Thoughts on economics and liberty

Euthanasia is justifiable subject to stringent checks and balances

While revising the section re: fast unto death in DOF, I thought I'd share my views on euthanasia (which are part of that section which analyses to what extent, if any, are we free to injure ourselves) so I can get your comments on this important topic.

As usual, these are provisional views. My final views will be documented in the version of DOF that is finally published (if ever!).


Where there is no hope of medical relief from totally unbearable pain and suffering, and one has otherwise lived long enough and well, and met one’s obligations, euthanasia can be a potentially ethical option. In choosing his death the sufferer of pain could still end up harming others, although such claims of harm are weakened because of the severity of pain – one’s loved ones will likely feel better through one’s peaceful death and relief from pain. One of the real problems, of course, is that except for extreme cases, we still hope that science will discover some way to ease pain.

On a practical level, the process of authorising euthanasia remains a major problem. How does one know for sure that the pain someone is experiencing is ‘severe enough’ to warrant euthanasia? Even if a particular proposal for euthanasia has merit, how can we prevent its use (or misuse) by mentally depressed people or by those without adequate rational capacity? Psychologists almost invariably differ in their diagnoses, as well. We must also ensure that opportunistic psychologists or doctors aren’t bribed to kill, for that would not be euthanasia but murder. Given the many potential risks that attend the practice of euthanasia, Rawls and Nozick both agreed to stringent procedural regulation, thus:

[The state] may not deny [terminally-ill patients in agonizing pain who feel doomed to an existence they regard as intolerable] … the opportunity to demonstrate, through whatever reasonable procedures the state might institute – even procedures that err on the side of caution.[1]
It is apparent, therefore, that if cast-iron processes can be devised, euthanasia can be legitimised. To control risks, the euthanasia processes would have to be transparent and judicious. Expert evidence would need to be considered – perhaps by a randomly selected jury. The authorisation for euthanasia would follow diligent inquiry broadly on par with a murder trial (albeit far more expeditious and empathetic).
The state of Oregon in USA legalised euthanasia in 1997 through its Death with Dignity Act. Under this act the ‘patient’ who seeks lethal medicine must fulfil the following steps:
1) the patient must make two oral requests to the attending physician, separated by at least 15 days; 2) the patient must provide a written request to the attending physician, signed in the presence of two witnesses, at least one of whom is not related to the patient; 3) the attending physician and a consulting physician must confirm the patient’s diagnosis and prognosis; 4) the attending physician and a consulting physician must determine whether the patient is capable of making and communicating health care decisions for him/herself; 5) if either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder (such as depression), the patient must be referred for a psychological examination; 6) the attending physician must inform the patient of feasible alternatives to the Act including comfort care, hospice care, and pain control; 7) the attending physician must request, but may not require, the patient to notify their next-of-kin of the prescription request. A patient can rescind a request at any time and in any manner.[2]
Careful evaluations of this system in the coming years could help devise a system that can be globally adopted. Indeed, a study published in 2007 reported that there was ‘no evidence of heightened risk for the elderly, women, the uninsured, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations’.[3] That is a positive sign, and shows that euthanasia can be appropriately managed (I wouldn’t recommend it for a country like India at the moment, though, where governance is in shambles).

[1] ‘Brief of Ronald Dworkin, Thomas Nagel, Robert Nozick, John Rawls, Thomas Scanlon, and Judith Jarvis Thomson as Amici Curiae in Support of Respondents’, in Issues in Law & Medicine, Fall, 1999. []

[3] Battin, P. et al., ‘Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups’ in Journal of Medical Ethics 2007;33:591–597.

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