Ethical Considerations in Life and Death Situations: A Comparative Analysis

1. Quiz (morning group) Was Chase justified in causing Dibala to die? Answer with reference to at least 2 of the following 3 ethical systems: • Virtue ethics • Kantian ethics (deontological ethics) • Utilitarianism

2. Quiz – The Transplant Case (afternoon group) Could a doctor be morally right to kill a cancer patient who has only 6 months to live in order to give his heart to a heart patient. Without the new heart, the heart patient will die in 2 hours. With the new heart, he could live for 30 healthy years. No other heart is available. Answer with reference to one of these three ethical systems: • Virtue ethics • Kantian ethics (deontological ethics) • Utilitarianism What would someone who disagree with you say?

3. Paternalism vs. Individual Rights

4. Debates (morning group) February 21: Smoking should be banned in public places February 28: Apes should be granted basic human rights March 13: It is wrong to eat meat

5. Debates (afternoon group) February 21: Smoking should be banned in public places March 6: It is wrong to eat meat

6. Videos • Videos should be like a short documentary on a topic related to the course • 15-20 minutes for 3 people groups • 20-25 minutes for 4 people groups • Some video clips from other sources may be used, but the source must be clearly indicated. No more than 30% from other sources • You should give me your proposed topics today

7. Paternalism We know what’s best for you. The state should protect people from themselves. The state is modeled after the family Very popular historical understanding of the state’s relationship to its citizens Aristotle compared the family to the state, the head of household to the monarch, the wife, children and slaves to the subjects

8. Confucius Five relationships: 1) Ruler to Subject 2) Father to Son 3) Husband to Wife 4) Elder Brother to Younger Brother 5) Friend to Friend In every relationship except friend to friend, the relationship is hierarchical, with the former using his wisdom and power to govern, guide and protect the latter.

9. Individual Rights John Stuart Mill “On Liberty” 1859 Rejected paternalism in favor of freedom Proposed the harm principle: That principle is, that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others, to do so would be wise, or even right... The only part of the conduct of anyone, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.”

10. Justification of the Harm Principle • Utilitarianism (Mill) • Mill’s view: if the harm principle is followed, the greatest good for the greatest number will result • Problem: is that true? What if violating rights leads to an increase in the general welfare? E.g. putting an innocent person in jail to avoid violent riots, likely deaths • Lockean justification • People by nature are free and equal • Everyone has an inborn right to life and liberty

11. The Declaration of Independence “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness” • Self-evident: • Known to be true by immediate understanding or by definition and requiring no proof or explanation, e.g. “I think therefore I am” • Obviously true to all right-thinking people, esp. morally self-evident • Inalienable: • Cannot be denied, surrendered or taken away

12. Concrete issues regarding paternalism vs. individual rights • Suicide/euthanasia • Motorcycle helmets • Smoking in public places • Smoking privately • Illegal drugs, e.g. marijuana, cocaine, heroin • Refusing life-saving medical treatment on religious grounds for yourself/your children

13. Case studies of rights • 1) The right to free speech • 2) Euthanasia • 3) Heroin • 4) Cigarette smoking in public places (debate next week) • 5) Medical marijuana (debate?)

14. Freedom of speech • In the ideology of the United States, freedom of speech is one of the most important freedoms • Even in the U.S., though, there are restrictions on freedom of speech, e.g. • Slander • Shouting fire in a crowded theater • Calling for overturn of the government • Revealing state secrets • Inciting a riot • Perjury (lying under oath)

15. More restrictions to free speech Many countries have more extensive restrictions to free speech. E.g. Germany the following are illegal: • Insult • Malicious gossip • Hate speech • Holocaust denial • Rewarding and approving crimes • Insulting faiths and religious beliefs

16. Setting boundaries • What kind of limits to free speech are justifiable? • Is causing offensive considered causing harm (hence falling under the harm principle?) • What about offensive language, pornography, satirizing political and religious leaders • Some use of symbols are protected by freedom of speech laws and some aren’t, e.g. wearing a swastika, burning the flag, defacing a picture of the king

17. Promoting bad ideas • Ideas, like people, need defense • The public are the judge, not the state or a state-appointed authority • Seemingly wrong ideas should be defended as vigorously as possible, so the public can make an informed decision • Examples: communism is good, capitalism is good, women are inferior, smoking is not bad for your health, gun control is unnecessary • Defending ideas legitimately can involve promoting controversial views and philosophies, finding and promulgating evidence and putting facts into favorable contexts, but not lying.

18. Mill’s defense of the free promulgation of mistaken or morally repugnant ideas • An idea that seems wrong might be right. Only open debate can ensure that we eventually arrive at the truth. • Outlawing the expression of a wrong-headed idea doesn’t get rid of the idea, but just drives it underground. • Countering wrong-headed ideas requires the correct ideas to be clarified and sometimes improved “…there ought to exist the fullest liberty of professing and discussing, as a matter of ethical conviction, any doctrine, however immoral it may be considered…. If all mankind minus one were of one opinion, and only one person were of the contrary opinion, mankind would be no more justified in silencing that one person than he, if he had the power, would be justified in silencing mankind.” (Mill, On Liberty)

19. “I disapprove of what you say, but I will defend to the death your right to say it” (Evelyn Beatrice Hall, describing the beliefs of Voltaire) “Let a hundred flowers bloom, let a hundred schools of thought contend” 百花齐放，百家争鸣 (Mao Zedong)

20. Euthanasia • “Good death” • Voluntary: with patient’s consent/at patient’s request • Non-voluntary: patient is unable to request/consent • Involuntary: against the explicit desires of the patient

21. Necessary conditions for Voluntary Euthanasia “Advocates of voluntary euthanasia contend that if a person 1) is suffering from a terminal illness; 2) is unlikely to benefit from the discovery of a cure for that illness during what remains of her life expectancy; 3) is, as a direct result of the illness, either suffering intolerable pain, or only has available a life that is unacceptably burdensome (because the illness has to be treated in ways that lead to her being unacceptably dependent on others or on technological means of life support); 4) has an enduring, voluntary and competent wish to die (or has, prior to losing the competence to do so, expressed a wish to die in the event that conditions (a)-(c) are satisfied); and 5) is unable without assistance to commit suicide” Stanford Encyclopedia of Philosophy, Voluntary Euthanasia

22. Active vs. Passive • Active euthanasia • Assisted suicide • Lethal injection, provision of lethal substances, suicide machine • Passive euthanasia • Voluntary refusal of food and fluids • Voluntary refusal of life-saving treatment • Borderline • Toxic/lethal dosage of pain relieving drugs (e.g. opioids) • The doctrine of double effect

23. Not classic euthanasia • Refusal of medical treatment • Ceasing life support for brain dead/legal dead patient • Ceasing life support for patients in persistant vegetative state • “Do not resusitate” (DNR) orders via living will or family decision

24. Legality • Illegal in most countries • Legal or decriminalized in: • The Netherlands • Albania • Germany (passive) (as of June 25, 2010) • Belgium • Luxembourg • Switzerland • The U.S. states of Washington, Oregon and Montana Many other countries with unclear or contested laws, e.g. Canada, Japan

25. Washington Initiative 1000 Washington State 2008 Public referendum • 85% turnout • 58% for • 42% against

26. Some arguments for euthanasia • Right to privacy and autonomy • the harm principle • Equal access • Humanitarian: reduce pain, suffering, loss of dignity • Economics • utilitarianism

27. Some arguments against euthanasia • Effect on doctors and doctor-patient relationship • Original Hippocratic Oath includes “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan” • Hope of cure or “medical miracle” • Open to abuse • Possibility of patients being pressured by hospitals or families • Slippery slope: eroding our idea of the sanctity of all human life

28. Heroin Highly addictive High fatality rate of users 2004 U.K. Study Heroin: 744 deaths/40,000 users (1.9%) Cocaine: 147 deaths/800000 users (.018%) Tobacco: 114,000 deaths/12.5 million users (0.9%) Ecstasy: 33 deaths/800,000 users (0.004%)

29. Arguments for Legalization • Ideological argument Harm principle • People have the right to do whatever they want with their own lives and bodies as long as it doesn’t harm other people • Heroin only directly harms the user • So, people have the right to choose whether or not to take heroin

30. Arguments for Legalization (cont.) • Practical arguments: • Criminalization does more harm than good • Waste of resources • High rate of relapse among ex-prisoners • Forces users into criminal activites/criminal world • Makes it hard for people to seek treatment • HIV infection rate higher where heroin is illegal

31. Arguments against Legalization Arguments against ideological argument 1) Denying the harm principle: People need to be protected from themselves 2) Claiming the harm principle doesn’t apply here: a) Heroin does harm others, e.g. families, society But is this kind of harm covered by the harm principle? b) Harm principle is supposed to protect individual autonomy, but addictive substances erode autonomy

32. Arguments against Legalization (cont.) Argument against practical arguments Decriminalization would be even more harmful than criminalization (contentious)

33. Required reading • Stanford Encyclopedia of Philosophy, at: http://plato.stanford.edu/entry on Paternalism Suggested readings: • J.S. Mill, “On Liberty”, full text at: www.serendipity.li/jsmill/on_lib.html • Ronald Bayer, “Ethics of Health Promotion and Disease Prevention” at: www.asph.org/UserFiles/Module6.pdf