Euthanasia and Physician Assisted Suicide

1. Euthanasia and Physician Assisted Suicide Vaughn, Ch 10

2. Defining Suicide Suicide =df the intentional termination of one’s own life • Passive suicide =df omitting what is necessary to preserve one’s own life with the intention of ending it • Active suicide =df taking action to end one’s own life with the intention of ending it

3. Defining Suicide To some degree, the question of what a suicide is depends on intention: • We are both snake bit with just one dose of anti-venom. You giving the dose to me does not constitute your suicide • this action fails the qualification “with the intention of ending it” in the definition of both active and passive suicide • Nonetheless, we have, historically, called Kamikazes “suicide attackers” • does this action fail the qualification “with the intention of ending it” in the definition of both active and passive suicide? What difference between these cases accounts for the difference in usage?

4. Defining Suicide One difference could be that we deem suicide as wrong, and judging Kamikazes to be wrong, simply applied the term as added condemnation. A principled, alternative account would be that … • in the poisoning case, there is no option that avoids death • in the Kamikaze case, the option of using standard warfare is simply judged intolerable (because it means losing the battle or war) In the Kamikaze case, such a value judgment presents us with what the book calls “proportionate reasons.”

5. Defining Suicide Examples of choices that entail death based on proportionate reasons: • Maintaining your profession of faith despite facing execution by arrows, hanging, lions, etc. • Diving on a grenade to save buddies • Removing your oxygen mask due to unbearable pain Which of the above are suicides? This last example differs from the first two how?

6. Defining Suicide When someone chooses to end their life by a proportionate reason, the question of whether that act constitutes suicide will be a real question • mainly in non-altruistic cases (previous slide) • also in cases where the reasoning looks bad (suffering doesn’t appear that serious, person has other responsibilities, etc.) or, a mere verbal question. It will be … • an arbitrary decision about use of the word, • not a judgment about whether suicide has occurred

7. Four Arguments Against Suicide • God owns your life • creating something or working for it results in ownership • Human life is precious • intrinsically, or as the basis of all other goods, human life is too precious to terminate • Suicide harms the community • it eliminates a contributor to society • Suicide harms others • it interferes with carrying out duties to others around us

8. A, B, C - Replies to Argument 1 • Argument 1 works only for those who accept the premises. • Should humanistic / secular folks get their way in the scheme of things? They’re in the minority, statistically • Even if God owns your life, theists typically hold that • dying for your faith is or can be right (martyrs are not condemned traditionally) • dying for others is or can be right (e.g., “No greater love … lay down his life for a friend”)

9. A, B, C - Replies to Argument 1 • God can’t own our lives because we own them • we’re the ones who feed ourselves • rest ourselves • clothe ourselves • educate ourselves • it’s all work and working for something is a standard basis of ownership On the contrary (OTC): God gives us life in the sense of existence and continued existence; those form God’s basis for ownership

10. Reply to OTC Reply: It is wrong to give people things that • they didn’t ask for, and (1 diamond) • are hard for them to return (1 & 2 fish tank) That sort of giving implies • no duty of gratitude, • no duty to return what’s given, • no duty to treat what was given according to the wishes of the giver Therefore, we have no duty to God to preserve our own life based on his giving us existence or continued existence

11. A & B - Replies to Argument 2 • Life does not always form the basis on which all other goods depend: • When ‘life’ refers to a person terminally ill who experiences such severe and constant pain that none of life’s ordinary goods can be experienced, life does not appear too precious to terminate • When ‘life’ refers to a person in a persistent vegetative state, again, life does not appear too precious to terminate • The intrinsic value of existence is not decisive against suicide • even if existence is intrinsically good, that doesn’t mean it is better than any other intrinsic goods • If life is not necessarily better than other intrinsic goods, then perhaps it is not better than • freedom from suffering, or • the indignity of having one’s body artificially sustained

12. Reply to Argument 3 Suicide only may reduce contributors to society • If everyone over 75 died society would likely have a net gain • those over 75 are not terribly productive on average; that group is very expensive to care for medically • If freeloaders, bums, drug addicts, etc., committed suicide, the net result would likely be positive • costs of supporting addicts and freeloaders are high; costs of rehabilitation are high

13. Reply to Argument 4 While the obligation to dependents will often outweigh the right to end one’s own life, that may not always be the case: Terminally ill patients in unceasing pain perhaps have the right to terminate their own lives even if they have dependents • dependents are 17 years old, • able to be cared for by others better positioned, • dependents are independent in temperament, • etc.

14. Slippery Slope of Suicide? In Garrett, p169, is consideration of an empirical and logical version of a slippery slope argument against permitting any form of suicide. • Empirical argument: allowing exceptions to the prohibition against suicide will lead to the widespread increase in the number of suicides • Reply: it probably won’t … suicides will never be popular • Logical argument: allowing exceptions makes us inconsistent in opposing suicide • Reply: consistency is no virtue when misapplying rules (fallacy of accident); this appears to be such a case

15. Ethics of Suicide Prevention By and large, suicide is legal in the US Assisting a suicide, however, is only presently legal in Oregon, Washington state, and Montana. http://www.straightdope.com/columns/read/2501/is-suicide-against-the-law Reasons society has the right to prevent suicides: • Life is intrinsically valuable • Most individuals contribute to society • Some individuals contribute a lot • Some individuals have duties to family which society will have to assume if suicide is allowed • Some groups, such as physicians, may need protection from the effects of active suicide on their profession

16. Ethics of Suicide Prevention Garrett notes a libertarian argument, p171, that rejects all limitation on suicide (of the competent). The argument admits some suicides involve reneging on responsibilities (to family and others), but that society ought not attempt to sanction or punish for such offenses. Those “moral wrongs” cannot be “properly punished.” The book points out in response that laws can be crafted to prevent such suicides on the basis of protecting others from harm, laws that permit coercion in some form … • interventions? • forced institutionalization? • jail time until the urge to kill yourself passes?

17. Ethics of the Death of a Patient Garrett, 172-178, discuss a wide array of situations that involve the ethics of cooperating with a competent, terminal patient’s refusal of treatment The principles relied on are: • Omitting treatment (okay) • Omitting care (never okay) • Extending life v. prolonging dying p174 • relies on judgment of physician • Reducing suffering: • Feeding and hydration can become painful p175 • Antibiotics can cure a condition but prolong dying

18. Ethics of the Death of a Patient Garrett 178, discusses the ethics of cooperating with the refusal of treatment of non-terminal patients • Patient cites a proportionate reason for choosing to terminate care (respirator, feeding tube, etc.), eg, preferring death to life on a respirator • Health care providers have the right to disagree with patient’s judgment of a proportionate reason • cannot force treatment on an unwilling patient • must continue care in this situation? Book says ‘no’ • Is abandonment okay then? Book says ‘no’

19. Bibliography Health Care Ethics, 4th ed., Thomas M. Garrett, et al, Prentice Hall, 2001.