Euthanasia and the Right to Die

Frances M. Kamm - A Right to Choose Death?

Frances M. Kamm argues for the moral permissibility of euthanasia and physician-assisted suicide, emphasizing the importance of the patient's greater good, such as ending severe pain. She challenges the notion that preserving life should always override other considerations, especially when death is the only way to alleviate suffering. The central argument is in the second section, focusing on moral rather than legal terms.

Logical Troubles

Kamm addresses the objection that death cannot benefit the person who dies by arguing that death can prevent a worse life filled with uncompensated misery and pain. Therefore, euthanasia and physician-assisted suicide can be aimed at the patient's good, making the concept logically coherent.

A Right to Choose

Kamm presents a scenario where a doctor treats a terminally ill patient in severe pain with morphine, which could hasten death but provides pain relief. She argues that it is morally permissible because the greater good is pain relief, and death is the lesser evil as the patient is already terminally ill. She also addresses the Doctrine of Double Effect, arguing that intending death as a means to relieve pain can be permissible, similar to intending other lesser evils for a greater good, such as amputation to remove cancer.

Kamm constructs a three-step argument for physician-assisted suicide and euthanasia:

1. Causing death as a side effect is permissible if it relieves pain because death is sometimes a lesser evil.

2. Intending other lesser evils for the patient's greater good is permissible.

3. Therefore, intending death to stop pain is permissible when death is a lesser evil.

An Argument for Duty

If a doctor has a duty to relieve pain and being a killer does not override this duty when giving morphine for pain relief, then they may also have a duty to kill or aid in killing to relieve suffering.

Is Killing Special?

Kamm addresses the argument that "death is different" by pointing out that giving lethal morphine also involves killing, which is sometimes approved. She argues that a patient has the option to waive their right to live, releasing others from the duty not to kill them, especially when death is the lesser evil.

She also counters the Kantian argument against intending death, which claims it treats persons as mere means. Kamm distinguishes three ways one may treat a person as a mere means:

1. Giving insufficient weight to the worth of being a person.

2. Treating the nonexistence of persons as a means to a goal.

3. Using persons to bring about their own end.

Kamm argues that only the strongest case for euthanasia and physician-assisted suicide can be made if the overriding aim is to end physical pain. Kamm introduces the idea of a "disjunctive" right: either to adequate pain control or the assistance in suicide of a willing doctor. She proposes a test: would we give a drug to treat psychological suffering if we foresaw that it would rapidly kill as a side effect? If not, then giving pills to a patient intending that they kill him in order to end psychological suffering would not be permissible.

A Philosopher's Brief

Kamm critiques the "philosophers' brief" by Dworkin et al., who argue from the permissibility of omitting treatment with the intention of death, to the permissibility of assisted killing (intending death). She suggests that killing is not on a moral par with letting die, thus a move from Cruzan's right to refuse treatment to the permissibility of assisted suicide is not generally available.

David Velleman - Against the Right to Die

Concerns about Dignity and Autonomy

David Velleman argues against institutionalizing a right to die, questioning arguments based on "dignity" and "autonomy." He worries these terms may reflect cultural obsessions with independence and youth, rather than the Kantian sense of inherent worth. Velleman distinguishes between respecting autonomy (declining to act for reasons that cannot be rationally proposed as valid for all rational beings) and valuing autonomy (maximizing effective options). Velleman says respect for dignity can require facilitating death when dignity is irremediably compromised; however, he believes a person's dignity is compromised only by circumstances that are likely to compromise the capacity for fully rational and autonomous decision-making.

Consequentialist Arguments

Velleman opposes euthanasia as a protected option because it would be immoral in the majority of cases since their dignity as persons would still be intact and advances a consequentialist argument. He assumes patients are infallible in their choice of euthanasia but believes a right to die would harm many by increasing autonomy in an undesirable sense, that some patients may feel a sense of obligation to have themselves eliminated.

The Undesirability of Options

Velleman draws on Thomas Schelling and Gerald Dworkin to argue that options can be harmful, even if exercised beneficially. Options can subject one to pressure, deprive one of desirable unchosen outcomes, or express undesirable implications. He contends the offer of euthanasia may harm some who will be harmed simply by having the option because it will deny them the possibility of staying alive by default, our perception of one another's existence as a given is deeply ingrained. If people come to regard you as existing by choice, they may expect you to justify your continued existence.

Cultural Hostility and the Ethics of Gifts

Velleman argues our culture is hostile to justifying passivity, and those prolonging life may face pressure, even if unspoken. He frames the decision to die as a "gift" to loved ones, but protections for euthanasia would prevent beneficiaries from declining it.

Tacit Permission vs. Explicit Policy

Velleman favors a policy of permitting euthanasia by default (tacit failure to enforce barriers), rather than an explicit law, to avoid pressuring patients and trusts in individual judgment in relationship between physician and patient, and he is convinced that public policy regulating the relation between physician and patient should be weak and vague by design.