Euthanasia

1. Euthanasia Some thoughts before a film.

2. Euthanasia and Assisted Suicide: Some Terminology (I) • Euthanasia = “good death” • Broad definition: doing what will result in death, for the good of the person who will die • Narrow definition: intentionally killing a person, for the good of that person • Active versus passive euthanasia • active—killing • passive—letting die (withholding treatment)

3. Euthanasia and Assisted Suicide: Some Terminology (II) • Voluntary, involuntary, and non-voluntary euthanasia • voluntary — in accordance with the wishes of the recipient • Involuntary — against the wishes of the recipient • non-voluntary — recipient has no wishes • Assisted Suicide — occurs when one person helps another person commit suicide (often by providing the “means” of death)

4. Medicine & the end of Life Voluntary Involuntary Non-voluntary ? ? ACTIVE ? ? OK PASSIVE

5. Singer • Thesis: Given the presence of appropriate legal safeguards, there are no paternalistic reasons that justify denying voluntarily euthanasia. • First key principle of the argument: Persons can waive their rights "if one so chooses." • Second key principle of the argument: If we endorse the principle of respect for autonomy, we will assist others to do as they choose. 

6. Singer • Given these two key principles, a rational person with "an irreversible condition causing protracted physical or mental suffering" who chooses to waive the right to life should be assisted in ending his or her life. • To prohibit voluntary euthanasia is to promote less happiness, for it promotes the continued suffering of a self-conscious being who desires to end that suffering but knows that it will continue (and who therefore suffers the added burden of fearing continued suffering).

7. Wolf • Women, although autonomous, are more likely to succumb to “pressures” that may make them more likely to choose PAS. • As such, women may not be freely choosing PAS • Social Pressures: • Women “ought” to be self-sacrificing • Women are more likely to suffer from depression • Women are less likely to have adequate pain management. • Women are likely to be poorer, with sub-par resources for end-of-life care • (See the analogies to domestic violence.)

8. Wolf • MDs need to adopt the virtues of beneficence and caring to ensure that women aren’t merely “doing the right thing” and that MDs aren’t overlooking women’s vulnerabilities • “We cannot ignore that [the existing practice of PAS] would allow what for now remains an elite and predominantly male profession to take the lives of the “other.” We cannot explain how we will train the young physician both to care for the patient through difficult starts and to kill. We cannot protect the most vulnerable.”(226)

9. Gill • Thesis: Respecting autonomy requires that we let autonomous people make “the big decisions” about their lives, including PAS. • People like Kass claim that PAS restricts autonomy since once someone is dead they can no longer make decisions (remember from last week.) • But: respecting autonomy means respecting someone’s ability to make the “big decisions.”

10. Gill • Non-terminal cases of suicide are different: • A healthy person has the ability to make many more autonomous decisions in the future, and killing herself now does restrict her autonomy; however, a terminally ill person won’t be able to make big decisions in the future, so he doesn’t restrict his autonomy by choosing to end his life.

11. Autonomy argument 1) My life is my property. 2) I can do as I will with my property. • American argument • Privacy argument in abortion debate. 3) I can do as I will with my life. 4) I can authorize my agents to carry out my wishes with regard to my life. 5) My agents can be justified in killing me.

12. Oregon’s “Death with Dignity Act” • Protects physicians and pharmacists from facing criminal, civil, or professional penalties for prescribing or distributing lethal doses of medication in certain situations. • The patient must… • Be an autonomous, informed adult. • Submit oral and written requests. • Undergo a waiting period. • Have 6 months or less to live. • “Good Faith” provision protects doctors if some requirements are (unbeknownst to doctor) not met

13. Top Reasons for Requesting Lethal Rx in Oregon (as reported by doctors) • Losing autonomy (89%) • Decreased ability to participate in enjoyable activities (87%) • Loss of Dignity (82%) • Loss of control of bodily functions (58%) • Burden on family and friends (39%) • Inadequate pain control (27%) • Financial Concerns (3%)

14. Disability Rights Objections to Legalizing Euthanasia and PAS (I) • Prejudice against disability is a primary motive for legalization of euthanasia and PAS. • Legalization will disproportionately harm the disabled. • Suicide intervention compromised • Familial and social pressure • The problem of managed care

15. Disability Rights Objections to Legalizing Euthanasia and PAS (II) • Inadequate safeguards in actual legislation • Life expectancy prognoses unreliable • Danger of “doctor shopping” • “Good faith” provision gives doctors effective immunity from negligence • Undue coercion and lack of effective choice will undermine autonomy