Presentation on theme: "Decisions at the end of life"— Presentation transcript:
1Decisions at the end of life EuthanasiaDecisions at the end of life
2What is Euthanasia? Euthanasia means “a good death,” or “dying well.” What is a good death?PeacefulPainlessLucidWith loved ones gathered around
3Some Initial Distinctions Active vs. Passive EuthanasiaVoluntary, Non-voluntary, and Involuntary EuthanasiaAssisted vs. Unassisted Euthanasia
4Active vs. Passive Euthanasia Active euthanasia occurs in those instances in which someone takes active means, such as a lethal injection, to bring about someone’s death;Passive euthanasia occurs in those instances in which someone simply refuses to intervene in order to prevent someone’s death.
5Criticisms of the Active/Passive Distinction in Euthanasia Vague dividing line between active and passive, depending on notion of “normal care”Principle of double effectDoes passive euthanasia sometimes cause more suffering?
6Compassion for Suffering The most important question when lives are ending is: how do we respond to suffering?Hospice and palliative careAggressive pain-killing medicationsSitting with the dyingEuthanasia
7The Sanctity of Life Life is a gift from God Respect for life is paramountImportance of personhoodThe approach of Natural LawImportance of ministering to the sick and dyingSee life as “priceless” (Kant)Respect for life once the dying process has begun
8The Quality of LifePeter Singer – low quality of life justifies ending a lifeBUT what is quality of life – is it more than can be judged medically?Would extraordinary means improve the quality of life of a patient?Refusal of medical treatment
9The Right to Die Do we have a right to die? Negative right (others may not interfere)Positive right (others must help)Do we own our own bodies and our lives? If we do own our own bodies, does that give us the right to do whatever we want with them?Isn’t it cruel to let people suffer pointlessly?
10Two ethical approaches A Utilitarian approach, which emphasises consequencesA Kantian approach, which emphasises autonomy, rights, and respect
11The Utilitarian approach Goes back at least to Jeremy Bentham (1748 – 1832) and John Stuart Mill ( )The greatest good for the greatest number
12Main Tenets Morality is a matter of consequences We must count the consequences for everyoneEveryone’s suffering counts equallyWe must always act in a way that produces the greatest overall good consequences and least overall bad consequences.
13The CalculusMorality becomes a matter of mathematics, calculating and weighing consequencesKey insight: consequences matterThe dream: bring certainty to ethics
14What is a good death? Jeremy Bentham Hedonistic utilitarians: a good death is apainless death.John Stuart MillEudaimonistic utilitarians:a good death is a happydeath.
15Euthanasia and personal autonomy John Stuart Mill – in matters which do not concern others, individuals should have full autonomyShould a competent adult be allowed to decide the time and circumstances of their death?
16The Kantian ModelCentral insight: people cannot be treated like mere things.Key notions:Autonomy & DignityRespectRights
17Autonomy & RespectKant felt that human beings were distinctive: they have the ability to reason and the ability to decide on the basis of that reasoning.Autonomy = freedom + reasonAutonomy for Kant is the ability to impose reason freely on oneself.
18Protecting AutonomyAdvanced Directives are designed to protect the autonomy of patientsThey derive directly from a Kantian view of what is morally important.
19Autonomy: Who Decides?Kantians emphasize the importance of a patient’s right to decideUtilitarians look only at consequences – but it can justify too much, as there is no protection for the minority or safeguarding of the individual’s rights
20ConclusionMany of the ethical disagreements about end-of-life decisions can be seen as resulting from differing ethical frameworks, especially Kantian vs. Utilitarian.or Quality of Life vs. Sanctity of Life