1. Euthanasia and Physician-Assisted Suicide

2. Many Issues Euthanasia as an individual act vs. euthanasia as a public policy Euthanasia as an individual act vs. euthanasia as a public policy Euthanasia vs. physician-assisted suicide Euthanasia vs. physician-assisted suicide Is the patient conscious? Is the patient conscious? Is the patient suffering? Is the patient suffering? Is the patient terminal? Is the patient terminal? If the patient can’t decide, who should make decisions on his/her behalf? If the patient can’t decide, who should make decisions on his/her behalf?

3. What is euthanasia? Deliberate Deliberate Intentional Intentional Taking of a life Taking of a life Of a presumably hopeless person (injured or ill, without prospects for recovery) Of a presumably hopeless person (injured or ill, without prospects for recovery)

4. Arguments for Euthanasia Argument from Mercy Argument from Mercy Argument from the Golden Rule Argument from the Golden Rule Contractarian Argument Contractarian Argument Argument from Liberty Argument from Liberty

5. Argument from Mercy Terminal patients sometimes suffer horrible pain Terminal patients sometimes suffer horrible pain Euthanasia puts an end to such suffering Euthanasia puts an end to such suffering So, euthanasia is justified So, euthanasia is justified

6. Pain and dignity The end of life often includes severe pain The end of life often includes severe pain It may also include a serious loss of dignity— sedation, helplessness, loss of privacy, tubes, respirators, etc. It may also include a serious loss of dignity— sedation, helplessness, loss of privacy, tubes, respirators, etc. It can be in a person’s interests to avoid this It can be in a person’s interests to avoid this

7. Utilitarian Mercy Argument If an action promotes the best interests of everyone concerned, that act is morally acceptable If an action promotes the best interests of everyone concerned, that act is morally acceptable In some cases, euthanasia promotes the best interests of everyone concerned In some cases, euthanasia promotes the best interests of everyone concerned Therefore, euthanasia is sometimes acceptable Therefore, euthanasia is sometimes acceptable

8. Cases Jonathan Swift Jonathan Swift Jack, the cancer patient Jack, the cancer patient The lorry driver The lorry driver Jane Doe, Jane Roe, advanced cancer Jane Doe, Jane Roe, advanced cancer George Kingsley, John Doe, AIDS George Kingsley, John Doe, AIDS James Poe, emphysema James Poe, emphysema

9. Golden rule Golden rule: “Do unto others as you would have them do unto you.” Golden rule: “Do unto others as you would have them do unto you.” Categorical imperative: “Act only on that maxim you can will to be universal law.” Categorical imperative: “Act only on that maxim you can will to be universal law.” So: If you are not willing to have a rule applied to you, don’t apply it to others So: If you are not willing to have a rule applied to you, don’t apply it to others

10. Golden rule argument Would we be willing to have a rule prohibiting euthanasia applied to us? Would we be willing to have a rule prohibiting euthanasia applied to us? Imagine a choice: live to 80, and die quietly and painlessly, or live to 80 + a few days of terrible torment Imagine a choice: live to 80, and die quietly and painlessly, or live to 80 + a few days of terrible torment Which would you choose? Which would you choose? You would want to have the first option You would want to have the first option So, you must allow it to others So, you must allow it to others

11. Contractarian argument The right moral rules are those we would choose in an initial position of fairness, based on our own self-interest The right moral rules are those we would choose in an initial position of fairness, based on our own self-interest It would be in our self-interest to allow ourselves the option of euthanasia It would be in our self-interest to allow ourselves the option of euthanasia So, the right moral rules allow euthanasia as an option So, the right moral rules allow euthanasia as an option

12. Argument from Liberty People should be free to make “deeply personal” choices for themselves People should be free to make “deeply personal” choices for themselves Deeply personal matters: momentous in impact on your life; pose controversial questions about the value and meaning of life Deeply personal matters: momentous in impact on your life; pose controversial questions about the value and meaning of life Religious faith, political and moral values, marriage, procreation, direction of children’s education, death Religious faith, political and moral values, marriage, procreation, direction of children’s education, death

13. Argument from Liberty People should be free to make “deeply personal” choices for themselves People should be free to make “deeply personal” choices for themselves How and when to die is a deeply personal choice How and when to die is a deeply personal choice So, people should be free to decide how and when to die So, people should be free to decide how and when to die So, people should have the option of euthanasia or physician-assisted suicide So, people should have the option of euthanasia or physician-assisted suicide

14. Dangers An agent exercises freedom only if he/she is free (uncoerced), competent, and informed An agent exercises freedom only if he/she is free (uncoerced), competent, and informed We can regulate to require that these conditions be met, having more than one physician verify that We can regulate to require that these conditions be met, having more than one physician verify that Patient is free of pressure or coercion Patient is free of pressure or coercion Patient is mentally competent Patient is mentally competent Patient understands prognosis and treatment options Patient understands prognosis and treatment options If desired, also that the patient is rational, and that his/her choice is stable If desired, also that the patient is rational, and that his/her choice is stable

15. Balancing risks Even if these protections are imperfect— so that, sometimes, a patient who is coerced, or incompetent, or uninformed is euthanized— the alternative of having thousands forced to suffer pain and a loss of dignity against their will is greater Even if these protections are imperfect— so that, sometimes, a patient who is coerced, or incompetent, or uninformed is euthanized— the alternative of having thousands forced to suffer pain and a loss of dignity against their will is greater

16. Arguments against euthanasia Argument from Nature Argument from Nature Argument from Self-interest Argument from Self-interest Argument from Practical Effects Argument from Practical Effects Argument from Tradition Argument from Tradition Argument from Agency Argument from Agency

17. Argument from Nature Every human being has a natural inclination to continue living Every human being has a natural inclination to continue living Euthanasia does violence to this natural goal of survival Euthanasia does violence to this natural goal of survival So, euthanasia is against nature So, euthanasia is against nature So, euthanasia is wrong So, euthanasia is wrong

18. Natural law theory (Aquinas) Eternal law: law of nature governing universe Eternal law: law of nature governing universe Natural law: governs what things should do or be Natural law: governs what things should do or be A thing’s nature determines its function, and thus its virtue (Aristotle) A thing’s nature determines its function, and thus its virtue (Aristotle) So, eternal law determines natural law So, eternal law determines natural law

19. What is natural law? General form: pursue good, avoid evil General form: pursue good, avoid evil Specifics: natural dispositions are guide Specifics: natural dispositions are guide Kinds of natural law precepts: Kinds of natural law precepts: Self-preservation Self-preservation Biological welfare Biological welfare Laws of reason Laws of reason Euthanasia violates the most basic natural disposition, to self-preservation Euthanasia violates the most basic natural disposition, to self-preservation

20. Argument from Self-interest Medical knowledge is incomplete Medical knowledge is incomplete Mistaken diagnosis or prognosis is possible Mistaken diagnosis or prognosis is possible Spontaneous remission occurs Spontaneous remission occurs Experimental technique may work Experimental technique may work Death is final Death is final Chance of error is too great to allow euthanasia Chance of error is too great to allow euthanasia

21. Self-interest Possibility of euthanasia may weaken our will to fight Possibility of euthanasia may weaken our will to fight We may feel pressure, thinking of welfare of family, friends, etc. We may feel pressure, thinking of welfare of family, friends, etc. So, possibility of euthanasia might lead to death of those otherwise capable of survival So, possibility of euthanasia might lead to death of those otherwise capable of survival

22. Practical Effects Argument Corrupting influence on medical profession: “First, do no harm” Corrupting influence on medical profession: “First, do no harm” Doctors and nurses might not try hard enough to save patients, deciding they would be better off dead Doctors and nurses might not try hard enough to save patients, deciding they would be better off dead Decline in quality of medical care Decline in quality of medical care Decline in patient trust Decline in patient trust AMA: “fundamentally incompatible with the physician’s role as healer” AMA: “fundamentally incompatible with the physician’s role as healer”

23. Slippery slope Hopelessly ill person allowed to take own life —> Hopelessly ill person allowed to take own life —> Allowed to deputize others to take life —> Allowed to deputize others to take life —> People act on behalf of others without such authorization —> People act on behalf of others without such authorization —> Euthanasia as social policy, without consent Euthanasia as social policy, without consent

24. Dutch example Netherlands has legalized euthanasia; results have been studied Netherlands has legalized euthanasia; results have been studied Guidelines frequently ignored Guidelines frequently ignored People have been euthanized without consent, without being terminally ill, showing signs of depression, etc. People have been euthanized without consent, without being terminally ill, showing signs of depression, etc. Cases: accident victim, woman with bouts of pneumonia Cases: accident victim, woman with bouts of pneumonia

25. Dutch statistics (1990) Voluntary euthanasia: 2,300 Voluntary euthanasia: 2,300 Assisted suicide: 400 Assisted suicide: 400 Euthanasia without explicit request: 1,000 Euthanasia without explicit request: 1,000 Lethal overdoses without consent: 4,941 Lethal overdoses without consent: 4,941

26. Argument from Tradition In almost every state, in almost every democracy, it is a crime to assist a suicide In almost every state, in almost every democracy, it is a crime to assist a suicide Long-standing expressions of commitment to protect and preserve human life Long-standing expressions of commitment to protect and preserve human life For 700 years, our tradition has criminalized suicide and assisted suicide For 700 years, our tradition has criminalized suicide and assisted suicide

27. Life vs. quality of life State protects life, not quality of life State protects life, not quality of life Danger to vulnerable groups: Danger to vulnerable groups: Poor Poor Elderly Elderly Neonates Neonates Disabled Disabled Mentally ill Mentally ill Membership in stigmatized social group Membership in stigmatized social group Those without access to good medical care Those without access to good medical care

28. Tradition and liberty We recognize a liberty to “deeply personal” choices— but tradition defines the class of protected choices We recognize a liberty to “deeply personal” choices— but tradition defines the class of protected choices Tradition is a good guide (Burke): Tradition is a good guide (Burke): It expresses generations of experience and reasoned judgment It expresses generations of experience and reasoned judgment It balances competing considerations in a way tested by a vast pool of experience It balances competing considerations in a way tested by a vast pool of experience

29. Argument from Agency Severely ill patients often fail to meet conditions of agency Severely ill patients often fail to meet conditions of agency They may be unconscious; who should speak for them? They may be unconscious; who should speak for them? Freedom: They may be pressured or coerced by family, friends, doctors, nurses, or pain Freedom: They may be pressured or coerced by family, friends, doctors, nurses, or pain Competence: They may be depressed Competence: They may be depressed Ignorance: They may have trouble understanding diagnosis and prognosis Ignorance: They may have trouble understanding diagnosis and prognosis Many withdraw consent if pain and depression are treated Many withdraw consent if pain and depression are treated