1. Applied Ethics Ethical Issues Section 2 Computer Science

2. Ethical Issues Euthanasia

3. Ethical Issue: Euthanasia Euthanasia (good death), also called mercy killing or assisted suicide. Withdrawal of life-support system in “brain death” patient is not considered euthanasia. Passive euthanasia: withdrawal of life-support system of the patient. Active euthanasia: induce death by drugs or other means. Voluntary euthanasia: decision made by the patient himself/herself. Nonvoluntary euthanasia: decision made by persons other than the patient. Assisted suicide: Knowingly giving excess dose of drug that would kill the patient. Dr. Jack Kevorkian (Dr. Death) developed a lethal drug delivery mechanism that allows the patient to trigger the injection himself/herself.

4. Conditions for legal euthanasia in The Netherlands (2000) Repeated voluntary request by the patient. Patient must be faced with unbearable and continuous suffering, though he/she need not be terminally ill. No reasonable alternative is acceptable to the patient. The doctor must consult other physicians who have examined the patient. The physician and not others must provide medically acceptable means to bring about the patient’s death. Children 12-16 who requested it must also have parent’s consent. Physicians were not to suggest this possibility to the patient. Euthanasia cases must be officially reported to authorities. Euthanasia must be approved by hospital’s ethics committee??

5. Reasons to Support Euthanasia Relieve from pain and/or suffering when there is no hope for cure. Relieve from prolonged suffering of people with low quality of life. Relieve mental and financial burden of family. Free up medical resources to help other people. The patient ought to have the freedom to choose, to die with dignity.

6. Reasons Against Euthanasia Devalues human life. Makes other forms of killing more acceptable. It is against nature, in which all life forms struggle to survive. Can become an excuse for family/institution to save money. Contradicts physicians and medical care people’s role to save life. The decision should be God’s and God’s only.

7. Moral Judgment on Voluntary Euthanasia (1) Is there a difference between Active and Passive euthanasia? American Medical Association made the distinction between “active” and “passive” euthanasia. Medical doctors will not initiate or maintain extraordinary means to preserve patient’s life when such means will not serve any useful purpose for the patient or patient’s family. Most medical professionals would allow passive euthanasia, but not active euthanasia. If patient die after non-treatment, then the cause of death is the patient’s disease, not non-treatment. Opposite view: both active or passive euthanasia involves a decision to kill a person. It makes no difference how it is done.

8. Moral Judgment on Voluntary Euthanasia (2) Ordinary vs extraordinary treatment. Ordinary: Surgical procedures, medicines, life-support machines ordinarily available in a hospital, that will offer a reasonable hope of benefit to the patient, without involving excessive pain, expenses, or other inconveniences. Extraordinary: Measures that are unusual, extremely difficult, extremely expensive but do not offer reasonable hope of benefit to the patient. Problem: Sometime it is difficult to decide what is ordinary and extraordinary. Extraordinary treatment in one hospital may be considered ordinary in another. Difficult to decide what is reasonable hope of benefit.

9. Moral Judgment on Voluntary Euthanasia (3) Utilitarian’s or consequentialist’s point of view Act utilitarianism: respecting people’s wish should have beneficial consequences. However, individual’s decision may not always be wise and the consequences may not be beneficial. Further, all althernate treatments (ordinary vs extraordinary) should be considered before deciding if euthanasia would bring about the best outcome. Rule utilitarianism: Should consider whether a policy that allows euthanasia as a rule would be beneficial all the time. If not, as a rule, the decision should be made by hospital ethics committee on a case by case basis. Active/Passive euthanasia: To a utilitarian whether euthanasia is active or passive makes no difference, as long as the action brings benefit to the patient and his/her family. However, whether active euthanasia is acceptable to all concerned should be evaluated.

10. Moral Judgment on Voluntary Euthanasia (4) Kantian’s point of view Freedom of choice: Every person is unique in being able to choose freely. This autonomy should be respected. However, individuals who are stressed or depressed might not think rationally. Natural urge to live: Kant would argue that the urge to live is a good thing and should be a categorical imperative. Euthanasia is contradictary to this. Active/Passive euthanasia: To those who distinguish between active and passive euthanasia, active euthanasia is not acceptable because killing other than self-defense is morally wrong. Ordinary vs extraordinary treatment: How would a Kantian decide?

11. Moral Judgment on Non-voluntary euthanasia Involves decision made by someone other than the patient. Patients who are unable to decide on their own due to mental impairment, unconsciousness, age etc. If the patient had a will or instructed family member when he/she was competent to decide, this is considered voluntary. However, without written instruction, sometime it is not clear. Maybe the patient expressed that view casually without serious consideration. Would the consideration for non-voluntary euthanasia same as that for voluntary euthanasia? No: The individual has no choice Yes: Should be same, search for the best outcome

12. Discussion case (1) Michael Brandon, a 51 year old lawyer had end stage lung cancer, and needed respirator to assist his breathing. The doctors think that he has only 2 months to live. He found the respirator extremely uncomfortable because he was not able to move around. He asked the doctor to remove the respirator to let him die peacefully. His wife and daughter objected to Michael’s decision. What should the doctor do?

13. Discussion case (2) Thomas Levine, a 40 year old man had end stage Huntington Disease. He was unable to walk, talk, feed himself, or clean himself. His mother poisoned him and was arrested by police. Her defense was that her husband, Thomas’ father had the same disease. She had to take care of him for 20 years before he died. Now, in her 70s she can no longer take care of her sick son. What would be your judgment as a juror in her trial?

14. Infant Euthanasia Reasons for infant euthanasia: Infants with severe congenital defects Premature infants Who has the right to decide? Parents Physicians, hospital ethics committee What is considered severe congenital defect? Is infant euthanasia different from or similar to euthanasia of adults?

15. Discussion case Mrs. Brown found out that her 2 weeks old daughter Emily has bowel obstruction that needs surgery to correct it. Earlier her daughter was diagnosed as having Down Syndrome, a genetic disorder that often leads to mental retardation. She asked the doctor not to operate on her baby to let her die naturally of bowel obstruction. What would you do if you were Emily’s doctor?