Ethics and Moral Problems



Ethics and Moral Problems

Philosophy 1120

Fall 2011

Euthanasia Group Presentation

Introduction

Etymology: Greek “eu” (well or good) and thanatos (death). Euthanasia refers to the intentional termination of a human life in order to end pain and suffering.

Definitions: “The House of Lords Select Committee on Medical Ethics of England defines euthanasia as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering".[1] In the Netherlands, euthanasia is understood as "termination of life by a doctor at the request of a patient".[2]”

Passive Euthanasia: The withholding of treatments, such as medicine, chemotherapy, radiation treatment, etc. necessary to sustain the life of the patient.

Active Euthanasia: Administering a lethal substance with the express intent to end the life of the patient.

Voluntary Euthanasia: Euthanasia occurring with the consent of the patient. Both passive and active euthanasia fall under this category. Passive euthanasia is legal throughout the United States; active euthanasia is legal in only the states of Montana, Washington and Oregon and countries: The Netherlands, Belgium and Luxembourg. The term, assisted suicide is often used when the patient takes his or her own life with the assistance of the doctor.

Non-voluntary Euthanasia: “Euthanasia conducted where the consent of the patient is unavailable is termed non-voluntary euthanasia. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.” Wikipedia article “Euthanasia”

In-voluntary Euthanasia: “Euthanasia conducted against the will of the patient is termed involuntary euthanasia. Involuntary euthanasia is usually considered murder” Wikipedia article “Euthanasia”

Wikipedia

[1]^ a b c d Harris, NM. (Oct 2001). "The euthanasia debate". J R Army Med Corps 147 (3): 367–70. PMID 11766225.

[2]^ Euthanasia and assisted suicide BBC. Last reviewed June 2011. Acessed July 25, 2011.

The Perspectives of Four Contemporary Philosophers

1. “Voluntary Active Euthanasia”

Dan Brock; Frances Glessner Lee Professor of medical ethics and Director of the Division for Medical Ethics, Harvard University

Brock argues “[It is] that the very same two fundamental ethical values supporting the consensus on patient’s rights to decide about life-sustaining treatment also support the ethical permissibility of euthanasia. These values are individual self-determination or autonomy and individual well-being.”

At the end of human life, it becomes more valuable to maintain a high quality of life, avoid suffering, maintain dignity and ensure that we are remembered as we wish to be than it is to extend the time of one’s existence. Thus, a sense of individual well-being should dictate when a person is to die, when life has become a burden rather than a benefit.

The two main arguments against euthanasia are, one: it is always ethically wrong, even if the well-being of the patient supports it and, two: even if euthanasia is not ethically wrong, the act of physicians performing euthanasia is in direct conflict with the moral and legal code to which those physicians must adhere. “Permitting physicians to perform euthanasia, it is said, would be incompatible with their fundamental moral and professional commitment as healers to care for patients and to protect life.” Brock’s answer to these arguments holds to his earlier statement centering the values of self-determination and well-being in the debate. These values should lie at physician’s moral center and “these two values support physician’s administering euthanasia when their patients make competent requests for it.”

All quotations: Dan Brock, “Voluntary Active Euthanasia,” Hastings Center Report. Vol 22, No. 2 (Mar-Apr 1992)

2. “The Wrongfulness of Euthanasia”

J. Gay-Williams; Professor of Philosophy

Gay-Williams begins his essay, “The Wrongfulness of Euthanasia” by mentioning Karen Quinlan, a woman in a persistent vegetative state, and our compassion for her and her family. Though the main viewpoint is that she and her family would be better off if she were dead, Gay-Williams argues that euthanasia is still inherently wrong. It is also wrong from the standpoints of self-interest and practical effects. His three main points:

1. The argument from Nature

We are built to survive; it is our natural inclination to protect ourselves from harm. “Our bodies are similarly structured for survival right down to the molecular level…Euthanasia does violence to this natural goal of survival. It is literally acting against nature.”

2. The Argument from Self-Interest

“Because death is final and irreversible, euthanasia contains within it the possibility that we will work against our own interest if we practice it or allow it to be practiced on us.” Approving the practice of euthanasia does not take into account any chance of error in diagnosis or prognosis; the finality of it is too great.

3. The Argument from Practical Effects

Accepting euthanasia would create a decline in the quality of the care of the medical profession in addition to corrupting the profession at its heart. Allowing euthanasia to step into public policy would be a moral downfall for society. He argues that the issue is a slippery slope.

All quotations: J. Gay-Williams, “The Wrongfulness of Euthanasia,” Intervention and Reflection: Basic Issues in Medical Ethics. 7th ed. Ronald Munson (ed.) (Belmont, CA: Wadsworth)

3. “Active and Passive Euthanasia”

James Rachels; (1941-2003) Distinguished moral philosopher at New York University, Duke University and the University of Alabama at Birmingham

Rachels begins his essay, “Active and Passive Euthanasia” discussing “[T]he distinction between active and passive euthanasia is thought to be crucial for medical ethics.” Most people seem to believe that passive is preferable to active, but Rachels argues active is preferable to passive. “To say otherwise is to endorse the option that leads to more suffering rather than less, and is contrary to the humanitarian impulse that prompts the decision not to prolong his life in the first place.”

The conventional doctrine leads to decisions concerning life and death to be made on irrelevant grounds. If a baby is born with a mental disease and a physical ailment, is the decision to withhold surgery for the physical ailment based on the existence of the mental disease? Is killing, in itself, worse than letting die? Rachels uses and example of two men, both standing to gain a large inheritance. One man killed the relative to get the inheritance, while the other man let his relative die and did nothing to help though he could have. Did either man behave better, morally? Rachels says no: the difference between killing and letting die does not, in itself, make a moral difference. The action is inherently the same. Thus, the arguments in favor of passive euthanasia make active euthanasia morally permissible also.

All quotations: James Rachels, “Active and Passive Euthanasia,” New England Journal of Medicine, 292 (2), January 9, 1975

4. “Objections to the Institutionalisation of Euthanasia”

Stephen Potts; Physician at Royal Edinburgh Hospital, scholar of medical ethics, author of children’s books

Potts main point is that even if it may be the best outcome for the individual patient, euthanasia as an institution is too open for abuse and too difficult to control for it to be socially morally permissible. “… the risks of such institutionalisation are so grave as to outweigh the very real suffering of those who might benefit from it..”

Risks of Institutionalisation:

1. Reduced Pressure to Improve Curative or Symptomatic Treatment

2. Abandonment of Hope

3. Increased Fear of Hospitals and Doctors

4. Difficulties of Oversight and Regulation

5. Pressure on the Patient

6. Conflict with Aims of Medicine

7. Dangers of Societal Acceptance

8. The Slippery Slope: CURE: the central aim of medicine

CARE: the central aim of terminal care once patients are beyond cure

KILL: the aim of the proponents of euthanasia for those patients beyond cure and not helped by care

CULL: the feared result of weakening the prohibition on euthanasia

(J. Gay-Williams also mentions the slippery slope)

9. Costs and Benefits

Probability of harm in question must be assessed: the odds, the stakes and the reversibility.

Potts goes on to discuss weighing the risks, the right to die and the duty to kill and assisted suicide. “The distinction between assistance in suicide and killing is so fuzzy as to be simply unworkable in any legislation.” He claims: “I object, not so much to individual acts of euthanasia, but to institutionalising it as a practice.”

Related Studies

Karen Ann Quinlan

Jack Kevorkian, “Dr. Death”

Historical Timeline: History of Euthanasia and Physician-Assisted Suicide

|Name: |International Task Force on Euthanasia and Assisted Suicide |

|Position: |Con to the question "Should euthanasia or physician-assisted suicide be legal?" |

|Reasoning: |"... The government should not have the right to give one group of people (e.g. doctors) the power to kill |

| |another group of people (e.g. their patients). |

| |Activists often claim that laws against euthanasia and assisted suicide are government mandated suffering. But |

| |this claim would be similar to saying that laws against selling contaminated food are government mandated |

| |starvation. |

| |Laws against euthanasia and assisted suicide are in place to prevent abuse and to protect people from |

| |unscrupulous doctors and others. They are not, and never have been, intended to make anyone suffer." |

| | (accessed Aug. 9, 2006) |



|Name: |American Medical Association (AMA) |

|Position: |Con to the question "Should euthanasia or physician-assisted suicide be legal?" |

|Reasoning: |"It is understandable, though tragic, that some patients in extreme duress--such as those suffering from a |

| |terminal, painful, debilitating illness--may come to decide that death is preferable to life. However, |

| |permitting physicians to engage in euthanasia would ultimately cause more harm than good. Euthanasia is |

| |fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, |

| |and would pose serious societal risks. |

| |The involvement of physicians in euthanasia heightens the significance of its ethical prohibition. The |

| |physician who performs euthanasia assumes unique responsibility for the act of ending the patient's life. |

| |Euthanasia could also readily be extended to incompetent patients and other vulnerable populations. |

| |Instead of engaging in euthanasia, physicians must aggressively respond to the needs of patients at the end of |

| |life. Patients should not be abandoned once it is determined that cure is impossible. Patients near the end of |

| |life must continue to receive emotional support, comfort care, adequate pain control, respect for patient |

| |autonomy, and good communication." |

| |Letter written on behalf of the AMA by then AMA General Counsel Kirk Johnson to then Michigan Attorney General |

| |Frank Kelley, Oct. 10, 1995 |



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