Velleman's Views on Euthanasia and Choices in Death

Etymology: The term "euthanasia" comes from Greek, where "Eu" means "good" and "Thanatos" means "death". This definition implies that euthanasia signifies a "good death".
Criteria:
- Death must be beneficial to qualify as euthanasia.
- The death must be intended and recognized as good for the patient.

If death is considered good for someone but not intended, then it does not qualify as euthanasia.
If the death is intended but not perceived as beneficial for the deceased, then it is likewise not euthanasia.

Nature of Patients:
- Euthanasia involves patients who are unwilling or unable to take their own lives, resulting in medical professionals either ending their lives or allowing them to die.
Patient's Role:
- In PAS, the patient actively participates in taking their own life, with the doctor's role being to assist by prescribing lethal pills and providing instructions on how to administer them.
Intent of Medical Doctor:
- Euthanasia involves the explicit intention of death by the physician. In PAS cases, the physician may not always intend for the patient to use the lethal pills prescribed, hoping instead that the patient will choose not to proceed with suicide.

There are six variations of euthanasia: three types categorized as Active Euthanasia and three as Passive Euthanasia.
Active Euthanasia involves directly killing (AE), while Passive Euthanasia involves allowing someone to die (PE).
Withdrawing aid may be classified under either Active (AE) or Passive (PE) Euthanasia.

Velleman's Position: He opposes establishing a legal right to die, although he does not object to a moral right to die. A legal right would imply that not only is there permission to die, but also an obligation for the medical doctor to provide assistance upon request.
Misguided Autonomy and Dignity: Velleman argues that contemporary interpretations of autonomy and dignity in the context of death are incorrect.
Independence vs. Dignity: According to Velleman, dignity is not necessarily compromised by the loss of physical independence, as the concept of dignity would imply that all illnesses requiring care would render life undignified.

Velleman's Claim: An increase in choices can be detrimental to an individual's well-being. The assumption that those with more options will always make optimal decisions for their interests is flawed.
Not Advocating Paternalism: He does not advocate for paternalism, which would entail restricting options due to a belief that individuals will choose poorly and harm themselves.

Bargaining Strength: Less choice can empower individuals, as seen with a union leader unable to negotiate due to multiple options diminishing their position.
Increased Danger: A convenience store night cashier may be safer without the option to open the safe; the mere knowledge of having that option increases their risk.
Refusing Invitations: It may be easier to avoid an unpleasant dinner party without an invite, as having the option to decline creates pressure to respond.
Unnecessary Help: A student receiving help they don't need may suffer a loss of confidence, ultimately resulting in actual need for assistance.
Psychological Pressures: The presence of more choices can create stress, challenge one’s self-perception, or result in the loss of comfortable routines without needing to make explicit choices.

Burden of Justification: Velleman suggests that the moral burden associated with justifying ongoing life can render existence unbearable.
Source of Meaning: For a bedridden patient, social interaction may be their sole source of meaning; being perceived as unreasonable could strip them of that meaning.
Perception of Rationality: If a patient does not choose legal death options, they may be viewed as irrational, potentially disqualifying them from meaningful communication.
Cultural Views on Passivity: Our culture typically does not favor lives that require dependency; thus, patients might view their situation as undignified.
Family Pressure: Families may face emotional and financial strains, indirectly pressuring patients to consider death as a relief to others' burdens.
Social Perception of Choice: Patients refusing to die could be viewed as selfish or cowardly, leading to social pressure for them to choose death based on external evaluations.

Support for PAS and Euthanasia: He advocates for both PAS and euthanasia in certain circumstances but is doubtful about creating laws that appropriately distinguish between voluntary and involuntary cases.
Default Legal Framework: He proposes that PAS and euthanasia should be permitted by default, keeping the act of administering death illegal, thereby allowing clinical decision-making without legal constraints.
Doctor-Patient Trust: Some patients have long-term relationships with healthcare providers, ensuring they feel secure in their decision-making; less affluent patients may lack such trust, leaving them vulnerable without rights to end suffering.
Principle of Choice Scenarios: Velleman challenges consideration of ethical scenarios posed by two choices regarding legal rights to die:
- a) Enabling those who want to die legally, despite risks that some who shouldn’t may be pressured into premature death.
- b) Denying the ability to die legally to protect individuals from being pressured into choosing death when their lives maintain inherent value.