Euthanasia

1
Euthanasia Physician-Assisted Suicide

• Vaughn, Chapter 10
• Supplement, Health Care Ethics Garrett et al.

2
Defining Suicide

• Suicide df the intentional termination of ones
  own life
• Passive suicide df omitting what is necessary to
  preserve ones own life with the intention of
  ending it
• Active suicide df taking action to end ones own
  life with the intention of ending it

3
Defining Suicide

• To some degree, the question of what a suicide is
  depends on intention
• We are both snake bit with just one dose of
  anti-venom. You giving the dose to me does not
  constitute your suicide
• this action fails the qualification with the
  intention of ending it in the definition of both
  active and passive suicide
• Nonetheless, we have, historically, called
  Kamikazes suicide attackers
• does this action fail the qualification with the
  intention of ending it in the definition of both
  active and passive suicide?
• What difference between these cases accounts for
  the difference in usage?

4
Defining Suicide

• One difference could be that we deem suicide as
  wrong, and judging Kamikazes to be wrong, simply
  applied the term as added condemnation.
• A principled, alternative account would be that
• in the poisoning case, there is no option that
  avoids death
• in the Kamikaze case, the option of using
  standard warfare is simply judged intolerable
  (because it means losing the battle or war)
• In the Kamikaze case, such a value judgment
  presents us with what the book calls
  proportionate reasons.

5
Defining Suicide

• Examples of choices that entail death based on
  proportionate reasons
• Maintaining your profession of faith despite
  facing execution by arrows, hanging, lions, etc.
• Diving on a grenade to save buddies
• Removing your oxygen mask due to unbearable pain
• Which of the above are suicides?
• This last example differs from the first two how?

6
Defining Suicide

• When someone chooses to end their life by a
  proportionate reason, the question of whether
  that act constitutes suicide will be
• a real question
• mainly in active cases
• mainly in self-centered (selfish) cases (previous
  slide)
• also in cases where the reasoning looks bad
  (suffering doesnt appear that serious, person
  has other responsibilities, etc.)
• or, a mere verbal question. It will be
• an arbitrary decision about use of the word,
• not a judgment about whether suicide has occurred

7
Four Arguments Against Suicide

• Garrett, p169
• God owns your life
• creating something or working for it results in
  ownership
• Human life is precious
• intrinsically, or as the basis of all other
  goods, human life is too precious to terminate
• Suicide harms the community
• it eliminates a contributor to society
• Suicide harms others
• it interferes with carrying out duties to others
  around us

8
Replies to Argument 1

• The book says this argument, Argument 1, works
  only for those who accept the premises.
• The trouble with that is
• thats true of every argument
• the great majority (90) of people believe in
  God or a universal spirit
• nonetheless, it is best to find universally
  acknowledged premises
• Even if God owns your life, theists typically
  hold that
• dying for their faith is right (martyrs are not
  condemned traditionally)
• dying for others is right (e.g., No greater love
  lay down his life for a friend)
• however, neither of these are suicides by the
  books earlier definition since the intention is
  not to end life, but to not prefer ones own life
  to something more important

9
Replies to Argument 1

• (Not in Garrett) God cant own our lives because
  we own them
• were the ones who feed ourselves
• rest ourselves
• clothe ourselves
• educate ourselves
• its all work and working for something (labor)
  is the standard basis of ownership
• On the contrary God gives us life in the sense
  of existence and continued existence those form
  his basis for ownership

10
Replies to Argument 1

• Reply It is wrong to give people things that
• they didnt ask for, and (1 diamond)
• are hard for them to return (1 2 fish tank)
• and at the same time expect something in return
• That sort of giving implies
• no duty of gratitude,
• no duty to return whats given,
• no duty to treat what was given according to the
  wishes of the giver
• Therefore, even if God exists and provides us
  with existence or continued existence, we would
  have no duty to God to preserve our own life
  based on that alone

11
Replies to Argument 2

• Life does not always form the basis on which all
  other goods depend
• When life refers to a person terminally ill who
  experiences such severe and constant pain that
  none of lifes ordinary goods can be experienced,
  life does not appear too precious to terminate
• When life refers to a person in a persistent
  vegetative state, again, life does not appear too
  precious to terminate
• The intrinsic value of existence is not decisive
  against suicide
• even if existence is intrinsically good, that
  doesnt mean it is better than any other
  intrinsic goods
• If life is not necessarily better than other
  intrinsic goods, then perhaps it is not better
  than
• freedom from suffering, or
• the indignity of having ones body artificially
  sustained

12
Reply to Argument 3

• Suicide only may reduce contributors to society
• If everyone over 75 died society would likely
  have a net gain
• those over 75 are not terribly productive on
  average that group is very expensive to care for
  medically
• If freeloaders, bums, drug addicts, etc.,
  committed suicide, the net result would likely be
  positive
• costs of supporting addicts and freeloaders are
  high costs of rehabilitation are high

13
Reply to Argument 4

• While the obligation to dependents will often
  outweigh the right to end ones own life, that
  may not always be the case
• Terminally ill patients in unceasing pain perhaps
  have the right to terminate their own lives even
  if they have dependents
• dependents are 17 years old,
• able to be cared for by others better positioned,
  
• dependents are independent in temperament,
• etc.

14
Slippery Slope of Suicide?

• On pp170-171 the book considers an empirical and
  logical version of a slippery slope argument
  against permitting any form of suicide.
• Empirical argument allowing exceptions to the
  prohibition against suicide will lead to the
  widespread increase in the number of suicides
• Reply it probably wont suicides will never be
  popular
• Logical argument allowing exceptions makes us
  inconsistent in opposing suicide
• Reply consistency is no virtue when misapplying
  rules (fallacy of accident) this appears to be
  such a case

15
Ethics of Suicide Prevention

• By and large, suicide is legal in the US
• Assisting a suicide, however, is only presently
  legal in Oregon and Washington. (And now,
  Vermont)
• Read about the history of Suicide here, in The
  Straight Dope ... Cecil Adams syndicated column.
• Reasons society sometimes claims the right to
  prevent suicides
• Life is intrinsically valuable
• Most individuals contribute to society
• Some individuals contribute a lot
• Some individuals have duties to family which
  society will have to assume if suicide is allowed
• Some groups, such as physicians, may need
  protection from the effects of active suicide on
  their profession

16
Ethics of Suicide Prevention

• The book notes a libertarian argument, p173, that
  rejects all limitation on suicide (of the
  competent). The argument admits some suicides
  involve reneging on responsibilities (to family
  and others), but that society ought not attempt
  to sanction or punish for such offenses. Those
  moral wrongs cannot be properly punished.
• The book points out in response that laws can be
  crafted to prevent such suicides on the basis of
  protecting others from harm, laws that permit
  coercion in some form
• interventions?
• forced institutionalization?
• jail time until the urge to kill yourself passes?

17
Ethics of the Death of a Patient

• Pages 174-180 discuss a wide array of situations
  that involve the ethics of cooperating with a
  competent, terminal patients refusal of
  treatment
• The principles relied on are
• Omitting treatment (okay)
• Omitting care (never okay)
• Extending life v. Prolonging dying (p174-6)
  (Discontinuing Treatment)
• Reducing suffering
• Feeding and hydration can become painful p176-8
• Antibiotics can cure a condition but prolong dying

18
Ethics of the Death of a Patient

• Pages 179-80 discuss the ethics of cooperating
  with the refusal of treatment of non-terminal
  patients
• Patient cites a proportionate reason for choosing
  to terminate care (respirator, feeding tube,
  etc.)
• Health care providers have the right to disagree
  with patients judgment of a proportionate reason
• cannot force treatment on an unwilling patient
• must continue care in this situation? Book says
  no
• What, then, must a healthcare provider
  do?___________

19
Bibliography

• Health Care Ethics, 6th ed., Thomas M. Garrett,
  et al, Prentice Hall, 2013.