act on the belief that they are serving Allah consider their actions as martyrdom not suicide. Suicide in Islamic nations therefore is not legalised or decriminalised.
Euthanasia is a process that is closely linked to medical ethics therefore, it becomes necessary for the opinion of physicians to be taken into the mix. Palliative care, the protocols to be followed and the reporting of such cases has to be done systematically to ensure that the ethical side of euthanasia is kept intact. This has to do especially with the constant recollection of Nazi era euthanasia programs. Furthermore, it has to be understood that euthanasia while a procedure to bring peace to an otherwise troubled patient is not to be substituted for actual medical care.
Neither on the grounds of the patient nor his/her family’s demand for euthanasia can the procedure be administered. It has to be a medically sanctioned (similar to how organ donation committees function in hospitals) otherwise we risk the skipping of dynamic treatments.
The Right to Die is a debate that is dependent on whether a person’s life is the property of the individual or the state. On this distinction lies the state’s power to for example imprison an individual or to pass down the death sentence. To this however we must also add in the actual consequences of the criminalisation of suicide.
Suicidal thoughts usually emanate from a desire to free oneself of the pain of existence, be it physical, mental or emotional. Thus, an individual who suffers from suicidal thoughts requires support, not punishment. Prosecution surrounding suicide only adds to the ongoing bouts of trauma the individual faces, it increases paranoia and exacerbates the frustration one may feel regarding one’s life. While it is true that many nations mandate psychological evaluations and counselling for those who attempt suicide the threat of criminal prosecution still remains a thorn.
It is my personal opinion that two things have to be eliminated. Firstly, the criminal prosecution of those who attempt suicide. No studies have shown any positive effects of such legislation and the misinformed argument of “fear” that may shroud the act does not positively affect an afflicted individual. Secondly, the stigma that society imposes upon those diagnosed with clinical depression or those who are known to have suicidal tendencies must be ended. This stigma is again not a positive modifier, it acts as a blockade to the successful reintegration of these individuals within society. The constant shame and fear of rumours is again a source for paranoia and frustration. To treat suicide as the “cowards’ way out” is not only not indicative of the psychological origins of suicidal thoughts but is also the gross misrepresentation of individuals who suffer from suicidal tendencies. Soldiers, doctors, teachers and students, all are equally susceptible to it. The courage, intelligence, rationale and wits one has is not an indicator as to whether one suffers from suicidal thoughts.
The end of two misinformed practices may well bring alleviation to the countless individuals who grapple with such thoughts on a daily basis. The philosophical and theological arguments are good for intellectual discussions but ground level practical decisions must be taken by our governments and civil societies especially if they purport life to be sanctified.