Does A Person have the Right to Die?

A right is a moral claim. If there exists a claim on death, do we possess it? The right to die entitles any human to commit suicide or to go through euthanasia. If you acquired this right, you can commit suicide if you have a terminal illness or you can insist not to take life-prolonging treatments because that means you just prolong your suffering that will eventually lead you to death. It has been a debate of who, if there is anyone, should have the authority to make these decisions. This research will side with those who believe that a person does not have the right to die.
There are many reasons why people choose to end their lives. Consider the case of Craig Ewert. Craig was 59 years old when he was diagnosed to a rare disease associated with motor neurons. This disease meant that that there would come a time that he will become physically paralyzed yet his mind will continue to perform its basic functions making aware of all the activities happening around him. Time passed swiftly and he was soon wheelchair-bound, fed through a tube which connects directly to his stomach, and unable to perform any physical task. It was during this time that he decided to undergo aided death. It was no sooner that Craig went to Zurich, and was administered the lethal drugs at Dignitas Clinic which gave him his wish – to end his life. His wife who was at his deathbed narrated that Ewert told her that he was tire of his disease for it prohibits him to enjoy his life. In other words, one possible reason which people think to be valid in taking their own lives is when their lives serves as emotional punishment to them.
Another case is that of renowned conductor Sir Edward Thomas Downes, aged 85. He travelled to Dignitas with his terminally-ill wife, Joan, 74, where they ended their lives together. Sir Edward had decided that he did not want to go on living without his beloved wife he was also blind and increasingly deaf, a terrible burden for a man who devoted his life to music. It is a common thinking that everyone has the right to control his or her body and life. Them he/she could also determine or plan the time and the way he or she will die. This idea lead to the thinking that man has freedom, a freedom that is extremely valued in our civilization. If you have a freedom to live, so does a freedom to die. Behind this also includes the idea that man are independent individuals, who can decide for himself or herself (Apkarian et al 131).
We can argue that human rights also imply the right to die. Dying is part of one`s life and an important event in a man`s life. Dying can be seen as a good or bad thing. Man is always responsible in every event in his or her life so they have the right to make his or her time of death a good one. If his or her death is not that good, man tends to reduce that unpleasantness. On the religious aspect, they disagree to it because they firmly believe that only God has the right to decide the death of a person. On the medical aspect, worldwide speaking, there exists a scarcity in health resources. This leads to incapability of curing some sick people because they don`t have an urgent access to the amenities they need for their cure. On the other hand, these amenities are also being used by people who are incurable and for their selfish reasons prefer not to continue their lives. Permitting those people to end their lives would not only give them their desire but also would give way for the amenities to other people. In this way, the freed amenities can be used to treat people who want to live (Apkarian et al 133). Moreover, justifying the right to die means giving them relief from pain from their illness, the loss of self-respect and the suffering of anticipating a sluggish, agonizing death. Man usually prevents themselves from their death because they want to live, live longer than they should live. They value life a lot because they have a lot of things they wish to do and things to experience. But this is not true for all people. The practices of euthanasia and assisted suicide are frequently confused with refusing treatment, withdrawing treatment and the “double effect.” Euthanasia involves an intentional act by a person (usually a physician) to end a person`s life for compassionate reasons. The Canadian Senate Special Committee on Euthanasia and Assisted Suicide defined euthanasia as “the deliberate act undertaken by one person with the intention of ending the life of another person in order to relieve the person`s suffering where the act is the cause of death” (Senate of Canada 8). In countries where euthanasia is not legal, ending a person`s life for whatever reasons is considered a homicide, although punishments vary depending upon the circumstances of the killing. Note that these practices, including assisted suicide, differ from refusing treatment and withdrawing life sustaining treatment, where a “natural” death occurs without life being maintained by “artificial” means.
The `double effect` in regard to end of life practices is when a physician provides only sufficient medication to completely arrest the pain and suffering, but that the effect of taking that medication in a sufficient amount to stop suffering has the side effect of accelerating death. Double effect reasoning follows from a long tradition that originated in the work of Saint Thomas Aquinas in the 13th century (Cavanaugh 12). Double effect reasoning is when the intended outcome is good (and thus morally justifiable), but one cannot realize the good outcome without also causing a foreseen, but not intended, bad effect. In double effect reasoning it is the morally justifiable intent and the accomplishment of the good outcome that counts. The secondary unintended harmful outcome is considered acceptable to attain the morally justified good result. In the case of a terminally ill person experiencing pain, control of pain and suffering is considered primordial, and controlling pain is justifiable even if life expectancy is compromised by the treatment, as long as the main intention of controlling pain is respected and no more medication is used than is required to attain an acceptable reduction in suffering. This approach indicates that in practice, only enough medication to control the pain and suffering can be provided so that life may be maintained as long as possible.
Despite generally accepted definitions of the different end of life practices, confusion remains in both scholarly writings and within the general public. In Quebec, 70% of the population favours legalization of euthanasia according to their public opinion poll. However, in delving into the matter further, over two-thirds were unable to identify if vignettes depicted end of life practices correctly, often thinking that legalizing euthanasia means legalizing other practices, such as refusing or stopping treatment, which are already legal in Quebec. The more people were confused about the nature of euthanasia and other end of life practices, the greater the likelihood they would be in favour of legalization. (Marcoux et al. 235)
It is curious that theological arguments are rarely in the forefront of debates on euthanasia and assisted suicide. Constitutional guarantees are generally invoked as both the justification for legalizing euthanasia and assisted suicide and the justification for forbidding these practices. The Constitutional guarantees of freedom and non-discrimination are often cited as reasons for legalization. Choosing the manner, time and place of one`s death has been described as a simple exercise of individual freedom of choice. However, legalization goes beyond simply allowing people to choose. In most countries there are no laws forbidding suicide, although the majority of countries have laws outlawing aiding and abetting in a suicide. Over and above accepting that people may choose to die, legalization involves either providing the means to kill oneself (as is the case in assisted suicide), or actually having a third party intervene to end a person`s life (as in the case of euthanasia). There are multiple justifications used to insist that the means and actions to end life be provided. To begin with, one can contend that without proper medical help, persons may botch their suicide attempt, the consequences leading to either suffering a horrific death or not dying, with the accompanying risk of becoming permanently handicapped. Constitutional arguments are made that there is an inherent inequity in the case of the severely handicapped, for example, in reference to paralysis that occurs in advanced stages of certain degenerative diseases. Such persons are viewed as being unable to exercise the “right” to commit suicide because of their illness, thereby implicitly obligating the state to provide a means of ending their life by euthanasia, in order to effectively implement a `choice to die.` The obvious counterargument is that being free to act does not additionally confer an obligation for a just government to provide means for everyone to realize their desired actions, particularly the act of committing suicide. In countries where euthanasia is practiced, almost all those who die in this manner are fully capable of committing suicide. It is a rare exception that people requesting euthanasia are truly incapable of executing the act. Dramatic exceptional cases of advanced paralysis do not depict the actual norm. In The Netherlands most cases of euthanasia involve people suffering from cancer (76%) and less than 6% have a neurological disorder that may result in loss of motor control, with euthanasia administered while the patient is still capable of assisted suicide (Regional Euthanasia Review Committees). In Belgium, 75% of persons who died by euthanasia suffered from cancer and 7% had degenerative neurological disorders (Commission fédérale de contrôle et d`évaluation de l`euthanasie 23). In addition, research on the relationship between “the desires to die”` and “physical handicaps” exposes that, contrary to popular beliefs, people with disabilities are less likely to want to die by suicide or euthanasia than people without physical handicaps (Mishara 353).
Are there ethical or important practical distinctions between the practice of euthanasia and assisted suicide? In the United States, assisted suicide has been legalized in four states but there has been little discussion of also legalizing euthanasia. In Belgium and Luxembourg, euthanasia is the practice and in The Netherlands, although both assisted suicide and euthanasia are legally available, euthanasia performed by physicians is the predominant practice. In Switzerland, assisted suicide was never formally legalized however it can be practiced because there never were any laws rendering the practice illegal. One of the most common characteristics of suicide is ambivalence on the part of suicidal individuals. Only a tiny proportion of persons who seriously consider suicide will attempt suicide (Mishara and Tousignant 271). Most seriously suicidal individuals change their mind and find ways of living with their problems or solving them. The small proportion of suicide attempters who die from their attempts (less than one in fifty) is not due to an extreme inability of humans to end their lives. It can be explained by the fact that most people, after they have initiated a suicide attempt, change their minds and stop the attempt or try to get help if they are able.
Humans have the capacity to reason and to make reasonable decisions. Nevertheless, most important human decisions are not reasonable in the sense that they are the result of a process of logical reasoning. Logic often falls by the wayside in the decision of whom to marry, the choice of a career or even with respect to the car one purchases. Most important human decision making has highly emotionally charged components that are influenced by social expectations and can easily cast reason aside. A myriad of feelings, preferences, social pressures and reactions to marketing ploys influence the “free” choices we make when it comes to a decision to terminate one`s life prematurely by euthanasia or assisted suicide. The requirements for access to euthanasia and assisted suicide overwhelmingly preclude the possibility of concluding that these decisions are likely to be rational. The typical requirement for providing access to death to a patient is that the person has interminable and unsupportable suffering. Research on human decision-making suggests that when a person is experiencing pain, decision making becomes less rational (Apkarian et al. 129). Because of this impairment associated with experiencing pain, people may tend to engage in more impulsive and irrational decision making in periods of intense suffering.
This results in the paradoxical situation where proponents of legalizing euthanasia and assisted suicide insist upon the right to make a “rational” choice under circumstances where rational decision making is much less likely to occur. We contend that when advocates of euthanasia or assisted suicide say that a choice is “rational,” what they mean is that the choice is understandable from the point of view of an external rational observer. This is a serious challenge for physicians who must determine whether or not to accept a request for euthanasia or assisted suicide. Such serious challenge is best shown in the study conducted by Buiting et al. Accordingly, he noted that the majority of the physicians who have received request from patients to perform euthanasia or assisted suicide, cannot fully discern whether the patient`s suffering is indeed deserving of the request. This is because there is no standard assessment to make such decision. The main point here is that the government cannot give the right to die to people, particularly patients, due to the possible lack of control in the implementation of said right.
End of life decisions are also influenced by our fears and anxieties about the future, in this instance our fears of dying. Research on fears about death has demonstrated that there is panoply of common fears associated with the process of dying. The most common fears are of experiencing pain, losing control, dying alone, feeling humiliated or undignified and being horribly incapacitated and dependent. Despite the fact that the majority of people have these (Kastenbaum 1) research on the actual experience of the end of life indicates that these fears are generally unwarranted, and those fears tend to be unfounded when terminally ill persons receive good hospice or palliative care (Kastenbaum 1). For example, a study of patients suffering from amyotropic lateral sclerosis (ALS) found that the most commonly reported reason for unbearable suffering in euthanasia requests in The Netherlands was related to suffocation, accounting for 45% of requests (Maessen et al. 1192). ALS patients actually have a very low incidence of suffocation in the terminal phase (0 to 3%), and there are available means for preventing this. There is a remarkable discrepancy between what we know is right and best and human behaviour. Smokers frequently do not accept free programs to stop smoking, even if they admit that it would be better for them. This ability to know what is best for oneself but still continue to do things that do not make us happier, healthier or reduce our suffering has been called “the neurotic paradox” (Shapiro 1965). We may know that there is assistance to alleviate suffering, but that does not mean that we will necessarily seek it out. We admittedly have a tendency to make decisions based upon our fantasies and projections of future experiences that do not accurately predict how we will react when the future arrives. For example, caregivers think that the majority of persons with Alzheimer`s disease would prefer to die than continue living with the illness, when in reality research has found that only 3.2% of Alzheimer` patients wished to die or had thoughts of death (Draper et al. 503).
Dying for a greater cause is a practice that has been present throughout history. It has been postulated that the change in the position of the Catholic Church, from the early acceptance of altruistic suicides of martyrs to condemning suicide as sinful, may have been motivated by a concern that the most devout practitioners were dying too often by suicide. The classic sociological study by Durkheim described both egoistic and altruistic suicides, resulting from either marginalization/alienation from society or over-identification and integration, as in the case of martyrs. It appears that when individuals express their desire to avoid burdening others, this is accepted as a plausible motivation. However, if others exercise pressure to die early to make life easier for them, this is regarded as unethical and therefore unacceptable. The Swiss laws concerning assisted suicide allow anyone to assist in dying, as long as there is no personal gain by the person who assists. Whenever legalization is debated, there is concern that euthanasia and assisted suicide not be practiced in order to alleviate the financial burden on families or free up a hospital bed for an acute care patient in need of treatment. People generally make sacrifices for others, ranging from trivial behaviours such as sharing a larger portion of food, to heroic behaviours, such as risking one`s life to protect family members. Laws and regulations about access to euthanasia and assisted suicide allow only for egoistic reasons of personal pain and suffering, yet human behaviour is often motivated by the need to please others and by concerns about meeting their needs. Sometimes those concerns may not be realistic. People who think that they are a burden to others often ignore the fact that caregivers can receive pleasure or satisfaction from taking care of a loved one and may feel cheated of that opportunity when a person chooses to die. There is a need to better integrate our acceptance of altruistic social behaviours and desires with our preoccupation with egoistic motivations for choosing to die by euthanasia and assisted suicide. Religious concepts of duty to God may guide believers in end of life decisions. If one believes that only God may decide when and how a person will die, then euthanasia and assisted suicide are clearly forbidden. However, one may also have non-theological values of responsibility to family and community that can guide decision making. These values can serve to motivate and justify euthanasia and assisted suicide, but equally to inhibit these practices this inevitably depends upon the context and one`s interpretation of the given factors. In some cultures the concept of honour killing exists, being meant to preserve cultural values. Consider the practice (now banned but still occasionally practiced) in India of Sati, where the widow is expected to throw herself on the funeral pyre of her husband if she refuses, family members may force her to do so. Another example is the suicide of a pregnant girl out of wedlock in Somaliland who commits suicide because of her desire to protect the honour of the family. There is the often cited example of the traditional Inuit elder who chooses to leave the village in winter for certain death when there is a scarcity of nourishment.
Altruistic euthanasia is rarely discussed, and its practice is excluded from descriptions of who should have access to euthanasia and assisted suicide within existing laws. However, social responsibilities and altruism may also be used to justify choosing to extend one`s life despite suffering from a terminal or degenerative illness. There may be a wish to continue living in order to present a role model for others about how to confront death. One might commit to stay alive to remain available to others as a community and family resource.
Generally in Western societies individual self-expression is increasing as we have greater opportunities to customize our life and lifestyle. Furthermore, in capitalist societies one may view one`s life as a commodity whose value to oneself and to others may be greater or lesser, depending upon what pleasures we derive from life extension and how that contributes to others, and society as a whole. In a society where the value of objects, and life itself, may be calculated, one may assess the value of continuing to live in comparison with the value of dying. Very often, persons promoting a “dignified” death speak of continuing to live in terms that suggest diminishing returns for the `investment`. They talk as if they are observers of their own `value` and have engaged in a cost – benefit analysis. Some feel that embracing death would constitute a stop loss decision cut the losses before they become too great, while preserving the assets for others to inherit. These assets may include the memory of a loved one in full control of his or her capacities. However, as in all material analyses, intangible and unanticipated factors may influence decision making. Fear of death and dying, the inclination to stay with loved ones as long as possible, and similar factors may influence how we deal with the commodity of life.
Often it is the fear of anticipated suffering, rather than actual suffering that leads people who are ill to end their lives. There has been considerable research attention to why cancer patients commit suicide, since they constitute by far the vast majority of those who have died by euthanasia and assisted suicide in countries where these practices have been legalized, including The Netherlands, Belgium, and the states of Oregon and Washington. A recent review by Spoletini et al. and Robson, et al. found that the risk of suicide in persons with cancer is highest in the first year after diagnosis, especially in the first 3 – 5 months, but declines thereafter. This has been interpreted by the authors as reflecting the fact that patients who receive a diagnosis of cancer are forced to face a life threatening experience, leading to painful emotions that may increase suicide risk. The periods immediately after receiving the diagnosis and following discharge from the hospital appear to be at highest risk of suicide because of the emotional impact of learning the diagnosis and the difficult psychological adjustment outside of the hospital environment. This concludes that the risk is greatest if there is a psychiatric disorder present as well and if the patient is experiencing physical pain. Following the period of initial shock and the beginning of treatment, usually after the first 3 – 5 months of living with the disease, the risk of suicide declines substantially.
There are a number of other significant risk factors for suicide in cancer patients, including having poor social support, loss of independence, fear of being a burden, having previously attempted suicide, being single, divorced or widowed and being male. However, the most powerful predictor of a desire for hastening death is major depression. In a study by Brown and his co-workers, it was shown that all patients who reported the desire for rapid death (23% of the sample) were diagnosed with a major depression. Research indicates that cancer suicide is not just a reaction to the diagnosis and to suffering from the disease, but it is also associated with psychological vulnerability to stress, which may be associated with immunological disturbances associated with having cancer. This hypothesis of the effect of immunological disturbances, weakening one`s ability to deal with stress is controversial and needs better substantiation in research.
Countries differ greatly in the extent and nature of their incursions into the lives of their citizens. There are major differences in the control of life-styles and the availability of social benefits. The Netherlands, the first country to accept the practice and legalize euthanasia and assisted suicide, is liberal in terms of its respect for individual freedom. It is in the minority of countries where marijuana can be legally purchased and prostitution is legal. However, The Netherlands also provides universal health care for its citizens and has a fairly extensive network of palliative care. The Economist ranked the Netherlands as 7th in overall quality of end-of-life care and Belgium 5th, in comparisons with 40 other countries (Economist Intelligence Unit). These countries are part of a wide spectrum of other socio-political systems that exist in the world, ranging from ultra-liberal constitutional structures to dictatorial monarchies and theocratic regimes. It is highly relevant to analyze the legalization of euthanasia and assisted suicide in the context of the nature of government, the culture of individualism and the availability of alternatives to ending life. In a theocratic country end of life decisions are determined by religious prescripts and there is little room for promoting individual freedoms which may go against fundamental beliefs. This model of a paternalistic society is one of many ways that a country may regulate practices for the best interest of its citizens. A society with a communitarian ethos may continually strive to do what is best for the masses to the detriment of individual choice. Where the state works to protect its citizens, how should one assess the value to citizens of making euthanasia and assisted suicide available? Where there are limited resources for health care, it may be for the greater good to have unproductive, ill people who drain valuable resources end their lives as early as possible in order to ensure that resources are equitably distributed. From another perspective, does respect for individual rights imply not only respect for the manner of dying, but an obligation on the part of the state to provide the means (assisted suicide) and the manpower (in the case of euthanasia) to end life on demand? Few liberal democratic societies are homogeneous in terms of religious beliefs and values. How should these issues be legislated in a pluralistic multicultural society with a range of affinities? A common response is that permitting euthanasia or assisted suicide does not obligate any person to choose that option. However, expectations can play a large part in medical practice. At the beginning of the 20th century it was considered to be “normal” and ethical for women to suffer during childbirth. Now, it is generally considered unethical to not offer help to control women`s pain. In The Netherlands, where there is an elevated percentage of persons who have ended their lives by euthanasia (for example, 1.4% of deaths, 1933 out of 136,402 deaths, in 2005), a study published in 2010 (Onwuteaka-Philipsen et al. 911) reported that two-thirds of requests for euthanasia did not lead to euthanasia or physician assisted suicide being performed. In about half the instances where the person`s request for euthanasia was not carried out, the person had died before the request was granted. In one-third of people who requested euthanasia, the physician denied the request because it was felt that the request was not well considered or/and the patient was determined not to be suffering unbearably. In the opinion of the physicians, due care criteria obligated them to not grant euthanasia since the patient had not exhausted other means of dealing with the problems that had resulted in requesting physician-assisted death by euthanasia. When the physician denied the request for euthanasia, indicating that other treatments or help should be tried first, patients rarely returned with their request. These data suggest that in a substantial number of cases, even in a country where euthanasia is a well-established practice supported by a majority of the population and the medical community, when patients tell doctors that they have insupportable suffering or loss of dignity, this is not necessarily well founded and the problems are not really insurmountable. A substantial number of people who feel there is no hope and request physician-assisted death to end their suffering change their mind when they are provided with necessary palliative care and psychosocial support.
For some, the ideal situation for end of life care would be a society where all citizens enjoy the optimum medical and psycho-social treatment and palliative care at home is provided to meet all the terminally ill person`s needs. This benevolent social state would also provide all the needed support for the family of the dying person, including respite care at a hospice if the family needs to take a regular or periodic break from being involved in caretaking. This was the dream of Dr. Cecily Saunders (BMJ) when she founded the hospice movement in England. It was her contention that if a full range of good palliative care is provided to terminally ill persons and their families, there would be no need to debate the legalization of euthanasia or assisted suicide. No one would experience the physical and psychological suffering that could motivate people to want to end their life prematurely. A recent Cochrane review of research on hospice care at home (Gomez et al. 1) concluded that there is “clear and reliable evidence” that home palliative care reduces symptom burden.
For the late supreme court judge of The Netherlands, Huib Drion, the ideal society in terms of end of life care would provide all citizens when they reached maturity (probably at age 18) a pill with which they could end their life at any time, if they felt that it would be unbearable to continue living. For Drion, the exercise of the decision to live or die is an inalienable right in a free and just society, and that right should be able to be exercised without any meddling by governments. He felt that knowing that we can die whenever we choose would provide a sense of freedom to live life fully and would provide for the utmost fulfilment in everyone`s life (Draper 504).
These two aforementioned examples can be supported and criticized on both philosophical and practical grounds. The example of the society where every aspect of end of life care is provided to ensure that all needs are met follows from a view of society as having extensive responsibilities to ensure that all citizens are provided the very best of care. Some may contend that such a materialistic society would be stifling of individual freedom. Others doubt that people suffering from all illnesses can have their suffering reduced, that being cared for is not a dignified way to live or die, and that one may question if the benefits are justified by the costs involved, feeling that the money could be better spent helping others who are not so ill. Drion`s utopia of each person deciding when to die can be criticized as overemphasizing individual freedom at the expense of people`s obligations to loved ones, and society at large. Critics predict dire consequences of having death so easily available, as people may carelessly kill themselves while inebriated or in a temporary crisis situation (Draper 501).
Between these two extremes in the role of the state and individual freedom to choose to die, one may envision a wide range of alternative models. Globally, we live in an imperfect world where people have false beliefs, unsubstantiated fears, biases and prejudices where they sometimes kill or want to exterminate others for tribal reasons, where there are intergenerational conflicts about sharing of resources, and obligations are not always respected. Medical personnel are burdened with time constraints and reveal prejudices. As well, it should be admitted that patients and doctors alike are impacted by whatever is conventional at any given moment in historical time.
Despite the possibility of holding an extreme position favouring an absolute right of individuals to choose to die when and how they please, most citizens continue to live, at least within industrialized nations, in places where governments are increasingly enacting legislation to protect their citizens from engaging in behaviours that compromise their health and well-being. Sometimes the motivations for these actions may appear to be based upon benefits for the state, despite their obvious benefits for the population. For example, one of the motivations for anti-smoking regulation is the reduction of health care expenses for treating smoking-related illness. In the case of the end of life practices of euthanasia and assisted suicide, if one puts the moral arguments aside, in many instances there is a delicate balance between corporate interests of the state and the benefits to citizens.
End of life care is expensive and having citizens opt for an earlier death is associated with substantial government savings. In countries where health costs are assumed by the patients, dying sooner results in more money being available to the patient`s family. In some instances entire inheritances are depleted because of hospital costs in the last days and weeks of life. Although philosophical arguments ignore the `crass` realities of financial advantages of end of life practices, this cannot be ignored. As we suggested earlier, people may decide that an honourable and dignified death is one in which they do not deplete their inheritance or cause the state `needless` expense for their end of life care.
In many modern societies where there is a secular government that purports to be neutral with regard to religious morality, the lack of absolute moral principles leads to more practical discussions, with the underlying moral principles being implicit and hidden behind practical concerns. Under these circumstances we tend to use consequentialist arguments about the benefits for the `individual` of having access to different practices and the risks involved. It is taken for granted that there are no moral imperatives that would contravene what is proposed.
Very little of the current debate examines perceived and morally explained obligations to family and society. These obligations can include on the one hand, obligations to die to make place for others or to spare grief to the family by dying earlier. On the other hand, they may be obligations to help the family grieve by not opting for a premature death, perhaps associated with feelings that it is necessary to help family members assuage their fears of death by living one`s dying days to the fullest. These obligations, depending upon individual concerns, can either encourage a premature death or promote living as long as possible. Both can be morally defensible. However, there is sometimes a thin line between the desire to die earlier for the sake of others and the choice of a premature death as a result of pressure to free up a bed needed for other patients, or family concerns about the high cost of care.
It is impossible to pretend that social pressures are not at play and that end of life decisions are devoid of external pressure and influence. It is important, to the extent possible, for individuals who must decide whether or not to approve a request for euthanasia or assisted suicide to be keenly aware of these potential pressures. Acknowledgment of these premises is critical for the creation of sensitive and coherent government policies. The main issue in the debate over the legalization of euthanasia and assisted suicide is the balance between respect for freedom of choice and the obligations of the state to protect citizens against their potentially distorted or unrealistic beliefs. Hitherto there has been a tendency to err more towards protecting life rather than respecting freedom of choice.
The obligation in The Netherlands is to alleviate suffering before having access to euthanasia or assisted suicide. That all other means must first be tried constitutes a moral middle ground between respecting individual freedom to choose to die and protecting citizens from making an irrevocable decision based upon the false premise that their suffering will be interminable. Finally, we cannot help wondering how much of the current desire to allow and support people in choosing how and when to die is a continuation of an age old attempt to assuage our fears that we all risk dying at a time that we do not want and in a manner that we cannot control. We live in an age where suffering is not valued, where we take medication to make us feel better when we are grieving, where all pain must be controlled and psychological angst can be reversed by a good therapist. In this context it is no wonder that the prospect of dying and anticipatory anxiety that the process of being terminally ill or incapacitated evokes, can be viewed as antithetical to all we have been trying to attain in our lives. If we cannot believe that death can be controlled or avoided, then the only options that remain in order to maintain psychological calm is to either accept a dying process that we can little control, while receiving palliative care for the pain and emotional suffering that may be associated, or to assert our autonomous personhood by cheating death of its haphazard destruction of the self. Finally, we should contemplate that if the desire to have governments facilitate our access to an earlier death by euthanasia or assisted suicide is related to our often unjustified fears of the dying process, then besides debating the legal, moral and practical concerns, we should also focus upon the psychological roots of our fears and examine ways to reduce those fears in individuals and societies.
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Nowadays, many exercised their right to die, few of them were Mr. Craig Ewert and Sir Edward Thomas Downes. Human rights also implies our right to die. If seen in the religious aspect, this claim is discouraged. On the medical aspect, it has its pros and cons. The right to die includes practices of euthanasia and assisted suicide. Euthanasia is “the deliberate act undertaken by one person with the intention of ending the life of another person in order to relieve the person`s suffering where the act is the cause of death”. On the other hand, assisted suicide needs another person provided assistance, by providing the means, by providing information about how to commit suicide, or both. In practice, assisted suicide generally involves providing lethal substances that one ingests in order to die. These practices differ from refusing treatment and withdrawing life sustaining treatment, where a “natural” death occurs without life being maintained by “artificial” means. The `double effect` in regard to end of life practices is when a physician provides only sufficient medication to completely arrest the pain and suffering, but that the effect of taking that medication in a sufficient amount to stop suffering has the side effect of accelerating death. There are ethical and practical distinctions of these practices which is further discussed in the paper. Suicide can be rationalized through logic and reality. But everyone is subject to the duty to die. But then again there exist a death customization given the right to die. There also exist an end of life practices in an ideal universe.
I. Introduction
II. People who exercised their right to die
A. Craig Ewert
B. Sir Edward Thomas Downes
III. Human Rights Arguments
IV. Religious Aspect
V. Medical Aspect
VI. Practices of euthanasia and assisted suicide
A. Definition of Euthanasia
B. Definition of Assisted suicide
C. Definition of Double Effect
VII. Ethical and Practical Distinctions
VIII. Rational Suicide: Logic and Reality
IX. The duty to die
X. Death customization
XI. End of life practices in an ideal universe
XII. Conclusion