Euthanasia and Physician-Assisted Suicide

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Euthanasia and Physician-Assisted Suicide
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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?

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What is euthanasia?

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

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Arguments for Euthanasia

• Argument from Mercy
• Argument from the Golden Rule
• Contractarian Argument
• Argument from Liberty

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Argument from Mercy

• Terminal patients sometimes suffer horrible pain
• Euthanasia puts an end to such suffering
• So, euthanasia is justified

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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

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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

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Cases

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

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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

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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

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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

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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

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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

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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

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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

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Arguments against euthanasia

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

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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

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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

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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

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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

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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

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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

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Slippery slope

• Hopelessly ill person allowed to take own life gt
• Allowed to deputize others to take life gt
• People act on behalf of others without such
  authorization gt
• Euthanasia as social policy, without consent

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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

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Dutch statistics (1990)

• Voluntary euthanasia 2,300
• Assisted suicide 400
• Euthanasia without explicit request 1,000
• Lethal overdoses without consent 4,941

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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

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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

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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

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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