Introduction to Euthanasia
Diana L. Glennie, PhD(c)
MRS 3Y03
March 24, 2014
Which is an example of heteronomous
ethics?
a)
b)
c)
d)
Ethics of care
Virtue ethics
Kantian ethics
Religious ethics
• Heteronomous ethics state that something is good or bad because
someone else says so
• Should avoid use because it evokes moral relativism
Which ethical theory states that the morality
of an action is based on a set of rules?
a)
b)
c)
d)
Deontology
Consequentialism
Virtue Ethics
Ethics of Care
• Example: We shouldn’t murder because murder is bad.
• Problem: Where do we get the idea that murder is bad?
What is Kant’s second categorical imperative?
a) Something is good if and only if it would be good if everyone did it
b) Treat humanity as an end-in-itself and not just as a means to an end
c) If at first you don’t succeed, try, try again
• CI #2 is the origin of the respect for autonomy
• Example: Slavery passes CI#1, but not #2
Which is an example of normative ethics?
a)
b)
c)
d)
e)
Consequentialism
Utilitarianism
Deontology
A&B
All of the above
• Normative ethics are centered around the study of ethical ACTIONS
• Utilitarianism is a subset of consequentialism
• Utilitarianism = “the end justifies the means”
• Consequentialism = “that which maximizes utility”
Who is the father of virtue ethics?
a)
b)
c)
d)
Plato
Aristotle
Epicurus
Confucius
• Virtue ethics focuses on moral virtues (wisdom, justice, etc.)
• Moral virtues walk the line between vices of excess and deficiency
• E.g. Courage is the virtue found between the vices of cowardice
and rashness
Who would have a problem lying to hide a
Jewish person in Nazi-Germany?
a) A deontologist
b) A consequentialist/utilitarian
c) A virtue ethicist
• Deontologist: Lying is always wrong no matter what
• Utilitarian: Lying prevents the unfair persecution of an individual
• Virtue ethicist: In this case, lying is a defiant, courageous act
Your factory burned down in a small town. It will
be cheaper to rebuild in the next city over. As a
subscriber of “ethics of care”, what do you do:
a) You build your factory in the next city to save yourself some money.
b) You don’t rebuild your factory and retire early.
c) You rebuild your factory in the small town despite the monetary
advantages otherwise.
d) You build your factory in China or India to save even more money.
• Your choices should take into consideration how they will impact
certain non-equal groups that you regularly interact with
Which of the following is the framework of all
medical ethics discussions:
a)
b)
c)
d)
Utilitarianism
Deontology
Virtue ethics
The four principles
• Four principles:
• Autonomy
• Beneficence
• Non-maleficence
• Justice
Three of the four principles of medical ethics
are:
a)
b)
c)
d)
Competence, information, non-maleficence
Autonomy, beneficence, justice
Impartiality, prognosis, support
Public acceptance, honesty, freedom
• Four principles:
• Autonomy
• Beneficence
• Non-maleficence
• Justice
Who was the first to write down the four
principles of medical ethics:
a)
b)
c)
d)
James Childress
Tom Beauchamp
Johnna Fisher
A&B
Which of the four principles states that medical
professionals must provide the best medical
treatment for their patients:
a)
b)
c)
d)
Autonomy
Beneficence
Non-maleficence
Justice
• This prevents you from running clinical trials with a known adversereaction cohort
In which of the following is the individual’s
right to autonomy violated:
a) An older woman who refuses to undergo back surgery
b) An older man whose physician and family coerce him to have foot
surgery
c) An infant whose parents elect for surgery to correct a congenital
heart defect
d) An athlete who seeks a second opinion based on his coach’s
suggestion
Which is not correct when determining
competency of a minor:
a) Minors are assumed incompetent and parents must provide
consent
b) Minors must always provide informed assent
c) Minors are always considered incompetent
d) If parents are unfit to provide consent, the courts may do so
• Minors who prove themselves to be mature (Gilick competence) may
be deemed “mature minors” and provide informed concent for
themselves
Which is not true about an autonomous
action:
a)
b)
c)
d)
It is performed intentionally
It is irreversible
It is done with understanding
It is done without controlling influences
• Intentional = Yes or no (black or white)
• With understanding and without influence has degrees
In addition to the three requirements for
autonomous action, what is additionally required
to create autonomous authorization?:
a) It needs to be written down
b) The patient must approach the physician personally
c) It authorizes a professional
• Without this, you have informed refusal
How does legally effective authorization differ
from autonomous authorization:
a)
b)
c)
d)
Authorization was given by the patient’s lawyer, not the patient
Consent is deemed “informed” if it is obtained by legal rules
The physician agrees with the patients choice
It doesn’t
• No way of knowing what degrees of knowing/influence
• Sense-2 authorization should conform with sense-1 authorization
whenever possible
When providing informed consent, which is
NOT a recognized level of information?:
a) The professional practice standard (What information would
another doctor give?)
b) The reasonable person standard (What would an average person
require to understand?)
c) The subjective standard (What does this individual person require
to understand?)
d) The universal standard (Give all information to the patient and let
them choose what to read)
Which was the first declaration regarding the
requirement of voluntary consent from all human
research subject?:
a)
b)
c)
d)
The Belmont Report
Declaration of Helsinki
The Nuremberg Code
The Tri-Council Policy Statement
• The Nuremberg Code followed the Nuremberg Trials (which followed
WW2) in 1948
• 1st point: “The voluntary consent of the human subject is absolutely
essential”
In research, web-based surveys are often used to
gather data. Completing an electronic survey is
known as which form of consent?:
a)
b)
c)
d)
Tacit
Informed
Explicit
Uninformed
• Tacit = understood or implied without being stated
Euthanasia in the news
Euthanasia
• Greek for “good death”
• Refers to the act of intentionally ending a life in order to relieve pain
and suffering
• Semantics:
• Euthanasia = Patient is killed by doctor (e.g. via injection)
• Physician-Assisted Suicide = Patient kills self with drugs provided by physician
• Will discuss euthanasia, but most arguments can be extended to PAS
Classifications
• Voluntary euthanasia
• Conducted with the consent of the patient
• Non-voluntary euthanasia
• Conducted when the patient’s consent is unavailable
• Involuntary euthanasia
• Conducted against the will of the patient
• NEVER legal
Passive vs. Active
• The 3 classifications can be subdivided into passive or active variants
• Passive euthanasia
• Withholding treatment deemed necessary for continued life
• Active euthanasia
• Administration of a lethal substance or force to kill the patient
Creates 4 unique cases
• Voluntary Active Euthanasia (VAE)
• Current up for debate around the world
• Focus of this class
• Voluntary Passive Euthanasia (VPE)
• Generally accepted around the world
• Non-voluntary Active Euthanasia (NAE)
• Non-voluntary Passive Euthanasia (NPE)
• Issues with non-voluntary forms illustrates importance of an advance
directive (living will)
Situation #1
• A middle aged man was involved in a tragic construction accident that
left him in a persistent vegetative state which meant he could not
communicate at all with the outside world. His family has requested
the doctors stop giving him hydration and nutrition – an act which
would ultimately result in his death.
• Question: What type of euthanasia is this?
• Informal poll: Should the doctors accept the family’s request?
Situation #2
• An elderly woman has ALS (Lou Gherig’s disease). With ALS, the
person slowly looses the ability to use their muscles and eventually
dies in great pain and from asphyxiation. She decides that she no
longer wishes to live in the condition she’s in, considering the
prognosis and ultimate death. She asks her doctor to administer a
lethal injection of cyanide to end her life.
• Question: What type of euthanasia is this?
• Informal poll: Should her doctor help her?
Situation #3
• A middle-aged woman also has ALS. She asks her doctor to administer
diamorphine to help manage her mental and physical pain, fully
aware that the drug will shorten her life and lead to an early death.
• Question: What type of euthanasia is this?
• Informal poll: Should the doctor give her the drugs?
Euthanasia in Canada
• Currently: PE is legal, AE is illegal (considered murder)
• The Criminal Code of Canada, section 241(b)
Every one who ….(b) aids or abets a person to commit suicide,
whether suicide ensues or not, is guilty of an indictable offence
and is liable to imprisonment for a term not exceeding fourteen
years
• June 2012 – BC Supreme Court struck down these sections since they
were “overly broad” and negatively impacted those with disabilities
• Currently in appeal
Arguments “For” and “Against” Euthanasia
For:
• Helps preserve quality of life
• Respect for patient autonomy
• Justice
Against:
• Coercion/influence
• Understanding
• Irreversible
• Competence
Next class:
• What’s the difference?
• The Trolley Problem
• The Doctrine of Double Effect
• Acts vs. Omission
• Morality vs. Legality
• Lecture slides available later today:
• Med Phys website  People  Grad Students  Diana Glennie