Into the Jaws of Yama, Lord of Death: Buddhism, Bioethics, and Death

9. Extending Life and Hastening Death

Chapter 9  Extending Life and Hastening Death In recent years, the topics of euthanasia and assisted suicide have become the focus of much heated debate. Now that medically extending life and deciding on a time to die have become options, the questions of whether and how long to live have become highly charged ethical and social concerns. Although the option of extending life technologically is still not open for terminally ill patients in most parts of the world, it has become the prerogative of a privileged segment of the world’s population—those who live in developed countries and have means and access to advanced medical technologies. Societies with the most advanced medical technologies also happen to have the most rapidly aging populations. It is probably not surprising that several end-of-life cases, particularly in the United States, have become the focus of public debate. To better understand this emotionally charged debate, it is necessary to distinguish between the terms euthanasia and assisted suicide , both active and passive, voluntary and involuntary. The word euthanasia derives from two Greek roots and can be translated as “good death.”1 Originally associated with the voluntary drinking of hemlock to painlessly escape the suffering of sickness and aging, the term gradually came to be applied to a physician’s means of hastening death.2 The term is often glossed as mercy killing or compassionate murder, though these interpretations are not universally accepted, as we shall see. According to Tom L. Beauchamp’s evaluation, active euthanasia involves “the act or practice of intentionally, mercifully, and painlessly causing the death of persons suffering from serious injuries, 163 164 Into the Jaws of Yama, Lord of Death system failures, or fatal diseases. Here the emphasis is on acting rather than omitting to act, suggesting killing rather than allowing a death to occur.”3 Passive euthanasia involves “failing to prevent death from natural causes in cases of terminal illness.”4 With advances in medical technology since the 1970s, passive euthanasia has increasingly come to mean withdrawing extraordinary means of preserving life but, by this definition, it could also include not seeking medical means of extending life. When euthanasia is requested by the patient, it is termed “voluntary.” An example of voluntary euthanasia is when a patient suffering severely from a terminal illness gradually stops eating or takes an overdose of barbituates and dies. When euthanasia is not requested by the patient, due to mental incompetence or some other debility, it is termed “involuntary.”5 An example of involuntary euthanasia is when a physician or caregiver, out of compassion, withholds nutrition or administers an overdose of barbituates to a mentally incapacitated patient suffering severely from a terminal illness, and the patient dies. In assisted suicide the death is caused by the patient’s action, whereas in voluntary active euthanasia the death is caused by another person’s action. Despite the usefulness of distinguishing these categories, however, it must be recognized that the lines between euthanasia, suicide, and assisted suicide, whether active or passive, voluntary or involuntary, cannot always be sharply drawn. Beauchamp specifies three necessary characteristics of euthanasia : (1) at least one other person is involved in intending and causing the patient’s death; (2) the primary consideration for intending the patient’s death is to end acute suffering or an irreversible comatose condition; and (3) the means of death is as painless as possible (unless moral justification exists for another method).6 Physician-assisted suicide is often regarded as a form of voluntary active euthanasia, but there is a distinction. In the case of euthanasia, the patient is often in great pain and the method chosen to terminate life is to relieve the patient’s suffering as painlessly as possible. In the case of assisted suicide, the patient is not necessarily suffering acutely and the means of death is not necessarily the most painless. Some believe that euthanasia is warranted only in the case of a diagnosed incurable terminal illness; others believe that euthanasia is justified for other mentally or physically debilitating conditions as well. In recent years, in relation to new medical technologies, there has been a shift toward greater precision in defining the boundaries between euthanasia, suicide, assisted suicide, and withdrawal of treatment . A careful delineation of these terms presupposes a system of medical technology capable of diagnosing terminal illness and a soci- Extending Life and Hastening Death 165 ety where medical professionals...