Euthanasia and Moral Philosophy

Euthanasia Lecture Notes

Definitions Related to Euthanasia

Physician-Assisted Suicide

  • Legal in some states like Colorado, Oregon, and Washington.

  • Involves taking a lethal overdose of drugs at home; prescription filled by a physician and dispensed by a pharmacist.

  • Pharmacists can refuse to fill the prescription if they have moral objections.

  • Requirements include:

    • Terminal illness diagnosis (less than six months to live).

    • Confirmation from two doctors.

    • Family awareness.

    • Counseling.

  • Considered a version of euthanasia because it involves suicide rather than direct killing.

Passive Euthanasia

  • Allowed in certain situations.

  • Involves intentionally withholding life-saving treatments by medical professionals to allow a patient to die.

  • Example: A patient in a coma with an advanced directive requesting no life support.

  • Death is caused by omission (withholding care).

Active Euthanasia

  • Illegal in the United States and most countries, but legal in a few (e.g., Netherlands).

  • Involves a doctor or medical professional intentionally ending a patient's life through a positive action.

  • Examples: Overdose of painkillers or lethal injection.

  • Exception: Hospice care allows pain medication beyond normal limits, even if it hastens death, as long as the intention is to relieve pain, not to kill the patient.

  • Active euthanasia is controversial, with debates focusing on its moral permissibility and potential legalization.

Moral Distinction: Killing vs. Letting Die

  • Common moral thinking suggests killing is worse than letting someone die.

  • Example: Drowning a child is considered worse than watching a child drown without intervention.

  • This idea is reflected in medical practices and laws regarding euthanasia.

Facts About Euthanasia

  • Physician-assisted suicide is legal in at least 10 US jurisdictions (possibly more now).

  • Also legal in Switzerland, Germany, Netherlands, Victoria (Australia).

  • Active euthanasia is legal in Netherlands, Belgium, Colombia, Luxembourg, and Canada (with restrictions).

Considerations and Concerns

  • Assisted suicide is allowed more often because doctors aren't required to participate; it occurs in the patient's home, seemingly less morally problematic.

  • Some argue assisted suicide doesn't go far enough because:

    • Some individuals may be physically unable to perform the act themselves.

    • Some may have moral objections to suicide itself.

    • Active euthanasia fills this gap for those unable to end one's own life.

Voluntary vs. Non-Voluntary Euthanasia

Voluntary Euthanasia

  • Patient makes a willful decision to die while alert, rational, and conscious.

  • Medical professionals carry out the decision.

Non-Voluntary Euthanasia

  • Patient is unable to make the decision.

  • Decision is made on their behalf by a proxy decision-maker (family member or specified individual).

  • Situations:

    • Patient is irrational or in a coma.

    • Persistent vegetative state.

    • Unborn fetus or young child.

  • Concerns exist about potential abuse, such as family members acting for malicious reasons (e.g., insurance money).

James Rachels' Thesis

  • There is no legitimate moral difference between active and passive euthanasia because there is no real difference between killing someone and letting them die.

  • Both are equally permissible in the context of a patient dying of cancer who wants to die.

  • Conventional medical ethics, as represented by the American Medical Association (AMA), is mistaken in drawing a distinction based on the idea that killings are inherently worse than letting die.

Conventional Medical Ethics

  • Permissible to withhold treatment and allow a patient to die (passive euthanasia).

  • Never permissible to take direct action to kill a patient (active euthanasia).

  • Dr. Kevorkian's actions (building a "death van" and assisting people to die) were driven by empathy but were illegal. He was viewed as a serial killer.

AMA's Position and Potential Contradictions

  • Most doctors traditionally accept that passive euthanasia is okay, but active euthanasia is seriously wrong.

  • The AMA states active euthanasia is against a doctor's oath to do no harm.

  • Rachels questions whether withholding life-saving treatment (passive euthanasia) is also a form of harm and whether the AMA's justification relies on a contradiction.

  • Alternatively, active euthanasia could be viewed as alleviating harm (suffering) the harm (what's harming them is the disease and the pain), assuming patient consent.

AMA Statement on Euthanasia

  • Intentional termination of life by another (mercy killing) is contrary to the medical profession's principles and AMA policy.

  • Cessation of extraordinary means to prolong life when biological death is imminent is the patient's or family's decision, with the physician's advice available.

Comparison to Animal Euthanasia

  • Active euthanasia is commonly accepted for animals to end suffering.

  • Question: Why is there a different standard for humans, who are forced to endure prolonged suffering in passive euthanasia?

  • Rachels argues no difference justifies treating humans worse than animals in this context.

The More Humane is Better Argument

  • Premise 1: When two policies are otherwise morally equivalent, the policy that reduces suffering the most is preferable.

  • Premise 2: The only morally relevant difference between active and passive euthanasia is that passive euthanasia is often more painful.

  • Conclusion: Therefore, active euthanasia is often morally preferable to passive euthanasia and deserving of legalization.

  • Rachels, a utilitarian consequentialist, believes ethics is about pain, happiness, and consequences.

  • Alternative viewpoints:

    • Sanctity of human life perspective: Human life is sacrosanct.

    • Humans have souls, animals do not.

Support for the More Humane Argument

  • Incurable cancer case: Passive euthanasia (withholding treatment) is justified to end agony when death is inevitable.

  • Less Suffering is Better Principle: When two policies are otherwise morally equivalent, the policy which reduces suffering the most is preferable.

  • Even non-utilitarian moral theories can agree with this principle.

  • Passive euthanasia is longer, causing pain for longer.

  • Active euthanasia, if painless and with consent, removes pain sooner.

  • Rachels argues to contradict this is to contradict the less suffering is better principle and to contradict the AMA’s justification for passive euthanasia.

Critique of the Central Distinction: Killing vs. Letting Die

  • The crucial divergence rests on the claim that passive euthanasia is more agonising.

  • We can hopefully deal with the abuses of policy making in the right way.

  • Killing someone is generally considered worse than letting them die.

  • Legal reflection: Laws often do not mandate intervention to save someone, reflecting a greater aversion to killing versus letting die.

Bare Difference Arguments & Cases

  • Bare difference arguments are constructed by outlining two cases (e.g., Smith and Jones), with only one point of variation between them.

  • Here (Smith and Jones) the variation is between a killing and letting die.

Smith

  • Smith stood to gain a large inheritance if his six year old cousin died.

  • Smith snuck into the bathroom and drowned the child in the bathtub making it look like an accident.

Jones

  • Jones stood to gain a large inheritance if his six year old cousin died.

  • Jones snuck into the bathroom intending to drown the child in the bath.

  • However, prior to Jones’ involvement, the child slipped and lost consciousness and submerged in the water.

  • Is Smith doing something better? Is Jones in a sense a better person? Was Jones' action morally better than Smith's?

  • They're both equally horrible, despicable human beings.

  • Why? The intentions are the same.

Evaluations

  • Rachel's wanted to say that these guys are equally bad people and their actions are equally wrong.

  • Demonstrates that the bare difference between something being a killing and something being a letting die does not matter ethically.

  • Consequently, it proves you can't use that as your reason for saying active euthanasia is worse.

  • After all, passive euthanasia is simply a way of killing someone.

Conclusions on Legal and Ethical Reform of Euthanasia Practices

  • As "letting die" is invariably a form of protracted violence, direct medical assistance can be more morally and legally effective.

  • Challenges the existing legal and ethical views.

Alternate Pond Case

  • Walking by a child, drowning in a pond and not reaching your hand in is an act of murder.

The Motivations and Ramifications Question

  • Did either man behave better from a moral point of view?

  • Rachel's says is going to say no; their behavior is equally reprehensible.

  • Smith has a lot of guilt.

Conclusions About Euthanasia

  • The AMA is mistaken to think that only cases of active euthanasia involve the intentional killing of the patient.

  • There is no distinction between killing and letting die because letting die is just a form of killing.

  • Euthanasia for animals also suggests ending suffering because the action is better.

  • Morally, active euthanasia is better than passive euthanasia. It should be legal