Physician-Assisted Suicide and Euthanasia II

1
Physician-Assisted Suicide and Euthanasia II

• Arguments Worth Considering

2
A Divisive Debate

• Polls Position on abortion strongly predicts
  position on PAS/VAE
• Polls Religiosity strongly predicts opposition
  to PAS/VAE
• Significant drop in support in minority
  communities vs. whites

3
Good arguments?

• Debate seems to make little progress same
  charges repeated
• Few authors as honest and candid as Kamisar try
  hard to identify the strongest reasons in
  opposition to ones own position and deal frankly
  with them

4
Concerns Worth Hearing

• Minority communities
• Disability rights community
• Still must be careful not to stereotype all as
  agreeing

5
Minority concerns

• Lack of trust in medical establishment
• How come we have had unmet health care needs in
  our neighborhood for years, and when you finally
  show up, its to advocate our right to die?

6
Disability Concerns

• Distrust of medical establishment
• Good will toward persons with disabilities
• Ability to make accurate prognoses
• Allowing person to die because of a disability
  sends wrong message

7
Concerns with Concerns

• Objections apply equally to forgoing treatment,
  PAS, VAE
• Does this position require that persons with
  disabilities devote their lives and health to
  the cause and not their own goals and needs?

8
NYSTF Position Paper

• Safeguards of proponents assumes ideal
  conditions
• Choice of medical care options
• Adequate pain management, hospice
• Quick access to expert psychiatric care
• Basic social support housing, family, etc.
• Too many today lack some or all of these

9
Anti-Hospice Argument

• Claim Allowing PAS will reduce felt need to fund
  and expand hospice programs
• With less availability of hospice will have even
  more people in future seeking PAS (vicious cycle)

10
Anti-Hospice Argument-?

• Data from Oregon show major expansion of hospice
• Most proposals to legalize PAS call for more, not
  less use of hospice as part of safeguards
• Hospice programs per se do not prevent all
  requests for PAS (Oregon)

11
Quills Paradox

• T. Quill May reduce the number of patients
  seeking PAS by openly permitting PAS
• Claim Today many terminal patients commit
  suicide privately because they know physicians
  cannot legally help them

12
Quills Paradox-- cont.

• If PAS legal, patients might seek physicians
  assistance
• Physician could then identify and treat
  depression, uncontrolled pain, etc.
• Treatment of these problems may reduce continued
  requests for death by as much as 8 of 9
  (Netherlands)

13
Argument from Frequency

• Best data show that legal prohibition does not
  eliminate PAS/VAE
• We have little way of knowing whether more
  abuses occur because PAS/VAE is underground
  practice
• Philosophers unfairness-- well-connected get
  PAS/VAE whether legal or illegal

14
Medicalization Argument

• Claim A major problem in society today is
  expecting medical technology to solve problems
  which are really social problems
  (medicalization)
• Legalized PAS is a way of inappropriately
  medicalizing dying, when real comfort comes
  from social, emotional, and spiritual support and
  working thru

15
Medicalization Argument-- II

• Common for PAS advocates to cite loss of control
  of dying process in hospital, etc. as reason
• But legalizing PAS with stringent safeguards
  places control of the process largely in hands of
  physicians
• Inconsistency, or hidden motive?

16
Medicalization Argument- III

• If I had to commit suicide all by myself, as way
  out of terminal illness, I might reaonably shrink
  from the act
• BUT if I can use the physician as a symbol of
  blessing or sanitizing the process I may be
  encouraged to go thru with it

17
Medicalization Rebuttal

• If I try to commit suicide on my own I may botch
  it, or else use messy means which will traumatize
  family
• Wishing to avoid suffering and leaving cruel
  memories among my family are hardly bad reasons
  to seek physicians help

18
Chabot Case

• Netherlands
• Dr. Chabot consulted 8 colleagues before
  assisting suicide of Mrs. B who was incurably
  depressed and begged for help to die
• Court Technically guilty because none of 8
  actually interviewed patient
• Court Mental illness physical

19
Chabot Case-- Concerns

• Did Dr. Chabot truly believe that suicide was the
  best medical option for Mrs. B?
• If not did Mrs. B in effect blackmail Chabot into
  PAS by her threats to commit suicide on her own?
• Shows major division between civil rights and
  physician discretion

20
Hardwig Sympathetic View

• Traditional wisdom (autonomy) Worry if patient
  wishes to die because feels a burden to family
• Could be a sign of coercion or undue influence
• My decision to die ought to reflect my individual
  best interests not concerns of family

21
Hardwig Sympathetic View- II

• Hardwig This view portrays family as fundamental
  conflict of interest rather than loving unit on
  which all of us depend
• Truth is that a chronically ill elderly person
  can be a severe burden

22
Hardwig Sympathetic View III

• Case from Moyers Woman promised mother never to
  put in nursing home
• In caring for mother at home woman lost job,
  home, car, insurance
• If mother could have predicted, should she have
  extracted promise?
• Hardwig If I did that to my family, maybe it
  would be wrong