To Be or Not to Be: Euthanasia is the Question

If euthanasia is made legal in the United States, various ethical debates surrounding end-of-life issues will arise as a result. Although American laws, attitudes, and customs differ from those in European nations, the Netherlands provides an example for one such end-of-life debate that could arise in the in the U.S. For instance, several years after the Netherlands legalized euthanasia, Dutch physicians developed the Groningen Protocol, which allows euthanasia for newborns who are deemed to be experiencing “unbearable suffering” and are predicted to have an “extremely low quality of life” despite continuously available treatment [1]. It is worth noting that having a terminal illness is not an explicit requirement under this protocol. Since it is obviously impossible to obtain the newborn’s “consent,” physicians are allowed to perform euthanasia if parents consent on behalf of their child. This is a dangerous precedent, because this means that individuals are no longer granted exclusive control over their own lives.

Philosopher Immanuel Kant would thoroughly criticize this situation; according to Kant, all humans possess the capacity for rational thought that allows them to govern their own behavior, make their own moral decisions, and control their own lives. In Kant’s opinion, depriving an individual of his/her right to live without obtaining his/her explicit consent is tantamount to depriving them of their humanity. This philosophical concept is called the categorical imperative, and is one of the most influential arguments of post-Enlightenment moral thought. Opponents of Kant’s thesis may suggest that infants do not yet possess rational agency due to their lack of a fully-developed frontal cortex, but Kant further argues that it is immoral to use another human being solely as a means to an end. In other words, it is immoral for the infant to be euthanized as a means to the end of “relieving unbearable suffering.”

Since the Groningen Protocol does not require an individual to have a terminal illness, it is entirely possible that euthanasia could eventually be legalized for other types of persons incapable of making their own medical decisions who are perceived to be suffering; in these cases, the person’s guardian and physicians would be able to determine whether the afflicted individual should live or die. One ethical analysis of the Groningen Protocol condemned it for recommending euthanasia for newborns with conditions like myelomeningocele (MMC), a neurological abnormality that meets Protocol criteria for “low quality of life,” because scientific advancements have offered more positive long-term prognoses for afflicted individuals [2].

MMC is known to have high rates of morbidity and mortality, but according to one 25-year follow-up study of 118 adults born with MMC, “75% of patients reached their early adult years, and 85%…either attend or have graduated from high school or college” [3]. Some of the main physical complications of MMC involve incontinence, but 80% of patients were able to achieve social levels of bladder continence and 90% were able to maintain appropriate levels of bowel continence after being treated with clean intermittent catheterization.

Therefore, despite MMC’s historically pessimistic prognosis, some patients were able to live significantly longer than previously expected due to early diagnosis and effective treatment. For this reason, the Groningen Protocol sets a very dangerous precedent for euthanasia of non-terminally ill patients.

Although it is clear that the United States has a very different legal system than the Netherlands, the “slippery slope” regarding euthanasia is still a valid concern for American lawmakers. The definition of “terminally ill” is constantly being redefined, and physicians are frequently surprised by individuals who live far longer than their expected lifespans due to the current pace of medical advancements. It is entirely possible that individuals who chose to be euthanized could have benefited from newly-developed treatments or cures for their conditions.

If euthanasia is made illegal, the next logical challenge becomes defining possible alternatives to the practice, especially in the case of intense suffering. There are numerous answers to this question, but one common suggestion is effective palliative care [4]. The World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” [5].

Ideally, patients faced with intense suffering and/or terminal illness could receive effective palliative care to improve their quality of life and relieve their pain [6]. Palliative care is a flexible, ongoing treatment plan that can be continually adjusted based on a patient’s changing physical, social, mental, or economic situation. By allowing these adjustments to be made based on the wishes of the patient and/or the patient’s family, palliative care grants a large degree of autonomy. Also, while the patient can opt out of life-saving medical treatment or palliative care at any time, this does not equate to euthanasia because the patient is not actively ending his/her life.

Palliative care is clearly not perfect, and studies have shown that numerous areas of the United States lack effective treatment methods. Whether euthanasia can do more to reduce patient suffering than substandard or non-existent palliative/hospice care is currently an unresolved question. However, based on new reform initiatives and funding incentives as a result of the 2010 Affordable Care Act, healthcare providers around the United States appear committed to integrating palliative care more fully into the American healthcare system [4].

It remains to be seen whether calls for legalization of euthanasia will diminish as the quality of palliative care improves and healthcare providers are better able to alleviate suffering without ending life.

1. Eduard Verhagen, and Pieter Sauer, “The Groningen Protocol-Euthanasia in Severely Ill Newborns,” New England Journal of Medicine, 352 (2005): 959-962.
2. Sean Barry, “Quality of Life and Myelomeningocele: An Ethical and Evidence-Based Analysis of the Groningen Protocol,” Pediatric Neurosurgery, 46 (2010): 409-414.
3. Bowman RM, McLone DG, Grant JA, Tomita T, Ito JA: “Spina bifida outcome: a 25-year prospective.” Pediatric Neurosurgery, 34 (2001):114-120.
4. Sherman, Deborah Witt and Jooyoung Cheon. “Palliative Care: A Paradigm of Care Responsive to the Demands for Health Care Reform in America.” Nursing Economics 30, no. 3 (2012): 153-62, 166.
5. World Health Organization, “WHO Definition of Palliative Care.” Last modified 2013. Accessed April 1, 2013.
6. Note: Palliative care broadly refers to treatment or relief of pain, while hospice care refers specifically to end-of-life care.

Aamir Hussein is a senior at Georgetown University studying the Biology of Global Health. He is the co-president of the Georgetown Student Interfaith Council and an EMT-B on the Georgetown Emergency Response Medical Service (GERMS). Follow The Triple Helix Online on Twitter and join us on Facebook.