MORAL CHOICES by Scott Rae - Clover Sites



MORAL CHOICES by Scott Rae

Chapter Nine: Physician-Assisted Suicide and Euthanasia

Study Guide

Key Terms

Euthanasia

Termination of Life Support

Physician-Assisted Suicide

Active Euthanasia

Ordinary Means

Extraordinary Means

Advanced Directives

Living Will

Durable Power of Attorney

Questions

1. What is the argument from mercy?

2. What response can you make to it?

3. What is the argument from utility?

4. What response can you make to it?

5. What is the argument from autonomy?

6. What response can you make to it?

7. What does it mean to say there is no morally relevant difference between killing and allowing to die?

8. What response can you make to it?

9. What does it mean to say that euthanasia does not always involve killing a person?

10. What response can you make to it?

11. “Assisted suicide and euthanasia violate both the Western social and legal prohibitions and the Judeo-Christian prohibitions on killing innocent people.” List seven reasons for this statement.

a. _

b. _

c. _

d. _

e. _

f. _

g. _

12. The person in a permanent vegetative state “still has all the essential elements of personhood. All that is lost is the ability to exercise them.” Explain how this position is used in relation to the issue of withdrawing nutrition and hydration.

13. What arguments are offered for withdrawing nutrition and hydration from PVS patients?

a. _

b. _

c. _

14. What arguments are offered against withdrawing nutrition and hydration from PVS patients?

a. _

b. _

c. _

d. _

EUTHANASIA: FINAL EXIT OR FORCED EXIT?

Problems

• Technology can keep a brain-dead human body alive for years

• Technology can keep a body-dead, brain-alive person going for an extended period of time

Death and the dying process are emotionally taxing events that require a response.

Medical Ethics is torn between two imperatives:

1. Protect life (avoid killing)

2. Respect individual autonomy

What solutions have been considered?

• Save all lives

• Extinguish all brain-dead patients and save all others

• Save the lives of those who want to be saved, and release from guilt all those who want to die

• For those unable to inform us and have not completed an advance directive, establish firm policies to follow, in all such situations

• Never actively kill a patient

• Never allow a patient to kill himself/herself

• Allow a patient to refuse extraordinary measures

• Allow _______________ case-by-case authority to determine the courses of actions (fill in the blank with “physicians,” “family,” “friends,” “hospital board,” “bioethicists,” or any combination of these)

• Establish rigid guidelines with strong qualifications for physician-assisted suicide

What non-controversial steps can we take to ease the problem?

1. Affirm the value of life and of living

2. Recognize the arbitrary nature of many quality-of-life discussions

3. Explore and fund and develop all options to euthanasia

• Hospice

• Pain regulation

• Dying at home

• Improvement of nursing homes

• Therapy and technology alternatives for those suffering from debilitating and/or degenerative diseases

• Participate in visitation programs

• Urge proactive counseling for depression

4. Encourage living wills and durable powers of attorney

5. Acknowledge that suffering is not to be avoided at all costs

If we choose as a society to approve of suicide, physician-assisted suicide, and/or euthanasia, be prepared for the consequences.

SLIPPERY SLOPES

|THIS ( . . . MAY BECOME ( |THIS ( | | |

|THE RIGHT TO EUTHANIZE |THE RESPONSIBILITY TO EUTHANIZE | | |

|THIS ( . . .MAY BECOME ( |AND THIS ( . . . MAY BECOME ( |THIS ( | |

|THE RIGHT TO ASSISTED SUICIDE OR EUTHANASIA |THE RIGHT TO A PHYSICIAN’S DECISION TO EUTHANIZE, BASED |THE RIGHT TO A PHYSICIAN’S DECISION TO EUTHANIZE, BASED ON | |

| |UPON PROBABLE WISHES |UTILITARIAN ETHICS | |

|THIS ( . . . MAY BECOME ( |AND THIS ( . . . MAY BECOME ( |AND THIS ( . . . MAY BECOME ( |THIS ( |

|THE DUTY TO END SUFFERING IN CONSENTING ADULTS |THE DUTY TO END SUFFERING IN ADULTS WHO WERE COMPETENT TO |THE DUTY TO END SUFFERING IN MENTALLY INCOMPETENT PATIENTS |THE EXPANSION OF THE TERM |

| |CONSENT, BUT WHO NEGLECTED TO, BEFORE THEY BECAME | |MENTALLY INCOMPETENT |

| |NON-COMMUNICATIVE | | |

THE GENERAL DECLINE IN THE PERCEIVED WORTH OF LIVING BELOW OPTIMAL CONDITIONS

1. THE NUMBER AND USE OF EUPHEMISMS WILL INCREASE:

o KILLING WILL BE CALLED “ASSISTING IN DYING”

o EUTHANASIA WILL INCREASINGLY BE CALLED “DEATH WITH DIGNITY”

2 SUICIDE WILL BE CALLED “”PLANNED DEATH”

THE DANGER OF COLLAPSING DISTINCTIONS

EVERY HEALTHY PERSON HAS AN INTEREST IN A LIFE THAT IS FREE FROM

• DISTRESS

• DISADVANTAGE

• DISCOMFORT

• DISABILITY

LIKEWISE, EVERY SANE PERSON HAS AN INTEREST IN

• TOP PAY FOR THE WORK S/HE DOES

• THE HIGHEST POSSIBLE PRICE FOR AN ITEM S/HE IS SELLING

• THE NICEST HOME S/HE CAN AFFORD

BUT DOES ONE HAVE A RIGHT TO THESE?

IF WE SAY “YES!” WHAT ARE THE IMPLICATIONS?

CONCLUSION: I HAVE INTERESTS THAT CANNOT BE ELEVATED TO THE CATEGORY OF RIGHTS

[pic]

THE QUALITY OF LIFE QUESTION

TWO VALUES ARE AT CONFLICT:

1. HUMAN LIFE IS VALUABLE AS HUMAN LIFE

2. HUMAN LIFE IS VALUABLE ONLY WHEN THE BEING’S ABILITY TO FUNCTION IS REASONABLY CLOSE TO NORMAL

THE SECOND VALUE IS OFTEN LOOSELY DESCRIBED AS “QUALITY OF LIFE”

TWO EQUATIONS EXPRESS “QUALITY OF LIFE” PROPORTIONALLY:

1. QL = NE

2. QL = NE x (H + S)

QL = QUALITY OF LIFE

NE = PATIENT’S NATURAL ENDOWMENT (PHYSICAL & INTELLECTUAL)

H = CONTRIBUTIONS MADE BY THE HOME AND FAMILY TO THE PATIENT

S = CONTRIBUTIONS MADE BY THE SOCIETY TO THE PATIENT

WHICH IS MORE CORRECT?

WHEN DOES NE = 0? IN CASES WHERE IT DOES,

QL = 0 x (H + S), so

QL = 0

WHEN DOES (H + S) = 0? IN CASES WHERE IT DOES,

QL = NE x 0, so

QL = 0

MORAL OF THE STORY: A PERSON’S QUALITY OF LIFE MAY BE INFLUENCED CRUCIALLY BY CONSIDERATIONS THAT PHYSICIANS

1. FREQUENTLY FAIL TO CONSIDER, AND

2. ARE NOT QUALIFIED TO ASSESS.

"The care of human life and happiness and not their destruction is the first and only legitimate object of good government."... Thomas Jefferson

"There is no quality of life when the patient is dead."... a nurse

"The terminally ill are a class of persons who need protection from family, social, and economic pressures, and who are often particularly vulnerable to such pressures because of chronic pain, depression, and the effects of medication."... from the State of Alaska's arguments that assisted suicide is dangerous. Subsequently (9/21/01), the Alaska Supreme Court ruled unanimously that state laws punishing assisted suicide as manslaughter are to be upheld.



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INTERESTSS

RIGHTS

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