This blog post deeply explores the meaning and ethical dilemmas surrounding euthanasia within the context of advancing medical technology, grounded in the dignity and autonomy of life.
Birth, aging, sickness, and death are inescapable truths of the natural world. Thus, humans are born, cultivate their lives to be valuable and fulfilling, and one day, afflicted by illness, conclude their existence with death. Ultimately, death can come to anyone, anywhere, at any time during life. And people have traditionally regarded such death as natural. While some have chosen to end their lives through suicide, this act has been morally condemned by the natural values formed across countless religions and societies throughout history. For centuries, we have believed that human life is sacred and an area where humans should not interfere recklessly.
However, cracks have begun to appear in this belief. These cracks stem from the issue of euthanasia. Advances in modern medicine have greatly expanded the medical possibilities for sustaining life compared to the past, making it possible to overcome illnesses that would have been fatal in earlier times through treatment. Conversely, it has also become possible to postpone the death of someone with an incurable disease through life-sustaining treatment. As a result, the question of whether it is right to allow a terminally ill patient, whose life is essentially already lost, to end their suffering without pain, or whether it is right to leave the patient’s life to divine providence, has become one that no one can readily answer.
Advances in medical technology have made saving lives easier than before, but conversely, ending lives has also become increasingly simple. Whereas death was once accompanied by suffering, today one can comfortably end their life with a simple injection of medication. However, the value of human life remains paramount, so indiscriminate euthanasia must not be permitted.
However, not all euthanasia represents an easy death chosen by abandoning the dignity of human life. Scholars classify euthanasia into several types, and their stance—whether in favor or opposed—depends on the specific type. Therefore, before proceeding further with the discussion, we will first examine the classifications of euthanasia.
There are several criteria for classifying euthanasia. First, based on the physician’s actions, it can be divided into active euthanasia and passive euthanasia. Active euthanasia is the act of intentionally shortening life by administering a lethal dose of medication, premised on the situation where “a terminally ill patient with no possibility of recovery has no way to overcome suffering except through death.” In contrast, passive euthanasia involves discontinuing artificial life-sustaining measures, allowing death to occur naturally and sooner than if treatment continued. This resembles the natural death experienced by most animals in their final moments. Additionally, euthanasia is sometimes classified as voluntary or involuntary based on the patient’s wishes. Voluntary euthanasia occurs when the patient explicitly requests it, while involuntary euthanasia occurs when the patient has not expressed a wish. Furthermore, euthanasia performed against the patient’s wishes is also termed involuntary euthanasia.
A crucial ethical issue here lies in how effectively communication occurs between the physician, the patient, and the family. Particularly in cases of voluntary euthanasia, controversy can arise regarding whether the patient’s true will is being reflected. For instance, doubts may be raised about whether a patient suffering extreme pain from an incurable disease might choose euthanasia due to unspoken pressure from the physician or family. In such situations, it is crucial to clearly distinguish whether a patient’s decision to choose euthanasia is genuinely voluntary or whether it was influenced by pressure from medical staff or society.
In this regard, the role of legal and social norms related to bioethics becomes even more important. For instance, countries that permit euthanasia establish strict procedures and requirements to confirm the patient’s voluntary intent. When a patient requests euthanasia, it must not be a single request but repeated requests over time, and the patient must have access to psychological counseling and legal advice during this process. These procedures help ensure the patient has sufficient time to deliberate carefully on the decision and remain free from external pressure.
Involuntary euthanasia and euthanasia against the patient’s will are opposed by most people and thus do not generate significant controversy. This is because such euthanasia is performed independently of the ‘right to self-determination’ at the heart of the euthanasia debate. The primary controversy centers on voluntary euthanasia: should active euthanasia be permitted, should only passive euthanasia be allowed, or should neither be permitted? This article will focus on this point for future discussion.
In South Korea, the issue of euthanasia began to surface in December 1997, triggered by the so-called ‘Boramae Hospital Incident’. At the time, the wife of a patient undergoing brain surgery and hospitalized in the intensive care unit demanded, “Discharge him because we cannot afford the treatment costs.” The medical staff at Seoul Boramae Hospital complied with this request, removing the ventilator and discharging the patient, leading to his death. The court ruled the medical staff guilty, stating they “aided and abetted death by discharging a patient in recovery.” The medical community protested, questioning “what constitutes the standard for recovery potential,” sparking significant social controversy and marking the beginning of serious debate on euthanasia. So, why has euthanasia become more prevalent in modern society? There are three main reasons.
The first cause is the changing perception of human death. Until the 19th century, and even into the early 20th century, death was a natural occurrence. During people’s lifetimes, death could come at any time; it was as natural as life itself. However, as the 20th century progressed, improved hygiene and advances in medical technology made many diseases that once caused death treatable, transforming death into something unnatural. Because death thus became something frightening, an object to be overcome and tabooed, people facing imminent death began reacting to it in two ways. One is to employ various technological methods to postpone the moment of death as far as possible. The other is to avoid confronting death itself. Euthanasia is the most appropriate means of avoiding this frightening, tabooed death.
The second cause stems significantly from the firm establishment of individualism in modern society. Individualism emerged with the establishment of modernity in Europe, transforming people’s lives. Individuals gained the right to assert all their rights, provided they did not threaten the very existence of society. The spread of individualism enabled sexual liberation, divorce and cohabitation, and homosexuality. Similarly, more people now view euthanasia as the right to choose one’s own death—that is, the right to self-determination over one’s life. They believe they have the right to choose a peaceful death with a morphine injection rather than prolonging a meaningless life in agony while battling an incurable illness. However, regardless of the reason, in a society where suicide is morally condemned, it is questionable whether euthanasia alone can be recognized as the ‘right to die.’ Meanwhile, the decision to choose euthanasia may not simply be about avoiding pain, but could be an unavoidable choice. According to a BBC documentary on euthanasia, it is not uncommon in Europe for friends, lovers, and family to suddenly leave and cut off contact once someone is diagnosed with an incurable illness. Consequently, as the dying process lengthens, the need for support from others grows, yet in modern society, this increasingly becomes something one must endure alone. At death’s door, one should be able to discuss their life and death with others, find closure, and receive comfort. But if one is treated like an object, forced to endure a painful existence without even that opportunity, wouldn’t choosing euthanasia be preferable to prolonging a meaningless life?
The third cause is the dazzling advancement of medical technology. Anyone visiting a hospital intensive care unit for the first time might be shocked by the sight of humans and machines coexisting there. Humans are surrounded by machines—breathing regulators, nutrient feeders, heart rate monitors, electrocardiogram machines, cardiopulmonary resuscitation devices—to extend their lives. Here, machine and human move as one; when the machine stops, so do the human’s vital functions. If such medical interventions proceed regardless of the patient’s wishes, questions arise about whether prolonging life with these machines is truly humane and ethical when the patient is in a situation where death is inevitable. How far should humans depend on machines to sustain life? This expands beyond mere biological survival into a question concerning human dignity. For example, in a situation where life is immediately endangered without life-sustaining devices like ventilators or dialysis machines, if a patient must rely on machines to prolong life regardless of their own wishes, can that truly be called ‘life’? At this point, another issue related to medical ethics arises. Medical staff, family, and society must deeply consider whether it is truly right to merely prolong life without considering the patient’s dignity.
These issues lead to the core of the euthanasia debate. While technological advances can grant humans more life, if human dignity and autonomy are not sufficiently considered in the process, technological progress risks undermining humanity itself. Therefore, when discussing euthanasia, we must remember that the focus should not be solely on whether life is extended, but on comprehensively considering human dignity, autonomy, and quality of life.
