PHI 227 Biomedical Ethics

Some initial distinctions

1. Definition: It is the taking of a direct action to terminate a patient's life Traditionally, "Euthanasia" was used to refer to both taking a direct action to terminate a patient's life and allowing to die. To avoid confusion, we will use it only in the first sense.
2. Voluntary, nonvoluntary, and involuntary euthanasia
   1. Voluntary: when the patient consents
   2. Nonvoluntary: when the patient lacks decision-making capacity and someone else makes the decision for him
   3. Involuntary: when euthanasia is done without the consent or contrary to the wishes of the patient
3. Physician-assisted suicide
   1. The patient carries out the act: swallows a lethal dose of drugs or activates a device. He commits suicide
   2. The doctor helps by providing the means for suicide and/or information; he does not cause death directly.
   3. Degrees of doctor's involvement:
      1. He provides the patient with the information only
      2. He prescribes the necessary drug
      3. He is present, prepares the equipment, the patient pushes the button



4. Arguments in favor of euthanasia

   1. Respect for patient autonomy. Voluntary requests for assistance in suicide or for lethal injections are morally justified; they allows patients to value quality of life more than length of life.
   2. Relief of suffering physical and/or emotional
   3. Provides patients with the opportunity to die with dignity
   4. Reply to the opponents of euthanasia
      1. Euthanasia is not a violation of the value of life principle. Those who undergo euthanasia are no longer persons; they are mere organisms.
      2. The longer people continue to live in pain and with incurable medical problems, the greater the financial and emotional burdens on the family and on society.
      3. Legal safeguards can be clearly established to prevent abuses of euthanasia



5. Arguments against euthanasia

   1. Sanctity of human life
      1. Bible: "Thou shall not kill" (Exodus 20:13).
      2. Koran: "Nor take life -- which God has made sacred -- except for just cause" (Sura XII 33).
   2. Possibility of abuse the acceptance of euthanasia could lead down a "slippery slope" to the killing of the unwanted, e.g., the old, the disadvantaged, and the disabled.
   3. Possibility of mistaken diagnosis
   4. Doubt about how voluntary patient's choice is
   5. It distorts the moral responsibility of doctors. The role of the doctor is to care for his patients not to shorten lives. Euthanasia has undesirable consequences for the doctor-patient relationship
      1. It undermines the trust between them
      2. It weakens doctors'commitment to keep in good health dying patients who refuse euthanasia
   6. Reply to advocates of euthanasia
      1. Suffering can most of the time be relieved
      2. Cures can be found and patients who were thought dead came out of deep comas. Administering euthanasia eliminates these possibilities.



6. Questions about the readings

   1. Quill, "Death and Dignity: A case of Individualized Decision Making"
      1. Why did Diane chose not to undergo treatment?
      2. Did Dr. Quill think that it was the right decision for her?
      3. What did Diane ask Quill for?
      4. What kind of precaution did he take before he decided to help her? What is its moral significance?
      5. What did Quill provide her with? Is that kind of involvement appropriate?
   2. B. Arras, "Physician-Assisted Suicide: A Tragic View"
      1. What is according to Arras the major flaw of the reasoning that underlies the legislation against PAS and active euthanasia?
      2. Arras uses two kinds of slippery-slope arguments against the legalization of APS and active euthanasia, what are they? what is the difference between them?
      3. What criteria should all requests for death meet according to the proponents of PAS and active euthanasia? What is Arras's reply?
      4. Until when does Arras suggest postponing the discussion concerning euthanasia? In the meantime, what does he recommend?