1. Life and Death Dr. Chan Ho Mun Department of Public and Social Administration City University of Hong Kong 11-12 December, 2008

2. Discussion Questions for the Ballard of Narayama ( 楢山節考 ) Is morality absolute or relative? A challenge to the sanctity of life: Is the value of life absolute? If not, would death penalty for criminals and their family members be morally justifiable even for non-murder cases under some special circumstances? Would infanticide, abortion, euthanasia, and withdrawing/withholding life sustaining treatment be morally justifiable under some special circumstances?

3. Euthanasia Euthanasia can be defined as a deliberate attempt undertaken by a physician to relieve the pain and suffering of a patient by killing him/her or terminating his/her life intentionally. Supporters of euthanasia believe that the intrinsic value of life can be overridden by the principle of autonomy and the welfare principle.

4. Withdrawing/withholding life sustaining treatment (LST) Does withdrawing/withholding life sustaining treatment that is medically futile amount to euthanasia? How about artificial nutrition and feeding? Letting a patient die naturally could still be very painful, why not ending the suffering by euthanasia?

5. Advance Refusal of Treatments Providing treatment to a patient without consent can be regarded as an assault or battery of the patient. Patients have the right to contemporaneous refusal of treatment when they are mentally competent. Patients can use advance directives to express their advance refusal of treatment before they lapse into mental incompetency.

6. Is It a Form of Euthanasia? No. Argument from Autonomy: The attending healthcare team just follows the wish of the patient. Argument from Intentionality: The attending healthcare team has no intention to kill the patient or hasten his/her death.

7. Is It a Form of Euthanasia? Argument from Futility: If the refused treatments could only prolong the dying process and their burdens outweigh their benefits, they are regarded as medically futile and the attending healthcare team does not have an obligation to provide them.

8. Is It a Violation of the Sanctity of Life? Not saving the life of a drowning person if you are in a position or obliged to do so is morally wrong. Yet if a patient is dying, withholding or terminating treatments that would only prolong the dying process does not amount to hastening the death of the patient.

9. Is It a Violation of the Sanctity of Life? The provision of life-sustaining treatment to a dying patient may only prolong the dying process, but saving a drowning person may not have this consequence.

10. Three Legal Cases 1. Karen Ann Quilian –Quilian had been in a persistent vegitative state (PVS) since 1965. In 1976, the New Jersey Supreme Court ruled that it was lawful for her father and the doctor to withdraw her life-sustaining apparatus. The court accepted that Quilian was in the terminal stage of her life, indeed dying, and that further treatment would not save her.

11. Three Legal Cases 2. Nancy Beth Cruzan –Cruzen fell into PVS after an accident in 1983. Only after a length legal battle did the US Supreme Court allow the removal of life- support system so that she is allowed to die in peace in late 1990. Although the right to decline treatment was recognized, the court required clear and convincing evidence of the patient’s wishes.

12. Three Legal Cases 3. Tony Bland –Bland, a victim of the Hillsborough football disaster in 1989, was in PVS. –The ruling of House of Lords in 1993: Stopping artificial feeding was an omission The doctor was under no duty to continue it because it was a medical treatment, which was not in the best interests of the patient as it was medically futile.

13. Justifications of Punishment Forward-looking justifications –Deterrence: Punishment is an effective deterrent against crime. –Rehabilitation: making the criminal a better person. –Incapacitation: prevent the criminal from turning to crime again.

14. Justifications of Punishment Backward-looking justification –Retribution: An eye for an eye. Criminals deserve to be punished. The punishment should be in proportion to the severity of the crime committed. Punishment is not merely a means to achieve social utility. –Vengeance: the suffering of the criminal can make the relatives of the victim and the society feel better.

15. Arguments against Death Penalty Inconsistency: If killing is wrong, executing a murderer is also wrong. The impossibility of rehabilitation. Irreversibility: Compensation is impossible if an innocent is executed by mistake. Discrimination: the chance for receiving death penalty is higher for the vulnerable (the poor, minorities, and so on), regardless of the crime rate.

16. Arguments against Death Penalty The uncertainty of the deterrence effect. A life term is adequate for incapacitation. In terms of proportionality (retribution) and deterrence, imprisonment for life may be a better option than death penalty. Is “an eye for an eye” always the guiding principle? Vengeance is an emotional response. It could be irrational.

17. Dead Man Walking: The Moral of the Story Death penalty is morally wrong because it is inhumane and not fair to the vulnerable groups in society. Yet the following are more important: – the criminal should take responsibility and admit his/her guilt. –The family of the victim should let go and get out of the hate.

18. Dead Man Walking: The Moral of the Story Christianity –Knowing the truth will make you free. –Life after death (so being executed doesn’t matter too much) –Forgiveness. –Reconciliation If people learn the moral of the story, they may support the abolition of death penalty.

19. Readings on end-of-life issues Chan, Ho Mun, “Euthanasia: Can life become not worth living?” in Julia Tao and Hektor K. T. Yan (eds.), Meaning of Life, Singapore: McGraw Hill, 2006, pp. 263-282. Chan, Ho Mun, “Sharing Death and Dying: Advance Directives, Autonomy, and the Family”, Bioethics, Vol. 18, No. 2, 2004.

20. Readings on the three legal cases “In the matter of Karen Quinlan: The Supreme Court, State of New Jersey”, in Albert R. Jonsen, Robert M. Veatch, and LeRoy Walters (eds.), Source Book in Bioethics: A Documentary History, Washington, D.C.: Georgetown University Press, 1998, pp. 143-148. “Cruzan v. Director, Missouri Department of Health: U.S. Supreme Court”, in Jonsen, Veatch, and Walters (eds.) (1998), pp. 229-237. Luke Gormally, “Walton, Davis, Boyd and the Legalization of Euthanasia”, in John Keown (ed.) Euthanasia Examined, Cambridge: Cambridge University Press, 1995, pp. 113-140

21. Readings on death penalty Nina Rosenstand, The Moral of the Story: An Introduction to Ethics, 5 th edition, Boston: McGraw Hill, 2005, pp. 224-341, 647-655, 688- 692. Ernest van den Haag, “In Defense of the Death Penalty”, in Steven M Cahn and Tziporah Kasachkoff (eds.), Morality and Public Policy, Upper Saddle River, N.J.: Prentice Hall, 2003, pp. 206-216. Hugo Adam Bedau, “Capital Punishment”, in Cahn and Kasachkoff (eds.) (2003), pp. 217-232.

22. Movies Euthanasia –The Sea Inside Death Penalty –Dead Man Walking –The Life of David Gale (see Rosenstand, pp. 688-692 for a discussion) Abortion – 伊莎貝拉 –Vera Drake: Wife.Mother.Criminal