Among the many problems, there is one, which is probably the most worried about both specialists and ordinary people who think about aging and death. This is a widely discussed phenomenon called euthanasia. (From the Greek words eu- pleasant, beautiful, and thanatos, death; thus, euthanasia means “beautiful, happy death.”)
However, to a greater extent, the exact thanatological meaning of this word is to accelerate the death of a sick person by medical means. The problem of euthanasia includes the question of the admissibility or inadmissibility of such an attitude towards a dying person and many other medical, psychological and legal issues.
The term "euthanasia", apparently, was first used by the English philosopher Francis Bacon (1561-1626) in his famous work "New Organon". However, this does not mean at all that euthanasia is a phenomenon of only new historical times. There is reason to believe that in the ancient world, in particular - in ancient Greece, it was often necessary to put an end to the life and suffering of seriously ill or wounded people on the battlefield.
This may be evidenced, in particular, by the fact that Plato in his famous work "Republic", predetermining the main features of the desired state structure, expresses the opinion that doctors should not treat a person who is no longer able to live. It is necessary to give such a person the opportunity to die, and such an attitude, but Plato's opinion, is favorable both for him and for the state. In modern terms, Plato was an advocate of passive euthanasia.
But in the past there were other thinkers - Thomas More, Francis Baconi, others, who spoke out in favor of more active, effective euthanasia. And this means that, in their opinion, doctors should help a hopeless patient so that he can die easier and faster and, most importantly, without suffering.
Thus, in our time, two types of euthanasia are distinguished:
a) active, effective euthanasia: the doctor takes targeted actions that accelerate the death of the patient;
b) in case of passive euthanasia, the doctor stops treating the patient, no longer strives to prolong his life, because he believes that this is meaningless and hopeless.
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In different countries of the world, passive euthanasia is used very often, and its active form is relatively rare. Here it is appropriate to ask the question: to what extent is euthanasia acceptable in the doctor-patient relationship? This problem is seriously discussed among doctors and philosophers, because with attempts to use euthanasia and with the corresponding messages we meet more and more often.
In specific cases, the advisability of passive euthanasia is accepted by specialists in the field of resuscitation. So, the famous Russian resuscitator V. A. Negovsky wrote:
“False humanism prescribes the doctor in all cases, without exception, to begin resuscitation measures and continue them until the cessation of breathing or cardiac activity. Meanwhile, world statistics convincingly show that if the cessation of blood circulation in a person under conditions of normal temperature and in the absence of anesthesia exceeds the time that the cerebral cortex can tolerate, then the restoration of the functions of the central nervous system, which is necessary to preserve the patient's personality, is impossible. It seems to us a reasonable point of view, according to which it is inappropriate to start the restoration of cardiac activity and respiration, if it is reliably determined that the cardiac arrest lasted longer than the period that the brain can transfer after the cessation of blood circulation. In the case of a reliable statement of irreversible brain damage, resuscitation should be stopped."
This conclusion would not raise doubts if science reliably knew the functions of all sections of the human brain. After all, there are times when lesions of large sections of the cerebral cortex do not lead to a noticeable change in human behavior! Be that as it may, the general approach that was expressed in the above words of the famous resuscitator is generally acceptable.
The desire to preserve a purely biological ("plant") human existence is considered "false humanism" and one cannot but agree with this. If you take a closer look at what is happening in real life, it is easy to see that passive euthanasia is a very common phenomenon.
Sometimes a hopelessly sick person himself refuses medical care, hiding his suffering in order to hasten his end. Many do not want to become a burden for their families. To denote this phenomenon, it is appropriate to use the term self-euthanasia, or auto-euthanasia.
In order to get rid of suffering, some hopelessly ill, unable to commit suicide, turn to doctors with a request to hasten their death. This can be done either with large doses of medication or in other ways. When a doctor finds himself in this kind of situation, he begins to experience an internal moral and psychological conflict.
How to find a morally and legally acceptable solution?
The doctor, the patient and his relatives, as well as specialists in the field of psychological thanatology, in order to find acceptable solutions, should discuss the following issues:
• Independent value of life;
• The right to deprive another, like himself, of life;
• The role of the doctor's personality.
• Independent value of life. What is the principle to follow in the face of this problem? If above all is a person and his intellect, his unique "I", then the individual life of everyone should continue as long as possible. Even a life full of terrible suffering is more valuable and more desirable than death.
• Does a person have the right to deprive another, like himself, of life, if he even asks for it? Everyone must decide for himself the question of life or death. Asking the other to hasten his death, he, in fact, shifts the responsibility lying on him to another. To what extent can such behavior be considered mature from a socio-psychological point of view? Perhaps, from a moral point of view, suicide is still preferable to euthanasia? Indeed, the latter in this case is also suicide, but, so to speak, mediated, with the help of another!
• An important question concerning the personality of the doctor: why some of the doctors agree to commit euthanasia, while others strongly reject such requests from patients? When a patient turns to the doctor with a request to hasten his death, the doctor experiences an acute internal conflict between the highest assessment of human life and the desire to save the patient from suffering. It is clear that the decision taken depends on philosophical ideas and the general level of moral development of the doctor's personality.
But does the patient have a "right to die"? Is it permissible to ask the doctor to hasten the approach of his death, thus placing the specialist, called to heal and save human lives, in a state of severe conflict?
The adherents of active evatanasia believe: if the patient, being fully conscious and aware of the severity of his illness, the inevitability of new suffering and death, asks to hasten his death at will, then such a free choice should be respected: after all, freedom of will and the independence of the individual are the highest values available to humans. They believe that the painful, "neurotic" attitude towards life and death should be replaced by wise realism. Let us remember that VA Negovsky called “false humanism” any desire to preserve the life of a person who suffers and is unable to live independently.
Proponents of this point of view also believe that prolonging the life of a suffering, inevitably dying person is cruelty, an expression of blind dogmatism, the erroneous idea that human life is sacred and one should not raise a hand against it.
However, this point of view, in my opinion, only outwardly looks humanistic. First of all, the question arises: to what extent is the decision to accelerate one's own death the result of free choice, the work of free will? The decision-making process is influenced by many factors, some of which may not be realized.
The patient can make this kind of decision for various reasons: because there are no people who would empathize with him and take care of him; because he does not want to become a burden to others; even such a circumstance as the knowledge of how other people in the past, having found themselves in a similar situation, did not wait passively, but accelerated the onset of their death, can play a role. Obviously, the listed circumstances are external social factors, and if they influence the decision made, then such a decision cannot be considered an expression of a person's free will.
It should be remembered that with a request to hasten their death, that is, to carry out active euthanasia on oneself, some prominent personalities also turned to doctors, people who knew this problem and thought about it. So, the famous psychologist and doctor Sigmund Freud, after several operations of the oral cavity, being in a difficult physical and mental state, asked his attending physician with the help of injections to hasten his death. The doctor, as far as we know, refused to participate in such a case.
And of course, along with supporters of euthanasia - active or passive - there are many other doctors for whom it is immoral and unacceptable. Active euthanasia is incompatible with the "Hippocratic Oath", which contains the following expression: I will not give anyone the deadly remedy that he asks of me, and I will not show such means by which he can fulfill his intention to die.
Indeed, as the opponents of active euthanasia note, by helping to accelerate the onset of human death, physicians thereby contribute to a decrease in the level of moral responsibility of medical workers. Active and even passive euthanasia can also demoralize patients, weakening their will to fight for their lives and health. It will lead to an increase in the number of deaths due to misdiagnosis.
But, we believe that the solution of all these specific medical, as well as moral and psychological issues and conflicts is due to how the problem of the fate of the human spirit, his "I" after the death of the physical body is solved. Because people with different religious and philosophical views solve this issue in different ways, it is natural that euthanasia cannot be assessed in the same way either. This problem should be specially discussed once again after stating all that has become known to us in recent years about the fate of the "I" of a dying person.
A. Nalchajyan
