Firstly it is important to clarify that in this scenario this is an otherwise healthy individual, who desires to die as they have a possibility of having dementia. It is not clear what type of dementia this individual may have, but for this argument I will set the parameters of dementia as an umbrella term covering the genetic specific types of dementia, these include vascular dementia and lewy body. Both are terminal, progressive and irreversible. There are many strong arguments for this patient to be denied active euthanasia; these include the wedge argument which is proving true in the Netherlands where euthanasia is permissible and the rule utilitarianism argument which favours the greater good of humanity rather than in individual cases such as this.
The argument could be made that society should encourage passive euthanasia rather than active as it is permissible to withhold treatment and allow a patient to die, however it is never permissible to take any direct action designed to kill the patient. This argument doesn’t fulfill the purpose of a humane exit because if one simply withholds treatment, it may take the patient longer to die, and they may suffer more than they would if more direct action were taken. Being allowed to die is relatively slow and painful whereas given a lethal injection is relatively quick and painless.
Many people believe that killing someone is morally worse than letting someone die; this is because being the cause of someone’s death is regarded as a great evil. This concept is refuted by Rachels’ scenario of the man who intends to murder his cousin by drowning him, in one scenario he proceeds to drown his cousin to gain an inheritance while the second scenario he has the same intention but the child slips, falls and drowns, the man did not actively kill him but stood by and watched as the boy drowned. Both actively killing a person and allowing them to die hold the same moral weight (Rachels 1975).
Beauchamp does make some strong points in response to Rachels’ thoughts, he explains that in the first case, death is caused by the agent, while the second is not, yet the second agent is no less morally responsible. However he argues that cases envisioned by the AMA and agent is held to be responsible for taking life by actively killing, but is not held to be morally required to preserve life and so not responsible for death (Beauchamp 1989).
Beauchamp discusses the reasons for alarm in response to Rachels’ article; he explains the repercussions of the wedge or slippery slope argument and recent arguments in defence of rule utilitarianism. He explains that;
“… If killing were allowed, even under the guise of merciful extinction of life, a dangerous wedge would be introduced which places all “undesirable” or “unworthy” human life in precarious condition. Proponents of wedge arguments believe the initial wedge places us on a slippery slope for at least one of two reasons; it is said that our justifying principles leave us with no principled way to avoid the slide into saying that all sorts of killing would be justified under similar conditions. Second it is said that our basic principles against killing will be gradually eroded once some form of killing is legitimated. For example, it is said that permitting voluntary euthanasia will lead to permitting voluntary euthanasia, which will in turn lead to permitting euthanasia for those who are a nuisance to society. Gradually other principles which instil respect for human life will be eroded or abandoned in the process. (Beauchamp 1989)”
Furthermore rule utilitarian’s argue that following rules that tend to lead to the greatest good will have better consequences overall than allowing exceptions to be made in individual instances, even if better consequences can be demonstrated in those instances. When these two arguments are combined it is more than enough reason to deny any patient active euthanasia, for the lack of respect for human life is detrimental to society overall regardless of its effects for an individual.
It is legally permissible for physicians to perform euthanasia under the euthanasia law that was introduced to the Netherlands in 2002. One of the requirements of due care of euthanasia is that the patient’s suffering is unbearable and hopeless, but there is no consensus about the extent of the suffering of demented patients. Most physicians do not consider dementia as grounds for euthanasia in itself, but they sometimes think that it could be if a demented patient with an advance euthanasia directive suffers unbearably and hopelessly from an additional illness (Schadenberg 2014).
It is evident however that Beauchamp’s concerns about the wedge argument are coming to fruition. In 2013 the Netherlands released information that stated that there was a 15% increase in voluntary euthanasia. It is evident that the wedge argument is already being fulfilled. The reasons for euthanasia in the Netherlands have begun to unravel. For instance:
– Recently the euthanasia clinic was reprimanded (not shut down) for lethally injecting a woman because she didn’t want to live in a nursing home.
– Dutch pediatricians want euthanasia extended to children under 12.
– A healthy woman, who was going blind, was euthanized because she was obsessed with cleanliness and feared being unable to clean the dirt on her clothes. (Rurup 2005)
There are only a few places where euthanasia is legalized to a degree and those places stand as a testament to what Beauchamp predicts in his argument, “…Gradually other principles which instil respect for human life will be eroded or abandoned in the process (Beauchamp 1989)”.
The Euthanasia Prevention Coalition predicted that there would be a continuous increase in the number and reasons for euthanasia after the Netherlands euthanasia lobby launched six mobile euthanasia teams. The mobile euthanasia teams claimed that they would fill the “unmet demand” for euthanasia for people with chronic depression (mental pain), people with disabilities, people with dementia and loneliness, and for those whose request for euthanasia was declined by their physician (Rurup 2005). This is proof that the fear of the slippery slope argument is justified as it is already taking place where euthanasia is a developed concept. There is also evidence from The Netherlands, now available in the official Dutch reports, and in a recently published research piece by the English legal academic John Keown, which provides conclusive evidence of abuse, of the slippery slope that Singer, Kuhse and others have denied would be the case. The Dutch reports contain abundant evidence that doctors kill more without their explicit request than with their explicit request, and that euthanasia is not restricted by the so-called “strict medical guidelines” provided by the Dutch courts (Flemming 1992). If these strict medical guidelines have already been corrupted how can we have any faith in the future of this concept? The answer is we cannot. It is a slippery slope that is already turning into and avalanche in the Netherlands.
Theo Boer, a Dutch ethicist who had been a 9-year member of a euthanasia regional review committee recently wrote an article explaining why he has changed his mind and now opposes euthanasia. He explained how the Netherlands law has expanded its reasons for euthanasia and how the number of euthanasia deaths was constantly increasing, turning euthanasia into a perceived right rather than an exception. Boer stated in his recent article that “I used to be a supporter of legislation. But now, with twelve years of experience, I take a different view. Once the genie is out of the bottle, it is not likely to ever go back in again.” (Schadenberg 2014)
It could be argued that the individual in this scenario could meet the requirements to be euthanized as dementia is a disease that causes death of brain cells and eventually brain failure, rendering them incapable of understanding the nature and effect of being actively euthanized. This is where it would be argued that an advance directive is crucial.
An advance euthanasia directive is a written request for euthanasia made by a patient, intended for a situation in which the patient has become incompetent. Compliance with the advance euthanasia directive of a demented patient is defined as the administration of drugs with the explicit intention to hasten the death of the patient at the explicit request of the patient, as stated in the advance euthanasia directive. However most physicians think it inconceivable that they would ever comply with the advance euthanasia directive of a demented patient were that, for patients with dementia, an advance euthanasia directive is not a valid request, they argue that a demented person becomes a psychologically different person and that therefore the previously competent person does not have the right to decide about the currently demented person.
It can also be interpreted as a simpler objection—that the advance directive was formulated at a time when the exact situation in which they would be used was not known, and therefore it is not certain that the patient would really want what is specified in the directive because he or she was unaware of the eventual situation. The other argument, that euthanasia for a patient with dementia is unacceptable, can be based on these same arguments, but it can also be based on religious beliefs or a more general philosophy of life (Rurup 2005).
Essentially society should not facilitate the humane exit of this individual – or any individual. Rachels makes some convincing arguments, however Beauchamp counters these with arguments that have been proven, such as the wedge argument and rule utilitarianism. Beauchamp’s argument is further justified as we can see the progression of euthanasia and the slippery slope effect that is happening right now, unjust reasons for euthanasia, corruption amongst physicians and euthanasia turning into a perceived right rather than an exception.
If we allow euthanasia to be permissible and accessible it will surely be the demise of the respect for human life. Society should not facilitate the death of this individual with a family history of early onset dementia but rather accept the fact that we are organic matter and allow this individual the follow the course that their body has paved for them in order to preserve the respect for life.
Beauchamp, Tom. “A reply to Rachels on active and passive euthanasia.” Contemporary issues in bioethics, 1989: 107-115.
Flemming, John. “Euthanasia, The Nethrlands, And Slippery Slopes.” Bioethics research notes ocasional paper 7 (1992).
Rachels, James. “Active and Passive Euthanasia.” New England Journal of Medicine, 1975: 490-497.
Rurup, Mette .L. “Physicians experience with demented patients with advanced euthanasia directives in the netherlands.” Journal of America Geriatrics Society 53, no. 7 (july 2005): 1138-1144.
Schadenberg, Alex. National right to life news today. 29th September 2014. http://www.nationalrighttolifenews.org/news/2014/09/netherlands-2013-euthanasia-report-15-increase-euthanasia-for-psychiatric-problems-and-dementia/#.VUL7GE2KCUk (accessed April 2015).