South East of Bulawayo, about six kilometers from the City Hall is Valejo clinic. This clinic has become the last home for many people who suffered from acute chronic diseases. The clinic has advanced equipment for life support. The equipment is more advanced than that of most central hospitals in the country. Two well-known doctors who practiced euthanasia and research on patents used to come for visitation in this clinic. For fear of litigation, I would call the two doctors Dr SX and Dr MX. Dr SX once worked in Mpilo Hospital and left when some of his colleagues were not happy with his unethical behaviours on patients. Even when he was working in Matabeleland South at Mnene hospital, he used to do consultations at the Valejo clinic. The mysterious deaths that occurred at Mnene hospital were not different from those that occurred at the clinic during his consultations.
Dr MX on the other hand worked in the Avenues clinic and some mysterious deaths occurred during his consultations at both Avenues and Valejo clinics. This paper attempts to discuss the moral problems arising from practicing of euthanasia and conducting of experiments on patients in this clinic. DEFINING THE MORAL PROBLEM The practicing of euthanasia and experimenting with patients is an ethical problem in Valejo clinic. Euthanasia is an act of bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for reasons of mercy. It is an effort to make possible a gentle and easy death for those affected with an incurable disease.
DISTINCTION BETWEEN PASSIVE AND ACTIVE EUTHANASIA
Passive euthanasia is the withdrawal of ordinary life-supporting techniques, such as intravenous feeding and resuscitation or not carrying such treatment when the situation is hopeless. Active euthanasia is the administration of increasing dosages to relieve suffering, until the dosage, of necessity reaches the lethal stage. In Zimbabwe it is illegal and morally wrong to kill for mercy. Even though Dr MX and Dr SX are no longer visiting the clinic the practice of euthanasia is still prevalent in this clinic. Passive euthanasia is the most practiced method of euthanasia in Valejo. Sometimes relatives of the patient secretly agree with the doctors to either remove life-supporting machines or deny such facilities to those suffering from acute chronic diseases. Unethical tests are also carried out on patients using unregistered, drugs or (mixtures of chemicals). These experiments userly result in death of patients.
Active euthanasia, although practiced to a lesser extent at Valejo, involves the administration of drugs such as morphine to the levels that are lethal. This is done to relieve suffering and finally to kill. Experimenting on patients occurs when a physician gives patients known lethal chemicals or mixture of these chemicals as a way of trying to test their effect on certain diseases. Most of these experiments result in death of patients. As mentioned, above the relative of the patients secretly agree with some unethical doctors to either administer passive or active euthanasia as a way of ensuring that their relatives die with dignity, free from pain. In 2003, someone I know was admitted in the clinic suffering from meningitis. The doctor gave the relatives a prescription to purchase morphine from the chemistry. Deep down my heart I knew this was killing for mercy. When the drug was administered, he became cabbage and within three days he was dead.
EUTHANASIA FROM A THEORATICAL PERSPECTIVE
This discussion will focus on two ethical theories by John Stuart Mill (1808-73) and Immanuel Kant (1724-1804). Mill believed in an ethical theory known as utilitarianism. He described this principle as follows; ‘According to the Greatest Happiness Principle, The ultimate end, end with reference to and the sake of which all other things are desirable (whether we are considering our own good or that of other people), is an existence exempt as far as possible from pain, and as rich as possible enjoyments’ In simple terms Mill meant that the goodness of an act might be determined by the amount of happiness or unhappiness caused. According to Mill a goodman is one who considers the other man’s pleasure or pain as equally as his own. Further, he believed that a free act is not an undetermined act. It is by the person performing the act. He said either external or internal forces compel an un-free act.
The utilitarianism states that rightness or wrongness of an action is determined by the net consequences. Therefore, according to Mill it will be morally right for a doctor or relative to mercifully kill a patient who is suffering from an acute chronic disease, as long as the net consequence is good. In this case the patient will be relieved, from suffering and made to die a ‘dignified’ death through euthanasia. In other words the practice of euthanasia at Valejo clinic is, according to Mill ethical. It should be pointed out however, that if Mills ethical theories were to be applied in societal ethics, they could give rise to the new Hitlers, operating from hospitals and surgeries. Doctors could hide behind the ‘mercy’ veil and kill enemies and political opponents. On the other end Emmanuel Kent’s ethical theory is based on the belief that the reason is the final authority for morality.
Kent pointed out that sources of any sort must be undertaken from a sense of duty dictated by reason, and that no action performed for expediency or solely in obedience to law or custom can be regarded as moral. Kent stresses that a moral act is one done for moral reasons. Two types of commands given by reason, as described by Kent are hypothetical imperative, which dictates a given course of action to reach a specific end and the categorical imperative, which states a course of action that must be followed because of its rightness and necessity. Kent believed that the welfare of each individual should be regarded as an end in itself. He believed that moral rules are exception-less and therefore it is wrong to kill in all situations, even in self-defense or for mercy. Kent’s ethical theory states that there are never any extenuating circumstances, such as self-defense or mercy killing. He said the act is either wrong or right.
Thus according to Kent, the moral problems at Valejo clinic, i.e. the practice of euthanasia and experimenting on patients are nothing else, but killings. His theory therefore points out that it is unethical to practice euthanasia for the sake of mercy. Mercy here becomes an extenuating circumstance, which the theory is against. Kent’s theory states that people should be prosecuted for everything since there are no extenuating circumstances. From the above discussion Mill’s theories would make a better societal order.
SOLUTIONS ON THE ETHICAL PROBLEMS BEING PRACTISED AT VALEJO CLINIC
The ethical problems discussed in this paper are not only specific to Valejo clinic but also the whole country, and the world over. It is high time that governments the world over comes up with legal guidelines on the practice of euthanasia. It is clear that this act cannot be suppressed. As stated above, that Mill’s ethical theories could make better societal order, the solution discussions will be biased towards his theories. Mill pointed out that as long as the act results in the net consequence that is good, it should be carried out. The net consequence of the practice of euthanasia is therefore good according to Mill as it make patients die with dignity, free from torment. The major problem is that of abuse as assisted suicides might result in flagrant murders that may be perpetrated by deliberately forcing or coercing self-destruction and that others may advance personal motives by aiding in suicide (Adams et. Al, p 2031).
When the entire medical profession is involved in euthanasia, including the poorly trained, the insensitive, the less skilled there becomes the danger that physicians might not do whatever they can do to avoid euthanasia if possible (Newman p. 177); and that some people who enjoy the exercise of power over others might become addicted to the process (Doerflinger, p.19). A legal framework should be put in place that will legalise euthanasia the world over. People should prepare ‘Living wills’ when there are in good health, stating unequivocally the expectation that the right to die with dignity will be respected. Family doctors and family members must have copies of such ‘living wills’.
The courts should actually acquit the ‘living will’ before the doctor applies euthanasia on a patient. It would, therefore be unethical for some people to deny the patient to die with dignity as the net consequence would be good for the patient (Mill). The introduction of the ‘living will’ might bring sanity to some of the health centers like Valejo where passive euthanasia is applied willy-nilly without the consent of the patient. The removal of life support systems will only be done after the ‘living will’ has been signed by the court of law.
The moral problem at Valejo clinic might be solved if the world can accept the existence and practice of euthanasia, by putting in place a legal framework, indicating the procedures that need to be followed in order to practice euthanasia. Some of these procedures must include the ‘Living will’. Once the society and the governments accept euthanasia practice, it will be unethical to apply it to a willing patient.
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North Dakota State University
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7. Different Moral Theories