Summaries 8,9,10

Chapter 10

Euthanasia and Physician-Assisted Suicide

Background –1

• Euthanasia: directly or indirectly bringing about the death of another person for that person’s sake
• Voluntary euthanasia:euthanasia performed on a person with his or her permission
• Advance directive:a legal document allowing physicians to withhold or withdraw treatments if a patient becomes terminally ill and unable to express his or her wishes

Background –2

• Nonvoluntary euthanasia:euthanasia performed on a person who is not competent to decide the issue and has left no instructions regarding end-of-life preferences. In such cases, family or physicians usually make the decision.
• Involuntary euthanasia:euthanasia performed on a person against his or her wishes

Background –3

• Active euthanasia:euthanasia performed by taking a direct action to cause someone’s death; “mercy killing”
• Passive euthanasia:euthanasia performed by withholding or withdrawing measures necessary for sustaining life
• Physician-assisted suicide:the killing of a person by that person’s own hand with the help of a physician

Background –4

Important cases:

• Karen Ann Quinlan (1976)
• Nancy Cruzan (1990)
• Terri Schiavo(2005)

The Concept of Death

• Traditional notion of death: An individual is dead when there is no respiration and no heartbeat.
• Whole-brain death: An individual is dead when all brain functions (including those performed in the brain stem) permanently stop.
• Higher brain death: An individual is dead when higher brain functions that give rise to consciousness permanently stop.

Moral Theories –1

Act-utilitarianism: two approaches

1. Considering the suffering of the patient and others and the likely success of any treatments, try to determine how much overall happiness would result from different actions.
2. Assume euthanasia is contrary to the goal of maximizing happiness because killing a person rules out any possibility of experiencing happiness in the future.

Moral Theories –2

A rule-utilitarian view:

Regardless of the moral permissibility of euthanasia in specific cases, a social policy or law permitting some types of euthanasia would cause more harm than good. Of course, a rule-utilitarian could devise a rule that would allow euthanasia that could result in a maximization of happiness for everyone.

Moral Theories –3

Kantian theory

• For patients who are persons—competent, coherent, and rational: Euthanasia is never permissible because it would entail treating persons as mere disposable things.
• For patients in a vegetative state:
  • If these patients are considered persons, performing euthanasia on them would be immoral.
  • If these patients are not considered persons, euthanasia would be morally acceptable.

Moral Theories –4

Natural law theory

• Euthanasia is wrong in almost every instance because we have a moral duty to preserve life.
• Doctrine of double effect:
  • Giving a suffering patient a large dose of morphine to end her life(terminal sedation)is never morally acceptable.
  • Butgiving her a large dose of morphine with the intentionof easing her pain—an act that has the side effect of expediting her death—is permissible.

Moral Arguments –1

The central question:

Is active voluntary euthanasia morally permissible?

Moral Arguments –2

The strongest arguments for active voluntary euthanasia are based on two principles:

1. a right of self-determination (autonomy)
2. an obligation to help someone in serious distress or peril (beneficence)

Moral Arguments –3

An argument for active voluntary euthanasia:

1. Competent persons have a right of self-determination (as long as exercising this right does not violate others’ rights).
2. The right of self-determination includes the right of competent persons to decide the manner of their dying and to choose active (voluntary) euthanasia.
3. We have an obligation to help others in serious distress or peril (if we are in a position to help without great risk to ourselves).
4. This duty of beneficence includes the duty, under appropriate conditions, to ease the pain and suffering of competent dying persons by performing active (voluntary) euthanasia.
5. Therefore, active voluntary euthanasia for competent dying persons is permissible.

Moral Arguments –4

Critiques of active voluntary euthanasia:

• The right of self-determination does notinclude the right to opt for active voluntaryeuthanasia.
• Active euthanasia is a type of unwarranted killing.
• Modern medicine can relieve the pain of dying patients, so euthanasia is unnecessary.
• Active euthanasia will actually harm patients by cutting their lives short unnecessarily and thus depriving them of the benefits that may accrue in their remaining days.

Moral Arguments –5

Responses to critiques of active voluntary euthanasia:

• The optimistic view of pain management is unrealistic: pain is often poorly managed; side effects add to the suffering; medication often cannot relieve psychological pain.
• Not all killing is wrong; only unwarranted killing is wrong.

Moral Arguments –6

Another argument for active voluntary euthanasia:

1. Passive euthanasia is morally permissible.
2. If passive euthanasia is morally equivalent to active euthanasia, active euthanasia is also morally permissible.
3. Passive euthanasia is morally equivalent to active euthanasia.
4. Therefore, active (voluntary) euthanasia is morally permissible.

Moral Arguments –7

A classic thought experiment: the alleged equivalence of passive and active euthanasia

• Smith kills his six-year-old cousin (active killing).
• Jones allows his six-year-old cousin to die (passive killing).

Are these actions equivalent?

Moral Arguments –8

A slippery slope argument against active voluntary euthanasia:

1. If the general acceptance or approval of active voluntary euthanasia leads to widespread abuses (unjustified killing), then the practice is morally wrong.
2. The general acceptance or approval of active voluntary euthanasia will lead to widespread abuses (unjustified killing).
3. Therefore, active voluntary euthanasia is morally wrong.

Moral Arguments –9

The slippery slope argument:

• The argument is valid.
• The contentious point is Premise 2, an empirical claim (“The general acceptance or approval of active voluntary euthanasia will lead to widespread abuses”).
• No good reasons have been provided to support Premise 2. At best, arguments for Premise 2 show only that dreadful consequences are possible.

Credits

This concludes the PowerPoint slide set for Chapter 10

Doing Ethics: Moral Reasoning and Contemporary Issues

Fifth Edition (2019) by Lewis Vaughn.