1 Voluntarily Assisted Suicide and Euthanasia Soazig Le Bihan - University of Montana

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Voluntarily Assisted Suicide Voluntarily Assisted Suicide

and Euthanasia and Euthanasia

Soazig Le Bihan - University of Montana

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IntroductionIntroduction

Why should we care?

- Our death

- Aging Society

Discussion

- When to stop?

- Definitions

- Doctors

- Decisions

What this class is about

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OutlineOutline

Introduction

Important Distinctions

The argument from autonomy and its critics

The utilitarian argument and its refinement

Slippery Slopes and the Pandora Box: Fears vs. Reality

Conclusion

A controversial distinction: Active vs. Passive Euthanasia

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OutlineOutline

Introduction

Important DistinctionsImportant Distinctions




Conclusion


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Important DistinctionsImportant Distinctions

Voluntary / Non-voluntary / Involuntary

Involuntary: against the patient’s will – nobody defends it!

Non-voluntary: the current desire of the patient is unknown because she is physically or mentally unable to express it

Voluntary: in agreement with the patient’s will

Assisted Suicide /Euthanasia

Assisted Suicide: the person kills herself with a medication prescribed by a doctor

Euthanasia: the doctor administrates herself the medication

We will focus on the morality of Voluntary Assisted Suicide (VAS) and Voluntary

Euthanasia.

We will focus on the morality of Voluntary Assisted Suicide (VAS) and Voluntary

Euthanasia.

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OutlineOutline

Introduction



The argument from autonomy and its criticsThe argument from autonomy and its critics



Conclusion

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The argument from autonomy The argument from autonomy

The argument from autonomy:

P1: Each individual’s autonomy ought to be respected

P2: Denying someone the right to assisted suicide amounts to disrespect her autonomy

CC: Nobody should be denied the right to assisted suicide

Is this a tenable argument? Is this a tenable argument?

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The argument from autonomy The argument from autonomy ProblemsProblems

The argument from autonomy is not the best argument!

The argument from autonomy is not the best argument!

Doerflinger:

The argument is self-contradictory because life is a necessary condition for the exercise of one’s autonomy.

“Suicide is not the ultimate exercise of freedom but its ultimate self-contradiction”

Voluntary vs Non Voluntary

The argument from autonomy only works for voluntary assisted suicide and euthanasia

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The Argument from AutonomyThe Argument from AutonomyConclusionConclusion

1. The argument from autonomy2. Problems: (a) Suicide in the name of autonomy is self-

contradictory(b) Could only work for voluntary cases

1. The argument from autonomy2. Problems: (a) Suicide in the name of autonomy is self-

contradictory(b) Could only work for voluntary cases

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OutlineOutline

Introduction



The utilitarian argument and its refinementThe utilitarian argument and its refinement


Conclusion


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The Utilitarian ArgumentThe Utilitarian Argument

The utilitarian argument:

P1: A given action is right if and only if it serves to increase the amount of happiness/ decrease the amount of misery

P2: Euthanasia for suffering patients with terminal illnesses decreases the amount of misery

CC: Euthanasia for suffering patients with terminal illnesses is right

Is this a tenable argument? Is this a tenable argument?

Advantage: the argument applies to Voluntary assisted suicide, voluntary and non-voluntary euthanasia.

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The Utilitarian ArgumentThe Utilitarian ArgumentProblemsProblems

General Problem for Utilitarianism:

Utility vs. Rights

The Problem applied to Euthanasia:

It seems that the utilitarian argument could be used to justify involuntary euthanasia – against the will

Which is of course unacceptable !

The Utilitarian Argument is not acceptable as it is.

The Utilitarian Argument is not acceptable as it is.

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The Utilitarian ArgumentThe Utilitarian ArgumentRefined by RachelsRefined by Rachels

The utilitarian argument:

P1: A given action is right if and only if it serves to increase the amount of happiness/ decrease the amount of misery

P2: Euthanasia for suffering patients with terminal illnesses decreases the amount of misery

CC: Euthanasia for suffering patients with terminal illnesses is right

The utilitarian argument as refined by Rachels is tenable!

The utilitarian argument as refined by Rachels is tenable!

and violates no one’s rights

and violates no one’s rights

Refined:

Refined:

and in many cases violates no one’s rights

and in many cases violates no one’s rights

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The Utilitarian ArgumentThe Utilitarian ArgumentConclusionConclusion

1. The argument from mercy: applies to VAS and euthanasia

2. Problem: Conflict with Rights3. Solution: Refined argument from mercy

1. The argument from mercy: applies to VAS and euthanasia

2. Problem: Conflict with Rights3. Solution: Refined argument from mercy

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OutlineOutline

Introduction







Conclusion

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Active vs. Passive EuthanasiaActive vs. Passive Euthanasia

The distinction: Killing vs. Letting die

Accepted in the US: AMA 1973

“The intentional termination of the life of one human being by another -mercy killing - is contrary to that for which the medical profession stands and is contrary to the policy of the American Medical Association.

The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family. The advice and judgment of the physician should be freely available to the patient and/or his immediate family.”

Does this make moral sense? Does this make moral sense?

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Active vs. Passive EuthanasiaActive vs. Passive EuthanasiaPb 1: Is the distinction morally relevant?Pb 1: Is the distinction morally relevant?

Moral Responsibility: Is “passive” euthanasia really passive?

- Rachels’ example: Jones and Smith and their cousin in the bathtub – Is Jones’ any less responsible than Smith is of his cousin’s death?

- Withhold food and fluids? grand ma, infant

- Withhold medication? diabetic

The Distinction is not morally relevant: passive and active euthanasia involve the same moral

responsibility

The Distinction is not morally relevant: passive and active euthanasia involve the same moral

responsibility

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Active vs. Passive Euthanasia Active vs. Passive Euthanasia Pb 2: Which is morally preferable?Pb 2: Which is morally preferable?Example from Rachels: infants with Down Syndrome

“I can understand why some people are opposed to all euthanasia and insist that such infants must be allowed to live. I think I can also understand why other people favor destroying these babies quickly and painlessly. But why should anyone favor letting “dehydration and infection wither a tiny being over hours and days”? The doctrine that says that a baby may be allowed to dehydrate and wither, but may not be given lethal injection that would end his life without suffering, seems so patently cruel as to require no further refutation.” (Rachels)

In some cases, active euthanasia seems morally preferable

In some cases, active euthanasia seems morally preferable

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Active vs. Passive Euthanasia Active vs. Passive Euthanasia Pb 3: ArbitrarinessPb 3: Arbitrariness

The problem: passive euthanasia:

(a) One agrees that it would be better that the unnecessary suffering ends

(b) But one waits until a separate health problem “allows” for a quicker death – a chancy event

Rachels’ argument:

- Either (a) is true, and then our moral action should not depend on irrelevant circumstances

- Or (a) is false, and then, not to treat the patient in (b) is wrong

Passive Euthanasia makes our action depend on arbitrary factors

Passive Euthanasia makes our action depend on arbitrary factors

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Active vs. Passive Euthanasia Active vs. Passive Euthanasia ConclusionConclusion

1. A distinction generally accepted by physicians2. Problems: (a) The distinction is not morally relevant – no

less responsible in the case of passive euthanasia

(b) Active euthanasia seems morally preferable in some cases

(c) Passive euthanasia makes our action depend on arbitrary factors

1. A distinction generally accepted by physicians2. Problems: (a) The distinction is not morally relevant – no

less responsible in the case of passive euthanasia

(b) Active euthanasia seems morally preferable in some cases

(c) Passive euthanasia makes our action depend on arbitrary factors

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OutlineOutline

Introduction





Slippery Slopes and the Pandora BoxSlippery Slopes and the Pandora Box

Conclusion

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Slippery Slopes Slippery Slopes Fears and RealityFears and Reality

Slippery Slopes: Beware!

Doerflinger’s slippery slopes:

Subtle coercion, economic incentives, substituted judgment, prejudice against people with disabilities etc.

The Facts: Oregon’s Death with Dignity Act

- Conditions to be eligible

- Conditions to receive the prescription

- Results?

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Number of qualifying people: ~ 80,000!

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OutlineOutline

Introduction






ConclusionConclusion

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ConclusionConclusion

Argument from autonomy: limited and arguably self-contradictory

Utilitarian Argument: refinement protecting rights

Passive vs Active Euthanasia: distinction not morally acceptable

Slippery Slopes: not supported by available evidence

Fundamental divide: absolute rules vs about serving everyone’s best interest

Argument from autonomy: limited and arguably self-contradictory

Utilitarian Argument: refinement protecting rights

Passive vs Active Euthanasia: distinction not morally acceptable

Slippery Slopes: not supported by available evidence

Fundamental divide: absolute rules vs about serving everyone’s best interest

Documents

1 Voluntarily Assisted Suicide and Euthanasia Soazig Le Bihan - University of Montana