Individual Dignity and Euthanasia: An Ethical Perspective

Euthanasia is one of the debated topics in the present scenario. Modern medicine has promoted honest and responsible relationship with dying patients allowing to prolonging their life. Euthanasia involves shortening the life of the patients with their knowledge along with physician and relatives. Dignity is an intrinsic and inseparable value of individual. Human dignity is one of the central, social and moral concepts of the medical ethics. Dignity belongs to every human being as ‘qua’ human brings out its universal character. It is viewed from an ethical perspective conveys that every human being has the same dignity. The respect for the human dignity means respect for the intrinsic value of human life. It is about the quality of the individual’s life. According to Kant’s view human beings have intrinsic dignity which makes them most valuable. The concept of dignity and autonomy are coupled to serve as the foundation of ethical issues. The person who is dying with dignity reveals the freedom of choice, self-rules and values. Accepting or practicing euthanasia within the respect of human dignity means respecting another person. Deontological ethics, which projects Kantian ethics defines one’s action is right or wrong depending on the action itself. The concept of dignity is important from deontological constrains in the respect of others. From this perspective, dignity and autonomy of patients are fundamentals considered in performing euthanasia.


INTRODUCTION
The term euthanasia is one of the hot topics in the field of medicine and bioethics.There are certain ethical, legal and social constraints involved in the application of euthanasia.In this paper I would like to discuss euthanasia from an ethical perspective especially in individual dignity and Kantian notion of deontological ethical theory.Kantian ethics focuses on moral duty of the individual.Deontological ethics does not depend on consequences of action.Every action is judged right or wrong on the basis of its intention.In this paper we will discus on euthanasia from a Kantian ethical view giving emphasis on individual dignity.

Euthanasia
Euthanasia is the act or practice of killing or permitting the death of hopelessly sick or injured individual… in a relatively painless way for reasons of mercy [1].Euthanasia is a deliberate act undertaken by an individual with the good intention of ending the life of the other or intentionally allowing the patient to die in order to relieve him/her from suffering.Generally, Global Bioethics Enquiry 2020; 8 (1) there is a misconception that euthanasia is another name of murder and for some people who believed that there is no point in prolonging the pain of dying period, it is mercy killing.There are different kinds of euthanasia they are passive, active, voluntary, non-voluntary and involuntary.Active and passive euthanasia is a process of commission and omission respectively.Other three division of euthanasia are depending on the individual willingness or self-decision making.The word euthanasia is interpreted in many different ways, but we tend to use it in the commonly accepted sense, of that which leads to painless death.It is used in three different senses; first one is the decision of shortening the life.We also agree that it is limited to the medical context: 'euthanasia' involves shortening the life of the patients' by doctors [2].The second is; euthanasia is a belief that death would benefit the patient, that he/she would be better off dead, typically because the patient is suffering gravely from a terminally or incapacitating illness or because the patient's condition is thought to be an 'indignity'.The third is a cold-blooded murder for selfish motives [2].These are three definitions about euthanasia involving doctors making decision in order to end the patient's life.It has the effect of shortening the patient's life and these decisions are based on the belief that the patient would be better off dead.The term euthanasia was first used by in Ancient Greek time by Hippocrates.The Hippocratic Oath dated around 400 B.C, is followed by the medical professionals around the world even today.Ancient time onwards euthanasia was rejected.According to the Hippocratic Oath I will give no deadly medicine to any one if asked, nor suggest any such counsel [3].In modern time the term euthanasia was introduced by the English philosopher in the 17 th century Francis Bacon.He was supporting euthanasia and he defined as "the role of medicine is to restore health and alleviate pain, not only when relief can lead to cure, but also when medicine may provide a peaceful and easy death" [1].Here the term euthanasia makes a contradiction between ancient and modern times.

Dignity
Human dignity is another corner stone in the freedom of the individual.'Dignity' is the quality of worth possessed by a living thing, as evaluated on a scale.'Human dignity' refers to the intrinsic value of humans as humans, and can be thought of in terms of 'basic' and 'personal' dignity, depending upon perspective [4].The term Dignity is derived from the Latin word 'dignitas' meaning worthiness and nobility.Human dignity is the battle against slavery, and segregation in relation to the concept of political freedom.It can be stated that in most of the cases, the application of euthanasia is to safeguard the patient's dignity.Yet, it is another freedom to choose life or death on the grounds of preserving one's own dignity.The Universal Declaration of Human Rights mentions that, dignity is something 'all human beings are born with free and equal in dignity and rights.Dignity implies living self-consciously.Dignity means intrinsic value or special quality of human being's life.Every individual's dignity has two dimensions human and social.The human dignity is intrinsic and inseparable value of each and every individual and it cannot be evaluated because it is an independent quality of individual.Even though, social dignity is part of human dignity it depends upon the individual's social status.Dignity belongs to every human being as 'qua' human.Therefore, there is equality for all men in relation to human dignity.It is difficult to measure the dignity or some possess something extra from others so he is qualified to have a better dignity.Everyone has equal dignity and rights.But in the contemporary world, the value of dignity of different individuals varies depending upon his personality.It will be different from individual to individual and depending on their social status.Generally human dignity is excellent value of one's own or his/her status in their society.It is the highest value of human beings and this value is affecting every person deeply and personally.Each man feels dignity is an essential part of every human being's life.In speaking of basic dignity, we distinguish humans as more valuable than animals and plants.In speaking of personal dignity, we focus on the cultural and social value of individuals.However, notions of personal dignity do not, and cannot, undercut basic dignity.They are simply different ways of speaking, and are drawn from one central concept.

Global Bioethics Enquiry 2020; 8(1)
According to Nordenfelt [5], dignity is vital goal and it consists of four aspects of human life.The first is dignity as merit which means person's social status or official position in his society.Dignity of merit is related to the individual's right and respect and it will be differentiating from person to person e.g.Minister's, Doctor's dignity of merit is different form a layman's or slum people's dignity.Hence dignity of merit is depending upon the social status of the individual.Second dignity as moral structure holds that 'depending upon the thoughts and deeds of the subject [5].A dignified character is identified by one's respect to moral laws and dignified action is one attune with moral law.Another aspect of dignity is one in conformity of one's physic, psychic and self-image developed in present and future [5].The last aspect of dignity depends on belonging to human being as universal character.All the above aspects of dignity are related to human rights without gender, race, sex and social discriminations and can be identified as inner feeling safeguarded from others.

Euthanasia and Dignity in Kantian Perspectives
Immanuel Kant, German philosopher, argued that human beings are rational so we have a choice to do things not 'just do things' but do the maxim.Kant's maxim means individual intentional action.It is our personal choice to do our maxim.His major metaphor is categorical imperative which means unconditional command.It mainly focuses on individual's duty.The doctor's duty is to save the patient at any circumstance.Whatever be the situation, the physician should perform his duty well.His goodwill is also known as 'duty for duty sake'.It means a duty is performed entirely for the sake of the duty.Kant's conception of duty is framed in its relation to its universal ethical principle.The doctor's commitment is to act for patient's welfare.His real duty is to decrease the patient's pain and divert them from thinking about the death.According to Kant, dignity and humanity are the virtues of human beings and they are special values of a person.The individual who loses their dignity loses their life value retains only biological value.Hence their life is no more important or their life becomes worthless.Kant also argues that biological life has no absolute value, so that honor is more valuable.In the passage 'Care for one's life', Kant writes: Life, in itself and for itself, is not the highest good that is entrusted to us.Life is not some-thing that we ought to take care of.There are duties that are higher in value than the life itself that must be achieved by sacrificing one's own life [6].He suggests that humanity is possible with in our personality and it should be highest respect of human being's life.Kant believes that if the person loses their respect in any circumstances then they have duty to sacrifices their life before shaming humanity.According to Kant dignity means inner value of rational beings [7].The irrational persons have physical life not a moral life because their life seems to be an animal life.All human beings have important quality of rational thinking.Kant's view is that once individual loses their rational capacity then they seem to be an animal.Kant argues about euthanasia, the patient who has been asking euthanasia means they lose their rationality.In his view rationality is valuable more than anything else.Hence it shows that rationality is the highest level of dignity of individual.So, we should respect the individual's dignity.The person who is asking euthanasia lost their rationality and dignity because of their pain or terminally illness.Therefore, we should try to protect or respect their dignity which means helping them for die with their own choice.Therefore, the preservation of life is not the highest duty; a man often needs to give up his/her life in order to live in a decent way, i.e. to preserve his/her honor [6].Deontological theory holds that morality is a matter of duty.It believes every individual have moral duty to do right action and moral duty not do wrong action.This theory makes right and wrong in individual action itself.It focuses on duty and obligation of the individual towards the society.It emphasises the action right over the good which means deontology focuses on right actions and right intentions.According to Kant, deontology human beings are unique so they are able to choose or act freely and also have capacity to choose ought to be respected.Autonomy is the basis of dignity and allows a person to act freely, and acting freely is the foundation of morality.Kant writes: 'Autonomy is the basis of dignity in human nature' [7].

Global Bioethics Enquiry 2020; 8(1)
For Kant the term human person is looked up from two perspectives.Human is merely biological category and person is moral term.A person is considered to be one with dignity and autonomy having ability to have control over one's decisions.Rational beings are referred to persons with dignity and respect.Euthanasia is the result of persons mental competence and their decision [7].Terminally ill patients become depressed and despondent.So, they think that there is no hope for return back to the life.In this circumstance they will opt euthanasia.They think whatever the consequences they want to relive form the pain.

CONCLUSIONS
The individual dignity is unique and refers to a sense of values in relation to personal goals and social environment.The metaphor dying with dignity in ethical context is defined as intelligence or wisdom.Respecting patients' dignity is a step towards increasing their satisfaction.People who prefer to die with dignity shows their personal qualities and their values.All human beings aim to live with virtues and quality of life.If they lose their virtue of dignity because of terminal illness then they will opt death with dignity.Considering, dignity as one of the focal points in the application of euthanasia, a patient who was healthy before the onset of incurable disease and after the disease he is completely deteriorated in his own physical and mental identity.Such patients may feel that, their dignity of normal life is completely lost and they want death as a boon.It is not that their wish to die but it is a wish that how they don't want to continue their life."I have had a good life and I would dearly like a good death…….My last wish is to die with dignity" [8].Considering euthanasia on basis of the Kantian ethical perspective it is argued that it is the right of the individual to hold dignity in life even at the risk of death.Dying with dignity is preferred to living with low dignity.However, the measurement and evaluation of dignity at the basic and personal level is complicated and complex.