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Euthanasia and

Physician-Assisted
Suicide

Many Issues

Euthanasia as an individual act vs.


euthanasia as a public policy
Euthanasia vs. physician-assisted suicide
Is the patient conscious?
Is the patient suffering?
Is the patient terminal?
If the patient cant decide, who should
make decisions on his/her behalf?

What is euthanasia?

Deliberate
Intentional
Taking of a life
Of a presumably hopeless person (injured
or ill, without prospects for recovery)

Arguments for Euthanasia

Argument from Mercy


Argument from the Golden Rule
Contractarian Argument
Argument from Liberty

Argument from Mercy

Terminal patients sometimes suffer


horrible pain
Euthanasia puts an end to such suffering
So, euthanasia is justified

Pain and dignity

The end of life often includes severe pain


It may also include a serious loss of
dignity sedation, helplessness, loss of
privacy, tubes, respirators, etc.
It can be in a persons interests to avoid
this

Utilitarian Mercy Argument

If an action promotes the best interests of


everyone concerned, that act is morally
acceptable
In some cases, euthanasia promotes the
best interests of everyone concerned
Therefore, euthanasia is sometimes
acceptable

Cases

Jonathan Swift
Jack, the cancer patient
The lorry driver
Jane Doe, Jane Roe, advanced cancer
George Kingsley, John Doe, AIDS
James Poe, emphysema

Golden rule

Golden rule: Do unto others as you


would have them do unto you.
Categorical imperative: Act only on that
maxim you can will to be universal law.
So: If you are not willing to have a rule
applied to you, dont apply it to others

Golden rule argument

Would we be willing to have a rule


prohibiting euthanasia applied to us?
Imagine a choice: live to 80, and die
quietly and painlessly, or live to 80 + a few
days of terrible torment
Which would you choose?
You would want to have the first option
So, you must allow it to others

Contractarian argument

The right moral rules are those we would


choose in an initial position of fairness,
based on our own self-interest
It would be in our self-interest to allow
ourselves the option of euthanasia
So, the right moral rules allow euthanasia
as an option

Argument from Liberty

People should be free to make deeply


personal choices for themselves
Deeply personal matters: momentous in
impact on your life; pose controversial
questions about the value and meaning of
life
Religious faith, political and moral values,
marriage, procreation, direction of
childrens education, death

Argument from Liberty

People should be free to make deeply


personal choices for themselves
How and when to die is a deeply personal
choice
So, people should be free to decide how
and when to die
So, people should have the option of
euthanasia or physician-assisted suicide

Dangers

An agent exercises freedom only if he/she is


free (uncoerced), competent, and informed
We can regulate to require that these conditions
be met, having more than one physician verify
that

Patient is free of pressure or coercion


Patient is mentally competent
Patient understands prognosis and treatment options
If desired, also that the patient is rational, and that
his/her choice is stable

Balancing risks

Even if these protections are imperfect


so that, sometimes, a patient who is
coerced, or incompetent, or uninformed is
euthanized the alternative of having
thousands forced to suffer pain and a loss
of dignity against their will is greater

Arguments against euthanasia

Argument from Nature


Argument from Self-interest
Argument from Practical Effects
Argument from Tradition
Argument from Agency

Argument from Nature

Every human being has a natural


inclination to continue living
Euthanasia does violence to this natural
goal of survival
So, euthanasia is against nature
So, euthanasia is wrong

Natural law theory (Aquinas)

Eternal law: law of nature governing


universe
Natural law: governs what things should
do or be
A things nature determines its function,
and thus its virtue (Aristotle)
So, eternal law determines natural law

What is natural law?

General form: pursue good, avoid evil


Specifics: natural dispositions are guide
Kinds of natural law precepts:
Self-preservation
Biological welfare
Laws of reason

Euthanasia violates the most basic natural


disposition, to self-preservation

Argument from Self-interest

Medical knowledge is incomplete


Mistaken diagnosis or prognosis is
possible
Spontaneous remission occurs
Experimental technique may work
Death is final
Chance of error is too great to allow
euthanasia

Self-interest

Possibility of euthanasia may weaken our


will to fight
We may feel pressure, thinking of welfare
of family, friends, etc.
So, possibility of euthanasia might lead to
death of those otherwise capable of
survival

Practical Effects Argument

Corrupting influence on medical


profession: First, do no harm
Doctors and nurses might not try hard
enough to save patients, deciding they
would be better off dead
Decline in quality of medical care
Decline in patient trust
AMA: fundamentally incompatible with
the physicians role as healer

Slippery slope

Hopelessly ill person allowed to take own


life >
Allowed to deputize others to take life >
People act on behalf of others without
such authorization >
Euthanasia as social policy, without
consent

Dutch example

Netherlands has legalized euthanasia;


results have been studied
Guidelines frequently ignored
People have been euthanized without
consent, without being terminally ill,
showing signs of depression, etc.
Cases: accident victim, woman with bouts
of pneumonia

Dutch statistics (1990)

Voluntary euthanasia: 2,300


Assisted suicide: 400
Euthanasia without explicit request: 1,000
Lethal overdoses without consent: 4,941

Argument from Tradition

In almost every state, in almost every


democracy, it is a crime to assist a suicide
Long-standing expressions of commitment
to protect and preserve human life
For 700 years, our tradition has
criminalized suicide and assisted suicide

Life vs. quality of life

State protects life, not quality of life


Danger to vulnerable groups:

Poor
Elderly
Neonates
Disabled
Mentally ill
Membership in stigmatized social group
Those without access to good medical care

Tradition and liberty

We recognize a liberty to deeply


personal choices but tradition defines
the class of protected choices
Tradition is a good guide (Burke):

It expresses generations of experience and


reasoned judgment
It balances competing considerations in a way
tested by a vast pool of experience

Argument from Agency

Severely ill patients often fail to meet conditions of


agency
They may be unconscious; who should speak for
them?

Freedom: They may be pressured or coerced by family,


friends, doctors, nurses, or pain
Competence: They may be depressed
Ignorance: They may have trouble understanding diagnosis
and prognosis

Many withdraw consent if pain and depression are


treated