Euthanasia and Causing Distress

One common argument against euthanasia is the emotional unhappiness to doctors, relatives and friends that such an act would cause. This is of course asserted, and there have been numerous instances of friends and family actually feeling a great deal of relief that their loved ones could die peacefully and without agony at the time of their own choosing. But admittedly, there are also instances (so artfully illustrated in the movie The Sea Inside), where the family members would strongly oppose such a move, and would be greatly distressed by it.

The case is more difficult with regards to doctors. Some doctors in places where euthanasia is legal (or in some cases such as Oregon, assisted suicide) do report emotional distress after their participation in an assisted death, or in prescribing the necessary medication to enable a patient to take their own lives. Others have found it an intrinsic part of what they view as their duty of care to a patient. However, it is reasonable to point out that if it offends a doctor's conscience (or religious beliefs) to assist in such an act, he can pass on the patient's case to another qualified medical practitioner who will be willing to carry out such a patient's wishes.

Let us assume, at the very least, that a patient's decision to take their own lives, at a time of their own choosing (which I deem the basic definition of euthanasia) will cause significant emotional distress to third parties (doctors, nurses, family, friends). Is this justifiable grounds for rejecting a person's request for euthanasia?

Say that a person, who is of sound mind, has decided that by their own assessment, their lives no longer have any value and they wish to die. One classic example would be a quadriplegic who is completely paralyzed from the neck down due to an accident. That person might feel that the loss of the independence and autonomy of his current condition that necessitates him being cared for by others even involving the most basic of needs, means that his life, to him is inherently valueless (or even of negative value) and he thus desires to die. I shall put aside, for now, questions over the person's capacity to make such a decision, and assume that it is a rational decision, not made under the duress of emotional distress or physical pain (though arguably these components make up a vital part of any decision is whether life is worthwhile or even tolerable). There is a demeaning tendency to associate anyone who is considering taking their own lives as being psychologically unsound, which I argue is not necessarily the case.

If we were to deny his request on the grounds of his action causing emotional distress to other people, we would effectively be saying that he should merely be living, not for himself but in due consideration to others. This is something most of us will find inherently odd. Think about a scenario when a somewhat angsty teenager who reads too much philosophy declared to his parents that he had come to the conclusion that his life was fundamentally meaningless and that the only reason why he continues to live was the psychological and emotional anguish that his suicide would cause his parents. If you were his parents you would probably be very disturbed and send him for counseling.

We thus seem to have a deep seated belief that we should have some individual purpose for our lives that is independent of merely living our life for other individuals (I leave aside the question of living for God, which is not anyhow, inherently a person). It thus seems strange that if that same teenager above were completely paralyzed from the neck down, and he told his parents that he found his life completely meaningless and he wished to die, we would tell him that he cannot do so because of the emotional anguish it would cause them and others.

This question of emotional anguish and causing distress relates to one of the fundamental problems facing strict utilitarians (and hedonists) with regards to murder. A strict utilitarian will argue that an action is right so far as it maximizes some ordinal value, usually taken as pleasure. So we should act in such a way as to maximize pleasure and to minimize pain. So according to such a view why is murder inherently wrong? A strict utilitarian could argue that it would cut short any possible future pleasure or happiness that the murdered person could experience.

This view is problematic - first of all it is not at all certain that, on balance, that person would necessarily experience a pleasurable life in the future had he not been murdered. Second of all, there is an inherent problem in committing to maximizing future pleasure. If it is a duty not to kill someone because of the inherent loss of possible future pleasure accrued to that person, will that not imply that we have a corresponding duty to maximize future happiness by creating other individuals that could possibly lead pleasurable lives? So, a couple, if indifferent to having a child (say the pros and cons balance out) on this view must have the baby if the baby will then have a resulting life that is pleasurable.

Strict utilitarians can then appeal to the indirect harmful effects of murder. Murder can lead to other individuals being fearful for their safety, which increases their unhappiness. It causes significant emotional anguish to the murdered individual's friends and family. It can even be argued to disrupt the basic functioning of society. On this view, a strict utilitarian can be said to take the view that the only thing that matters is present pleasure and suffering (of which the potential future pleasure of the murder victim would not count), and still argue against murder. On this view, the only wrong that is committed against the victim by his murderer is the possible pain involved in the ending of his life. Thus seems strange - would killing someone in his sleep through the use of a painless form of poison be any less wrong than stabbing him violently and repeatedly? And worse still, it seems to suggest that murder is wrong only because of the effects it has on society, and the victim's relations, not on the victim itself.

Drawing a parallel with the example at hand. Euthanasia is in effect a decision by an individual to take their own lives - 'self-murder' or bluntly a form of suicide. (The exact differences and similarities between euthanasia and suicide is outside the scope of the current discussion). If, as above we find it hard to accept the notion that murder is inherently wrong due to the indirect harm that it will cause, then it seems inconsistent to apply this same criteria of indirect harm to euthanasia. That is why suicide is no longer illegal in most countries (Singapore being an exception).

Of it can be argued that there is a difference between suicide and assisted suicide. In one case an individual unilaterally (often in distress), takes his or her own life, while in the latter case it usually involves the participation and consent of others, including a qualified medical practitioner. I will not delve into the complex arguments regarding legalizing assisted suicide and/or euthanasia here, but it does seem strange that in a country like Great Britain, you are legally allowed to end your own life by jumping off a building, but you are not allowed to do so by asking a doctor to prescribe you pills that will end you life if you are in a state of severe illness or pain in which otherwise ending your life would be impossible.