Euthanasia and Physician-Assisted Suicide

1. Euthanasia and Physician-Assisted Suicide

2. 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 can’t decide, who should make decisions on his/her behalf?

3. What is euthanasia? • Deliberate • Intentional • Taking of a life • Of a presumably hopeless person (injured or ill, without prospects for recovery)

4. Arguments for Euthanasia • Argument from Mercy • Argument from the Golden Rule • Contractarian Argument • Argument from Liberty

5. Argument from Mercy • Terminal patients sometimes suffer horrible pain • Euthanasia puts an end to such suffering • So, euthanasia is justified

6. 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 person’s interests to avoid this

7. 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

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

9. 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, don’t apply it to others

10. 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

11. 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

12. 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 children’s education, death

13. 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

14. 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

15. 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

16. Arguments against euthanasia • Argument from Nature • Argument from Self-interest • Argument from Practical Effects • Argument from Tradition • Argument from Agency

17. 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

18. Natural law theory (Aquinas) • Eternal law: law of nature governing universe • Natural law: governs what things should do or be • A thing’s nature determines its function, and thus its virtue (Aristotle) • So, eternal law determines natural law

19. 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

20. 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

21. 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

22. 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 physician’s role as healer”

23. Slippery slope • Hopelessly ill person allowed to take own life —> • Allowed to deputize others to take life —> • People act on behalf of others without such authorization —> • Euthanasia as social policy, without consent

24. 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

25. Dutch statistics (1990) • Voluntary euthanasia: 2,300 • Assisted suicide: 400 • Euthanasia without explicit request: 1,000 • Lethal overdoses without consent: 4,941

26. 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

27. 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

28. 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

29. 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