Euthanasia: right to die or mercy killing?

Il seguente scritto è stato elaborato per l’esame di Comparative Constitutionalism e verte sul tema dell’eutanasia.

Il lavoro, in lingua inglese, è diviso in tre parti, ciascuna delle quali tratta aspetti differenti, ma collegati, della materia in esame. Sono prodromici alle questioni giuridiche, quelle scientifiche, etiche e morali.

La prima parte, suddivisa in due capitoli, affronta il tema dell'eutanasia dal punto di vista scientifico, quindi introducendo brevemente il concetto di eutanasia e la differenza tra quest’ultima e il suicidio assistito.

In un breve paragrafo, all’interno del primo capitolo, sono trattati gli aspetti clinici dei soggetti che richiedono pratiche eutanasiche.

Il secondo capitolo verte sul delicato tema riguardante i problemi etici, morali e religiosi dell’eutanasia: il primo paragrafo di questo secondo capitolo approfondisce i precetti della religione cattolica con riferimento all’eutanasia e la cosiddetta death culture, ovvero la cultura della morte.

Il secondo paragrafo tratta, invece, degli aspetti morali dell’eutanasia: a questo proposito vi è una breve storia delle pratiche eugenetiche, indispensabile per comprendere i problemi etici e morali trattati in seguito.

La seconda parte approfondisce le problematiche connesse alla legalizzazione dell’eutanasia. Dopo aver brevemente considerato i modi in cui il soggetto agente viene giudicato processualmente, mi sono concentrata sull’analisi del sistema giuridico Americano, in materia di provvedimenti per l’eutanasia.

Il quarto capitolo, nonchè l’ultimo della seconda parte, riguarda la situazione dell’Olanda, partendo dal 1945, fino ad arrivare alla corrente situazione legale, in quanto interessante per la tematica da me trattata.

Ho inoltre analizzato il caso Schoonheim, quale esempio emblematico, all’interno di un lungo excursus storico, per rendere comprensibile il percorso che ha portato alla legislazione attuale sull’eutanasia.

La terza e ultima parte del trattato, riprende la disciplina sull’eutanasia negli Stati Uniti d’America; anche in questo caso l'incipit è avvenuto dall'analisi storica, per poi  analizzare più approfonditamente i vari movimenti pro e contro l’eutanasia, di modo da poter agilmente comprendere come si è arrivati alla legislazione attuale, soprattutto nello stato dell’Oregon.

Infine, anche in questo caso, ho analizzato un caso significativo, il "caso Cruzan", che ha tenuto banco nell'opinione pubblica nello Stato del Missouri già alla fine degli anni ’80.

CONTENTS: INTRODUCTION CHAPTER 1: Medical aspects of euthanasia 1.1 Clinic Situation     CHAPTER 2: Ethics and Religious problems of Euthanasia 2.1.“Thou shalt no kill”. The religion’s opinion about euthanasia 2.2. The euthanasia’s morality CHAPTER 3: Law and morality in Euthanasia CHAPTER 4: The Netherlands’ experience 4.1. 1945-1970, when public debate began   4.2. 1970-1982, when euthanasia became a debatable subject 4.3. 1982-1986: the breakthrough in the meaning of “euthanasia” 4.3.1. The Schoonheim case 4.4. 1986-1997: attempts to legalize euthanasia 4.5. The current legal situation  CHAPTER 5: Euthanasia in the United States  5.1. A little of history 5.2. The euthanasia movement (from 1930s to 1990s) 5.3. Predominant law today 5.3.1. Oregon’s situation 5.4. The Cruzan case CONCLUSION BIBLIOGRAPHY

INTRODUCTION

“Just as I shall select my ship when I am about to go on a voyage, or my house when I propose to take a residence, so I shall choose my death when I am about to depart from life.” [1]

The subject of euthanasia has thrilled a large group of academics, especially in the last decade. This interest do not derive only from jurists, called often to define the lawfulness or unlawfulness of the matters, but involves also many sectors of life sciences: ethics, philosophy, religion and medicine, that converge with law.

 The term euthanasia comes from the Greek word εὐθανασία, composed by εὖ that means good, and by θάνατος, that means death; these two words put together have the meaning of good death or simply death. In the Treccani’s encyclopedia there is a very clear definition, as a matter of fact it is called euthanasia the conduct, both active and omissive, which abbreviates the life of a much-suffering person. In detail, euthanasia is described as the killing of an agreeable person who could give voice to his death’s will, either as physician-assisted suicide or as voluntary euthanasia.

However, the medicalized killing of a patient without his consent cannot be define euthanasia but a proper murder; this is the case of those subjects who do not express their consent, or those who are not able to express it, for example infants, fetus, interdicts or subjects afflicted by serious diseas.

Altought this topic seems relatively recent, it is necessary to mention it from an historical point of view. In the ancient word, there was already something that we can call social euthanasia, which means society suppressed or left to his own destiny someone who could be a burden to it. This practice had been attested in Sparta, in the roman world and in most of the ancient societies.

I think it is important to briefly consider the greek’s culture and, especially, a fragment of Platone:

“Allora, insieme con tale arte giudiziaria, codificherai tu nel nostro Stato anche la medicina nella forma da noi detta? Così, tra i tuoi cittadini, esse cureranno quelli che siano naturalmente sani di corpo e d’anima. Quanto a quelli che non lo siano, i medici lasceranno morire chi è fisicamente malato, i giudici faranno uccidere chi ha l’anima naturalmente cattiva e inguaribile.”[2]

From this fragment we can easily figure out the attitude of Platone: if, in that period, we had talked about euthanasia with the meaning that we assign it nowadays, he would have not condemn it; rather, he believed that it was right to let ill people die. Radically different is the position that Aristotele expressed in the Etica Nicomachea: he presented the suicidal as a person who commits a huge injustice against his city and, most of all, the poet considered the much-suffering people as an example of courage: 

“Il morire per fuggire la povertà o la passione amorosa o qualcosa di doloroso non è di uomo coraggioso, ma piuttosto di un vile: è infatti debolezza lo sfuggire ai travagli e chi si uccide agisce non per affrontare una prova decorosa, bensì per sfuggire un male.”[3]

We have quickly considered the role of critically ill people in the greek’s culture, and the next step is about the analysis of the role of the physicians in cases of euthanasia or assisted suicide: on the one hand, according to that praxis, this kind of action was not excluded, on the other hand the Hippocratic oath strictly forbade it: “To please no one will I prescribe a deadly drug nor give advice which may cause his death”[4].

During the Medieval age, with the advent of the Catholic religion, the point of view towards the euthanasia completely changed: the absolute incompatibility between euthanasia and Christian morality is really stressed. For the Fathers of the Church, the human being is not the owner of his life and he can’t dispose of it as an arbiter. Tommaso d’Aquino expressed in a lapidary way the three reasons why suicide was considered such as an illicit act:

“Il suicidio è assolutamente illecito per tre motivi. Primo, perché per natura ogni essere ama se stesso; e ciò implica la tendenza innata a conservare se stessi e a resistere per quanto è possibile a quanto potrebbe distruggerci (…) Secondo, perché la parte è essenzialmente qualche cosa del tutto; ora, ciascun uomo è parte della società; e quindi è essenzialmente della collettività. Perciò uccidendosi fa un torto alla società, come insegna il Filosofo. Terzo, la vita è un dono divino, che rimane in potere di colui il quale “fa vivere e fa morire”. Perciò chi priva se stesso della vita pecca contro Dio (…). Infatti a Dio soltanto appartiene il giudizio di vita e di morte, secondo le parole della Scrittura: “Sono io a far morire e a far vivere”[5]

In the end, in the XX century, the requests for euthanasia grew up: in 1906 the Ohio Parliament presented the wording of a law of euthanasia (rejected by the Magistrates’ Governing Council) and in 1936 the same request in London was presented (rejected by the House of Lords). It is also necessary to mention the paradigmatic example of Germany before and during the Second World War: in 1920 was published a book called “Die Freigabe der Vernichtung lebensunwerten Lebens” (that means Allowing the destruction of life unworthy of living) where the author, Alfred Hoche, writes about euthanasia as a kind of natural selection, affirming that the killing of people who do not have no value for the society, must be allowed.[6]

Those ideas cough on so much with the coming of Hitler that has been created the Commission of the Reich for people’s health; this commission had to convince the German people of the goodness and the necessity of eugenics’ practices.

The years after the Second World War were very delicate for the euthanasia, especially because of the Norimberga’s lawsuit that contributed to make known all the terrible things mentioned before; as a matter of fact, going on with the practices of euthanasia was a continuous reference to the Nazi massacre.

In my opinion, these mentions to the history of euthanasia are essentials to understand better the reasons of the discussions about this topic, especially nowadays and in the past decade. Therefore my intent is to use an analytical procedure, deepening the topic of euthanasia; starting from the medical aspects, I will consider the ethics and philosophical problems. In conclusion I will consider the legislation and the cases of euthanasia in the U.S.A. and in Netherlands. [7]

CHAPTER 1: MEDICAL ASPECTS OF EUTHANASIA

Since I have decided to deal with the topic of euthanasia, I think I have to give prominence to the medical aspect of this complicated and much-discussed practice.

First of all, it is necessary to understand when a person, in spite of isolated activities of his body, can be defined dead or, instead, can be considered still alive. It is very important to comprehend this distinction: the problems concerning the lawfulness of euthanasia only regard the case in which a person can be considered alive.

The academics consider a very important aspect to determinate when a person chases to exist: dignity. Indeed, before the modern technique of reanimation, death was considered as the suspension of the cardiac, respiratory and nervous functions; for this reason, nowadays, we have to consider dignity also as the ability of a person to relate with others, so as something fundamental for the human being, defined ages ago as “social animal”[8]. Dignity stops in the moment when a subject is in a so acute condition that he cannot have anymore relations with other people. However the idea of death is clearly explained by legislators: in the first article of the law Dicember 29, 1993 number 578 it is affirmed that

“la morte si identifica con la cessazione irreversibile di tutte le funzioni dell’encefalo (la morte cerebrale)”. [9] After these preliminary remarks, we can start to examine euthanasia in a more specific way. “My father was a smart, savvy lawyer, the family patriarch. He was forceful, even intimidating at times. My father was diagnosed with a metastatic head and neck cancer in 2002. A top head and neck surgeon worked through conflicting pathology reports to locate the primary tumor in the thyroid. Metastases would crop up from time to time, but radiation and then CyberKnife radiosurgery kept them in check. Things changed in June of 2007. The last CyberKnife treatment was billed as the worst, with significant pain likely to follow. Sure enough, ten days later, my father’s pain on swallowing became severe. He began losing weight—a lot of it. He weakened. One look at my father and the surgeon ad- mitted him, ordering a gastrostomy tube to deliver nutrition. My father was becoming increasingly weak. He could not read, do the New York Times crossword puzzles. Fortunately, he could talk, but he was confined to bed. Then one morning he said he wanted to stop. (..) It seemed he was asking for more—a fast death, by assisted suicide or euthanasia. Reflexively, I said no, but I knew right away that I needed to think through my “no.”[10]

As it is possible to deduce from the text above, euthanasia can be voluntary, when a patient explicitly request to put end to his life (this can be the case for terminally ill patients) or involuntary, when there is no personal or proxy invitation to end the patient’s life. In this specific case, the person is competent to express his will, but he has not been consulted, so his life ended. Then euthanasia can be also non-voluntary: this means that the person is not competent to make a decision, or he cannot make his wishes known, for example in the case of a coma, of a person severely brain damaged or unable to express a wish.

The forms of euthanasia mentioned before can be active or passive; euthanasia is active when the patient dies after a physician's intervention by administering a lethal injection or by prescribing lethal drugs. On the contrary, euthanasia is passive when there is intentional omission or interruption of the treatment. However, in this case, it’s better not to use the term euthanasia but the term therapeutic abstention; this is the approach most common in the world as a consequence of the self-determination principle toward the sanitary treatments.

Conventionally, active and passive euthanasia are different from each other because the latter consists in withholding the treatment, whereas the first one is considered as active killing; James Rachels, despite that, claimed that in terms of moral aspect “active euthanasia is not worse than passive euthanasia, since the outcome is the same and both acts lead to the patient’s death”.[11]

A little different from euthanasia is PAS: Physician-Assisted Suicide. This is the act through which a patient succeeds to reach a fast death thanks to the physician’s assistance, who only prescribes necessaries drugs.

Since is not easy to manage all the complicated circumstances concerning euthanasia, it is significant to examine the conditions in which can arise the requests of euthanasia or PAS.

1.1 Clinic Situations

The patients with cancer are those who ask most frequently for euthanasia or PAS. Nowadays, some of the malignant tumours can be treated with different therapeutics procedure: surgery, chemotherapy, and radiotherapy. The point is that often those treatments only extend the patient’s life, because of the low recovery rate; when the cancer progressively extends in the organism, it arises very serious symptoms (like dyspnoea, paralysis, unbearable pain etc.).

The patients pained by AIDS are the clear example of all the possible behaviours –and consequent decisions- facing the death’s certainty and the accurate predictions of their life’s expectation.

All degenerative disease, for example Alzheimer’s disease or multiple sclerosis, are characterized by a slow course but, in the terminal phase, the person affected becomes unable to carry out the most elementary functions.

According to the problems mentioned before, we can easily understand the aware decision of a terminal ill patient who asks his physician to put an end to his life.

It’s important to underline that euthanasia is not the only solution for a terminally ill person: if physicians refuse to help a patient to die, he can resorts to palliative care: the World Health Organization affirms that palliative care the active, total care of patients whose disease is not responsive to curative treatment. Control of pain, other symptoms and psychological, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best quality of life for patients and families.  [12]

Obviously the two solutions presented are very different from each other and the choice of which one it’s better to apply can be only of the patient. [13]

CHAPTER 2: ETHICS AND RELIGIOUS PROBLEMS OF EUTHANASIA

“You matter because you are you. You matter to the last moment of your life, and we well do all we can, not only to help you die peacefully, but also to live until you die.”[14]

All of us are aware of the complications that the debate about euthanasia causes. Legalizing euthanasia has caused a hard dispute throughout the world and it will continue to do so, within the ambit of the law, of ethics and of religion; for this reason I am going to examinee euthanasia from these points of view.

Despite all the considerations, no one asks a terminally ill patient the kind of pain he goes through, neither if the person should have the right to choose at least a pleasant death for himself.

As I said in the opening of the first chapter, the essence of human life is to live with dignity; this aim cannot be always pursued because the same law forces a person to live in penetrating pain and humiliation. The question that spontaneously arises is: what kind of society would do something like that to a person who suffers? And who are we to protract the life of someone who has freely decided to die?

2.1. “Thou shalt no kill”. The religion’s opinion about euthanasia

These questions cannot be answered superficially: we have to consider that medicine makes great progress and, in years, we might have cures for very serious diseases. Also, in country like ours, a fundamental importance is given to the Church, and this is a very problematical aspect: the Bible says: “Thou shalt no kill”.[15] This is the fifth commandment but the translation is not completely exactly: a better translation would be “do not commit homicide” that, per definition, is an unjustified killing. This is the reason because, if euthanasia is justified, technically is not a murder and, technically, is not forbidden by this commandment.

However, we can find a clear condemnation of euthanasia in ecclesiastical tradition: Church takes position against killing for mercy.

As a matter of fact, since ancient times, both Jewish and Christians have denounce euthanasia, considering it as suicide and treating it as murder. This position is steadily expressed in the 1980 Vatican Declaration of Euthanasia[16], called Iura et Bona, and affirmed in recent speeches by Pope John Paul II: the Catholic Church inflexibly rejects euthanasia or physician-assisted suicide.

If we think about the Bible’s precepts, we can remember that for Catholics the arrangement regarding the moment of death only belongs to God: as they usually affirm, life is a gift, and even a life characterized by pain is life at least.

I would like to talk for a while about a culture that has something in common with Christianity but that considers the concept of life and death in a different way: in some Muslim societies, in which suicide is morally wrong, the Koran has been interpreted in way that permits to declare that it can be acceptable if it is achieved with the intention of glorifying God and not serving self-interests. [17] According to the Koran “ no person can ever die except by Allah’s leave at an appointment term” [18] There are two sins for which there will be no God’s forgiveness: idolatry and suicide consciously wanted (that is mean with not psychic disorders).

Considering our country, I think that it is better to focus on what Catholic religion declares: for Catholics the refusal of euthanasia has his roots in the faith and hope in God’s will, who, with his suffering and resurrection, gave a new meaning to the human existence. Therefore the refusal of euthanasia is considered as the pain that Jesus Christ felt on the cross.

Those are the words pronounced by Pope John Paul II:

“In conformità con il Magistero dei miei Predecessori e in comunione con i Vescovi della Chiesa cattolica, confermo che l'eutanasia è una grave violazione della Legge di Dio, in quanto uccisione deliberata moralmente inaccettabile di una persona umana. Tale dottrina è fondata sulla legge naturale e sulla Parola di Dio scritta, è trasmessa dalla Tradizione della Chiesa ed insegnata dal Magistero ordinario e universale. Una tale pratica comporta, a seconda delle circostanze, la malizia propria del suicidio o dell'omicidio. La scelta dell'eutanasia diventa più grave quando si configura come un omicidio che gli altri praticano su una persona che non l'ha richiesta in nessun modo e che non ha mai dato ad essa alcun consenso.” [19]

One of the reason recurring against euthanasia and physician-assisted suicide is about the sanctity and intangibility of life: this represents the supreme value, which should be respected and defended. So, life is inviolable, but what do people exactly intend for life? What distinguishes human life from a biological condition is the whole bit of experiences, relations with other people, delights and torments; in other terms, it is necessary to distinguish biological life from biographical life. When biographical life ends or becomes intolerable, as in the terminally illness, it has to consider to put end to the life.

According to the Catholic doctrine, even if euthanasia is not characterized by egoistic refusal to help those who suffer, it has to be defining as fake mercy. Indeed the true compassion makes sympathetic with other’s pain, and not hostile towards to sufferers; for this reason, some Catholics’ believer have individualized in euthanasia the principles of the “death culture”.

Death culture is characteristic of the affluent society that sees the ill person as a weight.[20] It considers humanity as the result of natural and not intentional forces, so as fruit of the coincidence; individuals are accidentally thrown to the life’s proscenium.

Therefore, there is a process of de-personalization that denies any qualitative difference between human being and not human being; a clear example is given by the complex phenomenon named New Age. One of its most important exponents is Robert G. Edwards, the gynaecologist who, using the technique of artificial insemination with the embryo’s transfer (FIVET), has first obtained a test-tube baby. He affirms that:

“Anzitutto lasciatemi affermare alcuni semplici fatti che io credo siano accettati dalla maggioranza di questo uditorio. In primo luogo, la fecondazione non dà inizio alla vita. La vita è un continuum. Essa si presenta nell’ovocita, nell’ovaio fetale e può essere ripercorso all’indietro attraverso le generazioni.”[21]

This attempt to change radically life’s meaning is expressed by Pierre Simon:

“La vita umana perde oggi il suo carattere assoluto, per diventare un concetto che si evolve e modella a seconda delle leggi, delle idee, della conoscenza. La vita è ciò che è la cultura che la determina.”[22]

According to what I briefly touched on, it is possible to affirm that euthanasia represents the necessary consequence to the death culture; this is what happens when human being dignity is no more considered as an objective and fundamental right, but something concerning subjective parameters.

To sum up, from the religious’ point of view, life has to be defended, even if it is full of pain and suffering; in the other hand, from the lay’s point of view, the most important thing that everyone has to defend is the quality of life.

However the Catholic Church do not oppose to the palliative cares which are fits for improving the life’s quality of a patient in death struggle: Pope Pius XII affirmed about narcotics and sedatives that “those are lawful, even if they might be the effect of reduce the conscience –if there are not other ways-“.[23]

Also an important Catholic philosopher, Daniel Maguire, in his book called Death by Choice, affirmed that “può essere morale e dovrebbe essere legale accelerare il processo della morte attraverso azioni dirette, quali la somministrazione di morfina o potassio” and, in the end, he tries to demonstrate that this solution can be compatible with the historical Catholics ethic. [24]

2.2 The Euthanasia’s morality

In 1970 an American oncologist used for the first time the term bioethics[25] to indicate a new knowledge, without which it would have been difficult facing all the new technologies and scientific progresses. The life and death problem represents an ethics and, consequently, a bioethics fundamental problem.

The introduction, in the medical praxis and in the legislation, of euthanasia and PAS, arouses the worry of a fall towards other forms of death acceleration: society might set out in a slippery slope, which might culminate in legally suppressing elderly men or disabled people.

Since bioethics born after Second World War and after the Nazi’s horror, the memories of what Hitler did justified fears: the Nazi period is considered the proof of what happens when voluntary euthanasia becomes involuntary and all the ethics rules suddenly disappear. However, the Nazi politics towards ill and weak people began and were effectuated breaking the German Criminal Code, so there is nothing in common with the today’s idea of euthanasia.

There are many ethics examples in our cultural and social situation: the disappeared Franz Ingelfinger, executive of the “New England Journal of Medicine” sustained that:

“E’ l’apogeo degli eticisti in medicina. Delineano i diritti dei pazienti, dei soggetti da esperimento, dei feti, delle madri e persino dei medici. (…) Con logica impeccabile –una volta accetate certe assunzioni di base- e con prosa accattivante, gli eticisti sviluppano i loro argomenti. Tuttavia i loro precetti sono essenzialmente i prodotti di esercizi a tavolino e rimangono astratti e idealistici finchè non sono stati messi alla prova nel laboratorio dell’esperienza.”[26]

Doctor Ingelfinger was right suspecting of absolute rules; nevertheless, actually there are rules that doctors consider unconditional. One of those is the prohibition of killing for mercy: physicians have been stuck to this absolute principle since the Hippocratic oath.

So, I am going to talk about the killing’s morality in the case that we can call “standard case of euthanasia”: the case of the terminally ill patient who, still having his right mind, asks to be killed as an alternative to a long and painful death.

The most common topic in support of euthanasia is the one that we can denominate “mercy subject”. It is based on a very elementary idea: sometimes the terminally ill patients suffer so much that who has been the luck to never tried it will be never comprehend what they feel. So, the mercy subject says that euthanasia is justified because put an end to pain.

Stewart Alsop was a famous reporter who died in 1975 for a rare type of cancer; before dying he left an account where he describes his experiences as terminally ill patient and his change of mind towards euthanasia, as a consequence of his stay in a room’s hospital with a patient that he called Jack.

“Jack aveva un melanoma allo stomaco, un tumore maligno solido che i medici ritenevano fosse delle dimensioni di una palla da softball. I medici erano intenzionati a rimuovere questo tumore, ma sapevano che Jack presto sarebbe morto; il cancro era in metastasi, la diffusione incontrollabile. (...) Il dolore era continuo, e il suo medico gli aveva prescritto un’iniezione endovenosa di un oppiaceo di sintesi ogni quattro ore. Nelle ore prescritte, un’infermiera faceva a Jack l’iniezione di analgesico sintetico, e questo controllava il dolore per due ore o poco più. Poi cominciava a lamentarsi, o a gemere, molto piano, come se non mi volesse svegliare. Infine iniziava ad ululare, come un cane. Quando accadeva, chiamavamo un’infermiera che gli dava della codeina, ma non aveva mai un effetto soddisfacente – dava gli stessi risultati che dà mezza aspririna a chi si è appena rotto un braccio. La terza notte di questa routine, mi venne in mente il terribile pensiero: “se Jack fosse un cane, pensavo, che cosa gli avremmo fatto?” La risposta era ovvia. Nessun essere umano con un barlume di pietà potrebbe lasciar soffrire un essere vivente in questo modo, invano.”[27]

With these words, we could in part imagine the kind of pain that we are talking about. Only considering it, we can appreciate the important of this subject: if a person implores the death as an alternative of this type of suffering, is truly immoral to help this person die?

Starting from this point, the typical utilitarian version of morality could be developed like this: an action is morally right if it helps to increase the happiness in the world or to decrease the unhappiness. So, killing an incurable patient might decrease the quantity of unhappiness and, logically, this action would be morally right, according to utilitarian view.

However, many philosophers consider utilitarian principles inacceptable because they think that the promotion of happiness or unhappiness is not the only important thing in people’s life: for example, people could be happier if there was no freedom of worship because, in that way, there would be more harmony between communities.

In the other hand, the contemporary utilitarian affirms that the promotion of happiness and the decrease of unhappiness could not be the only important things, but they are important anyway. Then they adopt a broader concept of individual well-being: instead of talking about happiness, that can causes misunderstanding, they start talking about maximizing interests. Using this better version of the utilitarian principle, we can reformulate it: if an action promotes the interests of all the people involved, then this action is morally acceptable. So, euthanasia, promoting sometimes interests of the people involved, it can be considered morally acceptable.

The moral philosophy of Kant is considered the best alternative to the utilitarianism doctrine: his principles said that we have to behave as we desire that every people could do towards us.

Therefore, the only supreme morality principle, the categorical imperative, says that: “Agisci soltanto secondo quella massima che, al tempo stesso, puoi volere che divenga una legge universale”. [28]

What is the meaning of this theory? It means that, when we are trying to make a decision about accomplishing or not an action, we have to ask ourselves first if we would like that all the people follow that same rule in the same occasion.

The application of this rule at the euthanasia’s problem is clear: everyone of us one day will die and, if we would have a choice between two ways for dying, one with a terrible pain and the other one without it, what way would we choose?

The contemporary English philosopher R. M. Hare has reached the same conclusion narrating this real story:

“Il guidatore di un camion cisterna di benzina fu coinvolto in un incidente in cui il suo veicolo si capovolse e prese immediatamente fuoco. Rimase intrappolato nella cabina e non lo si potè liberare. Pertanto chiese a chi gli stavae intorno di ucciderlo colpendolo alla testa, così che non sarebbe morto carbonizzato. Penso che qualcuno lo fece, ma non so cosa accadde in seguito in tribunale. Ora vi prego di chiedervi, come molte volte mi sono chiesto io, cosa vorreste che uno degli astanti vi facesse se foste nella situazione di quel camionista. Non posso credere che chiunque consideri la questione seriamente, direbbe che la regola è quella che esclude assolutamente l’eutanasia.”[29]

The irony is that, at the root of the question, it is expressed by the article, by Kant –mentioned before- and by Jesus the so-called golden rule: “fai agli altri, quello che vorresti fosse fatto a te”.

As Hare said, if this is the supreme principle of morality, how euthanasia can be completely wrong? It seems that this is a case in which Church strayed from the point established by her founder.

Il seguente scritto è stato elaborato per l’esame di Comparative Constitutionalism e verte sul tema dell’eutanasia.

Il lavoro, in lingua inglese, è diviso in tre parti, ciascuna delle quali tratta aspetti differenti, ma collegati, della materia in esame. Sono prodromici alle questioni giuridiche, quelle scientifiche, etiche e morali.

La prima parte, suddivisa in due capitoli, affronta il tema dell'eutanasia dal punto di vista scientifico, quindi introducendo brevemente il concetto di eutanasia e la differenza tra quest’ultima e il suicidio assistito.

In un breve paragrafo, all’interno del primo capitolo, sono trattati gli aspetti clinici dei soggetti che richiedono pratiche eutanasiche.

Il secondo capitolo verte sul delicato tema riguardante i problemi etici, morali e religiosi dell’eutanasia: il primo paragrafo di questo secondo capitolo approfondisce i precetti della religione cattolica con riferimento all’eutanasia e la cosiddetta death culture, ovvero la cultura della morte.

Il secondo paragrafo tratta, invece, degli aspetti morali dell’eutanasia: a questo proposito vi è una breve storia delle pratiche eugenetiche, indispensabile per comprendere i problemi etici e morali trattati in seguito.

La seconda parte approfondisce le problematiche connesse alla legalizzazione dell’eutanasia. Dopo aver brevemente considerato i modi in cui il soggetto agente viene giudicato processualmente, mi sono concentrata sull’analisi del sistema giuridico Americano, in materia di provvedimenti per l’eutanasia.

Il quarto capitolo, nonchè l’ultimo della seconda parte, riguarda la situazione dell’Olanda, partendo dal 1945, fino ad arrivare alla corrente situazione legale, in quanto interessante per la tematica da me trattata.

Ho inoltre analizzato il caso Schoonheim, quale esempio emblematico, all’interno di un lungo excursus storico, per rendere comprensibile il percorso che ha portato alla legislazione attuale sull’eutanasia.

La terza e ultima parte del trattato, riprende la disciplina sull’eutanasia negli Stati Uniti d’America; anche in questo caso l'incipit è avvenuto dall'analisi storica, per poi  analizzare più approfonditamente i vari movimenti pro e contro l’eutanasia, di modo da poter agilmente comprendere come si è arrivati alla legislazione attuale, soprattutto nello stato dell’Oregon.

Infine, anche in questo caso, ho analizzato un caso significativo, il "caso Cruzan", che ha tenuto banco nell'opinione pubblica nello Stato del Missouri già alla fine degli anni ’80.

CONTENTS: INTRODUCTION CHAPTER 1: Medical aspects of euthanasia 1.1 Clinic Situation     CHAPTER 2: Ethics and Religious problems of Euthanasia 2.1.“Thou shalt no kill”. The religion’s opinion about euthanasia 2.2. The euthanasia’s morality CHAPTER 3: Law and morality in Euthanasia CHAPTER 4: The Netherlands’ experience 4.1. 1945-1970, when public debate began   4.2. 1970-1982, when euthanasia became a debatable subject 4.3. 1982-1986: the breakthrough in the meaning of “euthanasia” 4.3.1. The Schoonheim case 4.4. 1986-1997: attempts to legalize euthanasia 4.5. The current legal situation  CHAPTER 5: Euthanasia in the United States  5.1. A little of history 5.2. The euthanasia movement (from 1930s to 1990s) 5.3. Predominant law today 5.3.1. Oregon’s situation 5.4. The Cruzan case CONCLUSION BIBLIOGRAPHY

INTRODUCTION

“Just as I shall select my ship when I am about to go on a voyage, or my house when I propose to take a residence, so I shall choose my death when I am about to depart from life.” [1]

The subject of euthanasia has thrilled a large group of academics, especially in the last decade. This interest do not derive only from jurists, called often to define the lawfulness or unlawfulness of the matters, but involves also many sectors of life sciences: ethics, philosophy, religion and medicine, that converge with law.

 The term euthanasia comes from the Greek word εὐθανασία, composed by εὖ that means good, and by θάνατος, that means death; these two words put together have the meaning of good death or simply death. In the Treccani’s encyclopedia there is a very clear definition, as a matter of fact it is called euthanasia the conduct, both active and omissive, which abbreviates the life of a much-suffering person. In detail, euthanasia is described as the killing of an agreeable person who could give voice to his death’s will, either as physician-assisted suicide or as voluntary euthanasia.

However, the medicalized killing of a patient without his consent cannot be define euthanasia but a proper murder; this is the case of those subjects who do not express their consent, or those who are not able to express it, for example infants, fetus, interdicts or subjects afflicted by serious diseas.

Altought this topic seems relatively recent, it is necessary to mention it from an historical point of view. In the ancient word, there was already something that we can call social euthanasia, which means society suppressed or left to his own destiny someone who could be a burden to it. This practice had been attested in Sparta, in the roman world and in most of the ancient societies.

I think it is important to briefly consider the greek’s culture and, especially, a fragment of Platone:

“Allora, insieme con tale arte giudiziaria, codificherai tu nel nostro Stato anche la medicina nella forma da noi detta? Così, tra i tuoi cittadini, esse cureranno quelli che siano naturalmente sani di corpo e d’anima. Quanto a quelli che non lo siano, i medici lasceranno morire chi è fisicamente malato, i giudici faranno uccidere chi ha l’anima naturalmente cattiva e inguaribile.”[2]

From this fragment we can easily figure out the attitude of Platone: if, in that period, we had talked about euthanasia with the meaning that we assign it nowadays, he would have not condemn it; rather, he believed that it was right to let ill people die. Radically different is the position that Aristotele expressed in the Etica Nicomachea: he presented the suicidal as a person who commits a huge injustice against his city and, most of all, the poet considered the much-suffering people as an example of courage: 

“Il morire per fuggire la povertà o la passione amorosa o qualcosa di doloroso non è di uomo coraggioso, ma piuttosto di un vile: è infatti debolezza lo sfuggire ai travagli e chi si uccide agisce non per affrontare una prova decorosa, bensì per sfuggire un male.”[3]

We have quickly considered the role of critically ill people in the greek’s culture, and the next step is about the analysis of the role of the physicians in cases of euthanasia or assisted suicide: on the one hand, according to that praxis, this kind of action was not excluded, on the other hand the Hippocratic oath strictly forbade it: “To please no one will I prescribe a deadly drug nor give advice which may cause his death”[4].

During the Medieval age, with the advent of the Catholic religion, the point of view towards the euthanasia completely changed: the absolute incompatibility between euthanasia and Christian morality is really stressed. For the Fathers of the Church, the human being is not the owner of his life and he can’t dispose of it as an arbiter. Tommaso d’Aquino expressed in a lapidary way the three reasons why suicide was considered such as an illicit act:

“Il suicidio è assolutamente illecito per tre motivi. Primo, perché per natura ogni essere ama se stesso; e ciò implica la tendenza innata a conservare se stessi e a resistere per quanto è possibile a quanto potrebbe distruggerci (…) Secondo, perché la parte è essenzialmente qualche cosa del tutto; ora, ciascun uomo è parte della società; e quindi è essenzialmente della collettività. Perciò uccidendosi fa un torto alla società, come insegna il Filosofo. Terzo, la vita è un dono divino, che rimane in potere di colui il quale “fa vivere e fa morire”. Perciò chi priva se stesso della vita pecca contro Dio (…). Infatti a Dio soltanto appartiene il giudizio di vita e di morte, secondo le parole della Scrittura: “Sono io a far morire e a far vivere”[5]

In the end, in the XX century, the requests for euthanasia grew up: in 1906 the Ohio Parliament presented the wording of a law of euthanasia (rejected by the Magistrates’ Governing Council) and in 1936 the same request in London was presented (rejected by the House of Lords). It is also necessary to mention the paradigmatic example of Germany before and during the Second World War: in 1920 was published a book called “Die Freigabe der Vernichtung lebensunwerten Lebens” (that means Allowing the destruction of life unworthy of living) where the author, Alfred Hoche, writes about euthanasia as a kind of natural selection, affirming that the killing of people who do not have no value for the society, must be allowed.[6]

Those ideas cough on so much with the coming of Hitler that has been created the Commission of the Reich for people’s health; this commission had to convince the German people of the goodness and the necessity of eugenics’ practices.

The years after the Second World War were very delicate for the euthanasia, especially because of the Norimberga’s lawsuit that contributed to make known all the terrible things mentioned before; as a matter of fact, going on with the practices of euthanasia was a continuous reference to the Nazi massacre.

In my opinion, these mentions to the history of euthanasia are essentials to understand better the reasons of the discussions about this topic, especially nowadays and in the past decade. Therefore my intent is to use an analytical procedure, deepening the topic of euthanasia; starting from the medical aspects, I will consider the ethics and philosophical problems. In conclusion I will consider the legislation and the cases of euthanasia in the U.S.A. and in Netherlands. [7]

CHAPTER 1: MEDICAL ASPECTS OF EUTHANASIA

Since I have decided to deal with the topic of euthanasia, I think I have to give prominence to the medical aspect of this complicated and much-discussed practice.

First of all, it is necessary to understand when a person, in spite of isolated activities of his body, can be defined dead or, instead, can be considered still alive. It is very important to comprehend this distinction: the problems concerning the lawfulness of euthanasia only regard the case in which a person can be considered alive.

The academics consider a very important aspect to determinate when a person chases to exist: dignity. Indeed, before the modern technique of reanimation, death was considered as the suspension of the cardiac, respiratory and nervous functions; for this reason, nowadays, we have to consider dignity also as the ability of a person to relate with others, so as something fundamental for the human being, defined ages ago as “social animal”[8]. Dignity stops in the moment when a subject is in a so acute condition that he cannot have anymore relations with other people. However the idea of death is clearly explained by legislators: in the first article of the law Dicember 29, 1993 number 578 it is affirmed that

“la morte si identifica con la cessazione irreversibile di tutte le funzioni dell’encefalo (la morte cerebrale)”. [9] After these preliminary remarks, we can start to examine euthanasia in a more specific way. “My father was a smart, savvy lawyer, the family patriarch. He was forceful, even intimidating at times. My father was diagnosed with a metastatic head and neck cancer in 2002. A top head and neck surgeon worked through conflicting pathology reports to locate the primary tumor in the thyroid. Metastases would crop up from time to time, but radiation and then CyberKnife radiosurgery kept them in check. Things changed in June of 2007. The last CyberKnife treatment was billed as the worst, with significant pain likely to follow. Sure enough, ten days later, my father’s pain on swallowing became severe. He began losing weight—a lot of it. He weakened. One look at my father and the surgeon ad- mitted him, ordering a gastrostomy tube to deliver nutrition. My father was becoming increasingly weak. He could not read, do the New York Times crossword puzzles. Fortunately, he could talk, but he was confined to bed. Then one morning he said he wanted to stop. (..) It seemed he was asking for more—a fast death, by assisted suicide or euthanasia. Reflexively, I said no, but I knew right away that I needed to think through my “no.”[10]

As it is possible to deduce from the text above, euthanasia can be voluntary, when a patient explicitly request to put end to his life (this can be the case for terminally ill patients) or involuntary, when there is no personal or proxy invitation to end the patient’s life. In this specific case, the person is competent to express his will, but he has not been consulted, so his life ended. Then euthanasia can be also non-voluntary: this means that the person is not competent to make a decision, or he cannot make his wishes known, for example in the case of a coma, of a person severely brain damaged or unable to express a wish.

The forms of euthanasia mentioned before can be active or passive; euthanasia is active when the patient dies after a physician's intervention by administering a lethal injection or by prescribing lethal drugs. On the contrary, euthanasia is passive when there is intentional omission or interruption of the treatment. However, in this case, it’s better not to use the term euthanasia but the term therapeutic abstention; this is the approach most common in the world as a consequence of the self-determination principle toward the sanitary treatments.

Conventionally, active and passive euthanasia are different from each other because the latter consists in withholding the treatment, whereas the first one is considered as active killing; James Rachels, despite that, claimed that in terms of moral aspect “active euthanasia is not worse than passive euthanasia, since the outcome is the same and both acts lead to the patient’s death”.[11]

A little different from euthanasia is PAS: Physician-Assisted Suicide. This is the act through which a patient succeeds to reach a fast death thanks to the physician’s assistance, who only prescribes necessaries drugs.

Since is not easy to manage all the complicated circumstances concerning euthanasia, it is significant to examine the conditions in which can arise the requests of euthanasia or PAS.

1.1 Clinic Situations

The patients with cancer are those who ask most frequently for euthanasia or PAS. Nowadays, some of the malignant tumours can be treated with different therapeutics procedure: surgery, chemotherapy, and radiotherapy. The point is that often those treatments only extend the patient’s life, because of the low recovery rate; when the cancer progressively extends in the organism, it arises very serious symptoms (like dyspnoea, paralysis, unbearable pain etc.).

The patients pained by AIDS are the clear example of all the possible behaviours –and consequent decisions- facing the death’s certainty and the accurate predictions of their life’s expectation.

All degenerative disease, for example Alzheimer’s disease or multiple sclerosis, are characterized by a slow course but, in the terminal phase, the person affected becomes unable to carry out the most elementary functions.

According to the problems mentioned before, we can easily understand the aware decision of a terminal ill patient who asks his physician to put an end to his life.

It’s important to underline that euthanasia is not the only solution for a terminally ill person: if physicians refuse to help a patient to die, he can resorts to palliative care: the World Health Organization affirms that palliative care the active, total care of patients whose disease is not responsive to curative treatment. Control of pain, other symptoms and psychological, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best quality of life for patients and families.  [12]

Obviously the two solutions presented are very different from each other and the choice of which one it’s better to apply can be only of the patient. [13]

CHAPTER 2: ETHICS AND RELIGIOUS PROBLEMS OF EUTHANASIA

“You matter because you are you. You matter to the last moment of your life, and we well do all we can, not only to help you die peacefully, but also to live until you die.”[14]

All of us are aware of the complications that the debate about euthanasia causes. Legalizing euthanasia has caused a hard dispute throughout the world and it will continue to do so, within the ambit of the law, of ethics and of religion; for this reason I am going to examinee euthanasia from these points of view.

Despite all the considerations, no one asks a terminally ill patient the kind of pain he goes through, neither if the person should have the right to choose at least a pleasant death for himself.

As I said in the opening of the first chapter, the essence of human life is to live with dignity; this aim cannot be always pursued because the same law forces a person to live in penetrating pain and humiliation. The question that spontaneously arises is: what kind of society would do something like that to a person who suffers? And who are we to protract the life of someone who has freely decided to die?

2.1. “Thou shalt no kill”. The religion’s opinion about euthanasia

These questions cannot be answered superficially: we have to consider that medicine makes great progress and, in years, we might have cures for very serious diseases. Also, in country like ours, a fundamental importance is given to the Church, and this is a very problematical aspect: the Bible says: “Thou shalt no kill”.[15] This is the fifth commandment but the translation is not completely exactly: a better translation would be “do not commit homicide” that, per definition, is an unjustified killing. This is the reason because, if euthanasia is justified, technically is not a murder and, technically, is not forbidden by this commandment.

However, we can find a clear condemnation of euthanasia in ecclesiastical tradition: Church takes position against killing for mercy.

As a matter of fact, since ancient times, both Jewish and Christians have denounce euthanasia, considering it as suicide and treating it as murder. This position is steadily expressed in the 1980 Vatican Declaration of Euthanasia[16], called Iura et Bona, and affirmed in recent speeches by Pope John Paul II: the Catholic Church inflexibly rejects euthanasia or physician-assisted suicide.

If we think about the Bible’s precepts, we can remember that for Catholics the arrangement regarding the moment of death only belongs to God: as they usually affirm, life is a gift, and even a life characterized by pain is life at least.

I would like to talk for a while about a culture that has something in common with Christianity but that considers the concept of life and death in a different way: in some Muslim societies, in which suicide is morally wrong, the Koran has been interpreted in way that permits to declare that it can be acceptable if it is achieved with the intention of glorifying God and not serving self-interests. [17] According to the Koran “ no person can ever die except by Allah’s leave at an appointment term” [18] There are two sins for which there will be no God’s forgiveness: idolatry and suicide consciously wanted (that is mean with not psychic disorders).

Considering our country, I think that it is better to focus on what Catholic religion declares: for Catholics the refusal of euthanasia has his roots in the faith and hope in God’s will, who, with his suffering and resurrection, gave a new meaning to the human existence. Therefore the refusal of euthanasia is considered as the pain that Jesus Christ felt on the cross.

Those are the words pronounced by Pope John Paul II:

“In conformità con il Magistero dei miei Predecessori e in comunione con i Vescovi della Chiesa cattolica, confermo che l'eutanasia è una grave violazione della Legge di Dio, in quanto uccisione deliberata moralmente inaccettabile di una persona umana. Tale dottrina è fondata sulla legge naturale e sulla Parola di Dio scritta, è trasmessa dalla Tradizione della Chiesa ed insegnata dal Magistero ordinario e universale. Una tale pratica comporta, a seconda delle circostanze, la malizia propria del suicidio o dell'omicidio. La scelta dell'eutanasia diventa più grave quando si configura come un omicidio che gli altri praticano su una persona che non l'ha richiesta in nessun modo e che non ha mai dato ad essa alcun consenso.” [19]

One of the reason recurring against euthanasia and physician-assisted suicide is about the sanctity and intangibility of life: this represents the supreme value, which should be respected and defended. So, life is inviolable, but what do people exactly intend for life? What distinguishes human life from a biological condition is the whole bit of experiences, relations with other people, delights and torments; in other terms, it is necessary to distinguish biological life from biographical life. When biographical life ends or becomes intolerable, as in the terminally illness, it has to consider to put end to the life.

According to the Catholic doctrine, even if euthanasia is not characterized by egoistic refusal to help those who suffer, it has to be defining as fake mercy. Indeed the true compassion makes sympathetic with other’s pain, and not hostile towards to sufferers; for this reason, some Catholics’ believer have individualized in euthanasia the principles of the “death culture”.

Death culture is characteristic of the affluent society that sees the ill person as a weight.[20] It considers humanity as the result of natural and not intentional forces, so as fruit of the coincidence; individuals are accidentally thrown to the life’s proscenium.

Therefore, there is a process of de-personalization that denies any qualitative difference between human being and not human being; a clear example is given by the complex phenomenon named New Age. One of its most important exponents is Robert G. Edwards, the gynaecologist who, using the technique of artificial insemination with the embryo’s transfer (FIVET), has first obtained a test-tube baby. He affirms that:

“Anzitutto lasciatemi affermare alcuni semplici fatti che io credo siano accettati dalla maggioranza di questo uditorio. In primo luogo, la fecondazione non dà inizio alla vita. La vita è un continuum. Essa si presenta nell’ovocita, nell’ovaio fetale e può essere ripercorso all’indietro attraverso le generazioni.”[21]

This attempt to change radically life’s meaning is expressed by Pierre Simon:

“La vita umana perde oggi il suo carattere assoluto, per diventare un concetto che si evolve e modella a seconda delle leggi, delle idee, della conoscenza. La vita è ciò che è la cultura che la determina.”[22]

According to what I briefly touched on, it is possible to affirm that euthanasia represents the necessary consequence to the death culture; this is what happens when human being dignity is no more considered as an objective and fundamental right, but something concerning subjective parameters.

To sum up, from the religious’ point of view, life has to be defended, even if it is full of pain and suffering; in the other hand, from the lay’s point of view, the most important thing that everyone has to defend is the quality of life.

However the Catholic Church do not oppose to the palliative cares which are fits for improving the life’s quality of a patient in death struggle: Pope Pius XII affirmed about narcotics and sedatives that “those are lawful, even if they might be the effect of reduce the conscience –if there are not other ways-“.[23]

Also an important Catholic philosopher, Daniel Maguire, in his book called Death by Choice, affirmed that “può essere morale e dovrebbe essere legale accelerare il processo della morte attraverso azioni dirette, quali la somministrazione di morfina o potassio” and, in the end, he tries to demonstrate that this solution can be compatible with the historical Catholics ethic. [24]

2.2 The Euthanasia’s morality

In 1970 an American oncologist used for the first time the term bioethics[25] to indicate a new knowledge, without which it would have been difficult facing all the new technologies and scientific progresses. The life and death problem represents an ethics and, consequently, a bioethics fundamental problem.

The introduction, in the medical praxis and in the legislation, of euthanasia and PAS, arouses the worry of a fall towards other forms of death acceleration: society might set out in a slippery slope, which might culminate in legally suppressing elderly men or disabled people.

Since bioethics born after Second World War and after the Nazi’s horror, the memories of what Hitler did justified fears: the Nazi period is considered the proof of what happens when voluntary euthanasia becomes involuntary and all the ethics rules suddenly disappear. However, the Nazi politics towards ill and weak people began and were effectuated breaking the German Criminal Code, so there is nothing in common with the today’s idea of euthanasia.

There are many ethics examples in our cultural and social situation: the disappeared Franz Ingelfinger, executive of the “New England Journal of Medicine” sustained that:

“E’ l’apogeo degli eticisti in medicina. Delineano i diritti dei pazienti, dei soggetti da esperimento, dei feti, delle madri e persino dei medici. (…) Con logica impeccabile –una volta accetate certe assunzioni di base- e con prosa accattivante, gli eticisti sviluppano i loro argomenti. Tuttavia i loro precetti sono essenzialmente i prodotti di esercizi a tavolino e rimangono astratti e idealistici finchè non sono stati messi alla prova nel laboratorio dell’esperienza.”[26]

Doctor Ingelfinger was right suspecting of absolute rules; nevertheless, actually there are rules that doctors consider unconditional. One of those is the prohibition of killing for mercy: physicians have been stuck to this absolute principle since the Hippocratic oath.

So, I am going to talk about the killing’s morality in the case that we can call “standard case of euthanasia”: the case of the terminally ill patient who, still having his right mind, asks to be killed as an alternative to a long and painful death.

The most common topic in support of euthanasia is the one that we can denominate “mercy subject”. It is based on a very elementary idea: sometimes the terminally ill patients suffer so much that who has been the luck to never tried it will be never comprehend what they feel. So, the mercy subject says that euthanasia is justified because put an end to pain.

Stewart Alsop was a famous reporter who died in 1975 for a rare type of cancer; before dying he left an account where he describes his experiences as terminally ill patient and his change of mind towards euthanasia, as a consequence of his stay in a room’s hospital with a patient that he called Jack.

“Jack aveva un melanoma allo stomaco, un tumore maligno solido che i medici ritenevano fosse delle dimensioni di una palla da softball. I medici erano intenzionati a rimuovere questo tumore, ma sapevano che Jack presto sarebbe morto; il cancro era in metastasi, la diffusione incontrollabile. (...) Il dolore era continuo, e il suo medico gli aveva prescritto un’iniezione endovenosa di un oppiaceo di sintesi ogni quattro ore. Nelle ore prescritte, un’infermiera faceva a Jack l’iniezione di analgesico sintetico, e questo controllava il dolore per due ore o poco più. Poi cominciava a lamentarsi, o a gemere, molto piano, come se non mi volesse svegliare. Infine iniziava ad ululare, come un cane. Quando accadeva, chiamavamo un’infermiera che gli dava della codeina, ma non aveva mai un effetto soddisfacente – dava gli stessi risultati che dà mezza aspririna a chi si è appena rotto un braccio. La terza notte di questa routine, mi venne in mente il terribile pensiero: “se Jack fosse un cane, pensavo, che cosa gli avremmo fatto?” La risposta era ovvia. Nessun essere umano con un barlume di pietà potrebbe lasciar soffrire un essere vivente in questo modo, invano.”[27]

With these words, we could in part imagine the kind of pain that we are talking about. Only considering it, we can appreciate the important of this subject: if a person implores the death as an alternative of this type of suffering, is truly immoral to help this person die?

Starting from this point, the typical utilitarian version of morality could be developed like this: an action is morally right if it helps to increase the happiness in the world or to decrease the unhappiness. So, killing an incurable patient might decrease the quantity of unhappiness and, logically, this action would be morally right, according to utilitarian view.

However, many philosophers consider utilitarian principles inacceptable because they think that the promotion of happiness or unhappiness is not the only important thing in people’s life: for example, people could be happier if there was no freedom of worship because, in that way, there would be more harmony between communities.

In the other hand, the contemporary utilitarian affirms that the promotion of happiness and the decrease of unhappiness could not be the only important things, but they are important anyway. Then they adopt a broader concept of individual well-being: instead of talking about happiness, that can causes misunderstanding, they start talking about maximizing interests. Using this better version of the utilitarian principle, we can reformulate it: if an action promotes the interests of all the people involved, then this action is morally acceptable. So, euthanasia, promoting sometimes interests of the people involved, it can be considered morally acceptable.

The moral philosophy of Kant is considered the best alternative to the utilitarianism doctrine: his principles said that we have to behave as we desire that every people could do towards us.

Therefore, the only supreme morality principle, the categorical imperative, says that: “Agisci soltanto secondo quella massima che, al tempo stesso, puoi volere che divenga una legge universale”. [28]

What is the meaning of this theory? It means that, when we are trying to make a decision about accomplishing or not an action, we have to ask ourselves first if we would like that all the people follow that same rule in the same occasion.

The application of this rule at the euthanasia’s problem is clear: everyone of us one day will die and, if we would have a choice between two ways for dying, one with a terrible pain and the other one without it, what way would we choose?

The contemporary English philosopher R. M. Hare has reached the same conclusion narrating this real story:

“Il guidatore di un camion cisterna di benzina fu coinvolto in un incidente in cui il suo veicolo si capovolse e prese immediatamente fuoco. Rimase intrappolato nella cabina e non lo si potè liberare. Pertanto chiese a chi gli stavae intorno di ucciderlo colpendolo alla testa, così che non sarebbe morto carbonizzato. Penso che qualcuno lo fece, ma non so cosa accadde in seguito in tribunale. Ora vi prego di chiedervi, come molte volte mi sono chiesto io, cosa vorreste che uno degli astanti vi facesse se foste nella situazione di quel camionista. Non posso credere che chiunque consideri la questione seriamente, direbbe che la regola è quella che esclude assolutamente l’eutanasia.”[29]

The irony is that, at the root of the question, it is expressed by the article, by Kant –mentioned before- and by Jesus the so-called golden rule: “fai agli altri, quello che vorresti fosse fatto a te”.

As Hare said, if this is the supreme principle of morality, how euthanasia can be completely wrong? It seems that this is a case in which Church strayed from the point established by her founder.