Lecture 8 Euthanasia Medical and Philosophical Perspectives Nov 2006
Component 1: Agent and subject? • Agent of death ≠ subject of death euthanasia • Agent of death = subject of death suicide
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)
Component 3: Motive of the agent? • Benevolent – concern for the subject’s best interest euthanasia • Malevolent – concern for the agent’s own interests murder
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)
Doctor Assisted Suicide • Oregon, USA • Northern Territory, Australia, July 1, 1996 – March 24, 1997 • Dr. Philip Nitschke
Component 5: Outcome? • The subject indeed dies • Otherwise, this is only an euthanasia attempt
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
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
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)
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.
Voluntary euthanasia • Non-voluntary euthanasia • Involuntary euthanasia
Cardiopulmonary resuscitation Surgery Dialysis Ventilator Antibiotics I.C.U. admission Artificial nutrition and hydration (?) Forgoing futile life-sustaining treatments ≠ Passive Euthanasia
Not to obstruct artificially a natural and imminent death (withholding and withdrawing treatments) ≠ killing, terminating life
p.v.s. and euthanasia • Is artificial hydration and nutrition a medical treatment? • Or is it a humane support to a temporarily disabled person?
Arguments in Favour of Voluntary Euthanasia
Intolerable pain Meaningless pain
仁：不忍人之心 〝Dr. Death〞(Dr. Kevorkian)and his “Mercitron”
Philosophical question: How to cope with pain & suffering？
愚仁？ 臨終關懷 善終服務 寧養服務
Back to the state of infancy (confined to bed; incontinence, feeding, weak consciousness) Dependence
寧為玉碎，不作瓦存Death as termination of a degrading life
“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
Philosophical Question: Are debilitating health and dependence humiliating & undignified?
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…..
“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)
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.
Should human mortality be accepted or be deemed unacceptable and to be overcome?
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 !
Right to Die • timing • circumstances
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!
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: