3rd Year
Assessment 3 – Research Essay – Death, Grief and Culturec
Human beings suffering from terminal illness should be able to decide the manner and timing of their own death. Discuss.
The argument of ethics and morality behind the practice of euthanasia is a very controversial topic with various aspects that need to be considered. The question of whether terminally ill individuals should have access is central to the argument, with issues defining “torment” or “pain”. Examples of conditions commonly discussed include terminal cancers, progressive neurological diseases such as dementia or motor neuron disease, and treatment-resistant mental illnesses. Ethical, legal and philosophical debates are therefore incredibly conflicting regarding the “ending of an individual’s life”, and the inclusion of neurological diseases such as dementia adds further ethical complexity, where the notion of autonomy and the ability to decide becomes central to the ethical debate. Pivotal to the discourse of my discussion is the idea of ethics and morals regarding the euthanasia of individuals. To briefly outline, these factors include philosophical and ethical considerations, legal frameworks and international standards, religious and moral objections, medical ethics, and professional duties related to end-of-life care, its safeguards, and social implications. This essay will examine these issues through the lens of ethical, legal, and philosophical values. The argument states that human beings suffering from terminal illnesses should have the fundamental right to decide the timing and manner of their death, with the inclusion of strict legal safeguards and ethical considerations being met.
Central to my argument is the ideology of autonomy and sanctity of life, arguing that terminally ill individuals should be permitted to choose the manner of their death, under strictly guided legal safeguards. Emanuel, Fairclough and Emanuel (2000) state that “Patients facing terminal illnesses often experience a profound loss of autonomy and dignity; the wish for euthanasia frequently arises not merely from physical pain but from the anticipation of dependence and loss of self” (p. 468). The argument therefore creates a recognition between personal freedom, dignity of the individual and primarily the relief from suffering an incurable disease. It is also essential to note ethical and moral concerns regarding vulnerability, coercion and the sanctity of life. However, sovereignty becomes complicated in cases such as dementia or motor neuron disease, where decision-making capacity deteriorates. Furthermore, Ezekiel Emanuel (2002) asserts that “The desire for control, autonomy, and dignity are among the most frequently cited reasons patients request physician-assisted suicide” (p. 194), further reinforcing that self-determination and dignity are central motivations. This demonstrates that while autonomy promotes ethical support for euthanasia, its application complicates conditions that cause an erosion of cognitive independence. Simultaneously, these perspectives reinforce that self-determination and a strong sense of dignity establish the foundation for voluntary euthanasia.
Euthanasia (Greek for ‘good death’) refers to the deliberate ending of an individual’s life to relieve suffering, in most cases due to terminal or incurable illnesses. There are three distinct forms of assisted suicide: euthanasia (active and passive), physician-assisted suicide and voluntary assisted suicide. They differ in practice, in ethical and moral philosophy, and predominantly in the global location of legality. The following discussion outlines each form, its ethical and legal implications, and its associated dimensions.
Voluntary euthanasia, both active and passive, is the intentional act of ending a patient’s life to relieve pain and suffering, usually in a legalised manner, such as lethal injection or prescribed medications. Active euthanasia involves direct action to cause death, whilst passive euthanasia involves inaction that allows death. Qualified doctors generally undertake this when there is no cure for the illness, such as terminal cancers and multiple neurological disorders. Voluntary euthanasia isn’t commonly legalised, and individuals need to travel to countries such as the Netherlands, Luxembourg, Canada and some Australian states under strict regulations. Whilst active euthanasia involves the patient’s consent, passive euthanasia includes the withdrawal of both life-conserving services, including ventilators, feeding tubes, or life-prolonging medication. This practice often involves joint consent between patients, families, and doctors. Situations such as brain death, comas, vegetative states, and injuries that have no chance of survival are often cases for passive euthanasia. Terri Schiavo is a prominent case for passive euthanasia; she was in a vegetative state for fifteen years, prompting legal battles, and eventually had her feeding tube removed in 2005, sparking global discussion regarding vegetative patients and life-prolonging treatments. The distinction between active and passive euthanasia raises significant ethical questions about intent versus omission in medical practice. A Do Not Resuscitate (DNR) represents a passive choice, allowing death through inaction, aligning very closely with passive euthanasia.
Assisted Dying is a practice where a doctor prescribes life-ending medication, yet the patient administers it themselves. This form of euthanasia is practised in American states such as Oregon and California, alongside countries such as Switzerland. There are also cases of illegal physician-assisted euthanasia, such as that of Dr Jack Kevorkian (1928–2011), often referred to as “Dr Death.” Between 1990 and 1998, he assisted more than 130 terminally ill patients in ending their lives, representing the practice of physician-assisted suicide before legal frameworks were established. His practices influenced Oregon’s Death with Dignity Act (1997), legalising Physician-Assisted Suicide under strict guidelines: “An adult who is capable, is a resident of Oregon, and has been determined by an attending physician and a consulting physician to be suffering from a terminal disease, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner” (Oregon Revised Statutes §127.805). This demonstrates a model where autonomy, dignity and compassion can coexist within a regulated system. An example of assisted suicide is Brittany Maynard (2014), who, after being diagnosed with terminal brain cancer, underwent physician-assisted suicide under Oregon’s legal system. The prominent distinction with physician-assisted suicide is the various legal and ethical frameworks that are necessary, as it involves patient autonomy. Australia’s model of assisted dying reflects similar principles of autonomy to Oregon’s but operates under distinctly stricter legal supervision. Australia’s legal framework reflects the equilibrium between compassion and humanity that lies at the centre of the euthanasia debate.
Victoria was the first Australian state to legalise euthanasia under strict guidelines, through the Voluntary Assisted Dying Act of 2017: stating “The purpose of this Act is to provide for and regulate access to voluntary assisted dying and to establish the Voluntary Assisted Dying Review Board” (Voluntary Assisted Dying Act 2017). Voluntary assisted dying (Australia’s euthanasia model) requires a mentally competent individual with a terminal illness to succeed through legal safeguards to end their life through prescribed medications, either self-administered or by a medical professional. The eligibility requirements of the Australian euthanasia process include terminal illness with a short prognosis, the individual must be of mature age (18 years old), multiple requests must be submitted, and permission from two independent doctors with oversight from the “Voluntary Assisted Dying Review Board” must be met. The legal parameters of Victoria’s euthanasia act demonstrate that assisted death can be legally and ethically managed.
The ethical and moral dilemma with respect to Australia’s euthanasia process is that the individual must have self-autonomy and the ability to decide for voluntary assisted dying; individuals suffering from neurological disorders are therefore not permitted. Rurup, Onwuteaka-Philipsen and van der Wal (2005) explain, “Advanced dementia challenges conventional frameworks of autonomy; as cognitive decline progresses, patients lose decision-making capacity, leaving families and physicians in ethically ambiguous positions regarding end-of-life choices” (p. 667). The suffering involved with late-stage dementia is immense; the complication arises with who has the autonomy to provide euthanasia for their loved ones with neurological disorders. Inability of independence extends to individuals being provided passive end-of-life care—persons with severe brain damage who are unable to recover, having their life support turned off, such as feeding tubes or automated breathing machines. The ethical and moral dilemmas are therefore complicated by factors extending beyond terminal illnesses.
Opposition to euthanasia often arises from the argument of sanctity of life, a religious position which argues it is only under God’s will when a person can perish, valuing individuals beyond their illness. Within religious practices such as Protestantism and Catholicism, life is sacred. Christian principles redeem “that life is a gift from God and only God should decide when it ends; euthanasia is seen as rejecting God’s sovereignty” (BBC, 2014). Therefore, euthanasia is condemned as sacrilege. This perspective is shared amongst Islamic beliefs, where life is a trust from Allah, and ending your life prematurely is sinful. The DNR act extends to religious beliefs such as the Amish and Jewish communities, which don’t accept medical intervention such as blood transfusions. Whilst most religious sects refuse euthanasia, their acceptance of life-saving medical intervention illustrates recognition of natural death and spiritual autonomy, further providing real-world diversity regarding modern medicine and the death of an individual.
Ethics and morality extend to medical professionals who typically save lives, and how their care extends to end-of-life care and the practice of euthanasia. Medical professionals practice under the “Hippocratic oath”, a tradition dating back to the Greek physician Hippocrates (460 BCE), which declares that doctors “do not harm” and focus on providing beneficial care while avoiding any negative harm to patients—yet is prolonging life occasionally harming the individual? The Victorian euthanasia act extends to doctors the right to deny end-of-life care under ethical and moral principles. The ethical principles often accepted by medical professionals include the right to autonomy, where “Respect for autonomy requires acknowledging a person’s right to hold views, make choices, and take actions based on personal values and beliefs” (Beauchamp & Childress, 2013, p. 106). This principle aligns directly with arguments for patient-centred end-of-life decisions that act in the best interests of patients and ensure fair access to end-of-life care, such as pain relief. Palliative care and hospice are provided to any individual suffering from terminal illness, whilst doctors may refuse euthanasia under moral and ethical guidelines.
To further the discussion, this section examines the safeguards and legality that protect individuals from malpractice. The concerns with safeguards include the elderly and individuals with neurological disorders who may accept euthanasia out of fear or coercion. Multiple legal safeguards protect individuals from fear or coercion; these include independent medical assessments, psychological evaluations, written and verbal consent, and oversight by the Voluntary Assisted Dying Review Board. Therefore, there are strong and heavily enforced structures in place to ensure that euthanasia is in the best interest of the patient and to negate any fear or coercion of any measure. Although there is a fear of coercion, the Victorian Board has ensured that no known cases of coercion have occurred; accordingly, the safeguards function as intended to protect individuals. Safeguards ensure that ethical integrity is upheld and require the public’s trust in the euthanasia process.
Social and psychological dilemmas challenge family members, healthcare staff and society as they experience issues with terminal illnesses. However, some families experience closure from seeing a loved one at peace after being provided euthanasia treatment. Others are forced to witness the gradual decline in ability, and the torment individuals may experience. As a result, this challenges moral and ethical perspectives in ways that haven’t been considered before. Some may struggle emotionally or with guilt, and some healthcare professionals may need ongoing counselling and support services to manage what they have witnessed. Although some nurses may feel accomplished with their patients passing away without pain, others may experience a traumatic death. For our society to approach death and disease correctly, we need to understand life’s value, but also the freedom of passing away without prolonged suffering. Amongst witnessing friends or family passing, “In Australia, approximately 70% of adults support voluntary assisted dying for terminally ill patients experiencing unrelievable suffering” (Pew Research Centre, 2018). This statistic reflects our society’s understanding of dignity, autonomy, and, most importantly, the quality of life. Consequently, it is established that end-of-life care affects not only the patient but also the medical staff and both close and extended family.
Illustrating ethical cases of voluntary euthanasia, I will use the case studies of Brittany Maynard, a 29-year-old American woman who was diagnosed with terminal brain cancer. Her prognosis was six months, and facing terrible symptoms, her reaction was to move to Oregon, and under the Dignity Act of 2014, she was able to undertake legally approved physician-assisted euthanasia to alleviate pain and remain with dignity. Her case depicts the perfect situation of autonomy in euthanasia, practised legally and properly through each medical requirement. Her assisted death promoted physician-assisted euthanasia internationally, with the U.S. state of California and Canada being impacted and influencing law reform. Her case identifies her own choice over her body, to end her life before experiencing what would have been a terrible death.
My second case study is Terri Schiavo, regarding passive euthanasia under life support. She suffered cardiac arrest in 1990, leaving her in a persistent vegetative state, meaning no brain function or state of “being”, sustained through a feeding tube. Her case demonstrates family conflict and legal battles. Her husband wanted her feeding tube to be removed so Terri could be at rest, whilst her parents wanted her to remain “alive”. The legal process between the family and the husband was extensive, involving both federal and state courts. In 2005, her feeding tube was removed, and she passed away through passive euthanasia. This case sparks debate around autonomy, familial rights and state intervention for end-of-life processes.
Dr Jack Kevorkian, otherwise known as “Dr Death” (1922–2011), assisted over 130 terminally ill patients in ending their lives between the 1990s and 1998, before assisted death was legalised in American states. He created a machine to assist the euthanasia of individuals in the comfort of their own home, ironically called “Mercitron”, which helped patients inject the life-ending medications. Dr Kevorkian strongly believed in autonomy in death, the ability to choose death when life is unbearable, therefore giving a humane method of physician-assisted euthanasia, seeing euthanasia as a humane principle even in the face of illegality. His campaign inspired Oregon’s Death with Dignity Act of 1997 and further shaped global perspectives on autonomy and the necessary legal boundaries.
A fascinating introduction to the debate of euthanasia and ethics involves the euthanasia of pets and animals, often framed as compassion in ending their suffering. This raises vast ethical inconsistencies within society. Why do we provide this service so readily and not extend the same notion to human life? The conversation becomes more contradictory: animals are put down without autonomy to make the decision, whilst individuals who are in pain are denied autonomy. This illustrates the comparisons between the moral boundaries of our society, the creation of contradictions and whether preserving life at all costs is genuine passion and care for the sick individual.
Academic studies of euthanasia provide accounts of philosophy and ethics in relation to assisted death. Ideologies such as utilitarianism, deontology, and virtue ethics strain the argument of both the positives and the consequences of permitting euthanasia. Utilitarianism holds that if euthanasia reduces the suffering of an individual to increase overall well-being, then the action is morally justifiable. Brittany Maynard is a perfect candidate for the utilitarian approach to euthanasia, who ended her own life on her own terms, eliminating prolonged suffering not only for herself but also for her loved ones around her. The utilitarian act itself is promoted by maximising happiness and reducing sadness, ultimately stating that if euthanasia benefits the individual and those surrounding them, then it is morally acceptable.
Deontology, as an ethical framework, directly contests utilitarianism, an ideology that holds that any death of an individual is wrong, regardless of its context. The deontological perspective argues that assisted death is in direct conflict with the human duty to preserve life, thereby disrespecting the worth of human life. This ideology can be correlated to religious perspectives of death, leading to the premature ending of life as a sinful act, as explored in both Christian and Islamic texts. Therefore, from a deontologist’s perspective, Dr Jack Kevorkian, even though motivated to end human suffering, diverges and becomes morally impermissible, regardless of intention. Essentially, from the deontologist perspective, life is sacred, and prolonging life holds more ethical and moral value than providing euthanasia.
Virtue ethics, a moral philosophy rooted in Aristotle’s Nicomachean Ethics, emphasises individual character, compassion, and wisdom. This philosophical perspective advocates for compassionate end-of-life care aimed at reducing suffering. The application of removing pain and torment from a suffering individual via euthanasia, if practised morally and ethically, can be recognised as morally praiseworthy. Virtue ethics therefore separates itself from utilitarianism and deontology as ethically acceptable and permitted when correct morality and ethics are practised.
My discussion introduced the three fundamental forms of euthanasia: active euthanasia, involving a direct action to end life such as a lethal injection; passive euthanasia, referring to the withdrawal or withholding of life-sustaining treatment; and physician-assisted euthanasia, in which a doctor provides the means for a patient to end their own life. Voluntary assisted dying, as legalised under strict frameworks such as Victoria’s Voluntary Assisted Dying Act 2017 (Vic), represents the regulated form of physician assistance in contemporary medical ethics. These forms were illustrated through case studies including Brittany Maynard and Dr Jack Kevorkian, whose actions generated global debate on the boundaries between ethicality, compassion, legality, and moral responsibility in end-of-life care.
In my discussion, I have also analysed religious objections, such as Christianity and Islam’s doctrine of the sanctity of life, while portraying the Do-Not-Resuscitate (DNR) directive and its relevance to religious sects such as the Amish. My analysis has examined legal models in Victoria, Belgium, the United States — particularly Oregon — and Canada, illustrating how law interacts with moral reasoning. I elaborated on how legal safeguards prevent coercion and misuse of the practice, while also addressing the social and psychological impacts on families and healthcare professionals who encounter euthanasia in practice. Although legality and morality provide the framework for euthanasia, religious belief systems frequently exclude themselves from modern medical treatment, including lifesaving interventions, and by extension dismiss the practice of euthanasia as contrary to divine law.
Conclusively, an industrialised and modern society should understand that, in an ethical and compassionate world, every individual deserves the right to a dignified death. The practice of euthanasia, when governed by rigorous legal and ethical oversight, reflects not the devaluation of life but its affirmation through choice, dignity, and humanity. The autonomy to determine the timing and manner of one’s own death embodies both moral courage and respect for human suffering, aligning medicine with the principles of compassion and freedom that define a truly humane society.
References
Aristotle. (2009). Nicomachean ethics (W. D. Ross, Trans.). Oxford University Press. (Original work published ca. 350 BCE)
BBC. (2014). Religion and ethics: Euthanasia. https://www.bbc.co.uk/ethics/euthanasia/religion/religion.shtml
Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). Oxford University Press.
Emanuel, E. J. (2002). Euthanasia and physician-assisted suicide: A review of the empirical data from the United States. Archives of Internal Medicine, 162(2), 142–152. https://doi.org/10.1001/archinte.162.2.142
Emanuel, E. J., Fairclough, D. L., & Emanuel, L. L. (2000). Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. JAMA, 284(19), 2460–2468. https://doi.org/10.1001/jama.284.19.2460
Oregon Health Authority. (1997). Death with Dignity Act. Oregon Revised Statutes § 127.800–127.897. https://www.oregon.gov/oha/PH/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx
Pew Research Center. (2018). Public opinion on assisted dying. https://www.pewresearch.org/
Rurup, M. L., Onwuteaka-Philipsen, B. D., & van der Wal, G. (2005). Cases of euthanasia and physician-assisted suicide in the Netherlands for patients with psychiatric disorders or dementia. Psychological Medicine, 35(5), 667–676. https://doi.org/10.1017/S0033291704004119
Singer, P. (1993). Practical ethics (2nd ed.). Cambridge University Press.
Victorian Government. (2017). Voluntary Assisted Dying Act 2017 (Vic). https://www.legislation.vic.gov.au/in-force/acts/voluntary-assisted-dying-act-2017/003
