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the degree of suffering, nor the incurable condition of the person |
killed, is a defence to a charge of murder. Advocates of voluntary |
euthanasia propose that this law be changed so that a doctor |
could legally act on a patient's desire to die without further |
suffering. Doctors have been able to do this quite openly in the |
Netherlands, as a result of a series of court decisions during the |
1980s, as long as they comply with certain conditions. In Germany, |
doctors may provide a patient with the means to end her |
life, but they may not administer the substance to her. |
The case for voluntary euthanasia has some common ground |
with the case for non-voluntary euthanasia, in that death is a |
benefit for the one killed. The two kinds of euthanasia differ, |
however, in that voluntary euthanasia involves the killing of a |
person, a rational and self-conscious being and not a merely |
conscious being. (To be strictly accurate it must be said that this |
is not always so, because although only rational and self-conscious |
beings can consent to their own deaths, they may not be |
rational and self-conscious at the time euthanasia is contemplated |
- the doctor may, for instance, be acting on a prior written |
request for euthanasia if, through accident or illness, one's rational |
faculties should be irretrievably lost. For simplicity we |
shall, henceforth, disregard this complication.) |
We have seen that it is possible to justify ending the life of a |
193 |
Practical Ethics |
human being who lacks the capacity to consent. We must now |
ask in what way the ethical issues are different when the being |
is capable of consenting, and does in fact consent. |
Let us return to the general principles about killing proposed |
in Chapter 4. I argued there that killing a self-conscious being |
is a more serious matter than killing a merely conscious being. |
I gave four distinct grounds on which this could be argued: |
The classical utilitarian claim that since self-conscious beings |
are capable of fearing their own death, killing them has worse |
effects on others. |
2 The preference utilitarian calculation that counts the thwarting |
of the victim's desire to go on living as an important reason |
against killing. |
3 A theory of rights according to which to have a right one must |
have the ability to desire that to which one has a right, so that |
to have a right to life one must be able to desire one's own |
continued existence. |
4 Respect for the autonomous decisions of rational agents. |
Now suppose we have a situation in which a person suffering |
from a painful and incurable disease wishes to die. If the individual |
were not a person - not rational or self-conscious - |
euthanasia would, as I have said, be justifiable. Do any of the |
four grounds for holding that it is normally worse to kill a person |
provide reasons against killing when the individual is a person |
who wants to die? |
The classical utilitarian objection does not apply to killing that |
takes place only with the genuine consent of the person killed. |
That people are killed under these conditions would have no |
tendency to spread fear or insecurity, since we have no cause |
to be fearful of being killed with our own genuine consent. If |
we do not wish to be killed, we simply do not consent. In fact, |
the argument from fear points in favour of voluntary euthanasia, |
for if voluntary euthanasia is not permitted we may, with good |
cause, be fearful that our deaths will be unnecessarily drawn |
out and distressing. In the Netherlands, a nationwide study |
commissioned by the government found that 'Many patients |
194 |
Taking Life: Humans |
want an assurance that their doctor will assist them to die should |
suffering become unbearable: Often, having received this assurance, |
no persistent request for euthanasia eventuated. The |
availability of euthanasia brought comfort without euthanasia |
having to be provided. |
Preference utilitarianism also points in favour of, not against, |
voluntary euthanasia. Just as preference utilitarianism must |
count a desire to go on living as a reason against killing, so it |
must count a desire to die as a reason for killing. |
Next, according to the theory of rights we have considered, |
it is an essential feature of a right that one can waive one's |
rights if one so chooses. I may have a right to privacy; but I |
can, if I wish, film every detail of my daily life and invite the |
neighbours to my home movies. Neighbours sufficiently intrigued |
to accept my invitation could do so without violating |
my right to privacy, since the right has on this occasion been |
waived. Similarly, to say that I have a right to life is not to say |
that it would be wrong for my doctor to end my life, if she does |
so at my request. In making this request I waive my right to |
life. |
Lastly, the principle of respect for autonomy tells us to allow |
rational agents to live their own lives according to their own |
autonomous decisions, free from coercion or interference; but |
if rational agents should autonomously choose to die, then respect |
for autonomy will lead us to assist them to do as they |
choose. |
So, although there are reasons for thinking that killing a selfconscious |
being is normally worse than killing any other kind |
of being, in the special case of voluntary euthanasia most of |
these reasons count for euthanasia rather than against. Surprising |
as this result might at first seem, it really does no more |
than reflect the fact that what is special about self-conscious |
beings is that they can know that they exist over time and will, |
unless they die, continue to exist. Normally this continued existence |
is fervently desired; when the foreseeable continued ex- |
195 |
Practical Ethics |
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