EUTHANASIA GREEK FOR “GOOD DEATH”

PUTS INTO QUESTION THE VALUE OF LIFE.

SANCTITY OF LIFE--CATHOLICISM

END OF LIFE ISSUES, WHAT SORT OF DEATH SHOULD ONE HAVE?

PAIN AND SUFFERING--PALLIATIVE CARE.

DOES IT MAKE SENSE TO SAY A PERSON HAVE A RIGHT TO A GOOOD DEATH?

EUTHANASIA

ISSUE OF DIGNITY OR DYING WITH DIGNITY (DEONTOLOGY)

ISSUES IN SCIENCE AND TECHNOLOGY.

PRACTICE OF MEDICINE: HIPPOCRATIC OATH

EUTHANASIABILL C-384, A PRIVATE MEMBERS BILL PRESENTED TO PARLIAMENT.

ENDORSED OR LEGALIZED PHYSICIAN ASSISTED SUICIDE.

MADE CONSENT MANDATORY AND ALLOWED PHYSICIANS TO AID A PERSON TO DIE WITH DIGNITY (TERMINAL ILLNESS AND WITHOUT PROSPECT OF RELIEF FROM PAIN)

EUTHANASIA

some distinctions:

voluntary euthanasia

involuntary euthanasia

active euthanasia

passive euthanasia

EUTHANASIAvoluntary passive euthanasia: allowing patient to die as wished.

involuntary active euthanasia: actively using substance to kill patient, end their life, without knowledge of their wishes.

involuntary passive: allowing them to dies without knowing their wishes.

voluntary active euthanasia: actively using means to end life as wished by subject.

EUTHANASIAbrock and callahan: good to compare and contrast their articles.

most important contrast: killing and allowing to die.

Brock: the distinction is problematic, confused.

callahan: the distinction is all important and clear.

EUTHANASIA

Brock and Callahan

brock callahan

Supports Euthanasia and physician assisted suicide or thinks values support this.

Opposes both and takes on the values Brock uses to support his case.

In both, choice is with patient, though order of actions differ.

In both, physician and patient act and therefore both are social interactions, not simply extensions of self determination.

Only concerned with voluntary euthanasia, not withholding or withdrawing life sustaining treatment.

Euthanasia is not simply a matter of self-determination but is a social decision. It follows that doctors share in the act of killing someone.

Central Argument for V. Euth: Ethical values of self-determination, autonomy, dignity and well-being support.

Avoiding suffering and directing one’s life and death.

An individual’s life is not always good. It can be a burden.

No objective standard for determining value of life only person’s judgment.

Acceptance of Euth would sanction view of autonomy that allows individuals to access their individual good at the risk of doing harm to common good.

No individual good should be elevated above the common good. Limits of autonomy: slavery and duels outlawed, etc..

EUTHANASIA

Brock and Callahan

BROCKValue of self-determination does not compel physicians to act contrary to their own moral and professional values. Indeed the medical profession supports this value.

CALLAHAN

Self-determination leads to increase of power of physician.

Argues for a confusion between “killing” and “allowing to die” or foregoing life sustaining treatment.

There is a clear distinction between killing and allowing to die.

Competent ALS patient requests that her respirator is removed. Physician should comply and most people agree that this is the right thing to do.

Eradicating the distinction implies that death from disease has been or can be banished.

EUTHANASIA

B AND C

BROCK

Suppose: Greedy, hostile son, this act of extubation is the same as the physicians but is murder not allowing to die, although son uses this excuse.

Son acts without patient’s consent, doctor acts with this and with good motives.

Physician acts in social role but the difference means that the physician acted morally but the son did not.

So, the act itself does not tell us the difference between killing and allowing to die. They appear to be the same.

There is a significant blurbetween acts and omissions.

The disease did not kill but the omission of the physician

CALLAHAN

Mistake: confusing causality with culpability.

3 circumstances confirm this. 1. when action of physician in stopping treatment on a patient with underlying disease is construed as “causing death.”

Omission of physician only brings about death due to patient’s disease.

Sufficient condition is the disease, as cause.

Lethal injection will kill both a healthy and a sick person.

Omission will not harm healthy person

but ... emergency medicine?

To say the doctor kills by omission is only a moral judgment about the illicitness of the omission.

“The only deaths that human beings have invented are those that come from direct killing.” (412)

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B AND C:

BROCK

Stopping life is very much like killing.

Killing: I push you overboard and you cannot swim

Allowing to die: You fall in and I do not throw you a lifejacket knowing you cannot swim.

Euthanasia, hence, cannot be wrong simply because it is killing instead of allowing to die.

If Euth is killing, can it still be justified?

Suppose I am wrong and that killing is worse than allowing to die. What makes killing morally wrong? Back to earlier problem and Mr. Marquis did not solve the problem.

Brock does appeal to it, however.

Not all killings are unjustified deaths

CALLAHAN

Allowing to die is letting nature run its course

Notice: accepts CMA distinction

Killing is causing the death

CMA:

“Euthanasia and assisted suicide, as understood here, must be distinguished from the withholding or withdrawal of inappropriate, futile or unwanted medical treatment or the provision of compassionate palliative care, even when these practices shorten life.”

EUTHANASIA

B and C:

Brock

I can waive my right not to be killed. This justifies killing.

callahan

This right cannot be waived. Consenting to be killed is a strange path to the fulfillment of autonomy.

Like consenting to slavery and degradation. (Prostitution)

i.e. I consent to have someone eat me.

Allowing euthanasia does not mean that physicians will be killing.

Prohibition of killing in medical ethics

Physician is dedicated to the opposite, but see Dutch Case. Dr. Van Ogijen (2001)

Physicians have a needless burden and this added power gives doctors too much power. (Dutch case, but controversy)

Promotes quick judgments for killing in cases where doctor judges impossibility of effective treatment.

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B and C:

policy level for Brock

policy level for Callahan

We lack firm data on the consequences for policy; there is a way to write in safeguards against abuse. Abuse will happen regardless. It is happening now without a law.

No way to enforce or compose meaningful law that guarantees effective procedural safeguards.

There are good consequences: now possible to respect self-determination of competent patients who wants it but cannot get it (Sue Rodriguez)

Do not know numbers who are deprived of this thought his does matter.

Bad consequences, etc, Dutch case, main concerns will be addressed by Brock.

It benefits larger groups, as American polls seem to indicate. Majority support for this access.

Legal permissibility would insure that people who wanted it could get it, an insurance policy of sorts.

In Holland, less than 10% of physicians report their acts of euthanasia. (This was sometime ago and we need current data)

Once it is legalized, there are no good moral reasons to limit it to competent patients and no way to limit it based on virtue of absolute autonomy.

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B and C:

brock callahanEnds suffering when it cannot be alleviated, when is this? It may be the only release from agony.

Argument from Mercy is a strong one, he claims but it can be met by insuring that patients are provided with adequate measures of pain relief.

Humane end to life, quickly and peacefully.

Dignity is retained.

Suffering is judged individually. Suffering is a function of the values of the individual . . . (but then . . . )

No way to measure it. But, then the problem of controlling it follows.

Cannot judge patient’s statement that her life is not worth living?

Bad Consequences:

David Velleman’s position: making a new choice available can sometimes make people worse off. It denies people the alternative of staying alive by default. This becomes a subtle pressure to request it.

Does it weaken the general prohibition against killing?

If allowing to die is killing, then this prohibition has already been eroded.

Bad Consequences:

Undermines trust in doctors and the moral center of medicine.

Increases power of physicians.

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C and B:

brock callahan

Slippery slope argument: legal permission leads to morally wrongful death (Dutch case again, oh boy!)

Is it really true that permitting euthanasia is a first and fateful step to Nazism?

But the slip intro non-voluntary euthanasia. Pressures to legal this. This makes the moral evaluation of euthanasia more difficult. These are Brock’s words and Callahan agrees with them.

His procedures, page. 405.

Specifies how abuse can be reduced but nothing can eliminate possible abuse, like all laws. No law is perfect, etc.

Lack of legal control may make the US slip even more fatally into non-voluntary euthanasia.

Any case of abuse is too much.

Legal control is an acceptance of killing or murder. Dutch case testifies to this.

RODRIGUEZ CASEARGUED THAT S. 241 B OF THE CRIMINAL CODE PROHIBITING ASSISTANCE OF SUICIDE, VIOLATED HER RIGHTS AND SHOULD BE STRUCK DOWN.

CITED SECTION 7 OF CONSTITUTION: “EVERYONE HAS A RIGHT TO LIFE, LIBERTY, AND THE SECURITY OF PERSON AND THE RIGHT NOT BE DEPRIVED THEREOF EXCEPT IN ACCORDANCE WITH THE PRINCIPLES OF FUNDAMENTAL JUSTICE.”

RODRIGUEZ CASE

SOME HIGHLIGHTS:

LAMER: S. 241 B CREATES INEQUALITY; DISABLED PERSONS CANNOT ACCESS OPTION OF SUICIDE. IT IS DISCRIMINATORY.

BUT LAMER FINDS THIS SECTION IS JUSTIFIED BY PARLIAMENT’S OBJECTIVE, THAT OF PROTECTING VULNERABLE.

RODRIGUEZ CASE

“IT IS NECESSARY AND JUSTIFIABLE TO THWART THE SELF-DETERMINATION OF SOME PERSONS WITH PHYSICAL DISABILITIES IN ORDER TO ASSURE THE PROTECTION OF ALL THOSE WHO MANY BE VULNERABLE TO BEING PRESSURED OR COERCED INTO COMMITTING SUICIDE.”

RODRIGUEZ CASELamer: slippery slope argument is possible.

decriminalization of assisted suicide could increase possibility of homicide of physically disabled.

but he does not buy the rationality of the legislation.

slippery slope cannot justify the exclusion of disabled from self-determination.

parliament is not justified in denying to the disabled the choice of ending life.

RODRIGUEZ CASEsopinka: disagrees with lamer.

while s. 241 b may infringe right to security, it does so consistently with principles of fundamental justice.

infringement on rodriguez is minimal.

reluctant to recognize that law threatens values of life, liberty, etc. in S. 7 of charter.

RODRIGUEZ CASEsopinka: charter asserts value of life, sanctity of life. So no merit to argument that there is in S. 7 an implied right to end one’s life.

while S. 241 b includes right over one’s body, depriving rodriguez this autonomy is justified under fundamental justice.

autonomy and risk of allowing it to be so expansive to include a danger to personhood.

RODRIGUEZ CASErole of courts!

sopinka says proper role is not to legislate or make changes to legislative policy.

appeals to virtue ethics. s. 241 b is legitimate because parliament’s objective of preserving life is just.

while appellant (rodriguez) argues that principles of fundamental justice include human dignity and autonomy, he is not convinced.

RODRIGUEZ CASE

fundamental justice:

interests of state and individuals must be balanced and this is role of fundamental justice.

state: protect life and vulnerable.

Individual: have authority over life.

RODRIGUEZ CASEsopinka cont.

no consensus on decriminalizing assisted suicide, unlike consensus against abortion law.

medical ethics: courts are right to recognize individual’s right to refuse treatment.

physicians: applied to them this should not lead us to change interpretation of homicide provision to permit p.a.s.

RODRIGUEZ CASEsopinka identifies a dilemma:

physician in allowing patient to refuse treatment makes a decision akin to decision to perform active, voluntary euthanasia.

palliative care: he recognizes that palliative measures can lead to death.

intention differs though! why are they different? allowing death and causing death! issue of causation.

RODRIGUEZ CASEphysicians under guise of palliative care may commit euthanasia, he admits.

this does not amount to same thing. the act is not unjust, he admits.

role of intention: easing pain vs causing death.

in end, impairment of s. rodriguez’s right is minimal and justified. (utilitarianism)

RODRIGUEZ CASE

mclachlin:

argues case is not about discrimination but how far state may limit right of person over decision about their body and person.

denial of choice to rodriguez cannot be justified or saved under principle of fundamental justice. (identical to law against abortion)

RODRIGUEZ CASE

mclachlin: legislation is arbitrary limitation of self-determination.

legislature in decriminalizing suicide intended not to thwart self-determination.

hence, not consistent with this intent.

inconsistent view of culpability.

RODRIGUEZ CASEculpability is not criminal in such assistance.

state has not shown that such a law has objective importance and outweighs individual liberty.

legislative intention is to prevent abuses, not preventing suicides.

state has not show abuses follow.

Keyserlingk and causality

rodriguez case ignores the complexity of criminal liability.

this is based on causality and the majority judgement confuses standard and empirical causality from normative (moral) causality.

criminal liability based on committing an act, not on failing or omitting to do something.

Keyserlingk and causality

empirical causality: 5 cases he raises, all indicate that cause of death is act of physician.

i.e. stopping respirator is an “empirical cause.”

Keyserlingk and causality

normative causality. does not distinguish acts from omissions.

Good samaritan laws: seinfeld episode.

sopinka’s admission: administering pain medication is the empirical cause of death.

legal issue: physician’s are relieved of criminal culpability only because they do not intend to commit an illegal act.

Kantian aspect: no purpose to act wrong.

Keyserlingk and causality

death is still caused.

implication: physician cannot be brought up on criminal charges, though s/he causes death.

if so, one can kill if intention is not unlawful, that is to break a law.

latimer caseKrutzen, Rudy. Argues that Latimer did right for right reasons.

Issue of Justice. was it done?

question of punishment only arises if what he did was in fact immoral, Rudy says.

no in-between! if immoral, deserves punishment, if not, does not deserve punishment.

Law must follow morality, not other way.

latimer caseConsent. how important is this issue?

pain. Was her pain pointless? no one would consent to be subjected to torture!

compassion as moral principle. Mercy.

real villains: the interest groups.

red herring of the charge: open hunting season on the disabled. Also slippery slope.

latimer caseneed to draw the line. i.e. what constitutes quality of life?

quality of life is both objective and subjective.

role of emotions. jury is blameworthy.

misplaced compassion and duty. “If law is not changed, caregivers will continue to find themselves in guilt-ridden no-win situations.