Ethics Exam 2

According to Daniel Callahan, what are the three "turning points in Western thought" involved in the acceptance of euthanasia?

1. Expansion of the permissibility of killing

2. Elevation of individual autonomy over the common good

3. Redefinition of medicine's goal to promote an individual's private vision of "the good life"

How does Callahan describe the shift in medicine's primary goal under advocates of euthanasia?

It shifts medicine from preserving human health and treating illness to promoting the individualistic pursuit of general human happiness and relieving existential suffering

What four standard arguments or justifications for euthanasia does Daniel Callahan identify and critique?

1. Individual self-determination (autonomy)

2. The lack of moral difference between killing and letting die

3. The lack of evidence for euthanasia's harmful consequences

4. The compatibility of euthanasia with the purpose of medicine

According to J.S. Mill, why is an individual typically best suited to make decisions about their own well-being?

Mill argues that ordinary individuals possess knowledge of their own feelings and circumstances that far surpasses what any outside observer could know.

Under J.S. Mill's framework, under what specific circumstance is paternalistic interference justified?

Paternalism is justified when it prevents an individual from permanently surrendering or constraining their own future liberty (such as voluntarily entering into slavery or servitude).

Why might anti-paternalist arguments against suicide fail in non-terminal cases compared to terminal cases?

In non-terminal cases, paternalistic intervention can preserve future life and autonomy; in terminal cases, one cannot claim the person will benefit later, as death is already imminent.

What are the two distinct legal tracks under Canada's Medical Assistance in Dying (MAID) framework?

Track 1 applies when natural death is "reasonably foreseeable." Track 2 applies when natural death is not reasonably foreseeable.

Under Track 2 of Canada's MAID, what three criteria define a "grievous and irremediable" condition?

(a) A serious illness, disease, or disability; (b) An advanced and non-reversible state of decline; (c) Unbearable physical or mental suffering that cannot be relieved under acceptable conditions.

What three negative social consequences does Callahan argue are "almost certain" to occur if euthanasia is legalized?

1. Abuse of the law

2. Impossibility of precisely drafting and enforcing regulatory laws

3. The "slipperiness" and expansion of moral reasons for requesting euthanasia

How does Callahan argue that combining self-determination and mercy creates a slippery slope?

If self-determination alone justifies killing, any competent person could demand it for any reason; if relief of suffering alone justifies it, denying it to incompetent patients becomes cruel.

What is the modus tollens argument against physician-assisted suicide based on autonomy and suffering?

1. If PAS is permissible for those who are autonomous and suffering, it should be permissible for those who are autonomous but not suffering.

2. PAS should not be allowed for those who are autonomous but not suffering.

3. ∴ PAS is not permissible.

How does Callahan define the boundary of legitimate medical relief of suffering?

Medicine should relieve suffering caused by illness and biological phenomena, but not existential suffering originating from despair over the human condition.

What common objection is raised against Callahan's claim that medicine must strictly focus on biological health rather than human happiness?

Critics object that if medicine cannot address general well-being or non-biological distress, fields like psychiatry and cosmetic surgery would also have to be prohibited.

What is the general bioethical definition of euthanasia?

Directly or indirectly bringing about the death of another person for that person's sake.

What is the key functional difference between active euthanasia and passive euthanasia?

Active euthanasia involves directly causing death (e.g., lethal injection), whereas passive euthanasia involves indirectly causing death by withholding or withdrawing life-sustaining treatment (e.g., removing a feeding tube).

How do voluntary, nonvoluntary, and involuntary euthanasia differ from one another?

• Voluntary: Performed with the competent patient's explicit consent.

• Nonvoluntary: Performed when the patient is unable to give consent (e.g., incompetent or comatose).

• Involuntary: Performed against the explicit wishes of a competent patient.

In Cruzan v. Director, Missouri Department of Health (1990), what evidentiary standard did SCOTUS allow states to require before withdrawing life support?

The U.S. Supreme Court ruled that states have the right to require "clear and convincing evidence" of an incompetent patient's prior end-of-life wishes.

From which constitutional provision did the Supreme Court derive the fundamental right to refuse life-sustaining medical treatment in Cruzan?

The Due Process Clause of the 14th Amendment.

What four state interests are traditionally recognized by courts when reviewing requests to refuse medical treatment?

1. Preservation of human life

2. Protection of innocent third parties

3. Duty to prevent suicide

4. Maintenance of the ethical integrity of the medical profession

Why do courts hold that state interests do not override a terminally ill patient's refusal of care?

They hold that constitutional privacy rights, religious freedoms, and the doctrine of informed consent outweigh state interests when treatment merely prolongs the dying process.

What was the ruling of the Florida Supreme Court in Satz v. Perlmutter (1980)?

An elderly, competent patient with terminal ALS has the constitutional right to have his mechanical ventilator removed to allow natural death.

In Satz v. Perlmutter, why did the court reject forcing a patient to remain on life support against his will?

The court held that forcing treatment inflicts physical torture on the patient's body until death, violating their constitutional right to privacy and self-determination.

How did Bouvia v. Superior Court (1986) expand the right to refuse medical treatment beyond Satz v. Perlmutter?

It extended the right to refuse unwanted medical treatment (forced nasogastric feeding) to competent, non-terminally ill disabled patients who face decades of life.

What central legal argument did the California Court of Appeal use in Bouvia v. Superior Court?

1. If it is permissible for terminally ill patients to refuse care, it is permissible for non-terminally ill patients to refuse care.

2. Terminally ill patients can refuse care.

3. ∴ Non-terminally ill patients can refuse care.

In Washington v. Glucksberg (1998), what constitutional claim did Dr. Harold Glucksberg make against Washington state's ban on PAS?

He claimed that the prohibition on physician-assisted suicide violated a terminally ill patient's liberty interest guaranteed under the Due Process Clause of the 14th Amendment.

What test did the Supreme Court apply in Washington v. Glucksberg to determine if PAS is a fundamental right?

The Court asked whether physician-assisted suicide is a fundamental liberty interest "deeply rooted in this Nation's history and tradition." It held that it is not.

What standard of judicial review applied to state bans on physician-assisted suicide following Glucksberg?

Rational Basis Review. The state only needs a rational basis (e.g., preserving life, protecting vulnerable groups) to justify banning PAS.

What are the three constitutional triggers that elevate judicial review from rational basis review to heightened/strict scrutiny?

(a) Interference with a specific Constitutional right; (b) Interference with the political process; (c) Targeting of a discrete religious or racial minority

What was the core constitutional argument made by the plaintiffs in Vacco v. Quill (1998)?

They argued that NY's ban on PAS violated the Equal Protection Clause by treating terminally ill patients on life support (who can choose to die) differently from terminally ill patients not on life support (who cannot).

How did the U.S. Supreme Court rule on the Equal Protection challenge in Vacco v. Quill?

The Court ruled that state bans do not violate Equal Protection: everyone has the right to refuse unwanted medical treatment, and no one is permitted to assist in suicide.

How did SCOTUS distinguish passive refusal of treatment from active assisted suicide regarding causation in Vacco v. Quill?

When treatment is refused, the patient dies from the underlying fatal disease; when lethal medication is ingested, the patient is killed by the medication.

How did SCOTUS distinguish passive refusal of treatment from active assisted suicide regarding intent in Vacco v. Quill?

A doctor withholding care intends only to respect patient wishes or ease pain; a doctor assisting suicide must necessarily intend primarily that the patient be made dead.

Who were the six prominent moral and legal philosophers who authored "The Philosophers' Brief" in Vacco v. Quill?

John Rawls, Judith Jarvis Thomson, Robert Nozick, T.M. Scanlon, Ronald Dworkin, and Thomas Nagel.

What liberty interest does "The Philosophers' Brief" argue is protected under the Due Process Clause?

The right to make fundamental, personal choices about how and when to end one's life according to one's own deeply held beliefs and moral convictions.

How does "The Philosophers' Brief" use Planned Parenthood v. Casey (1992) to support a constitutional right to PAS?

Casey established that individuals have a right to define their own concept of existence and life's mystery; the Brief argues this principle applies equally to decisions about dying.

What counterexample do the authors of "The Philosophers' Brief" use to show that the distinction between killing and letting die is not morally decisive?

Organ harvesting: It is impermissible for a doctor to kill a patient for organs, but equally impermissible to deliberately let a patient bleed to death to harvest organs against their wishes.

How does "The Philosophers' Brief" answer state concerns about mistake or coercion in PAS?

They argue that risks of error, depression, or coercion exist equally in withdrawing life support—which is already constitutionally protected—so risk alone cannot justify a total prohibition.

What 1973 American Medical Association (AMA) policy statement did James Rachels challenge in his 1975 essay?

The statement condemning the intentional termination of life (mercy killing) while allowing the cessation of extraordinary means to prolong life when biological death is imminent.

What is James Rachels' first argument against the conventional active/passive euthanasia distinction?

Active euthanasia is often more humane than passive euthanasia because passive euthanasia prolongs agony and causes more suffering.

How does the treatment of Down's syndrome infants with intestinal blockages illustrate Rachels' argument about irrelevant grounds?

Infants are allowed to die from dehydration because of a minor intestinal blockage, while those without blockages live; the life-or-death decision is made based on the intestines rather than Down's syndrome.

Describe James Rachels' thought experiment involving Smith and Jones.

• Smith drowns his 6-year-old cousin in the bath to gain an inheritance.

• Jones plans to drown his cousin, but watches the child fall, hit his head, and drown on his own without intervening.

What conclusion does Rachels draw from the Smith and Jones thought experiment?

Since both men acted with identical motives and intended the exact same result, Jones is no less reprehensible than Smith; thus, the bare difference between killing and letting die carries no moral weight.

How does James Rachels respond to the claim that in passive euthanasia "the doctor does nothing"?

Rachels argues that letting someone die is itself a deliberate act (performed by withholding action) that is fully subject to moral evaluation.

Why does Rachels argue that being the physical cause of death is not morally wrong in legitimate euthanasia cases?

Causing death is usually bad because death is an evil; but if euthanasia has been judged desirable, death is no longer viewed as a greater evil than continued existence.

Why do people frequently confuse the moral assessment of killing versus letting die?

They conflate the bare difference between killing and letting die with the fact that most real-world killings are maliciously motivated (murders), while most instances of letting die are compassionately motivated.

What is the key takeaway of Satz v. Perlmutter (1980)?

Florida Supreme Court decision establishing that a competent elderly patient with advanced terminal ALS has a constitutional right to remove life support.

What is the key takeaway of Bouvia v. Superior Court (1986)?

California Court of Appeal decision holding that a competent, permanently disabled patient has the right to refuse forced medical feeding even if not terminally ill.

What is the key takeaway of Cruzan v. Director, Missouri Department of Health (1990)?

SCOTUS ruling affirming a constitutional right to refuse medical treatment under the Due Process Clause, while permitting states to require clear and convincing evidence of intent.

What is the key takeaway of Washington v. Glucksberg (1998)?

SCOTUS ruling that the Due Process Clause does not grant a fundamental right to physician-assisted suicide, leaving regulations to state legislation.

What is the key takeaway of Vacco v. Quill (1998)?

SCOTUS ruling that state bans on physician-assisted suicide do not violate the Equal Protection Clause because refusing treatment differs legally from assisting suicide.

What distinction does the Due Process Clause make regarding liberty interests in end-of-life cases?

It protects the liberty interest to refuse unwanted medical intervention (body integrity), but does not protect a generalized liberty interest to receive medical assistance in dying.

In bioethics, how does physician-assisted suicide (PAS) differ from active euthanasia?

In PAS, the physician provides the lethal means (e.g., a prescription), but the patient self-administers it; in active euthanasia, the physician directly administers the lethal agent (e.g., lethal injection).

How did the UK case of Paul Sagar challenge simple assumptions about autonomy and PAS?

Sagar sought PAS in Switzerland after becoming quadriplegic; blocked by bureaucracy, he later expressed gratitude that he had not completed it, showing that despair-driven requests can change over time

What case from Canada illustrates concerns about expanding MAID to young individuals with non-terminal conditions?

The case of Kiano Vafaelan, a 26-year-old with Type-1 diabetes complications and depression who received MAID under Canada's non-reasonably foreseeable death track.