Is it ever ethical to intentionally help someone end their life? What if the individual is in immense pain? What do you do if a patient has no chance of recovery or improvement, and faces even more painful physical deterioration? Does it become ethical to end their suffering? 

This article discusses the ethics of assisted dying, often referred to as ‘euthanasia’ in the medical context. We will discuss the concepts of assisted dying and ‘dignified death’, as well as the circumstances that may motivate individuals to seek medical help to end their life. Further, we will explore the prominent ethical arguments both for and against assisted dying, as well as the more binary stance taken by some organisations.

What is assisted dying?

Assisted dying is often referred to as “euthanasia”. The term “euthanasia” originated from ancient Greek, and approximately translates to ‘good death’.¹ Today, it most commonly refers to the process of intentionally ending someone’s life to end their pain and suffering. Supporters of euthanasia see this as a more dignified and compassionate end to life as opposed to allowing someone to continue suffering. However, euthanasia and assisted suicide are both controversial topics.

Active and passive euthanasia 

Euthanasia is legal and can be carried out under some medical laws.

Euthanasia can be active or passive. Active euthanasia involves giving some a lethal dose of painkillers (actively causing death), whilst passive euthanasia typically involves a withdrawal of food or medicine.² Some people feel that passive euthanasia is more ethical than active euthanasia, as it does not require a doctor to take any direct actions to end a patient’s life. Others feel that active euthanasia is more ethical, because passive euthanasia can be a longer process that prolongs a patient’s suffering. 

The most commonly used alternative to euthanasia is palliative (or end of life) care, through which medical professionals will make a patient as comfortable as possible in the final stages of their life. 

Voluntary and involuntary euthanasia

Voluntary euthanasia refers to when an individual directly requests help ending their life. Non-voluntary euthanasia can only be sanctioned in specific cases, such as when a patient is unconscious, in a coma, or otherwise unable to make informed decisions. Non-voluntary euthanasia can also apply if a patient is too young to understand their condition or make medical decisions, meaning a parent or guardian must make any decisions about their end-of-life care.² 

Outside of these express circumstances, involuntary euthanasia is viewed as murder and is illegal.² Several medical law cases have centred around well-intentioned euthanasia, where individuals have acted to “end their suffering” of family members. However, good intentions do not mean these acts are legal or sanctioned in the eyes of the law.³

Global context

It is worth noting that assisted dying is illegal in most countries. In the countries where it is legal, there are stringent and various safeguards and restrictions around it to prevent this practice being abused or misused.

Euthanasia is currently permitted in countries such as Belgium, the Netherlands, and Luxembourg, Canada, New Zealand, and Colombia. Switzerland allows assisted death, provided if the person assisting the death acts without selfish motives. Some US states, including Oregon, Washington, Vermont and Montana, also allow euthanasia. In contrast, euthanasia is still banned in the UK and most other countries.⁴

Despite the establishment of euthanasia/assisted dying laws in countries around the world, there is no universal public opinion anywhere, as the ethical considerations and questions surrounding euthanasia make it issue extremely difficult to legislate and manage. 

When does assisted dying usually become a consideration? 

Chronic pain and suffering

Individuals considering assisted dying are typically experiencing persistent and significant pain or suffering due to physical illness. Their condition may be untreatable or expected to get worse over time. Many individuals considering assisted dying have a terminal illness and are facing a painful death. Many do not wish to keep enduring the pain and/or suffer through an undignified death. Constant physical pain can also cause a great deal of mental and emotional anguish and significantly impact an individual’s quality of life.^5,6

Loss of autonomy and independence

A person’s illness may make them very dependent on others and render them unable to perform daily activities such as eating, washing, and going to the toilet without aid. This loss of autonomy and independence can cause people to feel shame and embarrassment, and may even make them feel like they have lost their purpose, hope, and joy. Individuals may also begin to feel like a “burden” to others.

Preserving their memory

Individuals facing degenerative or progressive diseases may want to preserve the memory their loved ones had of them pre-diagnosis (e.g. remembering their lively and happy relative, rather than someone who was bed-bound, heavily medicated, and increasingly disabled and vacant). 

This introduces the concept of having a ‘dignified death’, whereby assisted dying allows the individual to die on their terms, when and where they choose - and often before their deteriorating physical condition affects their dignity or autonomy. Euthanasia and assisted death can give people an element of control over the end of their life, freeing them from pain and suffering.² 

Euthanasia is used in the case of terminal cancer. In 2023, 50% of euthanasias performed in Belgium were performed on patients with terminal cancer. However, other illnesses which drive people to seek euthanasia include neurodegenerative diseases, severe cardiovascular issues, or debilitating respiratory conditions.^6,7

The ethics surrounding assisted dying

Ethical arguments for assisted dying 

The main argument for assisted dying is that it is a compassionate act that prevents someone who is ill from undergoing further suffering and pain. 

Some people also feel that everyone should have autonomy over their body and be able to choose to die if they are in immense and long-term pain. When a person begins to lose their bodily autonomy - their sense of control over their own body - they may feel that they are losing their sense of self and their dignity. Some argue that preventing individuals from pursuing assisted death is a violation of their freedom and human rights.⁵

Ethical arguments against assisted dying

Abuse 

A major concern regarding the legalisation of assisted dying is the need for caution and safeguards to prevent abuse. While safeguarding measures are often created and enforced with the utmost caution, it can be very difficult to ensure that they are always working effectively. This causes some people to fear legalising and using euthanasia. Others fear that legalising euthanasia may allow people to abuse the system or create loopholes that result in involuntary euthanasias. These individuals argue that legalising assisted dying could create a ‘slippery slope’ through which the ‘extreme circumstances’ needed to warrant assisted dying become less and less extreme over time. There is both criticism and support for this argument in medical contexts.⁸ 

Coercion

A key requirement of assisted death is the patient making the informed decision to end their life. This requires them to have full mental capacity (be of sound mind). Evaluating capacity can be very difficult. Some critics of assisted dying question 1) whether a psychological assessment can accurately determine whether someone has capacity, 2) who will be assessing the patient, and 3) if assessors have any biases that could impact their decision.

Similarly, it can be difficult to recognise if relatives or society are influencing a patient’s decision to end their life. Many fear that, were it made legal, assisted dying would be abused by relatives looking to benefit from a patient’s death. Coercion does not just refer to relatives acting with selfish or malicious intentions - any pressure on an individual to end their life (even using legal channels) is illegal. It is also worth questioning if medical professionals might influence an individual’s decision regarding end-of-life care. Having signed the Hippocratic oath (to do no harm), would doctors support palliative/ongoing care versus assisted dying? 

Whilst uncomfortable, it must be considered how an individual’s socioeconomic class, race, or gender may influence the advice they are given and the choices they make. Does the individual’s socioeconomic class, race, or gender, play into medical or social advice? Opinions of assisted dying can vary significantly from place to place due to differing cultural views, which again makes it difficult to legislate and enforce.⁵ 

Religious arguments 

A common argument against assisted dying is the ‘sanctity of life’ principle, which dictates that life is sacred and given by God - so we should not take it intentionally.³ This links to the Hippocratic oath, which is made by all medical professionals and defines their sole duty being to heal patients. As such, we must ask - at what point is the pursuit of healing perceived as more harmful than intentional death? 

Religious beliefs can pose ethical questions, too. A religious person may assume a higher power has a plan for each person - so ending their life would go against their core values.^9,10 This can create challenging and painful situations. For example, a devout Muslim may be taught that euthanasia is ethically wrong, yet feel personally that it is the right decision for a member of their family who lives in torturous pain. How are they to navigate this situation? 

Major figures and their arguments 

There are numerous charities and organisations that campaign both for and against assisted dying. Humanists UK believe that “any adult of sound mind who is intolerably suffering from an incurable, physical condition and has a clear and settled wish to die should have the option of an assisted death.”¹¹ Their campaigns and intentions are clear, and they also provide educational outreach services to schools and workplaces. 

Similarly, Dignitas is a UK based organisation who feels that having a dignified death is of huge importance, and when death is inevitable, suffering should not be. They reflect upon the increasing number of Britons traveling abroad in the pursuit of an assisted death. They feel that UK law should offer individuals nearing the end of their life (e.g. with six months or less to live) the option to control their death. They hold ongoing campaigning and lobbying events to support this.¹²

Alternatively, the organisation ‘Our Duty of Care’ strongly opposes euthanasia and assisted suicide in medicine. They use multiple key principles to support their argument against euthanasia. The first is that criminalising euthanasia protects vulnerable individuals from pressure to end their lives and protects the worth of disabled people. They believe that banning euthanasia helps preserve the futures of people with a disability, non-terminally ill individuals, and children. They also argue that banning euthanasia helps preserve patient-clinician relationships.¹³

Summary

Assisted dying is a controversial issue fraught with ethical uncertainty and strong opinions on both sides. The practical and ethical questions surrounding assisted dying have been debated for many years, and it is unlikely this debate will be resolved soon. Is it truly ever ethical to take a life? What degree of suffering must one be in for this to be warranted? Is it dangerous to give this power to medical professionals and governments, given the risk of it being abused? With these important questions having no definitive answers, it is likely they will remain contested for the foreseeable future. For now, however, each case must continue to be considered in its own context and circumstances.