Arguments for and against euthanasia and assisted suicide

There are arguments both for and against euthanasia and assisted suicide.

Some of the main arguments are outlined below. You should be aware that these arguments do not necessarily represent the opinions or policies of NHS Choices or the Department of Health.

Arguments for euthanasia and assisted suicide

There are twomain types of argument used to support the practices of euthanasia and assisted suicide. They are the:

• ethical argumentthat people should have freedom of choice, including the right to control their own body and life (as long as they do not abuse any other persons rights), and that the state should not create laws that prevent peoplebeing able to choose when and how they die
• pragmatic argumentthat euthanasia, particularly passive euthanasia, isallegedly already a widespread practice, just not one that people are willing to admitto, so it is better to regulate euthanasia properly

These arguments are discussed in more detail below.

Ethical argument

The ethical argument states thateveryone should beable to choose when and how they want to die, and that they should be able to do so with dignity.

The concept of "quality of life" is an important aspect of this argument. The idea put forward as part of the religious argument against euthanasia and assisted suicide (see below)that life is sacred and is therefore alwaysbetter than deathis rejected. The ethical argumentsuggests that life should only continue as long as a person feels their life is worth living.

For example, someone who supports the use ofeuthanasia or assisted suicide based on the ethical argument may believe that a person should be able to choose to end their life if they are living in intolerable pain and their quality of life is severely diminished.

Pragmatic argument

The pragmatic argument states that many of the practices used inend of life care are a type of euthanasia in all but name.

For example, there is the practice of making a "do not attemptcardiopulmonary resuscitation" (DNACPR)order, where a person requests not to receive treatment if their heart stops beating or they stop breathing.

Critics have argued that DNACPR is a type of passive euthanasia, because a person is denied treatment that could potentially save their life.

Another controversial practice is known as palliative sedation. This is where a person who is experiencing extreme suffering, for which there is no effective treatment, is put to sleep using sedative medication. Palliative sedation is often used to treat burns victims who are expected to die.

While palliative sedation is not directly carried out for the purpose of ending lives, many of the sedatives used carry a risk of speeding up death. Therefore, itcould be argued that palliative sedation is a type of active euthanasia.

The pragmatic argument is that if euthanasia in these forms is being carried outanyway, society might as well legalise it and ensure that it is properly regulated.

It should be stressed, however,that the above interpretations of DNACPR and palliative sedation are very controversial and are not accepted by most doctors, nurses and palliative care specialists.

They are known as the:

• religious argumentthat these practices can never be justified for religious reasons; for example, many people believe that only God has the right to end a human life
• slippery slope argumentthis is based on the concern that legalising euthanasia could lead to significant unintended changes in our healthcare system and society at large that we would later come to regret
• medical ethics argumentthat asking doctors, nurses or any other healthcare professional to carry out euthanasia or assist in a suicide would be a violation of fundamental medical ethics
• alternative argumentthat there is no reason for a person tosuffer either mentally or physically becauseeffective end of life treatments are available; therefore, euthanasia is not a valid treatment option, but represents a failure on the part of the doctorinvolved in a persons care

These arguments are described in more detail below.

Religious argument

The most common religious argument is that human beings are the sacred creation of God, so human life is, by extension, sacred.This is known as the "sanctity of life".

Only God should choose when a human life ends, so committing an act of euthanasia or assisting in suicide is acting against the will of God and is sinful.

This beliefor variations of itis shared by many members of the Christian, Jewish and Islamic faiths, although some individuals may personally feel that there are occasions when quality of life becomes more important than sanctity of life.

The issue is more complex in Hinduism and Buddhism.Scholars from both faiths have argued that euthanasia and assisted suicide are ethically acceptable acts in some circumstances, but these views do not have universal support among Hindus and Buddhists.

Some non-religious people may also have similar beliefs based on the view that permitting euthanasia and assisted suicide "devalues" life.

Slippery slope argument

The slippery slope argument is based on the idea that once a healthcare service, and by extension the government, starts killing its own citizens, a line is crossed that should never have been crossed, and a dangerous precedent has been set.

The concern is that a society that allows voluntary euthanasia will gradually change its attitudes to include non-voluntary and then involuntary euthanasia.

Legalised voluntary euthanasia could eventually lead to a wide range of unforeseen consequences, such as the following:

• Very ill people who need constant care, or people with severe disabilities, may feel pressured to request euthanasia so that they are not a burden to their family.
• Legalising euthanasia may discourage research into palliative treatments, andpossibly prevent cures for people with terminal illnesses being found.
• Occasionally,doctors may be mistaken about a persons diagnosis and outlook, and the person may choose euthanasia after being wrongly told that they have a terminal condition.

Medical ethics argument

The medical ethics argument,which is similar to the "slippery slope" argument,states that legalising euthanasia would violate one of the most important medical ethics, which, in the words of the International Code of Medical Ethics, is: "A physician shall always bear in mind the obligation to respect human life".

Asking doctors to abandon their obligation to preserve human life could damage the doctor-patient relationship.Hastening death on a regular basis could become a routine administrative task for doctors, leading to a lack of compassion when dealing with elderly, disabled or terminally ill people.

In turn, people with complex health needs or severe disabilities could become distrustful of their doctors efforts and intentions. They may think thattheir doctor would rather "kill them off" than take responsibility for a complex and demanding case.

Alternative argument

The alternative argument is that advances in palliative care and mental health treatment mean there is no reason why any person should ever feel that they are suffering intolerably, whether it is physical or mental suffering, or both.

According to this argument,if a person is giventhe right care, in the right environment, there should be no reason why they are unable tohave a dignified and painless natural death.