Bioethics: Autonomy, Organ Donation, and Saving Lives

for research essay: slides on canada’s c-7 bill + Catherine Frazee video

Informed Consent

• Emerged as a concept in the 1950s with serious discussion in the 1970s.

• Shifted focus to the patient's understanding, not just the doctor's disclosure.

• Legal acknowledgment in the 1960s/70s through court cases.

• Physicians initially reacted negatively to informed consent requirements.

Two Senses of Informed Consent (Beauchamp)

• Autonomous, self-determined authorization by patients.

• Legally effective authorization meeting institutional conditions.

• Beauchamp argues only the first truly qualifies as "informed consent."

Informed Consent

(1) As autonomous, self-determined authorization by patients or subjects • (2) As a legally effective authorization by patients or subjects that meets institutional conditions

• Beauchamp claims that only (1) deserves to be properly called “informed consent”

Nondisclosure and paternalism

no appreciation of patient’s right to consent

physicians allows to tailor or withhold information when it would distress the patient and make treatment harder

informed consent helps explain the paternalistic character if this kind of approach

Autonomy

• Etymology: Greek autos (self) + nomos (law).

• Kant: Autonomy as self-determination and using one's own understanding.

• Decisional autonomy: competency (rational decision-making) & authenticity (representing one’s own values)

• Libertarian autonomy: negative freedom from external interference.

Relational Autonomy

• Social conditions impact autonomy.

• Feminist philosophers emphasize relational autonomy.

• Autonomy is fostered or undermined by social context.

Euthanasia

• Greek origin: eu (good) + Thanatos (death).

• 20th century - used in nazi eugenics policy

• Modern usage: Doctor painlessly ending a terminally ill patient's life (active/voluntary).

• Also: Withdrawing life-prolonging measures (passive/indirect).

• Catholicism and Causing Death: “When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life…”

Euthanasia - Types

• Voluntary: Patient consents.

• Non-voluntary: Patient cannot consent.

• Involuntary: Patient is against it.

• Passive: Withholding treatment.

• Active: Actively ending life.

Medically Assisted Death

• Voluntary Assisted Dying (VAD); Med Assistance in dying (MAiD)

• Based on respect for autonomy and beneficence.

• Includes irreversible, not necessarily terminal, conditions.

• Excludes "existential suffering".

Key Premise

• Competent patients can refuse life-prolonging treatment.

• No moral difference between withdrawing treatment and medically assisting death, if requested by a competent patient.

Four Principles for Biomedical Ethics

Respect for Autonomy, Beneficence, Non-maleficence, Justice

Young's Argument

• Defense of voluntary medically assisted death for competent individuals with intolerable suffering.

• Based on autonomous choices and promoting well-being.

• Refusing treatment is a human right.

• Voluntary medically assisted death is as morally justifiable as refusing life-prolonging treatment.

Canada’s C-7 Bill (Medical Assistance in Dying - MAiD)

• Patients must be over 18, competent, and have a grievous/irremediable condition.

• Amends criminal code to permit MAiD even if natural death is not reasonably foreseeable (excluding mental illness as sole cause).

• Truchon vs. Attorney General of Canada: ruled "reasonable foreseeability" unconstitutional.

Catherine Frazee video

she’s a doctor

bill c7 begs the question “why us? why only us?”

“why not everyone that lives outside the margins”

advocates for everyone to be able to choose to end their life and not end their lives in violent means, points out that only certain people get the special pathway to peace

why do they only allow maid for people with disability and not for the main population who die from suicide? is their suffering not worth peace and dignity?

“autonomy be damned”

argues the argument of “not everybody wants to live that way” and points out that nobody wants to live in poverty, poor etc

(20) what position do Radcliffe-Richards et al. argue for concerning kidney