By Sam Vaknin
Author of "Malignant Self Love - Narcissism Revisited"

I. Definitions of Types of Euthanasia

Euthanasia, whether in a medical setting (hospital, clinic, hospice) or not (at home) is often erroneously described as "mercy killing". Most forms of euthanasia are, indeed, motivated by (some say: misplaced) mercy. Not so others. In Greek, "eu" means both "well" and "easy" and "Thanatos" is death.

Euthanasia is the intentional premature termination of another person's life either by direct intervention (active euthanasia) or by withholding life-prolonging measures and resources (passive euthanasia), either at the express or implied request of that person (voluntary euthanasia), or in the absence of such approval (non-voluntary euthanasia). Involuntary euthanasia - where the individual wishes to go on living - is an euphemism for murder.

To my mind, passive euthanasia is immoral. The abrupt withdrawal of medical treatment, feeding, and hydration results in a slow and (potentially) torturous death. It took Terri Schiavo 13 days to die, when her tubes were withdrawn in the last two weeks of March 2005. Since it is impossible to conclusively prove that patients in PVS (Persistent Vegetative State) do not suffer pain, it is morally wrong to subject them to such potential gratuitous suffering. Even animals should be treated better. Moreover, passive euthanasia allows us to evade personal responsibility for the patient's death. In active euthanasia, the relationship between the act (of administering a lethal medication, for instance) and its consequences is direct and unambiguous.

As the philosopher John Finnis notes, to qualify as euthanasia, the termination of life has to be the main and intended aim of the act or omission that lead to it. If the loss of life is incidental (a side effect), the agent is still morally responsible but to describe his actions and omissions as euthanasia would be misleading. Volntariness (accepting the foreseen but unintended consequences of one's actions and omissions) should be distinguished from intention.

Still, this sophistry obscures the main issue:

If the sanctity of life is a supreme and overriding value ("basic good"), it ought to surely preclude and proscribe all acts and omissions which may shorten it, even when the shortening of life is a mere deleterious side effect.

But this is not the case. The sanctity and value of life compete with a host of other equally potent moral demands. Even the most devout pro-life ethicist accepts that certain medical decisions - for instance, to administer strong analgesics - inevitably truncate the patient's life. Yet, this is considered moral because the resulting euthanasia is not the main intention of the pain-relieving doctor.

Moreover, the apparent dilemma between the two values (reduce suffering or preserve life) is non-existent.

There are four possible situations. Imagine a patient writhing with insufferable pain.

1. The patient's life is not at risk if she is not medicated with painkillers (she risks dying if she is medicated)

2. The patient's life is not at risk either way, medicated or not

3. The patient's life is at risk either way, medicated or not

4. The patient's life is at risk if she is not medicated with painkillers

In all four cases, the decisions our doctor has to make are ethically clear cut. He should administer pain-alleviating drugs, except when the patient risks dying (in 1 above). The (possible) shortening of the patient's life (which is guesswork, at best) is immaterial.

Conclusions:

It is easy to distinguish euthanasia from all other forms of termination of life. Voluntary active euthanasia is morally defensible, at least in principle (see below). Not so other types of euthanasia.

II. Who is or Should Be Subject to Euthanasia? The Problem of Dualism vs. Reductionism

With the exception of radical animal rights activists, most philosophers and laymen consider people - human beings - to be entitled to "special treatment", to be in possession of unique rights (and commensurate obligations), and to be capable of feats unparalleled in other species.

Thus, opponents of euthanasia universally oppose the killing of "persons". As the (pro-euthanasia) philosopher John Harris puts it:

" ... concern for their welfare, respect for their wishes, respect for the intrinsic value of their lives and respect for their interests."

Ronald Dworkin emphasizes the investments - made by nature, the person involved, and others - which euthanasia wastes. But he also draws attention to the person's "critical interests" - the interests whose satisfaction makes life better to live. The manner of one's own death may be such a critical interest. Hence, one should have the right to choose how one dies because the "right kind" of death (e.g., painless, quick, dignified) reflects on one's entire life, affirms and improves it.

But who is a person? What makes us human? Many things, most of which are irrelevant to our discussion.

Broadly speaking, though, there are two schools of thought:

(i) That we are rendered human by the very event of our conception (egg meets sperm), or, at the latest, our birth; or

(ii) That we are considered human only when we act and think as conscious humans do.

The proponents of the first case (i) claim that merely possessing a human body (or the potential to come to possess such a body) is enough to qualify us as "persons". There is no distinction between mind and abode - thought, feelings, and actions are merely manifestations of one underlying unity. The fact that some of these manifestations have yet to materialize (in the case of an embryo) or are mere potentials (in the case of a comatose patient) does not detract from our essential, incontrovertible, and indivisible humanity. We may be immature or damaged persons - but we are persons all the same (and always will be persons).

Though considered "religious" and "spiritual", this notion is actually a form of reductionism. The mind, "soul", and "spirit" are mere expressions of one unity, grounded in our "hardware" - in our bodies.

Those who argue the second case (ii) postulate that it is possible to have a human body which does not host a person. People in Persistent Vegetative States, for instance - or fetuses, for that matter - are human but also non-persons. This is because they do not yet - or are unable to - exercise their faculties. Personhood is complexity. When the latter ceases, so does the former. Personhood is acquired and is an extensive parameter, a total, defining state of being. One is either awake or asleep, either dead or alive, either in a state of personhood or not

The latter approach involves fine distinctions between potential, capacity, and skill. A human body (or fertilized egg) have the potential to think, write poetry, feel pain, and value life. At the right phase of somatic development, this potential becomes capacity and, once it is competently exercised - it is a skill.

Embryos and comatose people may have the potential to do and think - but, in the absence of capacities and skills, they are not full-fledged persons. Indeed, in all important respects, they are already dead.

Taken to its logical conclusion, this definition of a person also excludes newborn infants, the severely retarded, the hopelessly quadriplegic, and the catatonic. "Who is a person" becomes a matter of culturally-bound and medically-informed judgment which may be influenced by both ignorance and fashion and, thus, be arbitrary and immoral.

Imagine a computer infected by a computer virus which cannot be quarantined, deleted, or fixed. The virus disables the host and renders it "dead". Is it still a computer? If someone broke into my house and stole it, can I file an insurance claim? If a colleague destroys it, can I sue her for the damages? The answer is yes. A computer is a computer for as long as it exists physically and a cure is bound to be found even against the most trenchant virus.

Conclusions:

The definition of personhood must rely on objective, determinate and determinable criteria. The anti-euthanasia camp relies on bodily existence as one such criterion. The pro-euthanasia faction has yet to reciprocate.

III. Euthanasia and Suicide

Self-sacrifice, avoidable martyrdom, engaging in life risking activities, refusal to prolong one's life through medical treatment, euthanasia, overdosing, and self-destruction that is the result of coercion - are all closely related to suicide. They all involve a deliberately self-inflicted death.

But while suicide is chiefly intended to terminate a life – the other acts are aimed at perpetuating, strengthening, and defending values or other people. Many - not only religious people - are appalled by the choice implied in suicide - of death over life. They feel that it demeans life and abnegates its meaning.

Life's meaning - the outcome of active selection by the individual - is either external (such as "God's plan") or internal, the outcome of an arbitrary frame of reference, such as having a career goal. Our life is rendered meaningful only by integrating into an eternal thing, process, design, or being. Suicide makes life trivial because the act is not natural - not part of the eternal framework, the undying process, the timeless cycle of birth and death. Suicide is a break with eternity.

Henry Sidgwick said that only conscious (i.e., intelligent) beings can appreciate values and meanings. So, life is significant to conscious, intelligent, though finite, beings - because it is a part of some eternal goal, plan, process, thing, design, or being. Suicide flies in the face of Sidgwick's dictum. It is a statement by an intelligent and conscious being about the meaninglessness of life.

If suicide is a statement, than society, in this case, is against the freedom of expression. In the case of suicide, free speech dissonantly clashes with the sanctity of a meaningful life. To rid itself of the anxiety brought on by this conflict, society cast suicide as a depraved or even criminal act and its perpetrators are much castigated.

The suicide violates not only the social contract but, many will add, covenants with God or nature. St. Thomas Aquinas wrote in the "Summa Theologiae" that - since organisms strive to survive - suicide is an unnatural act. Moreover, it adversely affects the community and violates the property rights of God, the imputed owner of one's spirit. Christianity regards the immortal soul as a gift and, in Jewish writings, it is a deposit. Suicide amounts to the abuse or misuse of God's possessions, temporarily lodged in a corporeal mansion.

This paternalism was propagated, centuries later, by Sir William Blackstone, the codifier of British Law. Suicide - being self-murder - is a grave felony, which the state has a right to prevent and to punish for. In certain countries this still is the case. In Israel, for instance, a soldier is considered to be "military property" and an attempted suicide is severely punished as "the corruption of an army chattel".

Paternalism, a malignant mutation of benevolence, is about objectifying people and treating them as possessions. Even fully-informed and consenting adults are not granted full, unmitigated autonomy, freedom, and privacy. This tends to breed "victimless crimes". The "culprits" - gamblers, homosexuals, communists, suicides, drug addicts, alcoholics, prostitutes – are "protected from themselves" by an intrusive nanny state.

The possession of a right by a person imposes on others a corresponding obligation not to act to frustrate its exercise. Suicide is often the choice of a mentally and legally competent adult. Life is such a basic and deep set phenomenon that even the incompetents - the mentally retarded or mentally insane or minors - can fully gauge its significance and make "informed" decisions, in my view.

The paternalists claim counterfactually that no competent adult "in his right mind" will ever decide to commit suicide. They cite the cases of suicides who survived and felt very happy that they have - as a compelling reason to intervene. But we all make irreversible decisions for which, sometimes, we are sorry. It gives no one the right to interfere.

Paternalism is a slippery slope. Should the state be allowed to prevent the birth of a genetically defective child or forbid his parents to marry in the first place? Should unhealthy adults be forced to abstain from smoking, or steer clear from alcohol? Should they be coerced to exercise?

Suicide is subject to a double moral standard. People are permitted - nay, encouraged - to sacrifice their life only in certain, socially sanctioned, ways. To die on the battlefield or in defense of one's religion is commendable. This hypocrisy reveals how power structures - the state, institutional religion, political parties, national movements - aim to monopolize the lives of citizens and adherents to do with as they see fit. Suicide threatens this monopoly. Hence the taboo.

Does one have a right to take one's life?

The answer is: it depends. Certain cultures and societies encourage suicide. Both Japanese kamikaze and Jewish martyrs were extolled for their suicidal actions. Certain professions are knowingly life-threatening - soldiers, firemen, policemen. Certain industries - like the manufacture of armaments, cigarettes, and alcohol - boost overall mortality rates.

In general, suicide is commended when it serves social ends, enhances the cohesion of the group, upholds its values, multiplies its wealth, or defends it from external and internal threats. Social structures and human collectives - empires, countries, firms, bands, institutions - often commit suicide. This is considered to be a healthy process.

More about suicide, the meaning of life, and related considerations - HERE.

Back to our central dilemma:

Is it morally justified to commit suicide in order to avoid certain, forthcoming, unavoidable, and unrelenting torture, pain, or coma?

Is it morally justified to ask others to help you to commit suicide (for instance, if you are incapacitated)?

Imagine a society that venerates life-with-dignity by making euthanasia mandatory (Trollope's Britannula in "The Fixed Period") - would it then and there be morally justified to refuse to commit suicide or to help in it?

Conclusions:

Though legal in many countries, suicide is still frowned upon, except when it amounts to socially-sanctioned self-sacrifice.

Assisted suicide is both condemned and illegal in most parts of the world. This is logically inconsistent but reflects society's fear of a "slippery slope" which may lead from assisted suicide to murder.

IV. Euthanasia and Murder

Imagine killing someone before we have ascertained her preferences as to the manner of her death and whether she wants to die at all. This constitutes murder even if, after the fact, we can prove conclusively that the victim wanted to die.

Is murder, therefore, merely the act of taking life, regardless of circumstances - or is it the nature of the interpersonal interaction that counts? If the latter, the victim's will counts - if the former, it is irrelevant.

V. Euthanasia, the Value of Life, and the Right to Life

Few philosophers, legislators, and laymen support non-voluntary or involuntary euthanasia. These types of "mercy" killing are associated with the most heinous crimes against humanity committed by the Nazi regime on both its own people and other nations. They are and were also an integral part of every program of active eugenics.

The arguments against killing someone who hasn't expressed a wish to die (let alone someone who has expressed a desire to go on living) revolve around the right to life. People are assumed to value their life, cherish it, and protect it. Euthanasia - especially the non-voluntary forms - amounts to depriving someone (as well as their nearest and dearest) of something they value.

The right to life - at least as far as human beings are concerned - is a rarely questioned fundamental moral principle. In Western cultures, it is assumed to be inalienable and indivisible (i.e., monolithic). Yet, it is neither. Even if we accept the axiomatic - and therefore arbitrary - source of this right, we are still faced with intractable dilemmas. All said, the right to life may be nothing more than a cultural construct, dependent on social mores, historical contexts, and exegetic systems.

Rights - whether moral or legal - impose obligations or duties on third parties towards the right-holder. One has a right AGAINST other people and thus can prescribe to them certain obligatory behaviors and proscribe certain acts or omissions. Rights and duties are two sides of the same Janus-like ethical coin.

This duality confuses people. They often erroneously identify rights with their attendant duties or obligations, with the morally decent, or even with the morally permissible. One's rights inform other people how they MUST behave towards one - not how they SHOULD or OUGHT to act morally. Moral behavior is not dependent on the existence of a right. Obligations are.

To complicate matters further, many apparently simple and straightforward rights are amalgams of more basic moral or legal principles. To treat such rights as unities is to mistreat them.

Take the right to life. It is a compendium of no less than eight distinct rights: the right to be brought to life, the right to be born, the right to have one's life maintained, the right not to be killed, the right to have one's life saved, the right to save one's life (wrongly reduced to the right to self-defence), the right to terminate one's life, and the right to have one's life terminated.

None of these rights is self-evident, or unambiguous, or universal, or immutable, or automatically applicable. It is safe to say, therefore, that these rights are not primary as hitherto believed - but derivative.

ABOUT THE AUTHOR

Sam Vaknin is the author of Malignant Self Love - Narcissism Revisited and 25 other books. He served as a columnist for Global Politician, Central Europe Review, PopMatters, Bellaonline, and eBookWeb, a United Press International (UPI) Senior Business Correspondent, and the editor of mental health and Central East Europe categories in The Open Directory and Suite101 as well as the Economic Advisor to the Government of Macedonia. Visit Sam's Web site at http://samvak.tripod.com