The main question of ethics is the definition of what good behavior is and what makes the behavior right or wrong. A society carries out monitoring and correction of the behavior of people in an effort to reconcile the interests of individuals and human communities, to find a ‘balance’ of public and private good. Ethical evaluation of actions and attitudes is given depending on the orientation to achieve good or evil that acts, thus, as a criterion of ethical judgment. Euthanasia, which is the intentional painless killing of terminally ill people, is one of the most pressing issues today. It emerged at the end of twentieth century as a result of the intervention of science in the usual pattern of life and morality. According to the utilitarian theory, euthanasia should be recognized as a useful action, since it alleviates sufferings and saves resources for others.
There exist two kinds of euthanasia, passive and active. Passive euthanasia is when the patient stops any medical procedures and activities. Active euthanasia means that special measures are taken for the termination of life. Some people believe that the choice between active and passive euthanasia is the choice between killing and allowing to die, because passive euthanasia takes the form of long painful dying, when the patient refuses procedures for maintaining metabolism.
Life sustaining on the stage of dying, which is carried out with the help of sophisticated technology, is too expensive for society. Funds spent on the maintenance of life in hopeless situations would be sufficient to treat tens, hundreds, or even thousands of people who are treatable. Nevertheless, this argument is purely pragmatic and has a value within the practical organization of the health care system, but it is not to be taken into account when it comes to the moral justification of euthanasia. People think that active euthanasia encroaches on the idea of sanctity of human life, and crosses the border marked by the old law, “thou shalt not kill”. “Thou shalt not kill” is the normative expression of the very essence of humanistic morality. It is illogical to require moral sanctions to the actions, which are directed against the fundamental principle of morality itself. Morals are one of the last obstacles to the intrusion into human life. If one recognizes euthanasia, this barrier is removed and then the society, which breached an unconditional ban on killing, will be completely different.
Here arises the necessity of the ethical principle of utilitarianism. Utilitarianism is considered to be such an ethical theory, which considers utility as a basis of moral duty (or criterion of demarcation between good and evil). In order for a particular concept to be recognized as utilitarian, it should combine at least three characteristics. The first is consequentialism. It means that any choice is made in accordance with consequences that are generated by the results. The second characteristic is welfarism. The aim of a moral subject from the perspective of utilitarian ethics is to increase the well-being of those people who are affected by its actions. Combination of welfarism with consequentialism creates a special requirement, namely to judge any choice according to the utility that it brings. Finally, the third feature of utilitarian ethics is the total score, according to which the usefulness of individuals is simply added to determine their combined wealth. It does not matter how this amount is distributed among individuals.
According to the three components mentioned above, euthanasia is the utilitarian action. As a rule, euthanasia is performed when a person is incurably ill, and in any case he/she will die. At the same time, euthanasia can decrease sufferings of an incurably ill person, save money for treatment of other people and, of course, shift doctor’s attention to other people’s treatment. According to Felicific Calculus, one may argue that sufferings of a person are reduced while the number of people having benefits from this action is rather big (the patient himself, other patients, to whom doctors pay less attention, other patients, who get less money, etc.). That is why one can make a conclusion that euthanasia is a utilitarian action.
One should note one of the decisive arguments in favor of euthanasia, which is that the rejection of euthanasia would be a violation of rights of individuals when it comes to the voluntary euthanasia. It is believed that the patient has the right to be fully informed about his or her condition. This information must be provided to the patient in an accessible form, as well as one must respect the patient’s desires in making decisions concerning his or her body. Arguing the admissibility of euthanasia, which is the conscious will of the patient, one can say that if the patient was conscious to dispose of his or her own life when it becomes unbearable, he or she would have stopped it. It, in fact, recognizes the right of a patient to suicide. However, euthanasia still cannot be considered legitimate, as in this case the person moves the boundaries of his or her competence.
In addition, an indirect confirmation of the fact that the decision of euthanasia cannot be considered a morally blameless conduct can be found in the way of its adoption. The real experience of modern medicine in the countries, where the practice of euthanasia has legally ordered form, the relevant decisions are taken by a special ethics committee. This committee includes the attending physician, medical personnel, representatives of the hospital administration, the priests, philosopher of ethics, lawyers, social security services, etc. The method of decision taking indicates its extremeness. It is extreme in at least two respects: adequately comprehended, it is the responsibility of the unbearable severity and, hence, the need for a collective distribution of severity takes place; being out of ethical limits, it is fraught with abuses; here the inclusive membership to more reliably block the possible abuses.
In my view, hospice could help to reach a consensus in the dispute of supporters and opponents of euthanasia, as hospice neither speeds nor defers death, but due to the personal care and care of others, patients and their families can live the last period of patient’s life more fully. In addition, providing comfort to the patients, doctors use palliative care. Palliative care is a medical intervention that is intended to facilitate the physical and psychological pain, thereby improving the quality of life. The negative aspect is that the goal of palliative care is to stop suffering without stopping life. Palliative care often means putting a patient in a long unconsciousness of sleep, usually up to his or her death. Consequently, there is a shaky border between palliative care and euthanasia. According to utilitarianism, euthanasia is more useful since palliative care only defers the moment of death.
In most countries, euthanasia is officially prohibited and questions on this subject are not considered ethical. However, in case one holds a study on the treatment of terminally ill patients, for example, in cancer treatment center in underdeveloped countries, the conclusion is not cheering – passive euthanasia takes place quite often. Most often, after the examination of critically ill patients, doctors notify relatives (in such cases, most doctors decide not to inform the patients about their condition) that their near and dear is terminally ill, but there is a hope to cure or at least prolong life of the patient, having a paid course of treatment. It should be noted that the treatment in underdeveloped countries is very expensive and not everyone can pay for it. Even without a choice, the family or friends bear a moral responsibility for the death of a person close to them, and, in such situation, it is impossible to apply to the hospice to relieve the suffering. Thus, euthanasia, with an agreement of an incurably-ill person, can save life of another person, who can be treated but has no funds.
The attitude toward death and the conduct during dying is a vital part of a person’s life; it definitely remains within the morally conscientious choice. However, to choose death and to behave with dignity in the face of death is not the same thing. As well as facilitating the process of man dying and making the birth process easier are different things. It is hard to decide who is right in the debate of supporters and opponents of euthanasia. Most often, it is a dispute between people who are faced with a slow agonizing death of a loved one and those who only know about such cases. Similarly, to experience pain and to know about it is not the same. In my opinion, it is great when departure from life is natural. However, sometimes people suffer a lot, and euthanasia is the way out of these sufferings. Physicians have available medical means to alleviate sufferings of patients who are doomed to death. However, the person still does not live a full life (in case of palliative care, a person becomes half dead), and neither hospice nor palliative care brings the utility to the incurable patient as euthanasia does. Thus, according to the utilitarian approach and Felicific Calculus, euthanasia is the best solution for people who are incurably ill and suffer from pain. Attitude to death is within the moral choice. Whether euthanasia should exist or not is the decision that should be made individually, in accordance with conscience.