Euthanasia, according to BBC (n.d.), refers to the intentional termination of a life to relieve the suffering of a very sick person. It can be carried out at the person’s requests, or those of their relatives, doctors, or the courts if they are too sick to decide. This practice is illegal in many countries, including Singapore, but is legalised in some countries such as Belgium and the Netherlands (Andrew, 2018).
Bomford (2019) shared a case of a doctor in the Netherlands who was under criminal investigation after breaching euthanasia rule by slipping a sleeping drug into the coffee of a 74-year-old woman with severe dementia. Despite the woman’s protests, the doctor also asked the family members to restrain her so as to perform euthanasia on her. Though the woman had signed a written declaration earlier, indicating her desire for euthanasia when she is ready, but she protested against it in her current demented state. This raises a moral dilemma of whether euthanasia should be still administered to her. If so, does that mean that her decision now as someone with dementia is considered less important?
Doing good in this case means not legalising euthanasia for people with dementia as euthanasia causes more harm than good, and more unhappiness than happiness. Reason being that (1) elderly with dementia may be forced to die against their own will and (2) people’s happiness may be shortlived if they know that they too may be coerced to die.
According to Mill’s harm principle, one is only free to act as one pleases as long as one does not harm others (Ang & Wong, 2019). However, in the above-mentioned case, the doctor insisted on injecting the lethal poison into the woman despite her protests, and took away her life. According to the study by Cohen-Almagor (2015), there were 21.1 per cent of dementia elderly whose lives were ended without explicit requests. In countries where euthanasia is legalised, some people have been accused of murdering their elderly citizens with dementia. Hence, legalisation of euthanasia does more harm for elderly with dementia as they may be forced to die against their wishes.
Bentham’s utilitarianism theory state that one should choose the act that produces the greatest amount of happiness for the greatest number of people (Ang & Wong, 2019). In this case, the death of the woman, despite her unwillingness, could possibly bring about happiness for her family members as they may be rid of the burdonsome caregiving role. However, according to the view of rule-utilitarianism, utility is unlikely to be maximise in the long run if we have a rule that we should knowingly ignore others’ suffering, as they know that others will ignore them should they suffer one day (Ang & Wong, 2019). In this case, the woman’s protest against euthanasia was ignored by the doctor and her loved ones. If others were to know about this, they would be worried that something similar will happen to them if they were diagnosed with dementia in future, hence, it minimises utility.
Bentham’s theory could require a person to violate the standards of justice, for the sake of maximising happiness for the most number of people (Austin, 2015). In this case, the doctor can be judge to be morally right by helping the demented woman die, even though against her own view. Because doing so would bring maximum happiness to the family as they do not need to suffer and care for the patient. Hence, it justifies the doctor’s action as well as that of the family members who helped to restrain the woman, and it prevents them from being punish even though they are technically murdering the demented woman.
The word “harm” in Mill’s Harm Principle is vague and the criterion of harm is insufficiently determinate (Drips, 1998). For example, in the case, we can state that performing euthanasia on this demented woman equates to causing her harm. But what about those elderly who wish to die if they are diagnosed with dementia as it would mean a loss of dignity. Would that constitute as harm if there are informed consent? Therefore, it is difficult to determine.
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