1. Lecture 8 Euthanasia Medical and Philosophical Perspectives Nov 2006

2. Component 1: Agent and subject? • Agent of death ≠ subject of death  euthanasia • Agent of death = subject of death  suicide

3. Component 2:Intention of the agent? • To bring about the quick and painless death of the subject  euthanasia • To relieve the subject’s pain merely (though death is foreseen) ≠ euthanasia (e.g., administration of morphine, tranquilizer)

4. Component 3: Motive of the agent? • Benevolent – concern for the subject’s best interest  euthanasia • Malevolent – concern for the agent’s own interests  murder

5. Component 4: Causal proximity? • The agent’s act causes the subject’s death  euthanasia • The agent provides environmental factors, but the subject’s death is caused by his or her own action  assisted suicide • The agent’s act allows an imminent death arrive unhindered  let die (e.g., forgoing futile life-sustaining treatment)

6. Doctor Assisted Suicide • Oregon, USA • Northern Territory, Australia, July 1, 1996 – March 24, 1997 • Dr. Philip Nitschke

8. Component 5: Outcome? • The subject indeed dies • Otherwise, this is only an euthanasia attempt

9. NB: final phase of a terminal illness • It is not a component in this notional analysis of euthanasia • It can be used as a criterion of admitting patients to this procedure

10. Active euthanasia • Terminating life via action • Causing death by commission • Dying and death occur as a causal consequence of an action • E.g., lethal injection

11. Passive euthanasia • Terminating life via inaction • Causing death by omission • Dying and death occur as a causal consequence of an inaction • E.g., starving a Downs Syndrome baby who is dependent on you for feeding • E.g, Taiwan: wife of a medical doctor • (NB: the motives are not necessarily benevolent)

12. How about the case of Terri Schiavo (2005)? Response or reflex?In this image taken from four hours of videotape, the Schindlers argued that Terri was able to respond to her mother.

13. Voluntary euthanasia • Non-voluntary euthanasia • Involuntary euthanasia

14. Cardiopulmonary resuscitation Surgery Dialysis Ventilator Antibiotics I.C.U. admission Artificial nutrition and hydration (?) Forgoing futile life-sustaining treatments ≠ Passive Euthanasia

15. Not to obstruct artificially a natural and imminent death (withholding and withdrawing treatments) ≠ killing, terminating life

16. p.v.s. and euthanasia • Is artificial hydration and nutrition a medical treatment? • Or is it a humane support to a temporarily disabled person?

17. Arguments in Favour of Voluntary Euthanasia

18. 1. Argument of Mercy

19. Duty to relieve pain vs.Duty to preserve life

20. Intolerable pain Meaningless pain

21. 仁：不忍人之心 〝Dr. Death〞(Dr. Kevorkian)and his “Mercitron”

22. Philosophical question: How to cope with pain & suffering？

24. 愚仁？ 臨終關懷 善終服務 寧養服務

25. 2 Argument of Death with Dignity

27. Back to the state of infancy (confined to bed; incontinence, feeding, weak consciousness)  Dependence

28. 寧為玉碎，不作瓦存Death as termination of a degrading life

29. “Undignified health conditions”:incurable, but not terminal • Alzheimer's disease • Parkinson's disease • ALS, Amyotrophic lateral sclerosis (Lou Gehrig’s disease) • Multiple sclerosis • Quadriplegic • PVS, persistent vegetative state

30. 33岁的语文老师渴望“安乐死” 另外，得病后，他再也无法站上心爱的讲台，这使要强的他心理上无从慰藉。生病以后，常常有大量的学生来到病榻前探望老师，甚至有学生多次从绵阳赶到成都探病。但因为病痛，他已经越来越没有一个老师的尊严了。他不愿再让学生看到自己老师面对死亡时的狼狈相。他希望轻松体面的生活在世界上，如果生不如死，他宁愿有尊严地死去。

31. Philosophical Question: Are debilitating health and dependence humiliating & undignified?

32. Aussie Senate Cmt, 1997 • “With very few exceptions, pro-euthanasia submissions which dealt with the term ‘dignity’ described particular physical circumstances and described living or dying in such circumstances as necessarily involving a loss of dignity. These circumstances regularly included loss of continence and mobility…..

33. “A disturbing equation is thus drawn between having ‘dignity’ and being ‘without disability’…. Any notion that those who choose the path of natural death or those who choose to live with disabilities are in some way taking the less dignified path should be abhorrent to any caring society. • Unfortunately, the attitude from certain quarters that dying with dignity demands that life ends before such circumstances begin carries a message which only serves to devalue those who live in such circumstances” (p.126)

35. Morrie Schwartz • “it’s the ultimate sign of dependency. Someone wiping your bottom.” • Felt a little ashamed because of our culture • Ignore the culture • Began to enjoy; it’s like going back to being a child again – bathing, lifting, wiping you • We all yearn in some way to return to those days when we were completely taken care of – unconditional love, unconditional attention. Most of us didn’t get enough.

37. Should human mortality be accepted or be deemed unacceptable and to be overcome?

42. 31.10.2004

43. Dr. Helga Kuhse, Monash Univ. • “A dignified death is one which accords with the patient’s values and beliefs, a death that does not contradict the patient’s own view of what it means to lead a good human life and die a dignified death. A mode of dying that is prescribed by the imposition of the moral or religious beliefs of others is not a dignified death – even if it is relatively pain-free.” (Quoted from Euthanasia Laws Bill, 1997, p.61) • An even more extreme view !

44. 3. Argument of Autonomy

45. Right to Die • timing • circumstances

49. Echoes with other bioethical views • “To be human is to be in control” • Death control as well as birth control • Human-controlled death is better than a natural death （盡其天年  接受命運擺佈） • Voluntary euthanasia is a human right!

50. Right to euthanasia • Legal right – legalization of euthanasia • Moral right – euthanasia is sometimes morally permissible, though still might be illegal • Voluntariness – genuine? Or under pressure? • Example: