Euthanasia and Euthanasia and Physician-Physician-

Assisted SuicideAssisted Suicide

Many IssuesMany Issues

Euthanasia as an individual act vs. Euthanasia as an individual act vs. euthanasia as a public policyeuthanasia as a public policy

Euthanasia vs. physician-assisted Euthanasia vs. physician-assisted suicidesuicide

Is the patient conscious?Is the patient conscious? Is the patient suffering?Is the patient suffering? Is the patient terminal?Is the patient terminal? If the patient can’t decide, who should If the patient can’t decide, who should

make decisions on his/her behalf?make decisions on his/her behalf?

What is euthanasia?What is euthanasia?

DeliberateDeliberate IntentionalIntentional Taking of a lifeTaking of a life Of a presumably hopeless person Of a presumably hopeless person

(injured or ill, without prospects for (injured or ill, without prospects for recovery)recovery)

Arguments for Arguments for EuthanasiaEuthanasia

Argument from MercyArgument from Mercy Argument from the Golden RuleArgument from the Golden Rule Contractarian ArgumentContractarian Argument Argument from LibertyArgument from Liberty

Argument from MercyArgument from Mercy

Terminal patients sometimes suffer Terminal patients sometimes suffer horrible painhorrible pain

Euthanasia puts an end to such Euthanasia puts an end to such sufferingsuffering

So, euthanasia is justifiedSo, euthanasia is justified

Pain and dignityPain and dignity

The end of life often includes severe The end of life often includes severe painpain

It may also include a serious loss of It may also include a serious loss of dignity— sedation, helplessness, loss dignity— sedation, helplessness, loss of privacy, tubes, respirators, etc.of privacy, tubes, respirators, etc.

It can be in a person’s interests to It can be in a person’s interests to avoid thisavoid this

Utilitarian Mercy Utilitarian Mercy ArgumentArgument

If an action promotes the best If an action promotes the best interests of everyone concerned, interests of everyone concerned, that act is morally acceptablethat act is morally acceptable

In some cases, euthanasia promotes In some cases, euthanasia promotes the best interests of everyone the best interests of everyone concernedconcerned

Therefore, euthanasia is sometimes Therefore, euthanasia is sometimes acceptableacceptable

CasesCases

Jonathan SwiftJonathan Swift Jack, the cancer patientJack, the cancer patient The lorry driverThe lorry driver Jane Doe, Jane Roe, advanced cancerJane Doe, Jane Roe, advanced cancer George Kingsley, John Doe, AIDSGeorge Kingsley, John Doe, AIDS James Poe, emphysemaJames Poe, emphysema

Golden ruleGolden rule

Golden rule: “Do unto others as you Golden rule: “Do unto others as you would have them do unto you.”would have them do unto you.”

Categorical imperative: “Act only on Categorical imperative: “Act only on that maxim you can will to be that maxim you can will to be universal law.”universal law.”

So: If you are not willing to have a So: If you are not willing to have a rule applied to you, don’t apply it to rule applied to you, don’t apply it to othersothers

Golden rule argumentGolden rule argument

Would we be willing to have a rule Would we be willing to have a rule prohibiting euthanasia applied to us?prohibiting euthanasia applied to us?

Imagine a choice: live to 80, and die Imagine a choice: live to 80, and die quietly and painlessly, or live to 80 + a quietly and painlessly, or live to 80 + a few days of terrible tormentfew days of terrible torment

Which would you choose?Which would you choose? You would want to have the first You would want to have the first

optionoption So, you must allow it to othersSo, you must allow it to others

Contractarian argumentContractarian argument

The right moral rules are those we The right moral rules are those we would choose in an initial position of would choose in an initial position of fairness, based on our own self-fairness, based on our own self-interestinterest

It would be in our self-interest to It would be in our self-interest to allow ourselves the option of allow ourselves the option of euthanasiaeuthanasia

So, the right moral rules allow So, the right moral rules allow euthanasia as an optioneuthanasia as an option

Argument from LibertyArgument from Liberty

People should be free to make “deeply People should be free to make “deeply personal” choices for themselvespersonal” choices for themselves

Deeply personal matters: momentous in Deeply personal matters: momentous in impact on your life; pose controversial impact on your life; pose controversial questions about the value and meaning questions about the value and meaning of lifeof life

Religious faith, political and moral Religious faith, political and moral values, marriage, procreation, direction values, marriage, procreation, direction of children’s education, deathof children’s education, death

Argument from LibertyArgument from Liberty

People should be free to make “deeply People should be free to make “deeply personal” choices for themselvespersonal” choices for themselves

How and when to die is a deeply How and when to die is a deeply personal choicepersonal choice

So, people should be free to decide how So, people should be free to decide how and when to dieand when to die

So, people should have the option of So, people should have the option of euthanasia or physician-assisted suicideeuthanasia or physician-assisted suicide

DangersDangers

An agent exercises freedom only if he/she is An agent exercises freedom only if he/she is free (uncoerced), competent, and informedfree (uncoerced), competent, and informed

We can regulate to require that these We can regulate to require that these conditions be met, having more than one conditions be met, having more than one physician verify thatphysician verify that Patient is free of pressure or coercionPatient is free of pressure or coercion Patient is mentally competentPatient is mentally competent Patient understands prognosis and treatment Patient understands prognosis and treatment

optionsoptions If desired, also that the patient is rational, and If desired, also that the patient is rational, and

that his/her choice is stablethat his/her choice is stable

Balancing risksBalancing risks

Even if these protections are Even if these protections are imperfect— so that, sometimes, a imperfect— so that, sometimes, a patient who is coerced, or patient who is coerced, or incompetent, or uninformed is incompetent, or uninformed is euthanized— the alternative of euthanized— the alternative of having thousands forced to suffer having thousands forced to suffer pain and a loss of dignity against pain and a loss of dignity against their will is greatertheir will is greater

Arguments against Arguments against euthanasiaeuthanasia

Argument from NatureArgument from Nature Argument from Self-interestArgument from Self-interest Argument from Practical EffectsArgument from Practical Effects Argument from TraditionArgument from Tradition Argument from AgencyArgument from Agency

Argument from NatureArgument from Nature

Every human being has a natural Every human being has a natural inclination to continue livinginclination to continue living

Euthanasia does violence to this Euthanasia does violence to this natural goal of survivalnatural goal of survival

So, euthanasia is against natureSo, euthanasia is against nature So, euthanasia is wrongSo, euthanasia is wrong

Natural law theory Natural law theory (Aquinas)(Aquinas)

Eternal law: law of nature governing Eternal law: law of nature governing universeuniverse

Natural law: governs what things Natural law: governs what things should do or beshould do or be

A thing’s nature determines its A thing’s nature determines its function, and thus its virtue (Aristotle)function, and thus its virtue (Aristotle)

So, eternal law determines natural So, eternal law determines natural lawlaw

What is natural law?What is natural law?

General form: pursue good, avoid evilGeneral form: pursue good, avoid evil Specifics: natural dispositions are Specifics: natural dispositions are

guideguide Kinds of natural law precepts:Kinds of natural law precepts:

Self-preservationSelf-preservation Biological welfareBiological welfare Laws of reasonLaws of reason

Euthanasia violates the most basic Euthanasia violates the most basic natural disposition, to self-preservationnatural disposition, to self-preservation

Argument from Self-Argument from Self-interestinterest

Medical knowledge is incompleteMedical knowledge is incomplete Mistaken diagnosis or prognosis is Mistaken diagnosis or prognosis is

possiblepossible Spontaneous remission occursSpontaneous remission occurs Experimental technique may workExperimental technique may work Death is finalDeath is final Chance of error is too great to allow Chance of error is too great to allow

euthanasiaeuthanasia

Self-interestSelf-interest

Possibility of euthanasia may Possibility of euthanasia may weaken our will to fightweaken our will to fight

We may feel pressure, thinking of We may feel pressure, thinking of welfare of family, friends, etc.welfare of family, friends, etc.

So, possibility of euthanasia might So, possibility of euthanasia might lead to death of those otherwise lead to death of those otherwise capable of survivalcapable of survival

Practical Effects Practical Effects ArgumentArgument

Corrupting influence on medical Corrupting influence on medical profession: “First, do no harm”profession: “First, do no harm”

Doctors and nurses might not try hard Doctors and nurses might not try hard enough to save patients, deciding enough to save patients, deciding they would be better off deadthey would be better off dead

Decline in quality of medical careDecline in quality of medical care Decline in patient trustDecline in patient trust AMA: “fundamentally incompatible AMA: “fundamentally incompatible

with the physician’s role as healer”with the physician’s role as healer”

Slippery slopeSlippery slope

Hopelessly ill person allowed to take Hopelessly ill person allowed to take own life —>own life —>

Allowed to deputize others to take Allowed to deputize others to take life —>life —>

People act on behalf of others People act on behalf of others without such authorization —>without such authorization —>

Euthanasia as social policy, without Euthanasia as social policy, without consentconsent

Dutch exampleDutch example

Netherlands has legalized Netherlands has legalized euthanasia; results have been studiedeuthanasia; results have been studied

Guidelines frequently ignoredGuidelines frequently ignored People have been euthanized without People have been euthanized without

consent, without being terminally ill, consent, without being terminally ill, showing signs of depression, etc.showing signs of depression, etc.

Cases: accident victim, woman with Cases: accident victim, woman with bouts of pneumoniabouts of pneumonia

Dutch statistics (1990)Dutch statistics (1990)

Voluntary euthanasia: 2,300Voluntary euthanasia: 2,300 Assisted suicide: 400Assisted suicide: 400 Euthanasia without explicit request: Euthanasia without explicit request:

1,0001,000 Lethal overdoses without consent: Lethal overdoses without consent:

4,9414,941

Argument from TraditionArgument from Tradition

In almost every state, in almost In almost every state, in almost every democracy, it is a crime to every democracy, it is a crime to assist a suicideassist a suicide

Long-standing expressions of Long-standing expressions of commitment to protect and preserve commitment to protect and preserve human lifehuman life

For 700 years, our tradition has For 700 years, our tradition has criminalized suicide and assisted criminalized suicide and assisted suicidesuicide

Life vs. quality of lifeLife vs. quality of life

State protects life, not quality of lifeState protects life, not quality of life Danger to vulnerable groups:Danger to vulnerable groups:

PoorPoor ElderlyElderly NeonatesNeonates DisabledDisabled Mentally illMentally ill Membership in stigmatized social groupMembership in stigmatized social group Those without access to good medical Those without access to good medical

carecare

Tradition and libertyTradition and liberty

We recognize a liberty to “deeply We recognize a liberty to “deeply personal” choices— but tradition personal” choices— but tradition defines the class of protected choicesdefines the class of protected choices

Tradition is a good guide (Burke):Tradition is a good guide (Burke): It expresses generations of experience It expresses generations of experience

and reasoned judgmentand reasoned judgment It balances competing considerations in a It balances competing considerations in a

way tested by a vast pool of experienceway tested by a vast pool of experience

Argument from AgencyArgument from Agency Severely ill patients often fail to meet Severely ill patients often fail to meet

conditions of agencyconditions of agency They may be unconscious; who should speak They may be unconscious; who should speak

for them?for them? Freedom: They may be pressured or coerced by Freedom: They may be pressured or coerced by

family, friends, doctors, nurses, or painfamily, friends, doctors, nurses, or pain Competence: They may be depressedCompetence: They may be depressed Ignorance: They may have trouble understanding Ignorance: They may have trouble understanding

diagnosis and prognosisdiagnosis and prognosis Many withdraw consent if pain and depression Many withdraw consent if pain and depression

are treatedare treated