The Bioethics of Euthanasia and Assisted Suicide

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As a team, we have authored 14 posts that help provide an in-depth look at the current bioethical debates surrounding Euthanasia and Assisted Suicide from the lens of disability.

In addition to our authored posts, we have reblogged posts from all across Tumblr. These help to provide insight into the community’s attitudes and perspectives on the subject. 

You can read the posts of this blog in any order, but we did plan them out with a structure in mind. As Tumblr naturally orders its posts to have the most recent on top, you will find key organizational hashtags in the following three posts.

Our three types of hashtags are:

Structural

Categorical

All of our blog’s structure-based hashtags can be found hashtagged to this post. These provide a logical progression of how we wanted to present our information. The "introduction" and "body" of our analysis was all written by our team. The supplemental reblogs were posted by other members of the tumblr community. These posts provide a wide array of perspectives from the community, and are a primary reason as to why we chose Tumblr as our medium.

All of our blog’s category-based hashtags can be found hashtagged to this post. These explain the purpose of a post. Every post written by us will be placed into one of these three, however not every #reblog fits into this framework.

All of our blog's topic-based hashtags can be found hashtagged to this post. These explain what concepts are contained within a post.

The study described in Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups examines the idea of “slippery-slope” by looking to see if “vulnerable groups” are in fact at a heightened risk of utilizing assisted suicide. The “vulnerable groups” that were analyzed in this study were:

people with low educational status,

the poor,

the physically disabled or chronically ill,

minors,

people with psychiatric illnesses including depression,

people with AIDS,

racial or ethnic minorities.

After their analysis, it was determined that the only group that was of heightened risk was "people with AIDS". It was determined that no other group demonstrated evidence of a heightened risk of assisted suicide.

Euthanasia can be divided into 3 main forms:

voluntary euthanasia, when the patient requests it,

non-voluntary euthanasia, when the patient is unable to make the decision by him/herself,

involuntary euthanasia, when euthanasia is performed on a patient who is capable of making the decision for him/herself, but is not asked whether or not he/she wants it.

On a deeper level, euthanasia can be looked at as either active or passive:

Active euthanasia involves injection of lethal substances.

Passive euthanasia, on the other hand, is when a patient stops receiving medical treatment/assistance.

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The topic of euthanasia brings up many debates. People argue over topics such as the cost of medical treatment for terminally ill patients, the medical ethics behind the “right to die,” religious beliefs with regard to the gift of life, and legal issues including the prohibition of homicide and the right of an individual to their own autonomy.

With the increase in technology and improved medicine, it is easier for physicians to keep terminally ill patients alive for significant amounts of time. This has sparked further debate over the use and legalization of euthanasia. Keeping these patients alive might mean forcing them to endure pain and suffering for extended periods of time. It also means higher health care costs.

There is an especially turbulent debate over the use of euthanasia for patients with mental disabilities. Can a person with a severe mental disability express consent for euthanasia?

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When considering euthanasia and people with disabilities, it is very important to realize that legalizing euthanasia may lead physicians to prescribe lethal treatment to those who are vulnerable, unable to voice their own desires. According to an article published by S.K. Templeton, some might feel that euthanasia is their best option because they harbor feelings that their disability makes them a “burden” to others. Additionally, if a person with a disability is unable to fully communicate their desires regarding their treatment with their physicians, a conversation about euthanasia might yield a decision that is ultimately unwanted by the PwD. Because of their inability to fully communicate what they desire, a PwD might be unable to stop the physician from prescribing this for them. 

Euthanasia is considered a medical treatment, and, if legalized, will become a right for every patient to seek/be provided with this treatment. Prescribing euthanasia “becomes a proper duty towards anyone claiming or appearing to suffer unbearably, regardless of prognosis or capacity to consent.” In the Netherlands, where euthanasia and assisted suicide are legalized, it has been “extended to children, people with psychiatric illness, and those who are mentally incapable.”

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This is a chart contrasting the levels of acceptance of euthanasia by non-religious/non-denominational v. the countries as a whole. It is clear here that in every country (listed on the bottom of the chart), the non-religious (blue) groups are much more accepting of euthanasia than the totality of a country’s acceptance (red).

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This map shows the level of acceptance of different western European countries. Western European countries were found to be more accepting, in general, than eastern European countries. These results are based off of a 1-10 scale of acceptance.

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Data on people’s acceptance of euthanasia was collected from 47 European countries. The researchers utilized a 1-10 scale to rank participants’ level of acceptance: 1 being the lowest, 10 being the highest acceptance.

The results from the study are very interesting:

Relatively high acceptance rates was found in a small group of countries: Denmark, Belgium, France, the Netherlands, Sweden, Luxembourg

However, acceptance throughout the rest of Europe is pretty low

An East-West polarization of acceptance exists, which means it would be difficult to make one policy fit all of Europe

Religion, culture, socio-economic status, and health care policies correlated with the results

Religiosity was a key component of acceptance level:

Catholicism, Protestantism, Islam view life as a sacred gift from God, generally against euthanasia because it is morally wrong, Protestants were more supportive of euthanasia than Catholics, Orthodox, and Muslims

Secularism: desire to have freedom of choice over issues of life/death means that non-religious people are more inclined to legalizing euthanasia 

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Euthanasia and Assisted Suicide are viewed negatively in most contexts. Both are legal in the Netherlands, but there is a formalized review procedure created to ensure that doctors are not taking advantage of patients. Doctors are required to report each incident and provide proof for prudent practice.

If prudent practice is not proven, the physician may be prosecuted. The requirements of prudent practice are as follows:

The patient’s request must be voluntary and well considered

The patient’s condition must be unbearable and hopeless

No acceptable alternatives for treatment are available

The method is medically and technically appropriate

Another doctor is consulted before proceeding

The case is reported as an unnatural death 

This procedure was put in place in attempt to increase reporting of assisted suicide and euthanasia, making doctors less fearful of prosecution. Yet shockingly, they have found that still half of cases go unreported. Reporting may increase as doctors become more aware of this review procedure and the requirements for prudent care. A thought to consider is whether the cases that go unreported are linked to an ethical questioning of the procedure even amongst doctors in the Netherlands?

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In the article written by Christopher Newell entitled, Critical Reflections on Euthanasia and people with disability, some interesting ideas are expressed regarding the specific questions that Euthanasia presents to people with disabilities.

The first is the idea that arguments for euthanasia do not consider people who incur a disability, and how this often lead to a time of depression for people. The length of this depression varies drastically from person to person. Newell wonders: How would you distinguish suicidal depression that will end in the future from a true desire to die?

Furthermore, the society that we live in continues to oppress people with disabilities, promulgating the notion that “it is better to be dead than disabled.” If a positive social model existed that supported people with disabilities, then perhaps it would be easier to allow people to decide whether or not they wanted to end their lives. He argues that we are not in that current societal situation.

Another discussion occurred around people with intellectual and psychological disabilities. Newell states that often, people with intellectual and psychological disabilities are avoided like the plague. In legislation for medical killing, one cannot ignore people who fall under this category. He describes people with psychiatric conditions and how they may, at one point in time, try to commit suicide, but are later thankful that they were stopped.