EUTHANASIA
GREEK FOR “GOOD DEATH”
PUTS INTO QUESTION THE VALUE OF LIFE.
SANCTITY OF LIFE--CATHOLICISM
END OF LIFE ISSUES, WHAT SORT OF
DEATH SHOULD ONE HAVE?
PAIN AND SUFFERING--PALLIATIVE CARE.
DOES IT MAKE SENSE TO SAY A PERSON
HAVE A RIGHT TO A GOOOD DEATH?
EUTHANASIA
ISSUE OF DIGNITY OR DYING WITH DIGNITY
(DEONTOLOGY)
ISSUES IN SCIENCE AND TECHNOLOGY.
PRACTICE OF MEDICINE: HIPPOCRATIC OATH
EUTHANASIA
BILL C-384, A PRIVATE MEMBERS BILL
PRESENTED TO PARLIAMENT.
ENDORSED OR LEGALIZED PHYSICIAN
ASSISTED SUICIDE.
MADE CONSENT MANDATORY AND ALLOWED
PHYSICIANS TO AID A PERSON TO DIE WITH
DIGNITY (TERMINAL ILLNESS AND WITHOUT
PROSPECT OF RELIEF FROM PAIN)
EUTHANASIA
some distinctions:
voluntary euthanasia
involuntary euthanasia
active euthanasia
passive euthanasia
EUTHANASIA
voluntary passive euthanasia: allowing patient to die
as wished.
involuntary active euthanasia: actively using
substance to kill patient, end their life, without
knowledge of their wishes.
involuntary passive: allowing them to dies without
knowing their wishes.
voluntary active euthanasia: actively using means to
end life as wished by subject.
EUTHANASIA
brock and callahan: good to compare and contrast
their articles.
most important contrast: killing and allowing to die.
Brock: the distinction is problematic, confused.
callahan: the distinction is all important and clear.
EUTHANASIA
brock
Brock and Callahan
callahan
Supports Euthanasia and physician
assisted suicide or thinks values
support this.
Opposes both and takes on the
values Brock uses to support his
case.
In both, choice is with patient,
though order of actions differ.
In both, physician and patient act and
therefore both are social interactions,
not simply extensions of self
determination.
Euthanasia is not simply a matter of
Only concerned with voluntary
self-determination but is a social
euthanasia, not withholding or
decision. It follows that doctors share
withdrawing life sustaining treatment.
in the act of killing someone.
Central Argument for V. Euth: Ethical
values of self-determination,
autonomy, dignity and well-being
Acceptance of Euth would sanction
support.
view of autonomy that allows
individuals to access their individual
Avoiding suffering and directing
good at the risk of doing harm to
one’s life and death.
common good.
An individual’s life is not always
good. It can be a burden.
No objective standard for
determining value of life only
person’s judgment.
No individual good should be
elevated above the common good.
Limits of autonomy: slavery and
duels outlawed, etc..
EUTHANASIA
BROCK
CALLAHAN
Value of self-determination
does not compel physicians to
act contrary to their own moral
and professional values. Indeed Self-determination leads to
the medical profession supports increase of power of physician.
this value.
Brock and Callahan
Argues for a confusion between
There is a clear distinction
“killing” and “allowing to die” or
between killing and allowing to
foregoing life sustaining
die.
treatment.
Competent ALS patient
requests that her respirator is
removed. Physician should
comply and most people agree
that this is the right thing to do.
Eradicating the distinction
implies that death from disease
has been or can be banished.
EUTHANASIA
CALLAHAN
BROCK
Mistake: confusing causality with culpability.
B AND C
3 circumstances confirm this. 1. when action of
physician in stopping treatment on a patient with
Suppose: Greedy, hostile son, this act of extubation is
the same as the physicians but is murder not allowing to underlying disease is construed as “causing death.”
die, although son uses this excuse.
Omission of physician only brings about death due
Son acts without patient’s consent, doctor acts with this to patient’s disease.
and with good motives.
Physician acts in social role but the difference means
that the physician acted morally but the son did not.
Sufficient condition is the disease, as cause.
Lethal injection will kill both a healthy and a sick
person.
So, the act itself does not tell us the difference between
killing and allowing to die. They appear to be the same. Omission will not harm healthy person
There is a significant blur
between acts and omissions.
The disease did not kill but the omission of the
physician
but ... emergency medicine?
To say the doctor kills by omission is only a moral
judgment about the illicitness of the omission.
“The only deaths that human beings have invented
are those that come from direct killing.” (412)
EUTHANASIA
BROCK
CALLAHAN
Stopping life is very much like killing.
Killing: I push you overboard and you cannot swim
Allowing to die is letting nature run its course
B AND C:
Allowing to die: You fall in and I do not throw you a
lifejacket knowing you cannot swim.
Euthanasia, hence, cannot be wrong simply because
it is killing instead of allowing to die.
Notice: accepts CMA distinction
Killing is causing the death
CMA:
If Euth is killing, can it still be justified?
Suppose I am wrong and that killing is worse than
allowing to die. What makes killing morally wrong?
Back to earlier problem and Mr. Marquis did not solve
the problem.
Brock does appeal to it, however.
Not all killings are unjustified deaths
“Euthanasia and assisted suicide, as understood here,
must be distinguished from the withholding or withdrawal
of inappropriate, futile or unwanted medical treatment or
the provision of compassionate palliative care, even when
these practices shorten life.”
EUTHANASIA
callahan
Brock
B and C:
I can waive my right not to be killed. This
justifies killing.
This right cannot be waived. Consenting
to be killed is a strange path to the
fulfillment of autonomy.
Like consenting to slavery and
degradation. (Prostitution)
i.e. I consent to have someone eat me.
Allowing euthanasia does not mean that
physicians will be killing.
Prohibition of killing in medical ethics
Physician is dedicated to the opposite,
but see Dutch Case. Dr. Van Ogijen
(2001)
Physicians have a needless burden and
this added power gives doctors too much
power. (Dutch case, but controversy)
Promotes quick judgments for killing in
cases where doctor judges impossibility
of effective treatment.
EUTHANASIA
policy level for
Brock
policy level for
Callahan
We lack firm data on the consequences for
policy; there is a way to write in
No way to enforce or compose meaningful
safeguards against abuse. Abuse will
law that guarantees effective procedural
happen regardless. It is happening now
safeguards.
without a law.
B and C:
There are good consequences: now
possible to respect self-determination of
competent patients who wants it but
cannot get it (Sue Rodriguez)
Bad consequences, etc, Dutch case, main
concerns will be addressed by Brock.
Do not know numbers who are deprived of
this thought his does matter.
In Holland, less than 10% of physicians
It benefits larger groups, as American polls
report their acts of euthanasia. (This was
seem to indicate. Majority support for this
sometime ago and we need current data)
access.
Legal permissibility would insure that
people who wanted it could get it, an
insurance policy of sorts.
Once it is legalized, there are no good
moral reasons to limit it to competent
patients and no way to limit it based on
virtue of absolute autonomy.
EUTHANASIA
brock
Ends suffering when it cannot be
alleviated, when is this? It may be the
only release from agony.
Argument from Mercy is a strong one,
he claims but it can be met by insuring
that patients are provided with
adequate measures of pain relief.
Humane end to life, quickly and
peacefully.
B and C:
callahan
Suffering is judged individually.
Suffering is a function of the values of
the individual . . . (but then . . . )
No way to measure it. But, then the
problem of controlling it follows.
Cannot judge patient’s statement that
her life is not worth living?
Dignity is retained.
Bad Consequences:
David Velleman’s position: making a
new choice available can sometimes
make people worse off. It denies people Bad Consequences:
the alternative of staying alive by
default. This becomes a subtle pressure Undermines trust in doctors and the
to request it.
moral center of medicine.
Does it weaken the general prohibition
against killing?
If allowing to die is killing, then this
prohibition has already been eroded.
Increases power of physicians.
EUTHANASIA
brock
C and B:
callahan
Slippery slope argument: legal
permission leads to morally wrongful
death (Dutch case again, oh boy!)
But the slip intro non-voluntary
euthanasia. Pressures to legal this.
This makes the moral evaluation of
euthanasia more difficult. These are
Is it really true that permitting
Brock’s words and Callahan agrees
euthanasia is a first and fateful step to
with them.
Nazism?
His procedures, page. 405.
Specifies how abuse can be reduced
Any case of abuse is too much.
but nothing can eliminate possible
abuse, like all laws. No law is perfect,
Legal control is an acceptance of
etc.
killing or murder. Dutch case testifies
to this.
Lack of legal control may make the
US slip even more fatally into nonvoluntary euthanasia.
RODRIGUEZ CASE
ARGUED THAT S. 241 B OF THE CRIMINAL
CODE PROHIBITING ASSISTANCE OF SUICIDE,
VIOLATED HER RIGHTS AND SHOULD BE
STRUCK DOWN.
CITED SECTION 7 OF CONSTITUTION:
“EVERYONE HAS A RIGHT TO LIFE, LIBERTY,
AND THE SECURITY OF PERSON AND THE
RIGHT NOT BE DEPRIVED THEREOF EXCEPT IN
ACCORDANCE WITH THE PRINCIPLES OF
FUNDAMENTAL JUSTICE.”
RODRIGUEZ CASE
SOME HIGHLIGHTS:
LAMER: S. 241 B CREATES INEQUALITY;
DISABLED PERSONS CANNOT ACCESS OPTION
OF SUICIDE. IT IS DISCRIMINATORY.
BUT LAMER FINDS THIS SECTION IS JUSTIFIED
BY PARLIAMENT’S OBJECTIVE, THAT OF
PROTECTING VULNERABLE.
RODRIGUEZ CASE
“IT IS NECESSARY AND JUSTIFIABLE TO
THWART THE SELF-DETERMINATION OF SOME
PERSONS WITH PHYSICAL DISABILITIES IN
ORDER TO ASSURE THE PROTECTION OF ALL
THOSE WHO MANY BE VULNERABLE TO BEING
PRESSURED OR COERCED INTO COMMITTING
SUICIDE.”
RODRIGUEZ CASE
Lamer: slippery slope argument is possible.
decriminalization of assisted suicide could increase
possibility of homicide of physically disabled.
but he does not buy the rationality of the legislation.
slippery slope cannot justify the exclusion of
disabled from self-determination.
parliament is not justified in denying to the disabled
the choice of ending life.
RODRIGUEZ CASE
sopinka: disagrees with lamer.
while s. 241 b may infringe right to security, it does
so consistently with principles of fundamental
justice.
infringement on rodriguez is minimal.
reluctant to recognize that law threatens values of
life, liberty, etc. in S. 7 of charter.
RODRIGUEZ CASE
sopinka: charter asserts value of life, sanctity of life.
So no merit to argument that there is in S. 7 an
implied right to end one’s life.
while S. 241 b includes right over one’s body,
depriving rodriguez this autonomy is justified under
fundamental justice.
autonomy and risk of allowing it to be so expansive
to include a danger to personhood.
RODRIGUEZ CASE
role of courts!
sopinka says proper role is not to legislate or make
changes to legislative policy.
appeals to virtue ethics. s. 241 b is legitimate
because parliament’s objective of preserving life is
just.
while appellant (rodriguez) argues that principles of
fundamental justice include human dignity and
autonomy, he is not convinced.
RODRIGUEZ CASE
fundamental justice:
interests of state and individuals must be balanced
and this is role of fundamental justice.
state: protect life and vulnerable.
Individual: have authority over life.
RODRIGUEZ CASE
sopinka cont.
no consensus on decriminalizing assisted suicide,
unlike consensus against abortion law.
medical ethics: courts are right to recognize
individual’s right to refuse treatment.
physicians: applied to them this should not lead us
to change interpretation of homicide provision to
permit p.a.s.
RODRIGUEZ CASE
sopinka identifies a dilemma:
physician in allowing patient to refuse treatment
makes a decision akin to decision to perform active,
voluntary euthanasia.
palliative care: he recognizes that palliative
measures can lead to death.
intention differs though! why are they different?
allowing death and causing death! issue of
causation.
RODRIGUEZ CASE
physicians under guise of palliative care may
commit euthanasia, he admits.
this does not amount to same thing. the act is not
unjust, he admits.
role of intention: easing pain vs causing death.
in end, impairment of s. rodriguez’s right is minimal
and justified. (utilitarianism)
RODRIGUEZ CASE
mclachlin:
argues case is not about discrimination but how far
state may limit right of person over decision about
their body and person.
denial of choice to rodriguez cannot be justified or
saved under principle of fundamental justice.
(identical to law against abortion)
RODRIGUEZ CASE
mclachlin: legislation is arbitrary limitation of selfdetermination.
legislature in decriminalizing suicide intended not to
thwart self-determination.
hence, not consistent with this intent.
inconsistent view of culpability.
RODRIGUEZ CASE
culpability is not criminal in such assistance.
state has not shown that such a law has objective
importance and outweighs individual liberty.
legislative intention is to prevent abuses, not
preventing suicides.
state has not show abuses follow.
Keyserlingk and causality
rodriguez case ignores the complexity of criminal
liability.
this is based on causality and the majority
judgement confuses standard and empirical
causality from normative (moral) causality.
criminal liability based on committing an act, not on
failing or omitting to do something.
Keyserlingk and causality
empirical causality: 5 cases he raises, all indicate
that cause of death is act of physician.
i.e. stopping respirator is an “empirical cause.”
Keyserlingk and causality
normative causality. does not distinguish acts from
omissions.
Good samaritan laws: seinfeld episode.
sopinka’s admission: administering pain medication
is the empirical cause of death.
legal issue: physician’s are relieved of criminal
culpability only because they do not intend to
commit an illegal act.
Kantian aspect: no purpose to act wrong.
Keyserlingk and causality
death is still caused.
implication: physician cannot be brought up on
criminal charges, though s/he causes death.
if so, one can kill if intention is not unlawful, that is
to break a law.
latimer case
Krutzen, Rudy. Argues that Latimer did right for right
reasons.
Issue of Justice. was it done?
question of punishment only arises if what he did
was in fact immoral, Rudy says.
no in-between! if immoral, deserves punishment, if
not, does not deserve punishment.
Law must follow morality, not other way.
latimer case
Consent. how important is this issue?
pain. Was her pain pointless? no one would consent
to be subjected to torture!
compassion as moral principle. Mercy.
real villains: the interest groups.
red herring of the charge: open hunting season on
the disabled. Also slippery slope.
latimer case
need to draw the line. i.e. what constitutes quality of
life?
quality of life is both objective and subjective.
role of emotions. jury is blameworthy.
misplaced compassion and duty. “If law is not
changed, caregivers will continue to find themselves
in guilt-ridden no-win situations.