Euthanasia

1. Euthanasia

2. In this lecture… • General overview • A right to die? • Arguments for voluntary euthanasia • Arguments against voluntary euthanasia • The slippery-slope argument • Non-voluntary and involuntary euthanasia • Active vs. Passive euthanasia • Physician-assisted suicide • End-of-life care

3. General overview • In earlier periods of human history, physicians could do little to stave off death. Today, improvements in public sanitation, the development of immunization, antibiotics, and other breakthroughs in modern medicine have combined to lengthen the human lifespan, particularly in the developed world.

4. General overview • In the developed world, with its sophisticated healthcare systems, the majority of the population dies at comparatively advanced ages of degenerative diseases – cancer, stroke, heart disease, etc. – with characteristically long downhill courses, marked by a terminal phase of dying.

5. General overview • The developments in medical technology and treatments, which prolong and sustain life, mean that more patients stay alive for longer. • However, the extension of life isoftenassociated with severe pain as well as intense and burdensome treatments for terminally ill patients.

6. General overview • At the same time, there has been progress in the legal acknowledgement of patients’rights. • In many developed nations, patients have the right to refuse unwanted treatment or to discontinue it once it has been started.

7. General overview • Euthanasia is thetermination of a patient’s life in order to relieve him or her of suffering. The following are some related terms and definitions: • Voluntary euthanasia –death is brought about or hastened at the patient’s request.

8. General overview • Non-voluntary euthanasia –euthanasiaconducted where the explicit consent of the individual concerned is unavailable. • Involuntary euthanasia –euthanasiaperformed on a person who is able to provide informed consent, but does not, either because he or she does not choose to die, or because he or she was not asked.

9. General overview • Active euthanasia –hastening death by the use of drugs or other means, with a doctor’s direct assistance. • Passive euthanasia –hastening death by withholding or withdrawing life-sustaining treatment. • Physician-assisted suicide –the practice of a doctor providing the means for a patient to end his or her own life.

10. General overview • Can life become so burdensome, so filled with pain and suffering, that it loses all meaning and value? • Should life be preserved at the cost of continuous suffering when modern medicine makes this possible?

11. General overview • An accident or illness may bring people to an extreme of pain, disability, distress or dependency, so that continued living becomes intolerable. • If there is no reasonable prospect of substantial improvement, perhaps hastening the end of life is the only way to relieve suffering.

12. General overview • While most people think that unbearable pain is the main reason people seek euthanasia, surveys inthe USA and the Netherlands showed that less than a third of requests for euthanasia were because of severe pain.

13. General overview • Terminally ill patients can have their quality of life severely damaged by physical conditions such as incontinence, nausea and vomiting, breathlessness, paralysis and difficulty in swallowing.

14. General overview • Psychological factors that cause people to seek assistance in dying include depression, fearing loss of control or dignity, feeling a burden, or dislike of being dependent.

15. A right to die? • Most countries that put a value on individual liberty allow competent adults to refusemedical treatment even if such treatment is life-saving. • Besides, people have the right to die in the sense that they can choose to commit suicide – attempted suicide has been decriminalized nearly everywhere in theworld.

16. A right to die? • Supporters of the right to die argue that each person has the right to control his or her life and so should be able to determine at what time, in what way and by whose hand he or she will die. • In other words, the notion of ‘autonomy’ entails the right or freedom to make end-of-life decisions for oneself.

17. A right to die? • Some people, however, invoke the right to life (or the ‘sanctity of life’ principle) to justify banning suicide and euthanasia. • According to this view, if we have the right to life, we owe ourselves the duty to keep ourselves alive under any circumstances.

18. A right to die? • Kantians, in particular, believe that persons must be treated as ends in themselves and never merely as means. • Suicide, in Kant’s view, uses oneself merely as a means (by giving up one’s own life) to avoid pain and suffering. For Kant, treating oneself as a mere means debases one’s humanity.

19. A right to die? • Do you think that the terminally ill should have the right to die? Do you think that individuals who have no hope of recovery should have the right to decide how and when to end their lives?

20. A right to die? • It can be argued that the right to die is an integral part of our right to control our own lives. • However, euthanasia is not a completely autonomous act or personal decision in that it requires the assistance of another person.

21. A right to die? • We may have a right to do whatever we like, including ending our own lives, as long as our action does not harm others. • However, even if we havea right to die,it doesnotmean that doctors have aduty to killus (or help us commit suicide) –nodoctors should be forced to help patientswho want euthanasia.

22. A right to die? • Apart from that, end-of-life decisions will affect other people such as one’s family and friends, and therefore a balance may have to be struck between exercising one’s freedom and the consequences of one’s decision for others.

23. A right to die? • There is also thejustifiablefear thatsomeelderly patients might be pressured by family members or health care providers, or by the example of other terminally ill patients, to choose euthanasia.

24. A right to die? • For the elderly, the sick and the disabled, the right to die maybecome a ‘duty to die’. • These people may think of themselves as an unwelcome burden on others. If euthanasia has become a widely accepted option, they may feel under pressure to ask for it.

25. Arguments for voluntary euthanasia • There are two main arguments for voluntary euthanasia: • respect for patient autonomy • the argument from compassion

26. Arguments for voluntary euthanasia • ‘Autonomy’ or ‘self-determination’ refers to people’s right to making important decisions about their lives for themselves according to their own values or conceptions of a good life, and the right to be left free to act on those decisions.

27. Arguments for voluntary euthanasia • In exercising autonomy or self-determination, people take responsibility for their lives. • Since dying is a part of life, choices about the manner of their dying and the timing of their deaths are, for many people, part of what is involved in taking responsibility for their lives.

28. Arguments for voluntary euthanasia • Proponents of euthanasia argue that as long as a patient is free and autonomous, he or she should have a right to self-determination in end-of-life decisions. • They believe that individuals should have the right to control the circumstances of their own deaths and to determine how much suffering is too much.

29. Arguments for voluntary euthanasia • Patient autonomyincludes the right to full information concerning the nature and development of the terminal illness. • Any decision about how to die must be made on the basis of ‘informed consent’.

30. Arguments for voluntary euthanasia • Generally speaking, informed consent exists when patients can understand what they are agreeing to and voluntarily choose it. • Patients should be informed of their diagnosis, their prognosis, their options in responding to their condition and all other relevant information.

31. Arguments for voluntary euthanasia • Counterargument [1]: For a decision about death to be voluntary, the individual must give explicit consent. Patients in an indefinite coma or persistent vegetative state are not candidates for euthanasia.

32. Arguments for voluntary euthanasia • Counterargument [2]: Euthanasia cannot bejustifiablyadministered in cases of serious dementia or clinical depression. Clearly, if a patient is depressed or suffering from a mental disturbance, therapy and counseling–noteuthanasia–shouldbe recommended.

33. Arguments for voluntary euthanasia • Counterargument [3]: We can never be absolutely sure that we have voluntary and informed consent. The pain and drugs mayprevent patients from making a fully rational decision.

34. Arguments for voluntary euthanasia • Another argument for euthanasia is based upon compassion, mercy and beneficence. • In cases of intractable suffering and inevitable death, a spirit of mercy and compassion is supposed to be the correct response to a patient’s desire to die.

35. Arguments for voluntary euthanasia • On this view, life is devoid of quality and meaning to patients subject to severe and unremitting physical or mental suffering. • These patients should have the option of a quick and painless relief.

36. Arguments for voluntary euthanasia • Doctors, as the argument goes, have a duty to do everything within their power to relieve that suffering, even to the point ofhastening death if there are no realistic alternatives acceptable to the patients.

37. Arguments for voluntary euthanasia • Counterargument: Suffering is almost always relievable without killing the patient. Thanks to techniques of pain management and better palliative care, it is possible to treat virtually all pain and to relieve all suffering.

38. Arguments against voluntary euthanasia • There are 3 main arguments against voluntary euthanasia: • the argument from the intrinsic wrongness of killing • the argument from the integrity of the medical profession • the argument from potential abuse (i.e. the slippery-slope argument)

39. Arguments against voluntary euthanasia • One objection to euthanasia invokes the ‘sanctity of life’ principle which claims that all killing is morally wrong. • Humanlife is sacred and intrinsically valuable because it is a gift from God. Deliberately shortening life is against God’s will. Only God should determine the time of death.

40. Arguments against voluntary euthanasia • The deliberate taking of human life should be prohibited except in self-defense or the legitimate defense of others. • ‘Thou shalt not kill’and ‘Man should not play God’are typical objectionsto euthanasiabased on religious faith.

41. Arguments against voluntary euthanasia • Counterargument [1]: In a free, democratic society, the government should respect the right of its citizens to choose their own religious values and therefore should not use the law to enforce the religious views held by some people on others who do not share those views.

42. Arguments against voluntary euthanasia • Counterargument [2]: For those who believe that all matters of life and death must be decided by God, to use medicine to keep a sick person from dying is playing God. If playing God simply means doing what will affect the chances of life and death, then a lot of responsible social action does exactly that (e.g. giving aid to starving children).

43. Arguments against voluntary euthanasia • Counterargument [3]: The trouble with the sanctity of life principle is that it implies that every human being should be kept alive as long as possible, and that is a proposition few thoughtful people would accept. Most would agree, for example, that it is pointless to keep alive patients in an irreversible coma or a persistent vegetative state.

44. Arguments against voluntary euthanasia • Another objection to euthanasia is that there is always the possibility of an incorrect diagnosis or spontaneous remission. • Besides, allowing euthanasia may undermine the commitment of doctors and nurses to saving lives and discourage the search for new cures and treatments.

45. Arguments against voluntary euthanasia • There is also the worry that allowing doctors to abandon their duty to preserve human life could damage the doctor-patient relationship. • Patients could become distrustful of their doctors’ efforts and intentions, thinking that their doctors would rather ‘kill them off’than take care of them.

46. Arguments against voluntary euthanasia • Counterargument: If euthanasia is restricted to cases in which it is truly voluntary, then no patient should fear getting it unless he or she has voluntarily requested it. Patients’trust of theirphysicians could be increased, not eroded, by knowledge that physicians will provide aid in dying only when they ask for it.

47. The slippery-slope argument • One of the main arguments against legalizing euthanasiais the ‘slippery slope’argument. • Critics of euthanasia claim that legalizing voluntary euthanasia will lead to a slippery slope effect, resulting eventually in non-voluntary or even involuntary euthanasia.

48. The slippery-slope argument • They argue that if we permit voluntary euthanasia, then we will be authorizing doctors and nurses to sometimes kill their patients. • Once medical professionals are making decisions about whose life is worth living and whose life is not, then over time our commitment to protecting innocent life will inevitably weaken.

49. The slippery-slope argument • On this view, permitting voluntary euthanasia would weaken society’s prohibition against intentional killing, and thereby undermine the safeguards against ending patients’ lives against their will. • In order to prevent this from occurring, we need to resist taking the first step.

50. The slippery-slope argument • Slippery slope arguments have been used by conservatives and traditionalists to oppose all sorts of social change.But is there sufficient evidence for the slippery-slope argumentagainst euthanasia?