Lecture 5 Euthanasia cont'

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Lecture 5Euthanasia (cont.)
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Should active euthanasia be permitted?

• If you believe in the sanctity of human life and
  think that causing death is always wrong (for
  example, you believe that life is Gods gift,
  never to be revoked) all the previous
  considerations will not make you support active
  euthanasia. They were all based on the assumption
  that sometimes it was good to end a life (to stop
  suffering, pain, etc.).
• If you dont accept that assumption, you will say
  that it is wrong to kill someone even if he
  expresses a wish to die, simply because you will
  think that this wish is never reasonable.
• Can those who believe in the sanctity of human
  life support passive euthanasia?

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Sanctity of life and passive euthanasia

• If killing is always wrong, it seems that passive
  euthanasia must also be condemned.
• There is a way out of this predicament it is the
  doctrine of double effect (DDE).
• The idea here is that it is morally permissible
  to do something that leads to death, but only if
  the death is a side-effect and not the intended
  effect of that action.
• Example giving someone strong pain killers can
  lead to his earlier death. There are two effects
  here (1) alleviating pain, and (2) causing
  earlier death. According to DDE, it is OK to do
  (2) if the intended effect is (1), and (2) is
  just an anticipated effect. However it is wrong
  to do (2) if (2) itself is intended, and if pain
  killers are used to bring about (2).

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The doctrine of double effect

• There are two different possible actions here
• you intend (1), with the awareness that (2) will
  also happen.
• You intend (2), which you bring about by doing
  (1).
• Obviously, the result of your action is the same
  in both cases. Both (1) and (2) happen, and in
  both cases you are perfectly aware that they will
  both happen. The only difference is that your
  intention is directed at (1) in (a), whereas it
  is directed at (2) in (b).
• Is this small difference a sufficient basis to
  argue that these two actions have a totally
  different moral status, namely that (a) is
  morally OK but (b) is morally wrong?

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DDE applied to passive euthanasia

• Assume that it is anticipated that withholding
  treatment (WT) will lead to death (D). But DDE
  can be used to argue here that choosing WT is not
  as bad as active euthanasia because the intended
  effect is WT (although one knows that D will
  happen as well).
• Patients have a right not to be treated against
  their will even in some cases when this leads to
  death. When the doctors respect that right, this
  does not mean that they intend to kill them!
• Take the case of Jehovahs witnesses who oppose
  blood transfusion. They sometimes die because
  their autonomy is respected, and doctors are not
  blamed for death (for not forcing the blood
  transfusion that would have saved their life).

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Double effect is different from means-end relation

• DDE permits a bad outcome if it is a side-effect
  (unintended).
• Action A produces an intended good effect G,
  which produces an unintended bad effect B.

A
G
B

• Is it then also permissible to do something bad
  (that we dont intend) in order to bring about
  some good effect (that we do intend)?

A
B
G

• Actually, no. If B is a means (instrument) to get
  G, it cannot be unintended. For instance, if my
  goal is to feed my family by robbing a bank, I
  cant say I didnt intend to rob a bank!

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Lives not worth living?

• The idea that some lives are so bad that they are
  not worth living goes against the doctrine of the
  sanctity of human life.
• An issue immediately arising from this idea is
  that some lives are then more or less worth
  living than others.
• The Nazis used a very similar term lebenunwertes
  Leben.
• Those defending euthanasia today protest against
  comparing their views to the policies in Hitlers
  Germany.
• They stress that they are against involuntary
  euthanasia.
• But many of them are consequentialists (including
  Singer), and consequentialists are unable to
  absolutely exclude involuntary euthanasia.
• If we are preference utilitarians, we must allow
  that a desire to go on living can be outweighed
  by other desires (Singer, Practical Ethics, p.99)

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What to do with handicapped and sick?

• If it is all right for parents to kill seriously
  handicapped children, wont this also affect how
  we see adult handicapped people?
• And how about old people with Alzheimers
  disease, who no longer have a concept of
  themselves as subjects of experiences? Is it OK
  to kill them if a talk about their own interests
  becomes dubious and if they become just a burden
  for their relatives?
• Moreover, using the consequentialist logic would
  it not be possible to introduce a duty to die,
  not just a right to die?
• The argument for euthanasia in some sense works
  better for older people than for children because
  in these cases death does not deprive them of the
  value of future like ours.

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Opposition to euthanasia

• If you believe that death is sometimes a better
  option for a person who wants to die, can you
  still be against permitting euthanasia?
• In fact, yes. You can agree with the advocates of
  euthanasia about everything concerning the person
  who wants to die but you can still think that
  euthanasia should not be permitted because of the
  likely consequences of the permission of
  euthanasia.
• In other words, you may not have any
  intrinsically moral criticism of euthanasia, but
  only a purely consequentialist argument against
  it.

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Analogy with abortion

• It very often happens that ones moral attitude
  about a given phenomenon naturally implies a
  defense of a particular policy about that issue.
• For example, if you think that abortion is
  immoral you would naturally advocate a legal
  prohibition of abortion. But suppose that you
  realize that, the world being what it is, this
  would not stop abortions but would just lead to
  abortions being done illegally, under
  uncontrolled conditions, causing more deaths and
  health problems. This could make you oppose the
  legal prohibition of abortion, although you think
  that abortion is wrong and should not be
  practiced.

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Possible negative effects of legalizing euthanasia

• It would be very hard to regulate it.
• There would be less respect for human life.
• People would start requesting euthanasia on a
  massive scale.
• Slippery slope (If voluntary euthanasia is
  allowed, this could make it easier to accept
  non-voluntary or even involuntary euthanasia
  later. Is it a road to reviving the Nazi practice
  of killing sick and retarded?)
• Older and sick people would be pressured to
  request euthanasia (which is not possible if
  euthanasia is not an option).
• The medical profession would lose the trust of
  the patients.

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Can having a choice be harmful?

• It may seem that having more choices cannot be
  bad.
• If you expect A (no other options exist) but are
  then offered a choice between A and B, how can
  this harm you?
• To see that it is not that simple, consider a
  situation where you are invited to dinner. Now
  you have a choice between going to dinner (D) and
  not going to dinner (-D). But before receiving
  the invitation, your only option was -D.
• It is actually possible that you were better off
  before, and that the new option just made the
  situation worse for you.
• Previously, you could have (a) stayed home
  without offending anyone, and now you have a
  choice, say, between (b) attending the dinner you
  dont want to attend or (c) refusing to attend
  and offending someone.
• You prefer (a) to both (b) and (c), but (a) is no
  longer available as an option.

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Can having a choice of euthanasia be harmful?

• Consider a similar situation about euthanasia.
• If euthanasia is illegal then A will die a
  natural death.
• But if euthanasia is legalized, A has two
  options die a natural death or ask for
  euthanasia.
• Suppose that As relatives want him to choose
  euthanasia but he doesnt want it.
• Previously he had no choice, there was only one
  option (a) die a natural death (without
  disappointing anyone)
• Now his choices are (b) choose euthanasia, which
  he actually doesnt want, and (c) die a natural
  death, and disappoint his relatives.
• A prefers (a) to both (b) and (c), but (a) is no
  longer available to him as an option.
• In the end he may choose (b) because he prefers
  (b) to (c).

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A right or pressure?

• Is this the kind of choice...that we want to
  offer a gravely ill person? Will we not sweep up,
  in the process, some who are not really tired of
  life, but think others are tired of them some
  who do not really want to die, but who feel they
  should not live on, because to do so when there
  looms the legal alternative of euthanasia is to
  do a selfish or a cowardly act? Will not some
  feel an obligation to have themselves
  "eliminated?(Yale Kamisar, 1970, 'Euthanasia
  legislation Some non-religious objections', in
  A.B. Downing (ed.), Euthanasia and the Right to
  Die, Humanities Press, New York, pp. 85-133.)

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Euthanasia in practice the case of Holland

• In Holland, both active voluntary euthanasia
  (VAE) and physician assisted suicide (PAS) are
  legalized. The difference between the two is that
  in PAS, the last link in the causal chain that
  leads to the patients death is the patients
  action (e.g. taking the pill provided by the
  doctor). In VAE, in contrast, the last link is
  the doctors action (e.g. giving a lethal
  injection).
• Holland is widely discussed in relation to
  consequentialist considerations about
  legalization of euthanasia because it is the only
  country where euthanasia has been practiced
  legally for a number of years.

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The Dutch guidelines for euthanasia

• The request for euthanasia i.e., VAE must come
  only from the patient and must be entirely free
  and voluntary.
• The patient's request must be well considered,
  durable and persistent.
• The patient must be experiencing intolerable (not
  necessarily physical) suffering, with no prospect
  of improvement.
• Euthanasia must be a last resort. Other
  alternatives to alleviate the patient's situation
  must have been considered and found wanting.
• Euthanasia must be performed by a physician.
• The physician must consult with an independent
  physician colleague who has experience in this
  field.

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The points raised by the critics

• According to some calculations, taking all deaths
  in Holland in 1990, 1 out of 15 deaths was caused
  by euthanasia (more than 9,000 out of 130,000).
• Some patients received euthanasia on the grounds
  of their pointless and empty existence (no
  illness was involved). It seems that the phrase
  intolerable (not necessarily physical)
  suffering was interpreted very broadly.
• Apparently, serious breaches of all the
  guidelines were documented.
• There was not much support for non-voluntary
  euthanasia at the beginning, but this changed in
  a short time, and non-voluntary euthanasia
  increased in frequency.
• After a visit to Holland in 1993, a UK
  fact-finding committee recommended against
  adopting the practice.

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Summary

• The two ways of discussing euthanasia
• Discussing paradigmatic cases, and trying to see
  what is the best moral choice for those involved
• Discussing the consequences of a possible
  legalization of euthanasia
• The debate about (a) turns on questions about the
  sanctity of human life, the doctrine of double
  effect, rights of patients, etc.
• The debate about (b) focuses on empirical issues.
  (What is the correct picture of the Dutch
  experience? Are their negative experiences
  avoidable?)
• Even if the conclusion is in favor of euthanasia
  in (a), it can be reversed by considerations
  raised in (b).