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Ethical Frameworks in End-of-Life Decisions

Delve into the complexities of euthanasia, exploring the distinctions between active and passive euthanasia, the debates on the sanctity versus quality of life, personal autonomy, and ethical approaches like Utilitarianism and Kantianism.

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Ethical Frameworks in End-of-Life Decisions

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  1. Euthanasia Decisions at the end of life

  2. What is Euthanasia? Euthanasia means “a good death,” or “dying well.” • What is a good death? • Peaceful • Painless • Lucid • With loved ones gathered around

  3. Some Initial Distinctions • Active vs. Passive Euthanasia • Voluntary, Non-voluntary, and Involuntary Euthanasia • Assisted vs. Unassisted Euthanasia

  4. Active vs. Passive Euthanasia • Active euthanasiaoccurs in those instances in which someone takes active means, such as a lethal injection, to bring about someone’s death; • Passive euthanasiaoccurs in those instances in which someone simply refuses to intervene in order to prevent someone’s death.

  5. Criticisms of the Active/Passive Distinction in Euthanasia • Vague dividing line between active and passive, depending on notion of “normal care” • Principle of double effect • Does passive euthanasia sometimes cause more suffering?

  6. Compassion for Suffering • The most important question when lives are ending is: how do we respond to suffering? • Hospice and palliative care • Aggressive pain-killing medications • Sitting with the dying • Euthanasia

  7. The Sanctity of Life • Life is a gift from God • Respect for life is paramount • Importance of personhood • The approach of Natural Law • Importance of ministering to the sick and dying • See life as “priceless” (Kant) • Respect for life once the dying process has begun

  8. The Quality of Life • Peter Singer – low quality of life justifies ending a life • BUT what is quality of life – is it more than can be judged medically? • Would extraordinary means improve the quality of life of a patient? • Refusal of medical treatment

  9. The Right to Die • Do we have a right to die? • Negative right (others may not interfere) • Positive right (others must help) • Do we own our own bodies and our lives? If we do own our own bodies, does that give us the right to do whatever we want with them? • Isn’t it cruel to let people suffer pointlessly?

  10. Two ethical approaches • A Utilitarian approach, which emphasises consequences • A Kantian approach, which emphasises autonomy, rights, and respect

  11. The Utilitarian approach • Goes back at least to Jeremy Bentham (1748 – 1832) and John Stuart Mill (1806-73) • The greatest good for the greatest number

  12. Main Tenets • Morality is a matter of consequences • We must count the consequences for everyone • Everyone’s suffering counts equally • We must always act in a way that produces the greatest overall good consequences and least overall bad consequences.

  13. The Calculus • Morality becomes a matter of mathematics, calculating and weighing consequences • Key insight: consequences matter • The dream: bring certainty to ethics

  14. What is a good death? • Jeremy BenthamHedonistic utilitarians: a good death is a painless death. • John Stuart Mill Eudaimonistic utilitarians: a good death is a happy death.

  15. Euthanasia and personal autonomy • John Stuart Mill – in matters which do not concern others, individuals should have full autonomy • Should a competent adult be allowed to decide the time and circumstances of their death?

  16. The Kantian Model • Central insight: people cannot be treated like mere things. • Key notions: • Autonomy & Dignity • Respect • Rights

  17. Autonomy & Respect • Kant felt that human beings were distinctive: they have the ability to reason and the ability to decide on the basis of that reasoning. • Autonomy = freedom + reason • Autonomy for Kant is the ability to impose reason freely on oneself.

  18. Protecting Autonomy • Advanced Directives are designed to protect the autonomy of patients • They derive directly from a Kantian view of what is morally important.

  19. Autonomy: Who Decides? • Kantians emphasize the importance of a patient’s right to decide • Utilitarians look only at consequences – but it can justify too much, as there is no protection for the minority or safeguarding of the individual’s rights

  20. Conclusion • Many of the ethical disagreements about end-of-life decisions can be seen as resulting from differing ethical frameworks, especially Kantian vs. Utilitarian. • or Quality of Life vs. Sanctity of Life

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