Dr Paulina Taboada
Profesor Centro de Bioetica
Pontificia Universidad Catolica de Chile
Alameda 340 Correo Central 1
The Netherlands might be soon not the only country in the world in which euthanasia is legally permissible. The Belgian Senate is presently discussing a proposal to legalize euthanasia. Dutch law allows that a physician terminates the life of a patient on his voluntary, well-considered and sustained request, if the suffering is unbearable and hopeless. If approved, the Belgian legislation will be even more liberal than the Dutch one, in the sense that it would allow euthanasia not only for terminally ill, but also for chronically ill patients.
In the April 2002 number of Bioethics (Vol. 16, n. 2, pp. 154-172), a Dutch lawyer (J. De Haan) wrote an interesting article on "The Ethics of Euthanasia" analyzing the two main arguments provided to justify the "moral permissibility" of the practice of euthanasia in The Netherlands. In short, the most liberal view – referred to by the author as The Pure Autonomy View - sustains that the principle of respect for autonomy is the moral foundation of "legitimate euthanasia". The alternative view – called The Joint View – asserts that euthanasia is only ethical if the autonomous request is sanctioned by the principle of beneficence ("compassion"). Even though the author points out some of the pitfalls and shortcomings of both views, at the end of the paper the question of the justification for "legitimate euthanasia" remains open.
I do not intend to discuss here in depth either the different arguments presented in the paper or its conclusion. I have rather chosen to reflect on one of the paper’s ideas that I found to be specially valuable, namely a relevant clarification of the extension of quality-of-life judgments. The author states: "It is one thing to make a judgment about a person’s quality of life and quite another thing to make a judgment about a person’s value as a person, ‘as such’. Saying that a particular patient has not much quality-of-life left does not imply at all that he himself is not worthwhile." (De Haan 2002, p. 161).
The idea that quality-of-life judgments leave the right to life entirely intact is extremely relevant for shedding some light on the current debate on so-called "legitimate euthanasia". Indeed, these judgments do not need to be understood in way the Nazi ideology did: ein lebensunwertes Leben (‘a life that is not worth living’). Genuine compassion involves both the awareness of the particular content of another person’s suffering, and the awareness of the essential dignity of the person in her suffering. Hence, eliminating the person in order to eliminate her suffering cannot be conceived as a truly compassionate act, because the very ‘object’ of compassion would be eliminated this way: the suffering person. An authentically compassionate act intends to eliminate - or at least alleviate - the suffering and/or its sources, while affirming the value of the person who is suffering.
We should keep in mind that for evaluating the ethical character of any concrete medical act - like any free human act - the fundamental question that needs to be answered is always: "Which are the ethical principles or values that are actualised and/or violated through this act?" In other words, we have to ask: "Which kind of person and/or society do we want to become through our present decisions?" It remains to be seen what effects the tendency towards an individualised autonomy will yield within a context of declining solidarity in and an increasing economic pressure on the health care systems.
Dr. Paulina Taboada, MD, PhD
Palliative Care and Bioethics