Euthanasia is a topic not unlike abortion, in that it generates a great deal of heat in a conversation and very little light. Like abortion, it is being practiced in New Zealand. Unlike abortion, there is no set of rules to guide it’s use and overt euthanasia often meets the business end of Law Enforcement – manslaughter and murder convictions being common sequelae. Unlike abortion, the issues involved are often far more complex and often involve decision processes from many different people at the same time. There are also multiple meanings for the word euthanasia which creates additional confusion in the debate.
Normally, I break up the term into three distinct groups:
- End of life issues. These are the debates about whether a patient is actually dead or not.
- Quality of life issues. These include the severely brain-damaged and the terminally ill who are in constant pain. Quality of life issues further sub-divide into voluntary – where the patient makes the choice to end their life – and involuntary – where the decision is made by an external agent such as a relative, friend or doctor.
- Quantity of life issues. Where treatment is withheld or active euthanasia is offered solely on the basis of a single criteria, without regard to quality of life. The commonest example here is ageism in medicine. Nasty things like eugenics come into this.
I will deal with each of these separately in other posts. For today, I want to look at another way that euthanasia is divided – into passive and active euthanasia. I am uncertain as to whether this is actually a real division. While there seems a clear distinction between, say, a doctor witholding futile treatment from a dying patient and the same doctor injecting an overdose of morphine into the same patient, the distinction becomes a bit fuzzier in the middle. If this same doctor witholds fluid from the same patient, is that passive or active euthanasia? Is the witholding of futile treatment euthanasia at all? After all, one is not killing the patient, simply not intervening in the dying process to extend life. Can that argument then apply to the witholding of food and fluids? I would say there is a difference between a futile medical intervention and the provision of the necessities of life and that difference is this: If I don’t give an antibiotic to a patient, then it is the infection that kills them; if I don’t give them food then I have killed them.
You might consider this reasoning sophistry, but I think it is a valid distinction. In the first, I am simply not intefering with the dying process. In the second, I am deliberately hastening the end. This would be my way of determining the difference between passive and active euthanasia or, as I prefer to term them – natural death and assisted death.
When we discuss euthanasia is further posts, I will be using the term to denote assisted death only.
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