Assisted Suicide and
Euthanasia
Michael Wassenaar, PhD
February 16, 2012
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Goals
Identify arguments on both sides of ethical debate
Understand significant ethical distinctions
Practice respectful conversation
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Withholding/withdrawing life support
No ethically relevant distinction between withholding and
withdrawing.
Both are question of harms and benefits.
W/w life support is not assisted suicide or euthanasia.
Intention matters: intention is not to kill, but to prevent harm
and allow disease/condition to run its course
Killing vs. letting die
“[W]hen a patient refuses lifesustaining medical treatment,
he dies from an underlying
fatal disease or pathology; but
if a patient ingests lethal
medication prescribed by a
physician, he is killed by that
medication.”
US Supreme Court, Vacco v. Quill, 1997
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The principle of double effect
Is it ever morally acceptable to administer a drug that may
hasten the patient’s death?
Does this count as assisted suicide?
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Principle of double effect
EFFECT 1
(intended)
ACT
EFFECT 2
(unintended)
Principle of double effect: there is a morally
significant difference between A-E1 and A-E2.
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Principle of double effect
Relieve
symptoms
Administration of
IV morphine
Hasten
death
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Continuous deep sedation
Evidence suggests CDS hastens death
Does the principle of double effect apply?
It depends: Is unconsciousness, or death, the means to
symptom relief?
If death is intended as the means, then it counts as killing (ie,
double effect does not exonerate).
Palliative vs. terminal sedation
Terminology
Suicide: Intentionally ending one’s own life
Assisted suicide: Clinician assists patient to perform an act
that is intended to end his/her life
Euthanasia: Clinician acts intentionally to end a patient’s life
■ From the Greek: eu (good) + thanatos (death)
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Historical context
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Ancient Greece and Rome tended to be tolerant
Hippocrates represented the minority view:
■ “I will neither give a deadly drug to anybody if asked for it,
nor will I make a suggestion to this effect” (Hippocratic
Oath)
Historically, Christianity opposed suicide and endorsed
Hippocratic view
Contemporary context
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Legal in 6 countries: Albania, Switzerland, Belgium,
Netherlands, Luxembourg, Columbia
Legal in 3 US states: Oregon (1994), Washington (2008),
Montana (2009)
Between 1994 and 2010, there were 75+ legislative bills to
legalize assisted suicide in at least 21 states
AMA, ACP, ASIM do not support legalization
MedScape.com survey, 2010
“Should physician-assisted suicide be allowed in some
situations?”
Yes: 45.8%
No: 40.7% It depends: 13.5%
Motivations
Loss of autonomy
Abandonment
Loss of dignity
Burden on family
Inadequate pain/symptom
control
Self-image
Depression
Prospect of long-term care
Finances
In Oregon
Oregon Death with Dignity Act passed in 1994, implemented in
1997.
Safeguards:
 Terminally ill (6 month prognosis)
 Mentally competent
 Confirmed by a second opinion
 Waiting period of two weeks
Lower rates than rest of nation (?)
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Main arguments: Pro
Killing is not always murder (e.g. self-defense, warfare, capital
punishment).
Respects the patient’s autonomy.
Relieves the patient’s suffering.
Safeguards can mitigate abuse.
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Main arguments: Con
It is not our right
Corrupts traditional role of health provider
Erodes trust
Risks abuse
Slippery slope
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Ethical vs. Legal
If one believes assisted suicide may be justified in some cases,
it does not necessarily mean it should be legal.
Recall utilitarianism: What would the consequences be if
something became a general rule?
How to respond?
Clarify the Request
Determine the Root Causes
Affirm Your Commitment to Care for the Patient
Address the Root Causes of the Request
Educate the Patient About Legal Alternatives for Control and
Comfort
Consult With Colleagues
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Source: Endlink Resources for End of Life Care Education.
http://endoflife.northwestern.edu/eolc_physician_assisted_suicide_debate.cfm