PHL 116 Bioethics - Mod 3 Euthanasia

coma

a state of prolonged unconsciousness, appears asleep

persistent vegetative states (PVS)

a state of unconsciousness in which the patient can appear awake but doesn’t respond meaningfully

not brain death, but almost always irreversible

substituted judgement

what the patient would have wanted if they could decide

with advances in medicine decision making has moved from paternalism to patient authority

Griswold v. Connecticut (1965)

right to contraception, secured by right to privacy

Nancy Cruzan (1957-1990)

PVS at age 25 from car accident; feeding tube kept in besides the parents’ wishes. Court said there was “no clear and convincing evidence: of Nancy’s wish to die

Cruzan v. Missouri Dept. of Health (1990)

allowed states to require “clear and convincing standard” of evidence for patient’s wishes

allowed right of patient to refuse treatment

stimulates the spread of advance directives

Terri Schiavo (1963-2005)

PVS at age 26 from cardiac arrest. Husband wanted to withdraw treatment, parents did not.

Terri’s Law - allows governor to overrule a court decision

Joseph Fletcher (1905-1991)

professor at harvard and virginia, “four indicators of humanhood”

defended “situationist ethics”

a person (rather than just a human)

a being with inalienable rights to life, liberty etc.

usually identified by emotion, creativity, culture, autonomy, self-awareness, and conscience

cardiopulmonary death

death = irreversible cessation of heart function and respiration. the person is dead because a person is a whole functioning human organism

since the 1970s, legal death is typically

brain death

Jahi McMath

parents moved her to NJ, where brain-dead people can be kept alive for religious reasons

whole-brain death

loss of all brain activity

includes the brain stem (thus, no breathing)

higher-brain death

irreversible loss of consciousness

neocortical death

loss of higher cognition (reasoning, self-awareness, etc.)

what type of brain death counts Terri Schiavo as alive?

whole brain death (she did not have this)

Fletcher’s view: a living person must have intact “neocortical function”

facilitates complex thought, sapience (self-awarenes, reasoning)

Fletcher’s arguments for neocortical criterion

1. some alternatives get wrong results

   1. biological view includes entirely brain-dead humans

   2. self-awareness excludes amnesiacs

2. other views aren’t fundamental

   1. self awareness

   2. ability to form relationships

   3. both and more are captured by neocortical function

Terri’s autopsy results: massive brain damage, loss about ½ brain weight, likely blindness

Apply neocortical death and Fletcher to Terri Schiavo

Fletcher would say Terri Schiavo was not still a person.

“the vegetable patient, no matter how many spontaneous vital functions may be continuing, is dead, a nonperson"

James Rachels (1941-2003)

Author of “elements of moral philosophy”

argues for active euthanasia

US euthanasia policy today

active is impermissible

passive is permissible

Rachel’s 2 arguments for Active Euthanasia

1. more suffering - sometimes more humane than passive euthanasia

2. no moral difference between active and passive

Rachels’ example for no difference between killing vs. letting die

choosing to drown a child vs. not helping a drowning child → same moral status/wrongness

therefore, the difference between killing and letting die isn’t in itself morally significant’

(a bit of a strawman fallacy)

Rachels’ no difference argument continued

4. the only difference between active and passive euth. is killing vs. letting die

5. so, these acts should have the same moral value

6. passive euthanasia is clearly moral in certain circumstances

7. thus, active euth. is also moral in certain cicumstances

Philippa Foot (1920-2010)

invented the trolley problem

defended virtue ethics

author of “killing and letting die” and “natural goodness”

Foot’s reply to Rachels no difference premise

“it was never suggested that there will always and everywhere be a difference of permissibility between the two [killing vs. letting die]

Why sometimes a difference”

positive moral duties vs. negative moral duties

the strength/justification of the duties is different

positive duties

duties to provide goods or services

negative duties

duties to not interfere