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Physician-Assisted Suicide and Euthanasia I

Physician-Assisted Suicide and Euthanasia I. Definitions: PAS. Patient commits suicide Reason is due to incurable medical problem Physician provides patient with the means to commit suicide Physician knows and intends that patient will use means for that purpose

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Physician-Assisted Suicide and Euthanasia I

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  1. Physician-Assisted Suicide and Euthanasia I

  2. Definitions: PAS • Patient commits suicide • Reason is due to incurable medical problem • Physician provides patient with the means to commit suicide • Physician knows and intends that patient will use means for that purpose • Physician does nothing directly to cause death

  3. PAS Spectrum • Physician provides patient with the knowledge of how to commit suicide, gives no medication, etc. • Physician writes prescription for necessary drug • Physician is present, hooks up necessary apparatus, patient “pushes button”

  4. Voluntary Active Euthanasia (VAE) • Physician directly administers lethal drug to patient • Patient dies as a result • Purpose is “merciful” (patient suffers from incurable medical condition) • Patient is fully competent • Patient has requested euthanasia

  5. Euthanasia (“good death”)

  6. Legal status • VAE • Illegal in US, most countries • Legally permitted in The Netherlands • PAS • Illegal in Michigan, most states • Legal in Oregon only • Proposal on ballot in Maine • Legally permitted in Netherlands, Germany

  7. Ethical Positions on PAS/VAE • Pro • Respect individual autonomy • Duty to relieve suffering • Con • Wrongness of health professional causing death • Negative social consequences of policy (“slippery slope”)

  8. Ethical positions: Pro • “Civil Rights”-- Basic right of autonomous adult to choose “time and manner of one’s own death” • “Physician discretion”-- Usually wrong to hasten death; in extreme cases physicians may make exception if voluntary choice and irremediable suffering

  9. Ethical positions: Con • In principle opposition • Suicide or killing is always wrong • Always wrong for health professional to kill or aid death • “Slippery slope”-- Maybe individual cases in which justified; but too many risks as general public policy

  10. Drawing the Line • AMA, US Courts: OK to forgo treatment; PAS, VAE are wrong • Oregon: PAS is permissible within strict safeguards; VAE is wrong • Netherlands: PAS, VAE are OK, nonvoluntary or involuntary active euthanasia is wrong

  11. Borderline Cases • Janet Adkins cannot reach the button; asks Dr. Kevorkian’s assistance • Terminal sedation • Patient put in deep coma with no food, respiration • Promised not to awaken from coma • Stopping eating and drinking • Patient intends to die • Physician assists

  12. M. Benjamin’s Bus Route Treat all aggressively Eliminate social undesirables Forgo- patient values Nonvoluntary, great suffering Forgo- terminal VAE PAS

  13. Bus Route Analogy • The quicker you get off the bus, the more friends you leave behind • The longer you stay on the bus, the more undesirable the neighborhood • Same reasons to keep riding to this stop also argue for staying on the bus just one more stop-- and so on • (Almost) no one wants to go to end of line

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