1.Introduction

The lack of availability of euthanasia in most countries led to a general stereotypical belief that euthanasia is a despicable and unacceptable act. Most people reject euthanasia because of the mere fact that it shortens the course of life. A great proportion of religious people reject euthanasia because it involves the termination of a life. Little progress has been made on legalising euthanasia as proposals face multiple moral and ethical issues. If people’s opinions on euthanasia never alter, the legalisation of euthanasia will on the one hand be incredibly slow; on the other hand, even if euthanasia gets legally approved, the decision to perform euthanasia will be barely accepted or supported by the individual’s relatives and friends. This article attempts to discuss people’s views on euthanasia from religious, ethical and philosophical perspectives; to explore the origins of and reasons for rejection of euthanasia by investigating Eastern and Western traditions; to debate the ethical, legal and emotional dilemmas one faces when one confronts death decisions, by employing examples of various artists who would have chosen euthanasia but had to commit suicide because euthanasia was not an option, in order to provide an opportunity for readers to judge for themselves the extent to which euthanasia is ethically acceptable. The progression of civilisation is the process of increasing security of individual rights and increasing respect for personal choice. Whether humans have rights to choose their preferred way to die is undoubtedly a demoralising topic, but also an inevitable one.

2.Western Views on Euthanasia

2.1.Sanctity of Life and Christian Teachings

Most denominations of Christianity have opposed, and still oppose, euthanasia or any form of suicide. Despite the fact that the exact phrase ‘sanctity of life’ was not mentioned in the Bible, many Bible verses emphasise the holiness of human life, that life is God-given, and should only be created and ended by God himself. Ultimately this leads to many of the denominations of Christianity opposing euthanasia, namely Anglican, Baptist, Catholic, Lutheran Churches and more.

Christians believe that every human life is sacred and valuable from conception until death, as human life is created by God and in his own image. By “God created man in his own image” (Genesis 1:27), the Bible does not necessarily mean that humans resemble God by appearance; it is more likely to convey the concept that humans, to some extent, share the natures of God, for instance, the ability to think as a rational being, the ability to differentiate what is just and what is evil, and the urge to seek justice. It is these God-like natures, along with the fact that life itself is God-given, that makes life valuable. For some Christians, especially Catholics, seeking for euthanasia or physician assisted suicide indicates that the individuals disregard their lives and see their lives as worthless, which contradicts with the teaching that all human lives are God-given and are therefore valuable and respectable. This is the main reason for which Christians reject the proposal of euthanasia; sanctity of life—being a key concept of Christianity—can be sometimes dogmatic, but it remains to be a fundamental Christian teaching which is widely accepted.

According to Christian doctrine, only God can decide upon life and death, and human beings should not take the matter of death into our own hands. As God said in the Bible, “I kill, and I make alive; I wound, and I heal.” (Deuteronomy 32:39) By shortening one’s life and prematurely ending it before God’s designated time for one’s death, the individual ‘plays God’ and violates God’s power; that is arrogation by definition, which is one of the worst sins humans can commit. This belief indicates that the sanctity of life outweighs anything else in the matter of life and death, which then leads to certain strong opinions against euthanasia, for example, the Institute of Clinical Bioethics states that arguments based on the quality of life are “completely irrelevant”[1]. Such views are similar to traditional views in parts of Asia that to prolong life should be the primary concern, regardless of the quality of life.

2.2.How Philosophers Address this Issue

The argument of euthanasia was explored in depth by various philosophers; similarly, the ethical problem of suicide was widely investigated before the concept of euthanasia emerged.

Augustine famously argues in his book City of God that suicide is ethically wrong, along with other forms of killing:

Kill no other man, nor yourself; for he who kills himself kills another man. [2]

Augustine illustrates here that suicide and voluntary euthanasia are actions of taking lives, not to mention involuntary euthanasia. He suggests that by considering taking life (even one’s own), one shows vicious tendencies and also potentials to take other lives, as the individual breaks God’s commandment “thou shalt not kill” (Exodus 20:13). Christians also believe that the commandment “thou shalt not kill” suggests that euthanasia itself is a form of taking life, and the action itself should be condemned.

Indeed, the Bible quote “thou shalt not kill” (Exodus 20:13) has been massively overused on a range of different ethical issues, including arguments on abortion, suicide, euthanasia and murder. One can also argue that the commandment is written in the Old Testament, in Exodus, which essentially means that the commandment itself is dogmatic and may not be completely relevant in modern ethics. A similar example would be “If a man commits adultery with another man's wife, even with the wife of his neighbour, both the adulterer and adulteress must be put to death.” (Leviticus 20:10-12), as both capital and corporal punishment have been abolished in the UK.

The explanation Aquinas gives for his objections towards euthanasia and suicide is that the individual damages the community by taking his own life: He who kills himself injures the community. [3]

A person committing suicide can potentially result in many others experience negative impacts. Immediately after the individual’s death, anyone who is close to the individual will experience emotional pain. They will also face legal pressure—what possibly causes the individual to commit suicide and who may be responsible—and media pressure. The suicide event will also cause negative influences on the communities the individual belonged to, such as the religious community and university.

On the other hand, fewer negative impacts will occur if euthanasia has been performed instead of suicide. Once euthanasia is made legal, it would become a respected choice rather than something to be looked upon with horror and disgust. The individual could properly bid his/her family farewell before dying painlessly. No legal problems concerning other individuals will emerge once the procedures before euthanasia are legally performed.

Aquinas believed that the world is created by God according to a set of Natural Laws, and human reasoning is designed to pursue the 7 basic goods, among which life is the first and apparently the most important one. He suggests that it is within Natural Law for humans to prolong life or attempt to prolong life, therefore euthanasia seems to be a contradiction to the principles by which humans are created. However, all theological theses are not proposed to uphold deity, but instead to function in favour of humans. Aquinas comes up with Natural Laws based on Aristotle’s teachings in the 13th century at the beginning of the Renaissance in an attempt to explain human nature; it now seems somehow outdated as mainstream ethical and theological beliefs have altered and evolved according to human benefit. Euthanasia is undoubtedly beneficial for all humans once legalised around the world; it has long been viewed as a dilemma only because providing it to society in a morally and ethically acceptable way is proven crucial and extremely difficult.

While some say that euthanasia and suicide are wrong, as they go against God’s plans for an individual and are therefore actions of ‘playing God’, some might argue against this by saying that it is within God’s plan for someone to perform euthanasia or to commit suicide. Rather than saying that only life and death are decided by God, some argue that all actions are predestined, therefore euthanasia or suicide is a part of God’s plan for an individual, rather than an action of taking God’s power into one’s own hands.

2.3.Paradoxical modern philosophers

Philosophers in the 17th century onwards started to take right of choice and human rights into consideration when discussing problems on euthanasia and suicide, rather than basing their arguments around God and Theology. However, their proposals and arguments were still paradoxical, because they were among the first philosophers to directly address the problem of suicide and euthanasia.

Kant illustrates a scenario in his book Groundwork of the Metaphysics of Morals that a sane man is forced into desperation by certain issues in his life to such a point that he considers committing suicide out of self-love, in order to terminate suffering. The man has a maxim that “from self-love I make it my principle to shorten my life when its longer duration threatens more troubles than it promises agreeableness.” [4]

Kant disagrees with euthanasia and self-killing by proposing that this maxim cannot be universalised. Self-love is a key teaching in Kantian ethics. The argument that suicide and euthanasia originate from self-love contradicts itself and does not stand, as self-love aims to improve quality of life and eventually prolongs life, whereas suicide (even out of self-love) shortens the course of life. Nevertheless, by arguing against the maxim as not universalizable, Kant admits that for a miserable individual, euthanasia might not be the worst choice and somehow understandable, after all, it is also derived from the core doctrine of self-love.

Nietzsche elaborates upon his opinions on euthanasia in his book The Twilight of the Idols. Using powerful words and phrases, he takes a different approach towards the issue by stating that the terminally ill and those in a PVS (persistent vegetative state) are “parasites of society”, and that doctors should “no longer prepare prescriptions, but should every day administer a fresh dose of disgust to their patients.” Although many may disagree with Nietzsche’s provoking arguments, he is correct when he says that the terminally ill barely contribute to the society, that some of them suffer extraordinary pain, may rely on technology to sustain life and merely remain alive in a pathetic state. Again, Nietzsche uses excessive language when he says that doctors have the “responsibility of ruthlessly suppressing and eliminating degenerate life”. [5]

It is undoubtedly immoral and unlawful for a doctor to stop a patient’s treatment unless required otherwise. However, Nietzsche’s proposal reflects that there was a severe lack of availability of any form of euthanasia, be it passive, active, or Physician Assisted Suicide (PAS) at that time. This remains true today; laws on euthanasia are yet to be passed in most countries. He also speaks in favour of euthanasia from the patient’s perspective in the same book, that “one should die proudly when it is no longer possible to live proudly. Death should be chosen freely.” He suggests that everyone should be offered the choice to die in decency when they are still conscious and to bid a final farewell to friends and family before passing away.

3.Eastern View on Euthanasia

3.1.Rather Live in Agony than Die in Dignity

The nations inhabiting the cold places and those of Europe are full of spirit but somewhat deficient in intelligence and skill, so that they continue comparatively free, but lacking in political organization and capacity to rule their neighbours. The peoples of Asia on the other hand are intelligent and skilful in temperament, but lack spirit, so that they are in continuous subjection and slavery. [6]

According to Aristotle’s observation, Asian people lack ‘spirit’. This relates especially well with the case of how my father attempted to keep my great-grandmother alive even against her own will, and it relates well with other similar cases in other parts of Asia. Most Asian cultures promote ‘being alive’ as the most important value, above quality of life, right to choose, etc. The popular Chinese saying “rather live in agony than die in dignity” (translated by the author) reflects exceptionally well upon this. Some are so obsessed with staying alive, that they do not hesitate to pay a fortune in order to postpone the death of their relatives, often at the cost of putting themselves into financial crises only making their beloved ones suffer several more days or months.

Buddhism has traditionally been the dominant religion in Asia. There are many schools and branches of Buddhism, and their beliefs vary; inevitably Buddhists from different schools hold different opinions towards euthanasia.

However, there is a list of concepts accepted by a majority of Buddhists:

The ultimate aim for Buddhists is to escape suffering (dukka) and achieve enlightenment; abstain from performing actions that could lead to suffering (the Five Moral Precepts); show compassion (karuna) to those who suffer.

In the Cycle of Samsara, there are six realms one could be reborn into. One can only achieve enlightenment in the human realm. One’s karmic value can decide which realm one is reborn into.

To end one’s own life (or assist to end someone else’s life) is an unskilful action on its own and could lead to bad karma.

Ending a life before it reaches the end of its course also means that one could potentially deprive the chance for individuals to achieve enlightenment in their current life, as Buddhists believe that every human life has the potential of achieving enlightenment.

None of the above support euthanasia. The first of the Five Moral Precepts teaches Buddhists to abstain from taking lives of sentient beings, which is considered to be one of the most important concepts in Buddhist practices; euthanasia is clearly a form of taking life, regardless of whether one takes one’s own life or someone else’s.

For Buddhists, death is never the end of suffering. Buddhists believe that one is reborn directly after death as a new life in according to one’s karmic values, in which a new round of suffering commences. Prematurely ending one’s life may allow the individual to escape from the suffering caused by pain, but the individual still cannot escape from further suffering once the individual is reborn. Suffering can only be terminated by achieving enlightenment, as the Buddha said in the Dhammapada, “Long is the cycle of birth and death to the fool who does not know the true path.” The key aim for Buddhists is not to avoid temporary suffering but indeed to achieve nibbana and escape the Cycle of Samsara.

In a utilitarian perspective, it is wrong for Buddhists to perform euthanasia in order to avoid suffering; if the action leads to bad karma and therefore leads to the individual being reborn into a worse realm, in which they will endure even more suffering and pain than they do at the end of their previous life, then it is not worth it for the individual to perform euthanasia, as ultimately it provokes even more suffering.

3.2.Euthanasia Being a Satisfactory Alternative

There is one possible way, however, in which Buddhist teachings may support euthanasia. Patients with terminal illnesses often experience suffering, physically or mentally. As stated above, all Buddhists aim to escape suffering (Siddhartha Gautama is initially inspired to leave his life of luxury by the thought of escaping suffering), therefore they should accept a peaceful ending of life for those who suffer. Accepting euthanasia also shows compassion, one of the Four Sublime states, towards others who suffer. As the 14th Dalai Lama of Tibet said, “I believe that at every level of society, the key to a happier world is the growth of compassion.” Buddhists encourage the action of alleviating others’ suffering when possible.

Enlightenment is the ultimate pursue for all Buddhists. Buddhists dedicate their lives to avoiding attachment and craving, performing skilful actions and achieving nibbana. However, most Buddhists do not achieve enlightenment in their current life, which means that they also face the problem normal people would face: how would one dispose of one’s carnal vessel when one’s consciousness departs? Some choose the path of incessant medication to prolong life; inevitably they experience suffering, sometimes leaving their vessels damaged and patched. Some choose the path of suicide; suffering before death also cannot be avoided, and some may even leave their vessels shredded and mutilated, in case of suicide by gunshot etc. Loving oneself and showing compassion to oneself are acts of karuna; showing respect to one’s own body is a skilful and compassionate act. “Be gentle first with yourself if you wish to be gentle with others.” [7]

Both the approaches above contradict this teaching, as one does not show compassion and loving-kindness towards one’s own carnal body. Euthanasia, on the other hand, can be a simple alternative for an individual to both die a dignified death and avoid excessive suffering. It also provides an opportunity for the body to be left unharmed over the event of death, allowing the “self” to depart the vessel in a respectful way.

4.Suicide or Dignified Death

Ryūnosuke Akutagawa (1 March 1892 – 24 July 1927) was a Japanese writer. He inherited mental disorder from his mother and suffered from visual hallucinations. In 1927 Akutagawa survived a suicide attempt and died in another suicide attempt later in the same year. He stated in his will that he felt a “vague insecurity” about the future; he did not want to suffer from the same symptoms as his mother did. Akutagawa sensed that ending his life before he lost all of his dignity would be ‘the lesser of two evils’ [8] thus took his own life by barbital overdose.

Akutagawa was certain that he would experience further mental disorder had he lived a few more years. This fits Kant’s principle of “to shorten my life when its continued duration threatens more evil than it promises satisfaction”; despite the fact that he died as a writer in his prime years, Akutagawa was convinced that his mental disease would greatly reduce his quality of life in all aspects.

Yasunari Kawabata (11 June 1899 – 16 April 1972) was a Nobel winning Japanese writer. He pursued beauty throughout his career as a writer; “beauty” and “melancholy” were the major themes in his works. In 1968 Kawabata was awarded the Nobel Prize for Literature “for his narrative mastery, which with great sensibility expresses the essence of the Japanese mind”. His famous lecture was entitled “Japan, The Beautiful and Myself" (美しい日本の私―その序説), with especial focus on Zen Buddhism and deathbed poems of past poets, including Akutagawa. Kawabata quoted Akutagawa’s suicide note, “I do not know when I will summon up the resolve to kill myself”. His quote on Ikkyū, a Zen Buddhist monk, “Among those who give thoughts to things, is there one who does not think of suicide?”, foreshadowed his own suicide in 1972.

Kawabata sought beauty throughout his life. Arguably he held in his mind that should beauty cease, life too ceases; he accomplished what he aimed for, and his body was aging and withering, his mind less sensitive, therefore he did not see much point in living a life that is no longer “beautiful”. By ending his life firm and resolutely, weirdly enough, he managed to make suicide “beautiful” in its own way. People like Akutagawa commit suicide because of fear, the fear for insanity or low quality of life, while others simply aim to terminate agony and further suffering. Kawabata, unique as always, made suicide part of his proactive choice of beauty.

On the other hand, Kawabata explicitly stated that he opposed suicide in his own essay:

“However alienated one may be from the world, suicide is not a form of enlightenment. However admirable he may be, the man who commits suicide is far from the realm of the saint.” (Kawabata, “Eyes in their Last Extremity”)

The title of Kawabata’s essay “Eyes in their Last Extremity” is taken from Akutagawa’s suicide note. Kawabata explains in Zen Buddhist terms that suicide does not, in any sense, equal to enlightenment (nibbana); instead, one’s self moves on to a new life, in which the quality of life and the realm it is reborn in can be negatively affected by the decision to commit suicide in the previous life. This, however, does not mean that Kawabata opposes the painless termination of the life of a terminally or irreversible ill person; Akutagawa could have chosen euthanasia instead of barbital overdose, and Kawabata would have chosen a painless and more “beautiful” and dignified end to his life instead of carbon monoxide poisoning.

5.Conclusion

A wide range of pre-existent beliefs in the East and West have formed a worldwide stereotypical anti-euthanasia perspective. Indeed, dilemmas of life and death decisions would inevitably face religious, ethical, and other philosophical controversies. However, it is also unwise to avoid discussing human-welfare-oriented choices such as euthanasia. They become more significant and imminent with the rise of quality of life and the increasing importance of human rights in society.

An increase of the extent to which individual rights and decisions are respected marks the progression of a society. Philosophers in different eras hold different arguments on euthanasia and suicide, as this dilemma never quite loses its perplexity and significance. People tend to be preoccupied with human rights, dignity and individual choice in modern society, and painless dying becomes possible as technology develops., Now it seems to be the right time to give euthanasia some reconsiderations. After all, death is the one ultimate and solemn choice of a civilised being, and euthanasia emerges as a satisfactory alternative.