A very difficult area to understand and discuss is that of suicide. As May (1983, p. 86) well puts it, ''The suicide reminds us of the deeper fault of a medical profession defined exclusively by the fight against death. Its sins are not simply those of excess in battle, a too-fanatical commitment to life at all costs, but also those of defect, a too-limited sense of the way beyond the battle to life and health.''
There are a number of writers and philosophers in the christian era who have defended man's freedom to commit suicide, for example, David Hume (1963) in his Essay on Suicide. The arguments that have been used in favor of voluntary positive euthanasia include the following: (1) The life of the suffering person has become useless to his family, society, and himself. A healthy person may not commit suicide because he has many duties he is morally obliged to fulfill toward his family, society, and his own development. The terminally ill have no more duties because they are incapable of carrying them out. (2) One has to choose the lesser evil. The prolongation of useless suffering is a greater evil than procuring immediate death, a death coming anyway within a short time. (3) It is inhuman and unreasonable to keep a terminally ill patient alive when he does not want to live. (4) One who does not believe in God can reasonably conclude that man is the master of his own life; therefore, he can freely choose.
(5) Man's freedom to act should not be restricted unless there are convincing arguments that his freedom to act comes into conflict with the rights of others.
(6) Voluntary positive euthanasia is an act of kindness toward one's family and society because the terminally ill person chooses not to burden them with his or her prolonged illness, expenses, and all the work of caring for a gravely ill patient. It is better to free scarce medical and financial resources to be employed in curing those who can lead a useful life. (7) Believers hold that God gave us our life, but it does not follow from this that we may not interfere in our lives, because God made us stewards of our lives. It is reasonable to assume that God does not want us to suffer unnecessarily when we can easily terminate our misery.
In the Western tradition, theistic philosophy has opposed direct killing of self either alone or with help from others. The main argument for this position is that God has direct dominion over human life; we are managers of our lives but do not own them; we may not destroy them. We cannot decide our beginning and we cannot decide our end. Although this is valid on the basis of theistic philosophy, it does not convince everybody, possibly not even the believer. The question that persons must answer for themselves is this: What are my spiritual values?
Voluntary passive euthanasia is the refusal of treatment. The right of a competent patient to refuse treatment is generally recognized in Western legal tradition. Is it morally justifiable? We have a moral duty to restore our health to fulfill our duty in life; however, many believe that it is not wrong to refuse treatment that is useless. Is there a natural right to die when our time comes? Rights are derived from natural needs and duties.
One of the practical difficulties of exercising the right to die is the fact that many patients are taken to the hospital in a critical condition that prevents them from revealing their will not to be placed on life-supporting machines. The living will is intended to remedy this situation. Questions that routinely arise around this issue include the following: Is it moral to let an incompetent terminally ill patient die by not starting or by stopping useless treatment? If a terminally ill and mentally competent patient may refuse useless therapy, shouldn't the guardians of a mentally incompetent patient have the same right? Is it morally right in the case of a terminally ill, mentally incompetent patient not to start useless treatment or to stop such therapy by turning off the machine or ''pulling the plug''? Who is entitled to make such a decision?
The controversy over euthanasia is about the moral difference between action and inaction, commission and omission. According to sound ethical principles, we are never allowed to perform an act that directly violates the rights of others, but we are not always obliged to perform an act that would save others from injury.
Patients cannot make a well-informed decision about whether or not to refuse treatment unless doctors tell them the truth about their illness. A solid ethical principle is that everyone has a right to the truth unless he or she has forfeited his or her right to it or indicates that he or she does not want to hear the truth, does not want to be informed.
Embedded in all of these positions and arguments is one overarching fact: the terminally ill have spiritual needs that will play an important role in their impending death and when it will or should take place. These needs include a search for meaning in life and death, a sense of forgiveness for oneself and others, a need for love, and a need for hope (Conrad, 1985). For many, their spiritual needs include a trust in a higher power, a sense of connectedness with the world, and a need to live to the fullest (Mudd, 1981).
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