Euthanasia and Physician-Assisted Suicide

Many IssuesEuthanasia as an individual act vs. euthanasia as a public policyEuthanasia vs. physician-assisted suicideIs 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?DeliberateIntentionalTaking of a lifeOf a presumably hopeless person (injured or ill, without prospects for recovery)

Arguments for EuthanasiaArgument from MercyArgument from the Golden RuleContractarian ArgumentArgument from Liberty

Argument from MercyTerminal patients sometimes suffer horrible painEuthanasia puts an end to such sufferingSo, euthanasia is justified

Pain and dignityThe end of life often includes severe painIt 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 ArgumentIf an action promotes the best interests of everyone concerned, that act is morally acceptableIn some cases, euthanasia promotes the best interests of everyone concernedTherefore, euthanasia is sometimes acceptable

CasesJonathan SwiftJack, the cancer patientThe lorry driverJane Doe, Jane Roe, advanced cancerGeorge Kingsley, John Doe, AIDSJames Poe, emphysema

Golden ruleGolden 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 argumentWould 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 tormentWhich would you choose?You would want to have the first optionSo, you must allow it to others

Contractarian argumentThe right moral rules are those we would choose in an initial position of fairness, based on our own self-interestIt would be in our self-interest to allow ourselves the option of euthanasiaSo, the right moral rules allow euthanasia as an option

Argument from LibertyPeople should be free to make deeply personal choices for themselvesDeeply personal matters: momentous in impact on your life; pose controversial questions about the value and meaning of lifeReligious faith, political and moral values, marriage, procreation, direction of childrens education, death

Argument from LibertyPeople should be free to make deeply personal choices for themselvesHow and when to die is a deeply personal choiceSo, people should be free to decide how and when to dieSo, people should have the option of euthanasia or physician-assisted suicide

DangersAn agent exercises freedom only if he/she is free (uncoerced), competent, and informedWe can regulate to require that these conditions be met, having more than one physician verify thatPatient is free of pressure or coercionPatient is mentally competentPatient understands prognosis and treatment optionsIf desired, also that the patient is rational, and that his/her choice is stable

Balancing risksEven 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 euthanasiaArgument from NatureArgument from Self-interestArgument from Practical EffectsArgument from TraditionArgument from Agency

Argument from NatureEvery human being has a natural inclination to continue livingEuthanasia does violence to this natural goal of survivalSo, euthanasia is against natureSo, euthanasia is wrong

Natural law theory (Aquinas)Eternal law: law of nature governing universeNatural law: governs what things should do or beA 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 evilSpecifics: natural dispositions are guideKinds of natural law precepts:Self-preservationBiological welfareLaws of reasonEuthanasia violates the most basic natural disposition, to self-preservation

Argument from Self-interestMedical knowledge is incompleteMistaken diagnosis or prognosis is possibleSpontaneous remission occursExperimental technique may workDeath is finalChance of error is too great to allow euthanasia

Self-interestPossibility of euthanasia may weaken our will to fightWe 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 ArgumentCorrupting influence on medical profession: First, do no harmDoctors and nurses might not try hard enough to save patients, deciding they would be better off deadDecline in quality of medical careDecline in patient trustAMA: fundamentally incompatible with the physicians role as healer

Slippery slopeHopelessly 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 exampleNetherlands has legalized euthanasia; results have been studiedGuidelines frequently ignoredPeople 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: 2,300Assisted suicide: 400Euthanasia without explicit request: 1,000Lethal overdoses without consent: 4,941

Argument from TraditionIn almost every state, in almost every democracy, it is a crime to assist a suicideLong-standing expressions of commitment to protect and preserve human lifeFor 700 years, our tradition has criminalized suicide and assisted suicide

Life vs. quality of lifeState protects life, not quality of lifeDanger to vulnerable groups:PoorElderlyNeonatesDisabledMentally illMembership in stigmatized social groupThose without access to good medical care

Tradition and libertyWe recognize a liberty to deeply personal choices but tradition defines the class of protected choicesTradition is a good guide (Burke):It expresses generations of experience and reasoned judgmentIt balances competing considerations in a way tested by a vast pool of experience

Argument from AgencySeverely ill patients often fail to meet conditions of agencyThey may be unconscious; who should speak for them?Freedom: They may be pressured or coerced by family, friends, doctors, nurses, or painCompetence: They may be depressedIgnorance: They may have trouble understanding diagnosis and prognosisMany withdraw consent if pain and depression are treated