The Logic of Relieving Suffering and Voluntary Euthanasia

Recently a seventeen year old Dutch girl, who had been repeatedly raped as a child and who suffered from post-traumatic stress disorder, anorexia and depression, starved herself to death. This was widely reported as an example of euthanasia, see BioEdge . Simply starving oneself to death isn’t euthanasia. It was unclear in this case whether her doctors helped to control her suffering. In this posting I want to explore whether doctors who relieve the suffering of a patient who starves himself to death should be regarded as assisting in suicide. In order to make my argument I will first explore what can be considered as the legitimate use of medical skills. Let us start with the premise that the decreasing of someone’s suffering is a legitimate use of medical skills. However accepting this premise is too simplistic. Surgery might actually increase someone’s suffering in the short term and surgery is clearly a legitimate use of medical skills. Let us revise the premise so that decreasing someone’s overall suffering is always a legitimate use of medical skills when this is possible.

Let us now agree that decreasing someone’s suffering is usually a legitimate use of medical skills but is it always so? I now want to examine two arguments suggesting it isn’t. Firstly it might be argued that some people deserve to suffer and that it would be wrong to alleviate their suffering due to dessert. Consider a convicted rapist who became infected with HIV when committing his crime. Let us assume that he is now serving his sentence in relative isolation due to the hideous nature of this crime and as a result is unable to infect others. Would treating him for his HIV would be an illegitimate use of medical skills? What reason could be advanced for illegitimacy of treatment in this case? It might possibly be argued that in this case the rapist deserves to be HIV positive and that as a result treating him for this state should be an illegitimate use of medical skills. This extreme example might concur with many people’s intuitions but seems to run counter to the caring ethos of medicine. I would argue linking the legitimacy of the use of medical skills to dessert is problematic in all circumstances. Accepting that it is illegitimate to treat some people whilst it is legitimate to treat others because of dessert appears to imply that it is legitimate to use medical skills to achieve dessert. The domain in which the employment of legitimate medical skills is extended from simply treating suffering to treating suffering and ensuring just dessert. We might link suffering and dessert together but nonetheless they remain independent conditions. Someone can suffer without deserving to do so and someone may deserve to suffer without actually doing so. If we accept that the legitimate use of medical skills is linked to dessert in addition to suffering then provided a death sentence could be considered as just it would be a legitimate use of medical skills to carry out this sentence. An interesting account of the death penalty and the proper ends of medicine is to be found can Silver (1).

Secondly it might be argued that medical professionals have no duty to alleviate suffering when this is caused by self-harm and the sufferer is fully aware his behaviour is the cause of his suffering. In practice accepting this argument might mean that there is less of a duty to treat conditions when these conditions are caused by alcoholism, obesity and anorexia. Clearly alcoholics, the obese and anorexics suffer even if this suffering is caused by their own behaviour. What reason could be advanced as to why treating them would be regarded as an illegitimate use of medicals skills? One reason might be that because their suffering is self-imposed they can simply stop the suffering by changing their behaviour and there is no need to employ medical skills. I’m doubtful whether the eating habits of anorexics or the obese can simply change their behaviour and alcoholism is an addiction.  However let us assume that someone’s suffering is self-imposed and that can change his behaviour and he will cease to suffer. In this context is the use of medical skills to alleviate his is an illegitimate use? It might be suggested he deserves to suffer because his suffering is self-imposed. However if we accept this suggestion it would re-introduce all the problems of dessert outlined above. Both of the above arguments as to why medical professionals don’t always have a duty to alleviate suffering when this is possible appear to be unsound. It follows that we should accept the premise that the decreasing someone’s overall suffering is always a legitimate use of medical skills when this is possible. It is of course possible that there are other legitimate uses of medical skills, see Cosmetic Surgery, Enhancement and the Aims of Medicine . 

I now want to consider the relationship between the relief of suffering and voluntary euthanasia. In particular I want to focus on the relief of suffering of those people who voluntary stop eating and drinking (VSED). Most people who adopt VSED do so because they have a terminal illness but this isn’t true in all cases as the Dutch girl shows. Let us assume that the relief of someone’s suffering caused by VSED is assisting in voluntary euthanasia. I have argued above that decreasing someone’s overall suffering is always a legitimate use of medical skills. It follows relief of someone’s suffering caused by VSED is a legitimate use of medical skills. It further follows that assisting in voluntary euthanasia is a legitimate use of medical skills. Some might be unhappy to accept these conclusions but being unhappy about these conclusions has nothing to do with the logic of the argument or the validity of the conclusions. 

Lastly let us assume that the relief of someone’s suffering caused by VSED isn’t assisting in voluntary euthanasia. If this is the case then there would seem to be no reason to be unhappy about the deployment of medical skills to alleviate someone’s suffering caused by VSED. However I find hard to see how alleviating someone’s suffering, when this suffering is caused by a desire to die, shouldn't be regarded as a case of physician assisted suicide without using the principle of double effect.

1. Silver D, (2003) Lethal Injection, Autonomy and the proper ends of Medicine, Bioethics 17(2), pp. 205-211.