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Comm 1312: Writing and Research
Section # 202, Dr. Runna Alghazo
Name:
ID:
Major: Computer Engineering
Assignment #4: Results and Discussion
Topic: Euthanasia
RESULTS

Research Q 1: How is euthanasia in human beings classified, and what are the
distinctions between each type of euthanasia?
Euthanasia may be classified by means or by consent (Stanford
Encyclopedia of Philosophy [SEP], 1996). Euthanasia can be conducted with
consent, also known as voluntary euthanasia, or without consent. It may also be
classified as active, non-active, or passive, on the basis of the means used to carry
out the procedure.

Research Q 2: What are the various moral, ethical, emotional and financial
considerations that need to be taken into account before any legalization decision
can be made?
Of the many influential factors into making this decision, moral and ethical
arguments often take precedence. Ethical arguments that argue for the legalization
of euthanasia generally cite the individual rights that a person should have over
one’s own body. In contrast, there exist several cases against euthanasia, the
strongest of which involves the slippery slope argument (Harris, 1995; Rapin &
Roy, 1994; Singer 2003). Financial concerns associated with such a decision often
come into the forefront in the cases of patients being kept alive through intensive
life-saving machinery. Additionally, emotional considerations also arise
whenever a decision to terminate needs to be made, both in the cases of a person
in intolerable pain, and a patient that is being kept alive on life support with no
hope for neurological recovery.

Research Q 3: How does Islam view the medical practice of euthanasia and
under what contexts is it considered acceptable?
With evidence from the Qur’an, it is clear that the active killing of a
patient by a physician, or voluntary active euthanasia, is unlawful and judged as
an act of disobedience against God. Physician-assisted euthanasia is also not
permissible, as suicide is forbidden in Islam (Bazzaz, Larijani & Zahedi, 2007;
Sachedina, 2005).
However, in the case of patients suffering from complete and irreversible
brain death, including conditions such as an unresponsive coma and lack of an
ability to breathe on one’s own, withdrawal of life support is permissible in Islam
(Sachedina, 2005).

Research Q 4: What are the attitudes towards human euthanasia among
physicians and medical professionals, as well as the general public in Saudi
Arabia?
The majority of the individuals surveyed (64%) opposed active euthanasia,
whereas 35% stated that they believed a terminally ill, suffering patient should be
provided the option to end their own life. However, a mere 6% showed support
for physician-assisted suicide, with a significant majority opposed to both this
kind of suicide as well as active euthanasia.
A similar fraction of respondents (67%) opposed the legalization of active
euthanasia in Saudi Arabia. Amongst the medically-qualified respondents, 88%
indicated that they were strongly opposed to both active euthanasia and physicianassisted suicide, and also believed that this form of human euthanasia should not
be decriminalized in Saudi Arabia.
When questioned on whether the legal definition of death should be made
in terms of heart and lung function or on that of brain functioning, 57% of the
respondents stated that they believed the latter to be as a determiner of death.
A comparable proportion (46%) however, indicated that they believed
‘death’ takes place at the natural end of the heart and lung function. 75% of the
respondents
who
Are the forms of euthanasia above acceptable?
possessed
some degree of medical expertise chose brain death to be the sole
decider of death, however, and a small fraction equated death as the end of both
body and brain function.
Similarly, questions were posed in the form of hypothetical situations to
assess individual attitudes towards non-active and passive euthanasia. A
distinction was made in the case of non-active euthanasia, with one question
relating to a Persistent Vegetative State (PVS – a condition in which a person has
no cognitive brain function but is able to breathe on his/her own), and the other
relating to complete and irreversible brain death (a condition in which the person
can no longer breathe without the help of machines).
68% of the respondents stated that they disagreed with the option of
euthanasia in the case of PVS, but 73% supported its use in the case of complete
and irreversible brain death. The views of the medical experts surveyed roughly
coincided with these results, with 75% opposing euthanasia for a patient in PVS,
and 88% agreeing with its implementation in the case of complete brain death.
Lastly, the respondents were asked to choose one or more of the grounds
upon which their opinions were based. The overwhelming majority of these were
religious reasons (68%), ethical reasons (73%) and emotional reasons (57%).
Other reasons stated were legal (30%) and financial (10%). The proportions
varied amongst the physicians and medical students, with 88% choosing religious
reasons as the basis of their opinion, 75% ethical, 50% legal, 25% emotional and
25% citing financial concerns.

Research Q5: How do views on human euthanasia differ in Saudi Arabia and in
Europe and the Americas, and what are the foundations for these differences?
Several surveys have been published on the issue of human euthanasia in
Europe and the Americas; there are less so in Saudi Arabia and/or the Middle
East.
Cuttini et. al (2004) conducted a survey of neonatal intensive care units
staff across Europe on the issue of legalization of euthanasia. The results varied
widely between countries, though the general consensus amongst staff was that
the law in their country should be changed to allow active euthanasia “more than
now”. In other words, a significant percentage of the surveyors were in favor of
legalization of voluntary, active euthanasia. Netherlands had the highest
percentage of doctors supporting active euthanasia (more than 53%), whereas
France had less than a quarter who did the same.
In addition, Chater et. al (2006) investigated personal attitudes towards
euthanasia of patients receiving palliative care for advanced cancer, in a first-ofits-kind survey conducted in Canada. The results indicated that the majority of
participants (73%) believed that euthanasia or physician-assisted suicide should
be legalized, with their major reasons being pain and the right of an individual to
make their own choices concerning their bodies. 58% of the participants indicated
that, if legal, they might personally ask to be euthanized in the future, especially if
pain levels increase or become intolerable. The conclusions of the survey
indicated the fact that most patients in the survey with advanced cancer were in
favor of legalization of euthanasia.
These surveys indicate that there are significant differences in the attitudes
of people in Europe and Canada, and the Middle East. Active euthanasia is found
to be widely supported and even legalized (such as in the Netherlands), whereas it
is considered immoral both constitutionally and ethically in Saudi Arabia.
DISCUSSION
1. How is euthanasia in human beings classified, and what are the distinctions
between each type of euthanasia?
Euthanasia may be classified by means or by consent (Stanford
Encyclopedia of Philosophy [SEP], 1996). Euthanasia can be conducted with
consent, wherein the patient provides explicit permission to the physician to carry
out the procedure (voluntary euthanasia), or without consent. The latter category
has two very important distinctions. Involuntary euthanasia involves the
termination of a patient’s life against his/her wishes, and is more or less
equivalent to murder. Non-voluntary euthanasia, on the other hand, includes
instances in which the patient is unable to make a decision about euthanasia,
either because they are unconscious or not mentally competent, and a proxy is
requested to make medical decisions on his/her behalf.
Euthanasia may also be classified as active, non-active, or passive. Active
euthanasia is the practice of deliberately ending the life of an individual (with
consent) suffering from a terminal illness, as by lethal injection. Non-active
euthanasia includes the withdrawing of life support to end the life of an individual
(with consent from the medical proxy) who has suffered extensive and
irreversible brain damage. Passive euthanasia entails the withholding of common
treatments upon request (such as antibiotics, chemotherapy in cancer, or surgery)
or the distribution of a medication (such as morphine) to relieve pain, knowing
that it may also result in death. Physician-assisted suicide is also distinct from
active euthanasia, as it entails physicians providing the means for the patient to
end his/her life rather than actively administering death themselves. (Rachels,
1997; Rapin & Roy, 1997; SEP, 1996).
2. What are the various moral, ethical, emotional and financial considerations that
need to be taken into account before any legalization/criminalization decision can
be made?
There are several divergent opinions relating to euthanasia in the field of
medical ethics. Most arguments that are derived from concrete ethical and
philosophical principles are generally supportive of both active and passive
euthanasia, although a significant amount of moral opposition to these exist as
well.
Ethical arguments that argue for the legalization of euthanasia generally
cite the individual rights that a person should have over one’s own body,
particularly in the case wherein the patient undergoes the agonizing pain
associated with several terminal illnesses. It is argued that if the harm of ending a
life is linked directly to the harm of depriving the individual of something they
value and want, then voluntary euthanasia is justified and acceptable (Harris,
1995). Similarly, Rachels (1997) contends the legalization of passive and nonactive euthanasia over its active counterpart, stating that they are hardly any
different when one considers the motivations behind each, and their
consequences.
Conversely, there are several cases against the medical practice of
euthanasia. Arguably the strongest ethical opposition to euthanasia involves the
slippery slope argument, a utilitarian case that opposes euthanasia on the grounds
that vulnerable patients would be subtly pressured by physicians to end their life
for being a ‘burden’ (Rapin & Roy, 1994; Singer, 2003). In addition, it can also
be argued that euthanasia goes against every instinct of a humane doctor whose
first impulse is to devote him/herself to the protection and preservation of life.
Thus, any health professional would experience the ‘pause’ before carrying out
euthanasia because they recognize the sanctity of human life, and it is this
intuitive pause that plays an important role in one’s moral reasoning even though
it cannot be captured in concrete ethical principles. (Gillett, 2004)
Additionally, there are several financial concerns associated with
euthanasia. They are particularly more significant in the cases of patients who
have suffered extensive brain damage and are being kept alive through life
support. Intensive care is very expensive; it has been estimated that the costs
incurred from caring for patients in persistent vegetative states in skilled nursing
facilities range from $126,000 to $180,000 per annum (Breding et. al, 2004).
Patients who experience brain death require additional expenses, because they
require a heart and lung machine as well as an assortment of other costly lifesaving equipment to stay alive. The long-term expenses from these treatments can
therefore pose a great burden on both the surviving family and the economy,
especially in developing countries.
Several emotional considerations also need to be taken into account when
the issue of whether to terminate arises. The pain and distress terminal diseases
can cause, even after the use of pain relievers, can be incomprehensible to a
person who has not gone through it. Even without considering the physical pain, it
is often difficult for patients to overcome the emotional pain of losing their
independence (SEP, 1996). In the case of patients being kept alive on life support
with no hope for neurological recovery and/or ever regaining consciousness,
his/her family and friends may not find closure for the intellectual death for their
loved one. In other words, while the body of the patient may be alive and
functioning, there would be nothing left of the person that his/her family knew
and loved, and this would most likely add to their grief and distress.
3. How does Islam view the medical practice of euthanasia and under what contexts
is it considered acceptable?
It is stated explicitly in the Qur’an that “it is not given to any soul to die,
save by the leave of God, at an appointed time.” (3:145). Moreover, the
statements “God gives life, and He makes to die.” (Qur’an 3:156), and “A person
dies when it is written.” (Qur’an, 3:185; 29:57; 39:42) both indicate that destiny is
determined by God for every person, and that no man has the right to decide the
death of another person. Therefore, it is clear that the active killing of a patient by
a physician, or voluntary active euthanasia, is unlawful and judged as an act of
disobedience against God. As suicide is also forbidden in Islam, it follows
logically that any active step the patient may take to end his/her life is not
considered permissible. (Bazzaz, Larijani & Zahedi, 2007; Sachedina, 2005)
On the other hand, the Qur’an also provides a reminder that there are times
when human beings need to recognize their limits and let nature take its course
(39:42). As such, the repeated and continued use of intensive life-saving treatment
to keep a patient alive, when there is no possibility of reversal of the effects of the
disease and discontinuation of this treatment would result in immediate death,
would then be futile and against the will of God. At several meetings of the
Islamic Juridical Council held in Makkah, Jeddah and Amman, Muslim jurists of
different schools of thought ruled that “once invasive treatment has been
intensified to save the life of the patient, life-saving equipment cannot be turned
off unless the physicians are certain about the inevitability of death.” However, in
the instance of brain death, when the patient undergoes irreversible damage to the
brain stem and cannot breathe on his/her own, the jurists ruled that “if three
attending physicians attest to a totally damaged brain that results in unresponsive
coma, apnea, and absent cephalic reflexes, and if a patient can be kept alive only
by a respirator, then the person is biologically dead,” and that withdrawal of life
support was, in this case, permissible in Islam. (Sachedina, 2005)
4. What are the attitudes towards human euthanasia among physicians and medical
professionals, as well as the general public in Saudi Arabia?
The survey indicated that there were differing results relating to each
individual form of euthanasia (c.f. the Results section). The overwhelming
majority of both the general public and medically-qualified personnel were
opposed to active euthanasia and its legalization in Saudi Arabia. As roughly 70%
of both cited religious and ethical reasons behind this opinion, it is safe to assume
that the outcome is so because the majority of the population is Muslim, and the
Qur’an clearly states that God is the sole determiner of the death of a person, and
not man. Moreover, Saudi Arabia is a strictly conservative country, and the
greater part of its population is similar in terms of moral/ethical conventions.
Likewise, a very large percentage of respondents were opposed to physicianassisted suicide, another result that was most likely due to the fact that suicide in
Islam is forbidden (Sachedina, 2005).
When questioned on whether cessation of heart and lung function or brain
death should be used to determine time of death, the results were roughly equal,
with the latter option exceeding the former by a tiny percentage (9%). The former
option is more or less the traditional view of death, which is probably the reason
behind this choice. A small proportion (8%) also chose both for a person to be
declared dead. It is likely that this is largely due to ignorance or unawareness of
the fact that it is possible for a person to be kept alive on a heart-and-lung
machine, whilst they are entirely brain dead. In such circumstances, it becomes
important to choose one of the several options in order to make a decision of
whether to terminate. Amongst the medical experts, however, brain death was
chosen by 75% of the respondents as the primary determiner of death. Since they
have more expertise on the matter as well as more awareness about emerging
medical technology, their view roughly corresponds to the legal definition of
death in most countries, including Saudi Arabia.
In the questions relating to non-active euthanasia, specifically in the issue
of withdrawal of life-support, the results were conflicted between two forms of
consciousness – Persistent Vegetative State and Brain Death. 68% of the
respondents indicated that they were opposed to euthanasia in patients who had
suffered extensive brain damage but retained the capability to breathe on their
own, while only 27% were opposed to the same in patients who had suffered
complete brain death. This is most likely due to the belief that patients in PVS are
still alive and breathing, and euthanasia in this case would thus be equivalent to
murder. In the case of patients being kept alive solely on life-saving equipment,
he/she is already dead biologically and hence, it would be best to let nature take
its course and allow the person to die peacefully and painlessly.
On the issue of passive euthanasia, the results were once again nearly
equally dispersed between whether a person should be allowed to turn down lifesaving treatments or not, particularly with the knowledge that refusal of such
treatments will result in death. The question is tricky, because some view the
refusal of life-saving treatments to be more or less equivalent to suicide, which is
prohibited in Islam. However, 63% of the medically-qualified respondents
indicated that they believed patients should be given the option to refuse
treatment, most likely due to the legal ramifications and disputes that could arise
in the case of forced treatment.
5. How do views on human euthanasia differ in Saudi Arabia and in Europe and the
Americas, and what are the foundations for these differences?
In comparison with the survey conducted in Saudi Arabia, it was found
that there are significant differences in the attitudes of people in the two regions
towards hum Specifically, active euthanasia and physician-assisted suicide were
found to be widely supported in the Canada and many countries of Europe,
whereas it was quite strongly opposed to in Saudi Arabia (Chater et. al, 2006;
Cuttini et. al, 2004). This most likely due to the fact that these are secular
democracies, whereas Saudi Arabia is a religious monarchy. They have a
substantial faction of people that are atheistic, agnostic, or not Muslim, and the
environment in these countries is noticeably more liberal. Religious differences
are therefore the most likely grounds for the disparity, closely followed by ethical
and moral differences.
In the case of patients with irreversible and complete brain death,
however, the difference was not as profound. This may be due to the fact that
scientific technology today provides physicians the capability to gauge the extent
of brain damage, and to determine, quite accurately, the degree to which the
person may be brain dead. In such cases, the decision to prolong life through
intensive care becomes futile, and it is agreed in both regions that withdrawal of
life support may thus remain the only option.
Conclusion
The current legal ruling on human euthanasia in Saudi Arabia is decided by the
leading theological scholars of Islam, and is similar to the Islamic ruling on euthanasia;
that all forms of euthanasia are actively disallowed except in the cases of complete and
irreversible brain death (Sachedina, 2005). This statute is consistent with the view of
both the general public and medical experts on the subject of euthanasia, with most citing
religious, ethical and emotional reasons as the bases of the views.
The projected scenario for any change in policy is thus unlikely, not only due to
the fact that Saudi Arabia is first and foremost a religious country but also because there
is very little opposition from most of its population towards the rule.