1 Voluntarily Assisted Suicide and Euthanasia Soazig Le Bihan - University of Montana

2Introduction Why should we care? -Our death -Aging Society Discussion -When to stop? -Definitions -Doctors -Decisions What this class is about

3Outline Introduction Important Distinctions The argument from autonomy and its critics The utilitarian argument and its refinement Slippery Slopes and the Pandora Box: Fears vs. Reality Conclusion A controversial distinction: Active vs. Passive Euthanasia

4Outline Introduction Important Distinctions The argument from autonomy and its critics The utilitarian argument and its refinement Slippery Slopes and the Pandora Box: Fears vs. Reality Conclusion A controversial distinction: Active vs. Passive Euthanasia

5 Important Distinctions Voluntary / Non-voluntary / Involuntary Involuntary: against the patient’s will – nobody defends it! Non-voluntary: the current desire of the patient is unknown because she is physically or mentally unable to express it Voluntary: in agreement with the patient’s will Assisted Suicide /Euthanasia Assisted Suicide: the person kills herself with a medication prescribed by a doctor Euthanasia: the doctor administrates herself the medication  We will focus on the morality of Voluntary Assisted Suicide (VAS) and Voluntary Euthanasia.

6Outline Introduction Important Distinctions A controversial distinction: Active vs. Passive Euthanasia The argument from autonomy and its critics The utilitarian argument and its refinement Slippery Slopes and the Pandora Box: Fears vs. Reality Conclusion

7 The argument from autonomy The argument from autonomy: P1: Each individual’s autonomy ought to be respected P2: Denying someone the right to assisted suicide amounts to disrespect her autonomy CC: Nobody should be denied the right to assisted suicide  Is this a tenable argument?

8 The argument from autonomy Problems  The argument from autonomy is not the best argument! Doerflinger: The argument is self-contradictory because life is a necessary condition for the exercise of one’s autonomy. “Suicide is not the ultimate exercise of freedom but its ultimate self-contradiction” Voluntary vs Non Voluntary The argument from autonomy only works for voluntary assisted suicide and euthanasia

9 The Argument from Autonomy Conclusion 1. The argument from autonomy 2. Problems: (a) Suicide in the name of autonomy is self-contradictory (b) Could only work for voluntary cases 1. The argument from autonomy 2. Problems: (a) Suicide in the name of autonomy is self-contradictory (b) Could only work for voluntary cases

10Outline Introduction Important Distinctions The argument from autonomy and its critics The utilitarian argument and its refinement Slippery Slopes and the Pandora Box: Fears vs. Reality Conclusion A controversial distinction: Active vs. Passive Euthanasia

11 The Utilitarian Argument The utilitarian argument: P1: A given action is right if and only if it serves to increase the amount of happiness/ decrease the amount of misery P2: Euthanasia for suffering patients with terminal illnesses decreases the amount of misery CC: Euthanasia for suffering patients with terminal illnesses is right  Is this a tenable argument? Advantage: the argument applies to Voluntary assisted suicide, voluntary and non-voluntary euthanasia.

12 The Utilitarian Argument Problems General Problem for Utilitarianism: Utility vs. Rights The Problem applied to Euthanasia: It seems that the utilitarian argument could be used to justify involuntary euthanasia – against the will Which is of course unacceptable !  The Utilitarian Argument is not acceptable as it is.

13 The Utilitarian Argument Refined by Rachels The utilitarian argument: P1: A given action is right if and only if it serves to increase the amount of happiness/ decrease the amount of misery P2: Euthanasia for suffering patients with terminal illnesses decreases the amount of misery CC: Euthanasia for suffering patients with terminal illnesses is right  The utilitarian argument as refined by Rachels is tenable! and violates no one’s rights Refine d: and in many cases violates no one’s rights

14 The Utilitarian Argument Conclusion 1. The argument from mercy: applies to VAS and euthanasia 2. Problem: Conflict with Rights 3. Solution: Refined argument from mercy 1. The argument from mercy: applies to VAS and euthanasia 2. Problem: Conflict with Rights 3. Solution: Refined argument from mercy

15Outline Introduction Important Distinctions A controversial distinction: Active vs. Passive Euthanasia The argument from autonomy and its critics The utilitarian argument and its refinement Slippery Slopes and the Pandora Box: Fears vs. Reality Conclusion

16 Active vs. Passive Euthanasia The distinction: Killing vs. Letting die Accepted in the US: AMA 1973 “The intentional termination of the life of one human being by another -mercy killing - is contrary to that for which the medical profession stands and is contrary to the policy of the American Medical Association. The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family. The advice and judgment of the physician should be freely available to the patient and/or his immediate family.”  Does this make moral sense?

17 Active vs. Passive Euthanasia Pb 1: Is the distinction morally relevant? Moral Responsibility: Is “passive” euthanasia really passive? - Rachels’ example: Jones and Smith and their cousin in the bathtub – Is Jones’ any less responsible than Smith is of his cousin’s death? - Withhold food and fluids? grand ma, infant - Withhold medication? diabetic  The Distinction is not morally relevant: passive and active euthanasia involve the same moral responsibility

18 Active vs. Passive Euthanasia Pb 2: Which is morally preferable? Example from Rachels: infants with Down Syndrome “I can understand why some people are opposed to all euthanasia and insist that such infants must be allowed to live. I think I can also understand why other people favor destroying these babies quickly and painlessly. But why should anyone favor letting “dehydration and infection wither a tiny being over hours and days”? The doctrine that says that a baby may be allowed to dehydrate and wither, but may not be given lethal injection that would end his life without suffering, seems so patently cruel as to require no further refutation.” (Rachels)  In some cases, active euthanasia seems morally preferable

19 Active vs. Passive Euthanasia Pb 3: Arbitrariness The problem: passive euthanasia: (a) One agrees that it would be better that the unnecessary suffering ends (b) But one waits until a separate health problem “allows” for a quicker death – a chancy event Rachels’ argument: - Either (a) is true, and then our moral action should not depend on irrelevant circumstances - Or (a) is false, and then, not to treat the patient in (b) is wrong  Passive Euthanasia makes our action depend on arbitrary factors

20 Active vs. Passive Euthanasia Conclusion 1. A distinction generally accepted by physicians 2. Problems: (a) The distinction is not morally relevant – no less responsible in the case of passive euthanasia (b) Active euthanasia seems morally preferable in some cases (c) Passive euthanasia makes our action depend on arbitrary factors 1. A distinction generally accepted by physicians 2. Problems: (a) The distinction is not morally relevant – no less responsible in the case of passive euthanasia (b) Active euthanasia seems morally preferable in some cases (c) Passive euthanasia makes our action depend on arbitrary factors

21Outline Introduction Important Distinctions A controversial distinction: Active vs. Passive Euthanasia The argument from autonomy and its critics The utilitarian argument and its refinement Slippery Slopes and the Pandora Box Conclusion

22 Slippery Slopes Fears and Reality Slippery Slopes: Beware! Doerflinger’s slippery slopes: Subtle coercion, economic incentives, substituted judgment, prejudice against people with disabilities etc. The Facts: Oregon’s Death with Dignity Act -Conditions to be eligible -Conditions to receive the prescription -Results?

23 Number of qualifying people: ~ 80,000!

24Outline Introduction Important Distinctions A controversial distinction: Active vs. Passive Euthanasia The argument from autonomy and its critics The utilitarian argument and its refinement Slippery Slopes and the Pandora Box: Fears vs. Reality Conclusion

25Conclusion Argument from autonomy: limited and arguably self- contradictory Utilitarian Argument: refinement protecting rights Passive vs Active Euthanasia: distinction not morally acceptable Slippery Slopes: not supported by available evidence  Fundamental divide: absolute rules vs about serving everyone’s best interest Argument from autonomy: limited and arguably self- contradictory Utilitarian Argument: refinement protecting rights Passive vs Active Euthanasia: distinction not morally acceptable Slippery Slopes: not supported by available evidence  Fundamental divide: absolute rules vs about serving everyone’s best interest