EUTHANASIA AND ETHICS: RAISING SOME CRITICAL
BIO-ETHICAL ISSUES
BY
J. CHIDOZIE CHUKWUOKOLO
DEPARTMENT OF PHILOSOPHY AND RELIGION
EBONYI STATE UNIVERSITY ABAKALIKI
Introduction
The supremacy of life is not controvertible amongst various cultures and religions of the world. For the Judeo-Christian culture, life is sacred, of God and must never be taken, hence the injunction in the Decalogue, “thou shall not murder”. The Judeo-Christian scripture also avers that “Your body is a temple of the holy spirit”. It does not end at this point, it goes ahead to show that man cannot choose when to die: “For everything there is a season, and a time for every matter under heaven; a time to be born, and a time to die; a time to plant, and a time to pluck up what is planted”.1
In the same token, Islam conceives life as not only sacred but also created by Allah and held in thrust for Him. This is variously noted in the Qur’an thus” “Do not take life which God has made sacred except in the course of justice”2 The holy Qur’an elsewhere equates the saving of a life with that of all mankind: “Anyone who saved a life, it is as if he has saved the life of all mankind”3
The vedic teachings equally rates life supreme. It does not only hold life sacred but traces man’s problems on earth as resulting from the web of Karmic binding arising from the shedding of blood (animals inclusive).
The Bhagavad – Gita has this to say:
Everyone must engage in some sort of activity in this material world. But actions can either bind one to this world or liberate one from it. By acting for the pleasure of the supreme4, without selfish motives, one can be liberated from the law of Karma (action and Reaction) and attain transcendental knowledge of the self and the supreme.5
For the Igbos, the supremacy and sanctity of life could be derived from sanctions given to any violator of the right to life. For instance, anybody that commits murder or manslaughter is banished for seven years in which he is regarded as dead in his community. Again the name Ndubuisi (life is supreme) shows how valuable life is regarded in Igbo land. Edmund Ilogu infact asserts, “that “Ndu”, life, is the summon bonum”6
Be these as they may we are always faced with situations where decisions are taken on whether prolonged livings are still necessary to some victims of extreme terminal illnesses. This is more so as there is increased technical capacity to keep human beings alive even in vegetative states. It is obvious that previous generations were never faced with this problem as death was certified whenever brain activities ceased and are irreversible. But today, human life could be sustained even after a near failed brain activity. It is more problematic when we contrast the reality of the withdrawal of life from a patient with the duty of those in the medical profession to preserve life against all controllable odds. This is epitomized by the Hippocratic Oath and injunction to preserve and never to take lives. Certain concerns arise: should medical workers use “extra-ordinary” means to keep lives? Does the withdrawal of the lives of terminally ill patients cohere with the supreme values placed on life as supreme, sacred and sanctitious? When should a person be said to be dead? Is man imbued with the authority to euthanize when we all believe that we keep our lives in trust for our maker?
Several issues for concern could still be raised ad infinitum; however, my concern in this paper will be to reflect philosophically on the relationship between Ethics and Euthanasia. In doing this, I shall use the result of my reflections to examine the issues of concern that I shall raise in order to demonstrate that there is more to euthanasia than the “eye” can see.
EUTHANASIA – A CONCEPTUALIZATION
The word euthanasia is etymologically derived from two Greek words ‘eu’ meaning good and ‘thanatos’ meaning death. In this sense, the word Euthanasia means a good and honourable death. It is now used to mean the act of effecting a gentle and easy death to terminally ill and comatose patients. In medicine today, the word is seen as the act of assistance to the dying in order to bring about quick and painless passage aimed at removing pain for such a sick person. This is why euthanasia has been dubbed mercy-killing. The Webster’s Dictionary defines euthanasia as “the deliberate, painless killing of persons who suffer from a painful and incurable disease or conditions, or who are aged and helpless”7 From the fore-going, it is obvious that subjects of euthanasia are generally regarded as persons who share in one of the following categories: comatose patients, terminally ill patients or patients in excruciating pains and ipso facto require mercy from their surrounding neighbours. This means that this death has to be brought about deliberately.
Analyzing the meaning of euthanasia as painless death, and putting of a person to death painlessly, especially someone who is suffering from an incurable ailment, F.A. Adeigbo has this to say;
What are the implications of this expression? First, the death in question is understood or presumed to be a good to the patient in as much as it is intended to end his pain and suffering. Therefore, one may not bring about such death by methods which aggravate his pains no matter the duration. (for example, one may not bring about such death by cutting off the patient’s head of (sic) shooting him or stabbing him) secondly, it is the patient’s own good (ie, ending his pain) which is immediately and directly intended (even though relatives may sometimes also benefit).8
What is intended from all instances of euthanasia is that in no circumstance should such death be seen to portend evil or harm to the patients. What is evident is that the subject of euthanasia, its agent is any person or group of persons (as doctors or a certified medical practitioner) whose competence in diagnosing the patient as terminally ill can never be in doubt. Thus seem euthanasia involves acts or omissions.
At this juncture, we shall survey the forms and kinds of euthanasia namely: voluntary, involuntary, active, passive and indirect. Voluntary also known as “assisted suicide’ occurs when a terminally ill patient wills to die and has asked to be “mercifully” terminated. Supposing a paraplegic patient expresses the desire to be assisted to die, since he/she cannot assist himself/herself due to incapacitations, and this desire is obliged it would be regarded as a case of voluntary euthanasia. It is voluntary because the patient has willed to die of his/her own accord. Proponents of voluntary euthanasia opine that there must be safeguards as the prevention of pressure on patients; indubitable witnessed instructions from the patient that is informed by full information and sound judgment; the active collaboration of several doctors as to no reasonable hope of recovery. They however hinged the whole idea of euthanasia on the right of the dying patient to seek an “easy” and “painless” death. Joe Jenkins corroborated this view while citing the voluntary euthanasia society thus:
An adult person suffering from a severe illness, for which no relief is known, should be entitled by law to the mercy of a painless death, if and only if that is their express wish… Doctors should be allowed to help incurable patients to die peacefully at their own request.9
The proponents of voluntary euthanasia have advanced certain arguments grounding their view. Accordingly, they argue that to keep a human being alive against his will when all the dignity, beauty and meaning of life have vanished is morally questionable. This is especially when humans assist their agonized pets to die. Jenkins again enumerates these arguments:
Voluntary euthanasia can put an end to a patient’s suffering quickly and humanly. Voluntary euthanasia can help to shorten the grief and suffering of the patient’s loved ones… everyone has the right to choose how and when to die… Religious people often use phrases like the “sanctity of life” to justify the view that life is valuable and must not be destroyed. However if an individual has decided on rational grounds that his life has lost its meaning and value, have they not the right to die?10
The centrum of their arguments is that there is need for the legalization of euthanasia to enable the terminally ill face death boldly or doctors to let patients who want to die, die without the guilt of breaking the law.
However, voluntary euthanasia was severely criticized on several grounds:
A patient might not be able to make a rational decision or might change their mind but be incapable of telling the doctors. Some people recover after being “written off” by doctors. Old people might feel they are a nuisance to others and opt for euthanasia when in their hearts they want to continue living… The relationship of trust between doctors and patients could be destroyed. Under the Hippocratic Oath doctors must try to preserve life. If there were better facilities for caring for the dying there would be less need for euthanasia. It is not for doctors to play God. Life is a gift from God and only God can take it away.11
They surmised that there are many pain killers which can enable the patients die naturally with dignity. This stems from the view that the slippery slope or thin end of the wedge argument insists that if society allows voluntary euthanasia, involuntary one will follow. Let’s have a cursory look at other forms of euthanasia. Active euthanasia also known as direct euthanasia occurs when the patient concerned requests someone else to assist him to die. A terminally ill patient could persuade his relatives or doctors to assist him die. When this is not obliged him, he may refuse to accept any further treatment medically that are considered necessary to keep him living.
On its own involuntary euthanasia occurs when the consent, that is, the permission of the patient is not obtained. However, it is imperative to distinguish between non-voluntary euthanasia and involuntary euthanasia. Non-voluntary euthanasia occurs when the patient is in such hopeless condition where he cannot express the wish to die and he is mercifully killed for example, comatose patients, infants, or extreme senile dementia cases. But when a patient can express a wish to die but refuses to give it, involuntary euthanasia is said to occur. It is worthy of note that the desire to die by the sick is rarely expressed as there is always the hope that one will survive.
On its own passive euthanasia has some legal consensus. This occurs when a terminally ill patient is allowed to die by withdrawing treatments and/or nourishment. It usually occurs when the patient involved is incapable of making any decision. The decision to terminate such lives could be taken by the doctor and/or relatives of such persons. It could occur in cases of persistent vegetative states (PVS).
At times food treatment is regarded as medicinal in this regard and is withdrawn from the patient. However, this raises a problem as to who can live on if food is removed from him; even a healthy person can hardly survive two weeks of starvation.
Indirect euthanasia also known as the double effect is the practice of providing treatment, as pain relief whose side effects is to quicken the death of the patient. It is widely practiced in Netherlands and is considered legal if killing was not intended. We shall conclude this section by saying that though these varieties or forms of euthanasia exist, two broad patterns dorminates: voluntary and involuntary. Every other method is intermixed with each other.
WHAT IS ETHICS
Ethics is a branch of philosophy that studies values. In conjunction with aesthetics, it forms the division known as axiology. Ethics studies the rightness and wrongness of human behaviour. It goes on inquiry of how men ought to behaviour in the society. In other words, it addresses such questions as how ought men to behave? What is the good life for man? What should be the universal moral standard of behaviour? Why should we blame or praise people for some of their conducts? What is the good life? Part of the motivation for studying ethics rests in the attempts by philosophers to give satisfactory answers to the questions raised above.
We shall remind ourselves of the etymological derivity of ethics as originating from the Greek word “Ethos” meaning customary. U.O. Uduma draws a comparism between ethics and morality. As he puts it:
Ethics,…, corresponds to, or is the equivalent of moral because etymologically the latin “mores”, from which moral is derived corresponds to the Greek ‘ethos’. They both mean concerning habits, customs, and ways of life especially when these are assessed as good or bad, right or wrong. In this sense, ethics means customary way of acting in contrast to historical or anthropological way(s) of acting.12
From the foregoing, it shows that ethics is premised on the morality of human conducts. This is why it is sometimes referred to as moral philosophy. Its interest rests in the location of the ultimate values of human behaviour. Therefore ethics is not so much interested in how men behave as to how they ought to behave.
At this juncture, certain questions are rife for answering. What is the business of the ethicist in the euthanasia? Why should we study ethics? Several reactions have been given as regards why people should study ethics. But all in all, what is decipherable is that people’s varied backgrounds have influenced their reactions. For instance, the analytic tradition sees ethics as simply the analysis and clarification of ethical concepts. This is they R.M. have defines ethics as “the logical study of moral language”13 But we know that ethics functions much more than this. This is why we agree with J.I. Omoregbe that the analysis and clarification of ethical concepts is a means to an end; the end being to guide human conduct. As he puts it:
We do not study ethics only with the aim of finding out what precisely we men when we use moral terms. The clarification of terms is of course useful, but to say that it is the whole purpose of ethics or philosophy is to mistakenly take the means to the end of ethics. Ethics is the systematic study of the norms of human behaviour and the purpose of studying these norms is to ensure that human behaviour conforms to them.14
It is obvious from he above that ethical studies have some bearing on practical purpose of guiding human conducts. Even Hare inadvertently acquiesced to this when he situates the function of moral principle as “to guide conduct”15 This conduces with the Socratic moral tradition where ethics should be studied in order to lead a good life. Thus, the practical relevance of theoretical ethical studies can never be over emphasized. Suffice it to say that:
Practice is based on theory and guided by theory. The raison d’etre of theory is to influenced and guide practice. This is particularly true of ethical theories. They generate certain moral convictions and outlook which in turn influence and guide people’s conduct along certain direction.16
It is obvious from the fore-going discussion that ethics does not only study human conducts but aims at good lives. It is note worthy to assert that there would have been no need for the study of ethics if there are no interpersonal relationship and ipso facto society. If this is so, it follows that ethics should be interested in the practice of euthanasia. It is on this ground that we intend to raise certain bio-ethical issues relating to euthanasia. In this regards, ethics would have a nexus with the code of conduct of doctors in exercising their duties. This is intenderm with R.H. Popkin’s and Aurum Stoll’s views that in one of its most frequent uses, it refers to a code or set of principles by which people live. This, we speak of “medical ethics” and mean by this phrase the code that regulates and guides the behaviour of doctors in their dealings with each other and with their patients”17 It therefore, follows that the ethicist is a coroner in all human conducts. In this regards our duty here is to carry a coroner’s inquest into how medical doctors, relations of the terminally ill and the terminally cojoin to do euthanasia. This inquest shall raise some normative issues, here in lives the justification for this work.
SOME CRITICAL BIO-ETHICAL ISSUES
The ground on which pro-euthanasia advocates hinge their argument is that it should be limited to those with terminal illness. But the definition of “terminally ill” is not properly delineated. For instance, majority of the people would define terminally ill as meaning that the patient will surely die within a few months without sustained medical treatment. But they are derided on what amounths to medical treatments. While some restrict it to life sustaining gadgets other include food, lipids and fluids. However, if food and fluids are considered “medical treatment”, then by this definition who is not terminally ill? Certainly, anybody would die within few days if the “medical treatment” of eating and drinking is taken away from him. If the definition of terminally ill is controvertible then euthanasia has problem of conception. It follows that the first issue with euthanasia rests on lack of agreement of what is terminally ill.
Another pertinent issue is raised when we look at the array of modern medical and surgical aids technologically available to medical doctors nowadays, we ask how long should a conscientious doctor battle imminent death with these equipments? Adeigbo would answer “that the need for prolonging a patients life must be weighed over the balance of expected good”18
According, if it is apparently obvious that the patent can hardly ever regain consciousness and rationality, then the exercise should be stopped. This is because man is essentially arational animal and when ever his rationality and consciousness are in doubt, he ceases from being human. However, a problem with this is to contrast the role of the doctor enshrined in the Hippocratic Oath with the withdrawal of medical services to a sick patient and ipso facto killing such a patient. In other words, it is unacceptable for one who took the oath of prolonging and sustaining lives at all cost and at all times to kill another. But, pro-euthanasia doctors would argue that even though doctors take the oath to prolong and sustain live, it is not mere “vegetative or biological life but “human life” that there are called upon to save. This raises the other issue of what distinguishes a human from a biological life?
What are the criteria of meaningful life? It is obvious that severe handicap can not count as a disqualification for meaningful life. This is because, world history is replete with severely handicapped persons who are not daunted by their positions and have made marks in he sand of time. So, many of them have lived enjoyable and happy lives. This brings us to another aspect of it: should living be devoid of pains? The definition of pain is a strong determination for our answering of this question. Though pain can hardly be conceptualized satisfactorily to everybody, yet its categorization includes physical psychological, spiritual etc. it follows therefore that there is hardly anybody on earth without one form of pain or the other. Pain becomes an integral part of our existence. However, some people grade pains, according to them certain levels of pain are compatible with living while others are incompatible with it.
This will be clearer when we consider people’s categorization of what a life of worth entails. Adeigbo delineates this:
People expect that for life to be worth livings in an ordinary sense, (i) A person may not be asked (and least of all, forced) to work beyond his capacity; (ii) he should enjoy the moral support of his family or community: (iii) he can more or less satisfy his basic needs (hunger at the top of the list); (iv) his life-prospect and hopes are not wantonly thwarted, and (v) he is not subjected to needlessly prolonged and excruciating pain. It seems to me that if the life of a terminal patient can be prolonged only on terms that also prolong his pain, then the pain is to that extent senseless and morally objectionable.19
However, pain has the established to be a psychological issue, if this is so, it follows that determining when a painful situation is out of hand is difficult to determine. This is more so when one persons “out of hand” painful state differs from another’s.
Another issue of concern revolves around the “moment of death”. It is controvertible to establish when it could be said that a person has died. This has be compounded with the recent technological break-throughs in the development of resuscitation procedures and techniques. This issue is relevant to us because if we determine the moment of death, we will be able to determine when we could be advised to cease treatment or prolongation of the lives of the terminally ills. Death was previously associated with the cessation of cardiac functions, but recently it has been observed that some of these cardiac functions are supplied by the heart of a deceased person. Moreso, the success in heart transplant has shown that a person’s heart could be removed without the person digging. Again the capacity for suspended animation which is determined by heart functions has established that the moment of death is not inextricably linked with cardiac functions. Another view is that the death moment is equitable with the complete cessation of the cerebral cortex. This is premised on the fact that it is the brain that gives man his earthly essence; when ever this function (especially, the cortical function) ceases, means live terminates. Adeigbo surmises that:
The claim that brain death in the sense of loss of those cortical centers which are responsible for consciousness and for typically human functions equals the moment of death has enjoyed considerable consensus among physicians. If one continues to preserve the patients life beyond this moment (and surely important organic functions of the heart, lungs, kidneys and liver can be kept on artificially) then one is preserving the patient’s life purely in its biological organization only.20
From the above it is obvious that though doctors certify patients death, yet it is controvertible the criteria for death. It goes without saying that since the decision of establishing when actually death occurs, is difficult, he cessation of conscious attempt to prolong life is morally wrong as there is always hope for survival.
Again, the challenge of brain death in recent years support our claim, while it is possible that a person may be incapable of some brain function (higher mental functioning) as talking, lower-brain functions as breathing can still continue. Anti-euthanasia advocates argue that on this ground death should be considered as the loss of consciousness or the ability to communicate. But this raises another issue; does lack of consciousness and inability to communicate mean death?
Consider the following: Mr. Okeke was a comatose patient for three months unable to communicate and consciousness. The doctors declared him a terminally ill patient. But surprisingly when all hopes were lost medically, his relatives brought a faith healer who kept praying and nursing the hope that God was capable of doing everything. At the fourth month, Mr. Okeke regained consciousness and was adjudged recuperated again by the same doctors. If he had been euthanized would it have ever amouthed to any moral burden? Any way several instances of case that doctors have declared incurable were reverted by mysterious circumstances. The issues becomes that since doctors are not the last hope in terms of life, when cases are incurable by doctors, hospices should be recommended.
Another very pertinent issues is what is doubled the “decision question”. Who decides when to euthanize? In medical situations, the roles of doctors are imperative especially as societal roles have put the patients unreservedly into the hands of his physician. But it is obvious that it is only to the extent of rights acceded to the doctor by the patient should the doctor possess. Thus, the role of the doctor in arriving at the decision to euthanize should be merely advisory and consultative. The constitution recognizes this role as it requires that consents form be signed by either the patient of his next of kin before any surgical session is undertaken on the patient. But this shows that the doctor is not the final decider in this matter; if not the doctor, who?
Some advocates have argued that patients have the right to take this decision. The tend to argue that patients have the right to take the decision of dying in order to obliterate the pains of hanging on to life. Jary Johansen captures a major problematic in letting a patient take this liberty of waiting to die:
It is extremely rare today for a doctor to try to force someone to receive medical care that he does not want. Pro-lifers readily agree that anyone should have the right to refuse medical treatment if he believes the side effects – whether pain or the burden of being tied to some machine or whatever – are worse than the disease, even if this means he will live a shorter, but presumably more enjoyable life. If someone refuses medical treatment because he literary decided that he would rather be dead, assuming that he is not being pressured by others and he is same and not making this decision rashly in a period of depression…. Well, this certainty stretches the limits of what we mean by personal liberty, may be that’s a difficult, debatable moral issues.21
The major issue is that when we reflect critically on the “capability” of the patient taking this decision, it points to despair. This is moreso when the majority of case of euthanasia are comatose patients. This means that they may be unfit to take rational decisions effecting the termination of their lives. Even in the cases of when they can take decisions, there is always the issue of pressure from the family, hence making the patient feel guilty of living. This points to the fact that in most of the cases the individual is not the best judge of his case.
But even the consideration of the relatives as those who have the right to take this decision is controvertible. This results from the often economic, social and psychological dimensions that is often attached to a patient’s condition by his family. For instance, some relatives might take the decision to euthanaze their relation due to the fact that their monetary circumstances of keeping or sustaining the patient has telling effects on the family. On this ground, they may tell the doctor to help them withdraw the life sustaining equipments in their care to enable the patient die. In other instances, the issue of greed towards inheriting the assert and liabilities of the terminally dead could lead to taking that decision. Instances abound where wealthy people’s. children attempt to kill them even when they are healthy in order to take over the culture of their wealth.
All we have tried to show is that it is difficult to see who can be reposed with the responsibility of taking the decision. Adeigbo suggests how this decision should be reached:
It seems, though, that at different levels of the decision –making process and with varying degrees of directless, the relatives of the patients and/or the attending physician may need to arrive at this decision together. It is in fact, safer to put that decision in the hands of more people by ascribing the decision-making responsibility to the relatives and medical Prof. Esionals who have cared for this patient. It may be that they agree that the continued used of life-support measures no longer has any beneficial significance for the patient and may in fact, be obstructive of the true meaning of death.22
Even a joint and broader decision making may not guarantee non collaboration amongst the parties involved for some selfish reasons. This is exemplified in some of the rash decision doctors take when for the fact that there are no more bed spaces they insist that terminal patients be killed with lethal injection to create bed spaces for new patients. In some countries people have looked at the issue of euthanasia for the aged as have the connotation of the duty to die.23 There could be bio-ethical issues to the raised but suffice it to say that the decision to “mercifully kill” anybody is not without moral squalors. In what follows we shall pass normative judgement as to the propriety or impropriety of euthanasia.
Conclusion
LIFE IS SACRED AND ONLY GOD CAN TAKE IT
We have examined the concept of euthanasia and established a nexus between it and ethics. We have raised bio-ethical concerns revolving around it. What is left is to pass normative judgment as to whether euthanasia should be practiced or not. What is the moral and legal justificability of euthanasia? There is to an extent a relationship between law and morality if we follow the natural law theory. This results from the fact that the promulgation of laws should derive from certain moral principles, hence any law that is bereft of elements of morality both in its conception and applicability is a pervasion of law.
But is euthanasia justifiable on any ground? Our reaction is an emphatic no. it is obvious that several cases where doctors have declared patients as “off roads” have been negated by acts of providence. This is collaborated by the fact that even the issue of the conception of the concept of “terminally ill” is still in contest. Consider the fact that diagnosis results are almost as varied as there are doctors or are dependent on the levels of technological hardwares available. The case of Gani Fawehimi who was diagnosed of acute pneumonia in Nigeria but was later diagnosed as a case of cancer of the lung is quite revealing. All we are trying to show is that due to inconsistence in diagnostic results, it is hardly reliable to establish terminality in illness.
Again, we have demonstrated that the moment of death is disputable amongst doctors. It follows that since doctors can not establish indubitably what constitutes death, it would amouth to mis-judgement for any doctor to decide to euthanize any patient. Though man has done much in terms of advancing his well being the cases of people who have outlined terminal situations points to the fact that there are more to life and death than doctors pressure.
We have observed earlier that pecuniary interests on the parts of those taking the decision to kill mercifully could lead to hasty conclusions. Thus is moreso where parties to the decision are not ethically sagacious. According to Adeigbo,
This limitation, then, implies (1) consultation ay the widest level possible, (2) the need to obtain as much relevant information on the case at hand as possible, and (3) a decision must follow from (1) and (2) above. Where (1) and (2) occur we have a case of informed conscience. The failure of (3) above, however, amounts almost to irresponsibility.24
What is noteworthy from the view of Adeigbo is that caution should be applied in cases of euthanasia to ensure informed decision. But Adeigbo submission that decisions taken from informed conscience should not be criminally liable amounths to man playing God. This is defeated by such cases as we have noted earlier where people have recovered earlier where people have recovered even after they were doubled terminal cases. Who knows whether those “killed mercifully” would have made it after wards?
Following from the view above is that since euthanasia is morally reprehensible, its legal empowerment should be jettisoned. This is informed by the view that any attempt to legalize euthanasia could affect adversely people’s attitudes towards the aged, the handicapped or the terminally ill. Cases where people could have applied care, sympathy, understanding and endurance would be met with rashness, intolerance impatience and harshness. The claim that there is dignity in death results from culpable ignorance on the facts of death. Death is nothing but a rile of passage to another life and anyway that man takes to this exit is dignifying. There is nothing like undignifying death for terminally ill patient.
We shall conclude by saying that the concern raised as to the telling economic effects on those catering for the sick points to the irresponsibility on the part of the government and co-operate organizations. Governments should rise to the challenges of their responsibility by caring for the sick until such a one finally transits. When hospitals fail, hospices will not fail. No man has the right over another’s life because such a one is helpless.
END NOTES
1. The Holy bible (RSV) Ecclesiastes 3:1-4
2. The Holy Qur’an, Surah 6:151
3. The Holy Qur’an, Surah 5:32
4. Acting for the pleasure of the supreme entails doing the will of God (Krishna) which includes the preservation of life at all costs.
5. A.C.B. Swami Prabhupada, Bhagavad-Gita As it is, (Los Angeles; The Bhaktivendaita Book Trust 1989) P. viii
6. Edmund Ilogu, Christianity and Igbo Culture, (Leider: Brill 1974) PP. 123-4
7. Lawrence .T. Lorimer et al (eds) The Webster’s Dictionary of the English Language, (New York: Lexicon International Publishers 1995) P. 327
8. F.A. Adeigbo, “Physicians and The Terminally Ill: Some Moral Questions Considered “in The Nigerian Journal of Philosophy, Journal of the Department of Philosophy University of Lagos Vol. 8 Nos 1 and (1988) P. 2
9. Joe Jenkins, Contemporary Moral Issues (Oxford: Heinemann 2002) P. 54
10. Jenkins P. 56
11. Jenkins P. 56
12. U.O. Uduma, The Fundamentals of Philosophy (Abakaliki: Willy Rose and Appleseed Publishing Coy 2000) P. 99
13. R.M. Hare, The Language of Morals (Oxford: Oxford University Press 1954) P. iii
14. J.I. Omoregbe, Ethics – A Systematic and Historical Study (Lagos: JOJA Press Reprt. Ed 2004) PP. 8-9
15. Hare P. i
16. Omoregbe P. 12
17. Richard .H. Popkin and Avrum Stroll, Philosophy Made Simple (New York: Made Simple and Double Day Books 1993) P. 1
18. Adeigbo P. 5
19. Adeigbo P. 5
20. Adeigbo P. 7
21. Jay Johansen, “Euthanasia: A case of Individual Liberty?” ANAN 14/Shared/Docs/Euthanasia A case of Individual Liberty.htm P. 1
22. Adeigbo P. 8
23. Richard Lamm A Former Governor of Colorado (USA) had argued that “the terminally ill elderly have a duty to die and get out of the way”, See “Elderly’s Duty to Die”, New York Times 29 March 1984.
24. Adeigbo P. 10