PHL 216 Bioethics Mod 2

competent

able to understand and make informed legal decisions

(both Gillian Bennett and Elizabeth Bouvia were competent)

example of not competent cases

persistent vegetative state

some psychiatric cases

Physician assisted death/suicide

patient gives/ingests the lethal dose, not the doctor

euthanasia (generally)

ending another person’s life for merciful reasons

active euthanasia

killing a patient

passive euthanasia

letting a patient die (ex: withdraw life-sustaining treatment)

voluntary

patient requests death competently

involuntary

patient intends to stay alive

nonvoluntary

patient doesn’t or cannot express wishes

Jack Kevorkian (1928-2011)

“Doctor Death”

assisted people in dying with the thanatron, which allowed the patient to pull the trigger

tried for murder, 8 years in jail, then parole

euthanasia legality in the US?

active is illegal; passive is legal, if conceived as just withdrawing life-sustaining care

physician assisted death US legality

legal in Oregon, Washington, Montana, Vermont, Cali, Colorado, DC, Hawaii, NJ, Maine, and New Mexico

Physician assisted suicide criteria

patient clearly competent

less than 6 months to live

15 day wait before filling the prescription

patient must be able to self-ingest the dose

main moral foundation for medical aid in dying

liberty, care (reduces suffering)

Elizabeth Bouvia (1983)

paralyzed by cerebral palsy, pain from severe arthritis

sought to die, was force-fed

became the precedent for the right to refuse medical treatment (1986)

Dan Brock (1937-2020)

former director of the center for bioethics at harvard medical school

argues for voluntary active euthanasia and physician assisted death to be legal

Brock’s Central Argument: Presumtive case in favor (prima facie)

1. euthanasia respects indiv. self-determination

2. promotes indiv. well-being (peace of mind, less suffering)

3. SO, we should allow euthanasia, unless there are powerful reasons against

Objection to Brock #1: deliberately killing (or helping to kill) an innocent person is always wrong.

Brock’s reply:

1. it is OK to let die, so it’s OK to kill

2. sometimes killing is OK

   1. because killing does not = murder, the unjustified ending of life

   2. killing is only wrong when it deprives someone of a valued future

Objection to Brock #2: Bad policy; sometimes euthanasia is moral, but legalizing it risks unnecessary harm (too many people dying).

Brock’s Reply:

the good consequences outweigh the bad

potential good consequences of legalizing euthanasia

1. respects people’s autonomy (liberty)

2. less suffering (care)

3. peace of mind (sanctity)

4. better ending for some lives (care)

potential bad consequences of legalizing euthanasia

1. lose trust in doctors

   1. brock argues for voluntary euthanasia only, though

2. worse treatment for dying patients

   1. brock points out that it hasn’t happened with the right to refuse treatment (the patients are still taken care of)

3. choosing life will require justification

   1. again, hasn’t happened with the right to refuse treatment

4. lead to involuntary euthanasia

   1. this slippery slope can be stopped with good policies

hypothetical syllogism (good slope argument)

1. if we do x, then y will happen

2. if y, then bad z will happen

3. so, we should not allow x

slipper slope fallacy

if-then connection is weak

Daniel Callahan (1930-2019)

pioneer of medical ethics, founder of hastings center

argues against physician assisted suicide and euthanasia; docs should only let patients die

Euthanasia in the netherlands

1980s physician assisted suicide

2002 voluntary active euthanasia

criteria for euthanasia in the netherlands

1. repeated, non-ambivalent, unpressured, documented

2. doc must consult another doc

3. unbearable suffering(psych of physical), unlikely improvement (doesn’t have to be terminal, though)

Callahan Claim 1: self-determination has its limits

1. patient autonomy doesn’t justify roping others into killing

   1. euthanasia requires 2 people

   2. pressure to participate

2. autonomy can be dangerous and undignified (sanctity)

   1. compares to dueling and slavery (tf??? o_o)

Callahan Claim 2: Bad consequences

1. inevitability of some abuse

   1. difficulties writing/enforcing law

   2. unbearable suffering is subjective

   3. abuse: criteria not met, involuntary euth/other subversions of the law

2. criteria too relaxed

   1. why unbearable suffering (shouldn’t self-determination allow any competent person to end their life)

      1. ex) Mark Langedijk, chose euthanasia to escape alcoholism after 21 rounds of rehab

Dr. Anna Pou

charged with murder of 45 patients at memorial hospital after hurricane katrina

grant jury did not indict her