Etičke dimenzije distinkcije između pasivne i aktivne eutanazije

Abstract

Više od pet decenija prošlo je od događaja (otkriće mehaničkog ventilator i aparata za veštačku ishranu i hidrataciju) koji su obeležili početak rasprave o moralnoj ispravnosti eutanazije. Međutim, konsezus o ovom pitanju još uvek nije postignut. Ključno pitanje koje se nalazi u fokusu rasprave i na koje se i danas pokušava pružiti odgovor jeste da li između pasivne i aktivne eutanazije postoji moralno relevantna distinkcija. Pasivna eutanazija podrazumeva uskraćivanje i prekidanje tretmana održavanja u životu umirućeg pacijenta, a aktivna, intervenciju lekara kojom se okončava život pacijenta ubrizgavanjem smrtonosne injekcije. Glavni cilj disertacije je da se utvrdi da li između ova dva oblika eutanazije postoji moralno relevantna distinkcija, i ukoliko postoji, u čemu se tačno ona sastoji. Pitanju moralne distinkcije između pasivne i aktivne eutanazije pristupa se iz ugla tri stanovišta: moralnog apsolutizma, utilitarizma i libertarijanizma. Ključna razlika između ovih stanovišta ogleda se u njihovom odnosu prema pitanju moralne ispravnosti naših postupaka. Prema moralnom apsolutizmu, moralna ispravnost postupaka zavisi u potpunosti i isključivo od njihove prirode, dok prema utilitarizmu, ona zavisi isključivo od njihovih posledica. S druge strane, u okviru libertarijanizma, moralna ispravnost postupaka zavisi od toga da li oni promovišu pravo na samoodređenje pojedinca, poštovanje njegove lične autonomije i da li su deo njegovih dobrovoljnih izbora koji ne nanose štetu drugima. Razmatranje moralne distinkcije između pasivne i aktivne eutanazije unutar pomenutih stanovišta u disertaciji, vrši se primenom deskriptivne i evaluativne metode, pomoću kojih se pruža temeljan opis i objašnjenje argumenata za i protiv ovih oblika eutanazije. Zastupanje moralnog apsolutizma i hedonističkog utilitarizma predstavlja dve krajnosti u moralnoj raspravi o ovom pitanju. Moralni apsolutizam uspostavlja apsolutnu zabranu aktivne eutanazije, pa čak i dobrovoljne. S druge strane, hedonistički utilitarizam negira bilo kakvu moralnu razliku između ova dva oblika eutanazije, a opravdava i sve oblike aktivne eutanazije, čak i protivvoljnu. Iako osuđuju aktivnu protivvoljnu eutanaziju (usled čega su prihvatljivija stanovišta od hedonističkog utilitarizma), utilitarizam preferencija i utilitarizam postupaka opravdavaju aktivnu nedobrovoljnu eutanaziju, i stoga se i oni (kao i moralni apsolutizam i hedonistički utilitarizam) smatraju neprihvatljivim. Alternativu moralnom apsolutizmu i utilitarizmu predstavlja libertarijanizam. Prema ovom stanovištu, jedina moralno relevantna distinkcija između pasivne i aktivne eutanazije počiva u dobrovoljnosti saglasnosti terminalno obolele osobe. Ako je terminalno obolela, ili na bilo koji drugi način onesposobljena, osoba za to dala valjanu dobrovoljnu saglasnost, aktivna eutanazija je opravdana i dopustiva, jednako kao i pasivna. Budući da pasivna eutanazija ovakve osobe predstavlja njeno ne samo moralno, već i zakonsko pravo, isti slučaj treba da bude i sa aktivnom eutanazijom.

More than five decades have passed since the events that marked the beginning of a debate on the moral permissibility of euthanasia took place (discovery of mechanical ventilator and artificial nutrition and hydration devices). However, the consensus on this issue has not been reached yet. The issue that lies in the focus of the debate is whether there is a morally relevant distinction between passive and active euthanasia. Passive euthanasia involves the withholding and withdrawing of a life-sustaining treatment, while active euthanasia entails the intervention of a physician terminating the patient’s life by injecting a lethal injection. The main goal of the dissertation is to determine whether there is a morally relevant distinction between these two forms of euthanasia, and, if so, what exactly it consists in. The issue of moral distinction between passive and active euthanasia in the dissertation is approached from three viewpoints: moral absolutism, utilitarianism and libertarianism. The key difference between these positions is reflected in their attitude towards the question of moral permissibility of our actions. According to moral absolutism, moral permissibility of acts depends entirely and exclusively on their nature, whereas according to utilitarianism, it depends exclusively on their consequences. On the other hand, within the framework of libertarianism, moral permissibility of acts depends on whether they promote the right to self-determination of an individual, respect for his personal autonomy, and whether they are a part of his voluntary choices that do not harm others. Consideration of the moral distinction between passive and active euthanasia is carried out in this dissertation by a thorough description and analysis of these positions and an evaluation of arguments for and against passive and active euthanasia grounded in them. Moral absolutism and hedonistic utilitarianism represents two extremes in the moral debate on this issue. Moral absolutism establishes the absolute prohibition of active euthanasia, even of active voluntary euthanasia. On the other hand, hedonistic utilitarianism denies any moral distinction between passive and active euthanasia, and justifies all forms of active euthanasia, even the involuntary. Even though they condemn the active involuntary euthanasia (which is why they are more acceptable views than the hedonistic utilitarianism), preference utilitarianism and rule utilitarianism justify active involuntary euthanasia, and therefore they (as well as moral absolutism and hedonistic utilitarianism) are deemed unacceptable. An alternative to moral absolutism and utilitarianism is libertarianism. According to this view, the only morally relevant distinction between passive and active euthanasia lies in the voluntariness of the terminally ill person’s consent. If the terminally ill person has given a valid voluntary consent, active euthanasia is justified and permissible, as well as passive. Since such a person has moral, as well as a legal right to passive euthanasia, the same should be the case with active euthanasia.