Euthanasia - Routledge

Decisions at the end of life
What is Euthanasia?
Euthanasia means “a good death,”
or “dying well.”
◦ What is a good death?
With loved ones gathered around
Some Initial Distinctions
Active vs. Passive Euthanasia
Voluntary, Non-voluntary, and
Involuntary Euthanasia
Assisted vs. Unassisted Euthanasia
Active vs. Passive Euthanasia
Active euthanasia occurs in those
instances in which someone takes
active means, such as a lethal
injection, to bring about someone’s
 Passive euthanasia occurs in those
instances in which someone simply
refuses to intervene in order to
prevent someone’s death.
Criticisms of the Active/Passive
Distinction in Euthanasia
◦ Vague dividing line between active and
passive, depending on notion of “normal
◦ Principle of double effect
◦ Does passive euthanasia sometimes
cause more suffering?
Compassion for Suffering
◦ The most important question when
lives are ending is: how do we respond
to suffering?
Hospice and palliative care
Aggressive pain-killing medications
Sitting with the dying
The Sanctity of Life
Life is a gift from God
 Respect for life is paramount
 Importance of personhood
 The approach of Natural Law
 Importance of ministering to the sick
and dying
 See life as “priceless” (Kant)
 Respect for life once the dying
process has begun
The Quality of Life
Peter Singer – low quality of life justifies
ending a life
 BUT what is quality of life – is it more
than can be judged medically?
 Would extraordinary means improve the
quality of life of a patient?
 Refusal of medical treatment
The Right to Die
Do we have a right to die?
Negative right (others may not interfere)
Positive right (others must help)
Do we own our own bodies and our lives?
If we do own our own bodies, does that
give us the right to do whatever we want
with them?
◦ Isn’t it cruel to let people suffer
Two ethical approaches
A Utilitarian approach, which
emphasises consequences
A Kantian approach, which
emphasises autonomy, rights, and
The Utilitarian approach
Goes back at least to
Jeremy Bentham
(1748 – 1832) and
John Stuart Mill
The greatest good
for the greatest
Main Tenets
Morality is a matter of consequences
 We must count the consequences for
 Everyone’s suffering counts equally
 We must always act in a way that
produces the greatest overall good
consequences and least overall bad
The Calculus
Morality becomes a matter of
mathematics, calculating and weighing
 Key insight: consequences matter
 The dream: bring certainty to ethics
What is a good death?
Jeremy Bentham
Hedonistic utilitarians:
a good death is a
painless death.
John Stuart Mill
Eudaimonistic utilitarians:
a good death is a happy
Euthanasia and personal
John Stuart Mill – in matters which do not
concern others, individuals should have
full autonomy
 Should a competent adult be allowed to
decide the time and circumstances of
their death?
The Kantian Model
Central insight: people cannot be
treated like mere things.
◦ Key notions:
 Autonomy & Dignity
 Respect
 Rights
Autonomy & Respect
◦ Kant felt that human beings were
distinctive: they have the ability to reason
and the ability to decide on the basis of
that reasoning.
◦ Autonomy = freedom + reason
◦ Autonomy for Kant is the ability to impose
reason freely on oneself.
Protecting Autonomy
Advanced Directives are designed to
protect the autonomy of patients
 They derive directly from a Kantian
view of what is morally important.
Autonomy: Who Decides?
Kantians emphasize the importance of
a patient’s right to decide
Utilitarians look only at consequences
– but it can justify too much, as there
is no protection for the minority or
safeguarding of the individual’s rights
Many of the ethical disagreements
about end-of-life decisions can be
seen as resulting from differing ethical
frameworks, especially Kantian vs.
 or Quality of Life vs. Sanctity of Life