Medical advances since the Industrial Revolution and the issue of euthanasia: How should we approach it?

Medical advances since the Industrial Revolution have increased life expectancy, but they have also raised the issue of euthanasia. In Korea, euthanasia is being debated through court cases and laws. This article discusses euthanasia from a bio-medical ethical perspective based on social perceptions and legal cases.

 

Humanity has made leaps and bounds in various fields since the Industrial Revolution in the late 18th century in England. The development of machinery, including the steam engine, advances in basic science and engineering, and the mass production of food, as well as significant advances in medicine, including the development of antibiotics and vaccines and the establishment of healthcare systems. This has led to an increase in human life expectancy from the 20s to the mid-60s, and in developed countries to the 80s. However, the increase in life expectancy and medical advancements have recently raised social and ethical issues. This is the issue of euthanasia. Currently, euthanasia is prohibited in South Korea under Article 252 of the Penal Code, but whenever the issue comes up, it is often met with sharp confrontation in society. In order to understand this, we will look at some cases related to euthanasia to understand the social perception and precedents of euthanasia, and then argue about it from the perspective of bioethics.
Before we get into the nitty-gritty, let’s explain a key concept that will be used frequently in this article: euthanasia. Euthanasia is defined as “the provision of death by another person, usually a medical professional, to relieve the suffering of a patient who is beyond recovery. Euthanasia is often categorized into active and passive euthanasia, or voluntary, non-voluntary, and semi-voluntary euthanasia. For the purposes of this article, I’m going to divide euthanasia into active and passive euthanasia, which is the more widely used distinction. First, active euthanasia is when the person performing the euthanasia actively shortens the life of a patient who is in a lot of pain or has a terminal illness, using drugs or other means. Passive euthanasia, on the other hand, is when the person performing the euthanasia gives up on prolonging life by stopping life-sustaining treatments for patients who cannot be saved. In other words, active euthanasia and passive euthanasia differ in that active euthanasia involves stopping life through active action or neglect.
Now, let’s talk about the social issues related to euthanasia in South Korea. The first case to deal with euthanasia in Korea was the Boramae Hospital case in 1997. In the Boramae Hospital case, medical staff were accused of murder for discharging a patient who was certain to die if discharged at the insistence of the patient’s guardian. Although the actual case was more of a “discharge of a patient against medical advice” (DAMA) than euthanasia, it sparked a lot of public discussion about euthanasia and DAMA. Since then, one of the most publicized cases with euthanasia as a keyword is the 2008-2009 case of Grandma Kim. In February 2008, while undergoing a biopsy for lung cancer at Severance Hospital, Grandma Kim suffered cardiac arrest due to excessive blood loss and became a vegetative person. In June 2008, her family filed a civil lawsuit against the hospital to stop the pointless life-sustaining treatment. After about a year of appeals and appeals, the matter ended on May 21, 2009, with the Supreme Court ruling in favor of Kim’s family. The Supreme Court ruled that a person’s right to self-determination, protected by the right to personhood and the right to pursue happiness under Article 10 of the Constitution, allows him or her to request the withdrawal of treatment that is administered solely to maintain the status quo in the absence of a possibility of recovery. The court also set out the following requirements for the withdrawal of life-sustaining treatment. First, the patient’s condition must be at a stage of death beyond recovery. Furthermore, the treatment that can be withdrawn is limited to life-sustaining treatment to maintain the status quo. An advance directive is considered to be an exercise of self-determination if the patient has made clear to a healthcare provider in advance that he or she wishes to refuse or withdraw life-sustaining treatment in the event of an unforeseen event. Among other things, the law states that the determination of whether a patient has reached the stage of irreversible death must be made by a committee that includes specialists. However, the ruling did not completely resolve the controversy, as the dissenting opinion was 9:4, not unanimous even among the Supreme Court justices. After various social discussions, the so-called “End-of-Life Decision Act” on life-sustaining treatment and hospice was enacted in early 2016, and as of February 4, 2018, life-sustaining treatment can be legally withdrawn with the consent of the patient or the patient’s family.
The two cases and one law discussed above illustrate the debates on euthanasia in South Korea over the past two decades. Notably, all three cases dealt with the issue of passive euthanasia, not active euthanasia. Cases involving active euthanasia are almost non-existent in Korea. For one thing, active euthanasia, unlike passive euthanasia, is strictly prohibited by law in most countries, including South Korea and the Netherlands. And whether it’s legal or not, active euthanasia is bioethically wrong in almost all cases. Of course, proponents of active euthanasia can make the libertarian argument that a patient’s body and life are their own, and they should be able to decide for themselves how to end their life. Of course, patient autonomy is very important in the treatment process. However, the libertarian argument is unjustified. First of all, in the case of active euthanasia, it’s not easy to find criteria to distinguish between terminally ill patients or patients in severe pain, so if we were to give everyone the right to end their lives on their own terms, as they claim, the distinction between suicide and active euthanasia would be blurred. Active euthanasia, whether voluntary or involuntary, is therefore more open to abuse than passive euthanasia. Moreover, active euthanasia is completely contrary to the basic principle of medical professionals: to save lives. As libertarians argue, active euthanasia puts the patient’s decision in direct conflict with the physician’s basic duty to save lives. Of course, in some exceptional cases, active euthanasia may be ethically sound and permissible in accordance with the patient’s wishes and values. However, we do not believe that it should be legalized in the same way as passive euthanasia. Passive euthanasia, on the other hand, may be acceptable to some extent. Does futile life support really help patients and their caregivers? Unlike active euthanasia, passive euthanasia is unlikely to violate the bioethical principles of do no harm and do good. And there is a medical practice similar to passive euthanasia that is currently legal. These are the withdrawal of life-sustaining treatment and organ donation for the brain dead. The withdrawal of life-sustaining treatment for the brain-dead and the donation of organs to the brain-dead are still practiced worldwide. It follows that passive euthanasia is the most desirable way to serve the best interests of the patient, but only if futile life-sustaining treatment is continued. Of course, the determination of medically futile life support and irreversible patient condition should be made strictly by a multi-disciplinary committee, as is the case with brain death.
So far, we’ve covered the social issues and court cases related to euthanasia, as well as when active and passive euthanasia can and cannot be justified. The issue of euthanasia is relatively new, and there are many arguments for and against it, so some of what we’ve discussed may be logical fallacies in the eyes of others. However, compared to the current situation, where the discussion of euthanasia has been hampered by a plethora of distinctions, complicated definitions, and illogical preconceptions, this article is a step in the right direction. I would like to conclude this article with the hope that there will be more bioethical discussions on socially controversial medical practices such as euthanasia.