Life and Death

Life and Death
Dr. Chan Ho Mun
Department of Public and Social
City University of Hong Kong
11-12 December, 2008
Discussion Questions for the
Ballard of Narayama (楢山節考)
• Is morality absolute or relative?
• A challenge to the sanctity of life: Is the
value of life absolute?
• If not, would death penalty for criminals
and their family members be morally
justifiable even for non-murder cases
under some special circumstances?
• Would infanticide, abortion, euthanasia,
and withdrawing/withholding life sustaining
treatment be morally justifiable under
some special circumstances?
• Euthanasia can be defined as a deliberate
attempt undertaken by a physician to
relieve the pain and suffering of a patient
by killing him/her or terminating his/her life
• Supporters of euthanasia believe that the
intrinsic value of life can be overridden by
the principle of autonomy and the welfare
Withdrawing/withholding life
sustaining treatment (LST)
• Does withdrawing/withholding life
sustaining treatment that is medically futile
amount to euthanasia?
• How about artificial nutrition and feeding?
• Letting a patient die naturally could still be
very painful, why not ending the suffering
by euthanasia?
Advance Refusal of Treatments
• Providing treatment to a patient without
consent can be regarded as an assault or
battery of the patient.
• Patients have the right to
contemporaneous refusal of treatment
when they are mentally competent.
• Patients can use advance directives to
express their advance refusal of treatment
before they lapse into mental
Is It a Form of Euthanasia?
• No.
• Argument from Autonomy: The attending
healthcare team just follows the wish of
the patient.
• Argument from Intentionality: The
attending healthcare team has no intention
to kill the patient or hasten his/her death.
Is It a Form of Euthanasia?
• Argument from Futility: If the refused
treatments could only prolong the dying
process and their burdens outweigh their
benefits, they are regarded as medically
futile and the attending healthcare team
does not have an obligation to provide
Is It a Violation of the
Sanctity of Life?
• Not saving the life of a drowning person if
you are in a position or obliged to do so is
morally wrong.
• Yet if a patient is dying, withholding or
terminating treatments that would only
prolong the dying process does not
amount to hastening the death of the
Is It a Violation of the
Sanctity of Life?
• The provision of life-sustaining treatment
to a dying patient may only prolong the
dying process, but saving a drowning
person may not have this consequence.
Three Legal Cases
• 1. Karen Ann Quilian
– Quilian had been in a persistent vegitative
state (PVS) since 1965. In 1976, the New
Jersey Supreme Court ruled that it was lawful
for her father and the doctor to withdraw her
life-sustaining apparatus. The court accepted
that Quilian was in the terminal stage of her
life, indeed dying, and that further treatment
would not save her.
Three Legal Cases
• 2. Nancy Beth Cruzan
– Cruzen fell into PVS after an accident in 1983.
Only after a length legal battle did the US
Supreme Court allow the removal of lifesupport system so that she is allowed to die in
peace in late 1990. Although the right to
decline treatment was recognized, the court
required clear and convincing evidence of the
patient’s wishes.
Three Legal Cases
• 3. Tony Bland
– Bland, a victim of the Hillsborough football
disaster in 1989, was in PVS.
– The ruling of House of Lords in 1993:
• Stopping artificial feeding was an omission
• The doctor was under no duty to continue it
because it was a medical treatment, which was not
in the best interests of the patient as it was
medically futile.
Justifications of Punishment
• Forward-looking justifications
– Deterrence: Punishment is an effective
deterrent against crime.
– Rehabilitation: making the criminal a better
– Incapacitation: prevent the criminal from
turning to crime again.
Justifications of Punishment
• Backward-looking justification
– Retribution:
• An eye for an eye.
• Criminals deserve to be punished.
• The punishment should be in proportion to the
severity of the crime committed.
• Punishment is not merely a means to achieve
social utility.
– Vengeance: the suffering of the criminal can
make the relatives of the victim and the
society feel better.
Arguments against Death Penalty
• Inconsistency: If killing is wrong, executing
a murderer is also wrong.
• The impossibility of rehabilitation.
• Irreversibility: Compensation is impossible
if an innocent is executed by mistake.
• Discrimination: the chance for receiving
death penalty is higher for the vulnerable
(the poor, minorities, and so on),
regardless of the crime rate.
Arguments against Death Penalty
• The uncertainty of the deterrence effect.
• A life term is adequate for incapacitation.
• In terms of proportionality (retribution) and
deterrence, imprisonment for life may be a
better option than death penalty.
• Is “an eye for an eye” always the guiding
• Vengeance is an emotional response. It
could be irrational.
Dead Man Walking:
The Moral of the Story
• Death penalty is morally wrong because it
is inhumane and not fair to the vulnerable
groups in society.
• Yet the following are more important:
– the criminal should take responsibility and
admit his/her guilt.
– The family of the victim should let go and get
out of the hate.
Dead Man Walking:
The Moral of the Story
• Christianity
– Knowing the truth will make you free.
– Life after death (so being executed doesn’t
matter too much)
– Forgiveness.
– Reconciliation
• If people learn the moral of the story, they
may support the abolition of death penalty.
Readings on end-of-life issues
• Chan, Ho Mun, “Euthanasia: Can life become
not worth living?” in Julia Tao and Hektor K. T.
Yan (eds.), Meaning of Life, Singapore: McGraw
Hill, 2006, pp. 263-282.
• Chan, Ho Mun, “Sharing Death and Dying:
Advance Directives, Autonomy, and the Family”,
Bioethics, Vol. 18, No. 2, 2004.
Readings on the three legal cases
• “In the matter of Karen Quinlan: The Supreme
Court, State of New Jersey”, in Albert R. Jonsen,
Robert M. Veatch, and LeRoy Walters (eds.),
Source Book in Bioethics: A Documentary
History, Washington, D.C.: Georgetown
University Press, 1998, pp. 143-148.
• “Cruzan v. Director, Missouri Department of
Health: U.S. Supreme Court”, in Jonsen, Veatch,
and Walters (eds.) (1998), pp. 229-237.
• Luke Gormally, “Walton, Davis, Boyd and the
Legalization of Euthanasia”, in John Keown (ed.)
Euthanasia Examined, Cambridge: Cambridge
University Press, 1995, pp. 113-140
Readings on death penalty
• Nina Rosenstand, The Moral of the Story: An
Introduction to Ethics, 5th edition, Boston:
McGraw Hill, 2005, pp. 224-341, 647-655, 688692.
• Ernest van den Haag, “In Defense of the Death
Penalty”, in Steven M Cahn and Tziporah
Kasachkoff (eds.), Morality and Public Policy,
Upper Saddle River, N.J.: Prentice Hall, 2003,
pp. 206-216.
• Hugo Adam Bedau, “Capital Punishment”, in
Cahn and Kasachkoff (eds.) (2003), pp. 217232.
• Euthanasia
– The Sea Inside
• Death Penalty
– Dead Man Walking
– The Life of David Gale (see Rosenstand, pp.
688-692 for a discussion)
• Abortion
– 伊莎貝拉
– Vera Drake: Wife.Mother.Criminal