In most societies, doctors and other healers have two chief aims: to prolong life, and to relieve suffering. Euthanasia seems to pinpoint the territory where these two aims conflict and perhaps become mutually exclusive.

The term ‘euthanasia’ is generally used to cover the practice in which doctors, or indeed anyone, terminates hopeless suffering or what is thought to be a meaningless existence. This understandably emotive subject has been one of concern for both the public and the medical profession for many decades. Attempts to bring about legislation to deal with it have been made in some countries, with little success. Although the practice of euthanasia is, in strictly legal terms, against the law, there is little doubt that it is carried out because certain medical professionals and members of the public believe it to be morally right. The practice may take one of two forms. Negative euthanasia is where treatment is withheld; the euphemism ‘letting nature take its course’ refers to this course of action. There is also positive or active euthanasia, in which intervention is sought to hasten death. A more recent definition of euthanasia refers to the death of a human being as part of the medical care being given to him. What follows is a description of the circumstances under which euthanasia may be thought to be a possible cause of action.

Severe deformities in the young

The subject of euthanasia has most bearing on the very young, who have yet to live their lives, and the very sick, who are at the close of their lives. According to published literature, it is likely that euthanasia is more commonly administered to the severely deformed newborn in the present decade, and generally more openly practised, than it was in the 1950s. Medical journals have published reports from paediatricians who have, with the consent of parents, allowed severely disabled or deformed children to die. Death is brought about by sedating the child, so that it does not want to eat, thus causing it to die of starvation. The reasoning behind the practice is that severe deformities may at best result in the child growing up to lead a life of little dignity, or at worst dying within a short time of birth. Other considerations are the emotional and economic difficulties a family may have in bringing up a deformed child, and the drain on resources which might deny facilities to those less seriously disabled.

It is difficult for doctors to predict the long-term state of health of a severely deformed child; and, more importantly, what life will be like for the child as he grows older. This is especially true for babies born with the handicap of spina bifida. In some cases corrective surgery enables the child to lead a relatively normal life, but in others it will only delay death or leave the child with further disabilities. The decision made by doctors and parents to take the life of another person who is unable to be consulted about his opinion will undoubtedly involve much soul-searching and be very hard to cope with.

Terminal illness

The terminally ill are another group for whom the issue of euthanasia has importance. In recent years some doctors have spoken of carrying out so-called ‘mercy killing’ to end the suffering of patients in great pain with cancer. Others have practised ‘euthanasia by instalments’ by giving an eventually lethal dose of pain-killing injections. Although the care of the terminally ill has improved enormously, and patients are helped to face inevitable death with some degree of ease and comfort, doctors are always likely to face some demand from both patients and their relatives to end life. In certain circumstances patients also have the right to refuse treatment when they feel it will have little bearing on the outcome. It can be argued that it is unethical to carry out a treatment just because it is technically possible.

A similar case can be made against the over-treatment of the elderly. In this context it has sometimes been said that death has been made obscene by technology. Although not legally supported, a doctor may regard it as his choice to withhold certain medication to a severely demented patient suffering with pneumonia. Some people have produced ‘living wills’ which are instructions to the medical profession not to carry out heroic life-saving measures beyond a certain point. The medical profession could itself be said to condone euthanasia for certain age groups; for example dialysis treatment and kidney transplants, which are the only treatments for terminal kidney failure are sometimes denied to the elderly. In the majority of such cases this results from there being too few resources present to help all members of society. Medical technology has prolonged the process of dying, and in recent years it has been necessary to change the definition of death. It is now possible for patients who have suffered ‘brain death’ to ‘live’ with the benefit of life-support systems for many years with almost no chance of recovery. Yet the act of switching off such machines was formerly regarded as manslaughter. Death has now been redefined as the cessation of brain function, which has allowed hopelessly injured people to be kept ‘alive’ so that some of their organs – with permission of their next-of-kin – can be used in transplant surgery. This allows valuable resources to be freed for patients with a greater chance of survival and recovery.

Points of view

When discussing the permissibility of euthanasia the crucial question is whether a human being has the right to dispose of his own life or the one of a fellow human being. To some groups in our society euthanasia constitutes, after permitting contraceptives and abortion, the latest in a series of moral principles to be eroded. On a principle they consider euthanasia inadmissible because their respect for life and their duty to aid the living and the dying does not allow any compromise.

These groups consider that once we start moving with this trend there would soon not be any principle left to prevent practices such as those carried out in the past under national socialism. On the other hand it is pointed out that a human life should be preserved only when that life is meaningful. And the first person who should give an opinion – indeed a decision – on this matter is the patient himself. Consequently this would mean that after a voluntary decision the patient would have the right to euthanasia.

Legal provisions

At present many European countries still consider euthanasia to be a penal offence under the criminal code. In practice these countries’ legal policies are mainly directed at setting down specific rules to determine whether, in any particular case, a physician has acted carefully enough to avoid legal prosecution. In this context the Postma case (1972-1973) has been epoch-making. At her specific request Mrs Postma (a physician) administered to her aging and ailing mother a lethal dose of morphine. For this, she was convicted and given a week’s suspended sentence, but the discussions on responsible euthanasia were greatly stimulated by this event. There are now a number of generally accepted conditions that precede the administration of euthanasia, among which is the condition that the patient must be in extremis and that after the request for euthanasia the physician has discussed the matter with one or more collegues. However, opinions are still very divided on whether or not euthanasia should be allowed when the process of death has not yet started.

The legal and ethical issues surrounding euthanasia remain controversion and delicate, and legislation is unlikely to be totally acceptable to everyone concerned in every application.