A Comparative Perspective Concerning Euthanasia and Physician-Assisted Suicide

Abstract

The literature on the issue of euthanasia has agreed that euthanasia is one of the most controversial topics that has been debated for decades. This dissertation does not claim to resolve the controversy over euthanasia completely, but it contributes to the ongoing debate about euthanasia, by providing a comprehensive and accurate analysis of this complex issue, especially as it compares two countries that greatly differ from a cultural point of view (Saudi Arabia and the United States). This comparison reviews the legal, religious, ethical, and medical views of the different forms of euthanasia in the two countries. Because euthanasia as considered in the literature encompasses different meanings, leading to some conflict, resolving these differences is this work’s first significant task. Proceeding from this analysis, this work classifies euthanasia into active and passive forms in addition to a separate form for physician-assisted suicide. Active and passive euthanasia can be considered voluntary (with the patient’s consent), non-voluntary (when a patient is unable to request euthanasia), and involuntary (against the patient’s will) euthanasia; however, the last two forms are beyond the focus of this dissertation because they require different legal and ethical examinations that do not exist within the discussed concepts of this research. This presented work is divided into three forms (voluntary active euthanasia, physician-assisted suicide, and voluntary passive euthanasia). For each form, the related landmark cases and the legal, religious, ethical, and medical arguments and counterarguments are reviewed, as applicable, for both the United States and Saudi Arabia. The main arguments and counterarguments have been closely studied, scrutinized, and evaluated from the perspective of natural and fundamental rights. Both Saudi Arabia and the United States have laws against voluntary active euthanasia, mainly because it involves purposeful killing, which creates ethical and legal challenges. Saudi Arabia and the United States both value life highly, independent of its foundation: in religion (life is a gift from God) or in the idea that it is a fundamental right from which all other rights arise and that states have to protect human life. Even with the patient’s consent or a fatal disease, killing is still illegal, and the motive of mercy is not seen as a justification for killing. American society has persisted in attempts to legitimize voluntary euthanasia but in vain. Unlike the United States, the right-to-die movement in Saudi Arabia is not supported by any historical instances. The status of the debate over physician-assisted suicide is different between Saudi Arabia and the United States. While physician-assisted suicide is also prohibited in Saudi Arabia on the same religious basis as other forms, it is allowed to date in eleven states in the United States. There is a substantial possibility that more states will soon join those that already allow physician-assisted suicide. Cases such as Washington v. Glucksberg and Vacco v. Quill have been significant in paving the way for states to permit such end-of-life procedures, with some relatively strict safeguards, although the Supreme Court has not acknowledged a constitutional right to a patient’s physician-assisted suicide. The Oregon Death with Dignity Act (DWDA), which has been evaluated in this work, was the first to legalize physician-assisted suicide in the United States. Some of the arguments used in support of or opposition to voluntary active euthanasia and physician-assisted suicide include personal autonomy, the sanctity of life and the wrongness of killing, relief of pain and suffering, compassion, the potential of abuse or mistake, and safeguards, dignity, quality of life, and medicines hastening death. The main arguments among these have been evaluated and found to have severe weaknesses, especially against the value of life, chosen as a primary argument because it is a universal value shared by almost all cultures, which renders it a consistent counterargument. Alienating this right entails the abolition of all other rights. The divine authority mentioned clearly in Islamic texts prohibits ending someone’s life, even in suicide, holding that life is not owned by the person and leaving no room for mercy killing whether in the form of voluntary active euthanasia or physician-assisted suicide under Saudi laws. The argument over whether voluntary passive euthanasia should be allowed has been less difficult than the argument over physician-assisted suicide and voluntary active euthanasia. Voluntary passive euthanasia includes withdrawing and withholding life-sustaining treatment from terminally ill patients or prescribing pain medicines that might hasten death. The main point of dispute around voluntary passive euthanasia is whether there is a moral distinction between killing and allowing to die, where the patient dies in both situations. All killing, except in a few justified cases, is morally wrong, but some cases of allowing to die are also morally wrong, while some are not. Intending death is morally different from intending the abatement of futile treatment; however, intentions per se are not what make the moral difference between killing and allowing a person to die, the acts, themselves, are rather what show the moral difference. The second point is the vital distinction between ordinary and extraordinary means of conserving life. Natural means are obligatory per se, but artificial means are obligatory per incident. The other argument against voluntary passive euthanasia is that it is impossible to rationally distinguish between ending someone’s life and allowing a doctor to provide morphine to a terminally sick patient while knowing that doing so may hasten the patient’s death. Even if using morphine may have the unintended side effect of hastening death, this outcome is acceptable because it is the result of the patient’s only option for relieving his pain and suffering, which is the intention of the doctor as well. The landmark cases of Quinlan and Cruzan were significant in addressing the right to refuse or discontinue medical treatment in the United States. The patient in the United States is allowed to refuse or withdraw either extraordinary treatment, such as a ventilator, or ordinary treatment, such as nutrition and hydration, when the court determines that the patient’s quality of life is below a certain threshold of insufficiency. The articulated ideas of the quality of life are closely linked to statements of intention and causation. Likewise, Saudi Arabian citizens are free to decide whether to take life-extending procedures because death occurs naturally. According to the Islamic viewpoint, taking medication may be obligatory, permissible, recommended, or optional depending on the situation. Still, it is against Saudi law to stop or refuse artificial nutrition and hydration because doing so would cause the patient to starve to death. Islam views natural support as fundamental care not as a medical intervention. Finally, I employ the value of life, family, and community to argue against the arguments of proponents of euthanasia that reference personal autonomy and compassion. We, as humans motivated by compassion, should be responsible for upholding the patient’s dignity in ways that do not diminish the value of life, and euthanasia must not be the only option for terminally ill patients because this will not be a true practice of autonomy. The experience in palliative care facilities must be improved to lessen the suffering of terminally ill patients because such a request at its root is a request for help, not a request for ending life.