EUTHANASIA and PHYSICIAN ASSISTED SUICIDE
CASES:
1. Karen Ann Quinlan: The right to refuse treatment
2. Oregon 1994 Law (in effect 1998) - Physicians prescribe Medications in Lethal Dosage
Doctors only (MD's) Protected-1998 only 15 in 29,000 deaths in Oregon
3. Federal Patient Self Determination ActRequires Notice of State Laws for refusal of treatment including Advanced Directives
Obstacles Preventing the Observance of the Act and Respect for Self Determination
4. The Cruzan Case(1983): a 25 year old with PVS
1990 US Supreme Court (5-4) Decision- a LIBERTY INTEREST
5. Dr. Jack Kevorkian: Dr. DEATH! Physician Assisted Suicide
Michigan Law vs Assisted Suicide; 1998 case, taped for CBS "Sixty(60) Minutes"
6. Elizabeth Bouvia(1983): Demand for Self Determination and Assistance while starving
7. A Canadian Tragedy: 12 year old girl with cerebral Palsy-carbon monoxide poisoning
EUTHANASIA
Meaning of the term: A good Death! An easy death?
Types of Euthanasia?
Active / Passive Distinction
Killing vs Letting Die
Voluntary vs Involuntary
Self Administered - Active Self Administered - Passive
Other Administered Active and Voluntary
Passive and Voluntary
Active and Involuntary Passive and Involuntary
Active non- voluntary
Passive non-voluntary
DEFINING DEATH
Traditional Heart Lung Criteria
Whole Brain Criteria- No Consciousness, No Brain Stem Activity, IRREVERSIBLE COMA
Uniform Determination of Death Act - Adopted by > 35 states not by New York
Higher Brain - Coma with brain stem activity
Personhood- neo cortex- loss of what is essential and characteristic
Dutch Experience- 1993 Rules to allow physicians to assist or to kill people at their request
28 point check list
1990 2300 deaths that were voluntary and 400 assisted suicides
1. Patient-initiated request
2. Patient Competence
3. Informed about alternatives
4. Enduring Decision
5. Unbearable Suffering
6. Professional Consultation
7. Government Report
8. Signed and Witnessed Authorization
Advanced Directives:
Do Not Resuscitate Orders- DNR's
Living Wills
Proxy Appointments-Legal Agents
The Right of Self Determination:
1. Children- guardians make decisions and may not refuse imperative (life saving) procedures
2. Adults
A. Incompetent - court appointed guardian makes decisions and may not refuse imperative 9life
saving) procedures
B. Competent- may refuse any and all treatments:
Exceptions: prisoners and those with dependents may not refuse imperative treatments
C. Formerly Competent and now incapacitated
OPTIONS:

Doctor Decides

Committee of Doctors

Advanced Directives

Document: Living Will

Surrogate: Durable power of Attorney: PROXY


Next of Kin
Court
ETHICAL THEORIES
Natural Law:
No direct termination of a life. Indirect is allowed. Pain relief even unto respiratory failure is
permitted. No moral obligation to treat the hopeless cases. Allowing to die is permitted allowing
nature or God's Will to take their courses.
UTILITARIAN:
Action or inaction that leads to death is correct when it alleviates suffering and promotes the
general welfare and better feelings (utility).
Kant:
Rational agents have the duty to preserve their lives if possible. No deliberate suicide. When
agent is no longer capable of rational thought then there is no longer a duty to preserve that life.
Allowing to die is thus permitted and compatible with Kant's principle even if not required as a
perfect duty.
Ross:
Duty to fulfill promise and a duty to act in a person's best interests.
Rawls:
Maximize Liberty and allow for self-determination. Minimizing the disadvantages allows for
terminating treatments and hastening the death of the hopelessly ill and suffering.
ARTICLES:
James Rachels: Active and Passive Euthanasia

No real Distinction

Crucial Element is Intention
Dan W. Brock: Voluntary Active Euthanasia; a Utilitarian justification
J. Gay-Williams: The Wrongfulness of Euthanasia
1. it is against Nature
2. It is against Self Interest

mistaken diagnosis

chance of cure

pessimism- self defeating
3. Practical Effects
a. Dr's and RN's are committed to saving lives. They would be corrupted to think that there
are occasions when the person (Patient) is better off dead.
b. Slippery Slope!!
from Self Administered to Other Administered

from Voluntary to non-voluntary

from for the benefit of the person to the benefit of
others, society, humankind
Daniel Callahan: When Self Determination Runs Amok
US Supreme Court: Karen Quinlan
Rebecca Dressen and John A. Robertson: Quality of Life and Non Treatment Decisions
Bernard Gert, James L. Bernat, R. Peter Mogielnicki: Distinguishing Between Patients' Refusalas
and Requests
Sandol Stoddard: Terminal But Not Hopeless
DECISION SCENARIOS:
1. Pneumonia and 92 year old male
2. Brain hemorrhage and 81 year old male
3.Five (5) Fatal Diseases in 70 year old male with a Living Will
4. Four deaths of elderly without higher brain functions
5. Shot dead
6.Netherlands Law 1993
7. Female 45 years old with leukemia and an overdose of prescribed medication
8. Flash Fire Victim and surrogate decision making
SUICIDE
What is suicide?
What is required for an act of suicide?
actions or omissions
actions or intentions
outcome or intention
Attempted Suicide
Committed Suicide
How are these to be described?
Suicide? Something else?
Situations:
1
Socrates
2
Jews at Masada
3
Christians in Coliseum
4
Irish in British Prisons
5
Buddhists in Indochina
6
Woman taken by would- be rapist
7
POW's
8
Spies
9
Slaves in the hold of a slave ship
10
Persons in intractable pain
11
persons with an incurable, life threatening, debilitating
12
Persons with an emotional problem in emotional pain
Would you act to prevent any of the acts above if you could?
Should family members be permitted to assist in suicides?
What conditions or safeguards should exist, if any?
Should health care personnel be permitted to assist in suicides?
Should doctors, nurses, others?
What conditions or safeguards should exist, if any?
disease
State Intervention to Prevent Suicide
State Intervention to Compel Life Saving Treatment
Acts of Paternalism!
Issues: Self Determination, Autonomy, Individual Liberty, Competency
with Dependents and Incompetents, the guardian must decide in favor of
treatment if there are such possible that will relieve , rectify or cure.
Only Life Saving Medical Treatment can be imposed on another
ETHICAL THEORIES:
Kant- No
St. Augustine- NO
Hume-Yes
St. Thomas Aquinas- No but maybe yes
RATIONAL SUICIDE - When Death is preferable both NOW and in the FUTURE.
The Role of others? A. To refrain from interference
B. To Assist