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Medical Ethics

Medical Ethics. Fall 2011 Philosophy 2440 Prof. Robert N. Johnson Thursday, November 13, 2014. Utilitarianism and Voluntary Euthanasia. Hentoff: Physicians are bad at palliative care. The only meaningful difference between terminal sedation and euthanasia is that the former takes longer.

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Medical Ethics

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  1. Medical Ethics Fall 2011 Philosophy 2440 Prof. Robert N. Johnson Thursday, November 13, 2014

  2. Utilitarianism and Voluntary Euthanasia • Hentoff: Physicians are bad at palliative care. • The only meaningful difference between terminal sedation and euthanasia is that the former takes longer.

  3. Utilitarianism and Voluntary Euthanasia • Some who want euthanasia are not in pain: Nausea, breathlessness, tiredness, lack of dignity.

  4. Utilitarianism and Voluntary Euthanasia • If patients can rationally opt for refusing life support or pain medication that will shorten life, they are rational enough to choose voluntary euthanasia.

  5. Utilitarianism and Voluntary Euthanasia • Slippery Slope Argument: If minor harm A occurs, then a series of events will occur culminating in major harm Z.

  6. Utilitarianism and Voluntary Euthanasia • “Legalizing VE will lead to involuntary euthanasia.”

  7. Utilitarianism and Voluntary Euthanasia • Evidence? No reports of such in Oregon since 1997.

  8. Utilitarianism and Voluntary Euthanasia • Evidence? • In Holland there was a slight rise initially in involuntary euthanasia. • Did legalization lead to this?

  9. Utilitarianism and Voluntary Euthanasia • Evidence? • A similar study of a later period showed no rise, however.

  10. Utilitarianism and Voluntary Euthanasia • Evidence? • Also, involuntary euthanasia has gone down in Australia and Belgium, suggesting the effect is quite the opposite.

  11. When is a person dead? • Permanent cessation of heart and lungs? • Permanent cessation of all brain functions? • Permanent cessation of higher brain function? • Cessation of personhood? Universal Determination of Death Act: 1 or 2. 99% of declarations are on the basis of 1. PVS is 3.

  12. When is a person dead? Determining death: Reversible coma (Fugu, curare)? Brain stem tests: CO2 reflect, gag reflex, pupil contraction, ‘doll eyes’. MRI, EEG, CT scans

  13. When is a person dead? PVS • Undamaged brain stem. • Cannot think or act intentionally. • Can breath, blink, have sleep cycles, their muscles respond. • Quinlan, Schaivo cases • Require total care: $ 100,000 a year • About 50 thousand cases in the US.

  14. When is a person dead? PVS is unlikely to change the medical definition of death to loss of higher brain function. Dementia is unlikely to change the definition to ‘loss of personhood’. So ‘legal’ death is cessation of cardiopulmonary or total brain function. But this is ethics. Is the law always moral?

  15. Assisted Suicide • Is suicide ever morally permissible? Under what conditions? • Is assisted suicide ever morally permissible? Under what conditions? • Is physician assisted suicide (PAS) ever morally permissible? Under what conditions? • Should PAS be made legal?

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