EUTHANASIA

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EUTHANASIA
Edvard Munch, Death in the Sickroom,1895
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Doctors Must Not Kill
Edmund D. Pellegrino
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SUFFERING AND EUTHANASIA

• Pellegrino is a physician and writes about
  euthanasia from that perspective.
• His position is that, while doctors have a duty
  to alleviate suffering, they cannot knowingly and
  willingly involve themselves in the death of a
  patient.
• And this is the case even if the patient requests
  it. Thus his view is opposed to voluntary active
  euthanasia as well as to nonvoluntary and
  involuntary euthanasia.

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PELLEGRINOS POINTS

• Although Pellegrino says that No one can
  reasonably oppose a good death, he is opposed
  to euthanasia even out of compassion for the
  following reasons.
• 1. Moral arguments for euthanasia are not
  convincing.
• 2. Euthanasia distorts the healing relationship
  between doctor and patient.
• 3. Euthanasia is likely to be abused by society,
  and so can have terrible social consequences.

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ARGUMENTS FOR EUTHANASIA I

• Those who argue for euthanasia typically say the
  following basic things
• 1. Euthanasia eliminates suffering, suffering is
  evil, and so euthanasia is good because it
  eliminates suffering.
• 2. People who are suffering from a terminal
  illness have the right to choose not to suffer.
  And if euthanasia is the only means of ending
  suffering, then those suffering have the right to
  end their suffering by ending their lives. This
  is the principle of autonomy.
• 3. Terminally ill patients cannot end their own
  lives, but depend on doctors who know best how to
  do it. Here a doctor acts as an agent on behalf
  of the patient.

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ARGUMENTS FOR EUTHANASIA II

• 4. Because part of a doctors moral duty is to
  end suffering, she has a moral duty to assist a
  patient in obtaining a good death when that is
  the patients desire.
• 5. There is no moral difference between a
  doctors killing a patient and letting her
  die. Rachels.
• 6. Abuses of euthanasia can be controlled by
  legislation.
• 7. No physician who is morally opposed need
  participate.

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EUTHANASIA AND RELIGION I

• Two arguments against euthanasia from the
  Judeo-Christian tradition are
• 1. Humans are given the gift of life and have no
  right to interfere with this gift. Plato.
• 2. Even human suffering can have meaning, that
  is, it can be meaningful in a positive way.
• Although Pellegrino thinks that these arguments
  are not lightly dismissed, he says that he will
  not try to make his argument against euthanasia
  by appeal to these things. And this is because
  Even without recourse to religious beliefs,
  active euthanasia is morally untenable.

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EUTHANASIA AND RELIGION II

• Pellegrino does say, however, that these are
  beliefs which are deeply rooted in our culture,
  and because they are so deeply rooted, he thinks
  that the burden of proof is on the person who
  argues against these beliefs in arguing for
  euthanasia.
• The idea here then is that someone who wants to
  argue against tradition and common opinion must
  give good reasons for doing so, and he thinks
  that the arguments offered in favor of euthanasia
  are not proof that it is morally acceptable.

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KILLING AND LETTING DIE I

• Pellegrino will first look at the idea made by
  some advocates of euthanasia that there is no
  moral difference between killing a patient and
  letting him die by deliberate withdrawal or
  withholding of life support or lifesaving
  treatment.
• The moral parity of killing and letting die can
  be understood to have two aspects whether it
  concerns a moral good or a moral evil.
• That you are as guilty of a wrongdoing if you let
  someone die whose death you could have prevented
  as you are in killing her is to see killing and
  letting die as equally morally evil.
• On the other hand, if letting someone die -
  passive euthanasia - is a moral good because it
  ends suffering, then why is not killing someone
  to end suffering - active euthanasia - also not a
  moral good? Arent these equally morally good?

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KILLING AND LETTING DIE II

• For Pellegrino, the difference is that in active
  euthanasia the doctor is the direct cause of the
  patients death, whereas in letting the patient
  die or passive euthanasia the illness is the
  cause of death.
• Therefore he does not see them as morally
  equivalent because in the first case the doctor
  does something and in the second instance he does
  nothing.

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KILLING AND LETTING DIE III

• James Rachels response is that it is not true
  that in passive euthanasia the doctor does
  nothing.
• After all, he lets the patient die, and letting
  someone die can be subject to moral evaluation -
  good or bad - as we have seen.
• Rachels says that if passive euthanasia is seen
  as medically acceptable, then that is because it
  is seen that death is an equal or lesser evil
  than suffering.
• And if passive euthanasia is acceptable to
  eliminate the equal or greater evil of suffering,
  then, for Rachels, so is active euthanasia.

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EUTHANASIA AND AUTONOMY I

• Pellegrino next looks at the argument for
  euthanasia based on the patients right of
  autonomy.
• The right of autonomy is the right to
  self-determination - to make free choices for
  yourself.
• This could include a terminally ill patients
  right to choose to die to end her pain and
  suffering. The idea is whose life is it anyway?

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EUTHANASIA AND AUTONOMY II

• Pellegrinos problem with the right to autonomy
  is that, in exercising her right to die, a person
  is using her freedom to give up her freedom.
• Thus, in the name of autonomy the patient decides
  to end the life which makes autonomy possible.
• When you give up your life you give up
  everything, including your freedom and control
  over a whole set of options, all of which cannot
  be foreseen and many of which would be of
  importance if life - the basis of freedom - had
  not been forgone.

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EUTHANASIA AND AUTONOMY III

• However, a proponent of euthanasia might argue
  that a dying patients using freedom to eliminate
  freedom is not a contradiction but is simply a
  use to which freedom is practically put, given
  his illness and suffering.
• And it might be further argued that, if the
  medical condition of the patient is such as to
  restrict or eliminate all future meaningful
  options, then the most meaningful thing for
  freedom to do is to eliminate the life which
  supports the suffering.

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EUTHANASIA AND AUTONOMY IV

• Pellegrino also says in regard to autonomy that,
  if the patient chooses death because of
  unbearable suffering, then the choice of death is
  really not free.
• But again, a euthanasia advocate might argue
  that, even if this is the case, and the patient
  is powerless to act otherwise, euthanasia can yet
  be seen as the only option to eliminate the evil
  of suffering.
• And here autonomy could yet be relevant in the
  patients having made the free choice to opt for
  euthanasia if such a medical condition as he now
  experiences were ever to arise. The patient
  would have simply exercised his freedom earlier
  in his life by planning for such an event through
  a will.

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THE BURDEN OF TERMINAL ILLNESS

• Pellegrino says that terminally ill patients
  often see themselves as social, economic, and
  emotional burdens to others.
• And in their debilitated condition they may be
  susceptible to subtle suggestion - such a
  doctors agreeing that they are a burden. They
  could then decide to choose euthanasia.
• For Pellegrino, euthanasia is too often an act
  of desperation - an act that could be avoided if
  pain is properly managed.
• But what about the cases where pain cannot be
  properly managed? And what about the medical
  conditions which are so terrible that modern
  medicine can do nothing for them?

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KINDNESS AND COMPASSION I

• Advocates of euthanasia will cite kindness and
  compassion as reasons for ending through death
  the terrible suffering of a terminally ill
  patient.
• Pellegrino recognizes that compassion is part of
  medicine, since every doctor desires to make his
  patients well, and he recognizes that even those
  who see meaning in suffering would prefer that
  someone not suffer.
• Do not compassion and mercy then override all
  other considerations?

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KINDNESS AND COMPASSION II

• The answer to this, for Pellegrino, is that
  compassion can concern removing the dying
  patients pain without resorting to euthanasia.
• By removing a patients pain, he can experience a
  good death - the one which nature intended.
• Pellegrino The aim of medicine should be to
  facilitate a death that is as pain-free as
  possible but that is also a human experience.

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DYING, EXPERIENCE, AND UNDERSTANDING

• Euthanasia of humans is morally unacceptable for
  Pellegrino because they have the capacity to
  understand the experience of dying, and possibly
  benefit from it, whereas such understanding is
  not possible for other lower life forms such as
  our pets.
• The experience of dying is important for
  Pellegrino since humans can grow morally even
  with negative experiences.
• Notice that dying can be treated as an experience
  for a person who is conscious while his life is
  ending, whereas death, at least from the
  perspective of life on earth, is the end of all
  experience.
• See the first two full paragraphs on page 176
  and compare with the questions for Pellegrino on
  the handout.

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THE MOTIVATION FOR EUTHANASIA

• Pellegrino says that The motivation for
  euthanasia arises principally from two worries
  fear of intolerable pain, suffering, and anguish,
  and fear of becoming a victim of overzealous
  physicians and dehumanizing medical
  technologies.
• Although Pellegrino recognizes that both of these
  are legitimate worries, he thinks that each can
  be handled without resort to euthanasia through
  improved measures for relief of pain and
  anxiety which physicians have a moral obligation
  to use, and through hospice programs and
  palliative care.

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MAKING DYING POSITIVE

• With the help of such programs, dying, according
  to Pellegrino, can be a communal experience, in
  which the dying person contributes something
  positive to those around her as well as to her
  own growth as a person.
• And Pellegrino thinks that the physicians
  obligation to act beneficently and to show
  respect for the patients dignity is better
  served by these measures than by killing the
  patient.

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MAJORITY OPINION

• Pellegrino points out, correctly, that that the
  majority of people believe something does not
  make it morally correct or incorrect. Thus
  comment consent does not guarantee the truth of
  whatever it is about which the majority agree,
  and philosophical argument with relevant evidence
  must be established to determine the truth of
  something, not popular opinion.
• If the majority is in favor of euthanasia that
  does not in itself show that euthanasia is
  morally correct, and if most people are against,
  that majority opinion also does not show that
  euthanasia is immoral.

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DISTORTING THE HEALING RELATIONSHIP I

• According to Pellegrino, euthanasia distorts the
  healing relationship between doctor and patient.
• A doctors aim is to heal her patient if
  possible, and if that is not possible, then the
  physician has an obligation to treat the
  patients pain to the best of her ability.
• Notice that he says this in spite of his respect
  for the moral value of suffering. Is this a
  problem for his view?
• Pellegrino notes that medicine is grounded in
  trust, and he thinks that euthanasia could
  destroy that trust.

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DISTORTING THE HEALING RELATIONSHIP II

• Euthanasia could destroy the patients trust of
  his doctor since, if euthanasia were legal, then
  some doctors might opt for killing their patients
  rather than healing them.
• The doctor who thinks his patient is better off
  dead might try to convince his patient to end his
  life rather than waiting to die naturally.
• This is the slippery slope idea that if we
  legalize euthanasia then abuses of the system
  would inevitably occur, human nature being what
  it is.

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A SLIPPERY SLOPE I

• As Mary Warnock puts it The slippery slope is
  the name of an argument based on a certain view
  of human nature, not on logic, and commonly used
  in nonphilosophical discussions of moral issues.
  
• Warnock The reasoning is that, though a
  practice may be unobjectionable in one type of
  case, if it is once permitted, its use will
  inevitably be extended to other more morally
  dubious cases.
• Warnock The inevitability here supposed is not
  logical inevitability, but is thought to result
  from peoples always wanting more than they
  have.
• Warnock In fact, legislation or other forms of
  regulation can usually control an undesirable
  slide down the slippery slope.

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A SLIPPERY SLOPE II

• According to the slippery slope argument then,
  although a certain kind of practice may be
  acceptable in one kind of case, once it is
  permitted, it will be extended to cases where it
  ought not to be used.
• The idea is that we slide down the slope from a
  good thing to a bad thing.
• In this instance, if euthanasia were okay for one
  kind of terminally suffering patient, it would be
  used in cases where it should not - where it is
  not really the wish of the patient to be put to
  death.

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A SLIPPERY SLOPE III

• A slippery slope argument such as this depends on
  seeing human beings as basically morally
  irresponsible, unable to make reasonable
  judgements, susceptible to external influence, or
  all of these.
• The common rebuttal to such slippery slope
  arguments is that potential bad cases can be
  prevented through proper legislation.
• Advocates of euthanasia, such as James Rachels,
  recognize the possibility of system abuses, but
  are willing to rely on legislation and the good
  judgement of the medical community to correct
  them.

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A SLIPPERY SLOPE IV

• The idea then is that the remedy for abuses is
  either to enforce legislation so that they dont
  occur, and if the violations become too excessive
  you simply repeal the law which legalized
  euthanasia.
• But Pellegrino might respond that this is not a
  risk worth taking. In fact he says that laws
  will not prevent abuses, and thinks that abuse
  is inevitable.
• On the other hand, James Rachels is a philosopher
  who thinks that the benefits of euthanasia will
  outweigh any abuses that may occur.

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A SLIPPERY SLOPE V

• Whatever the case about likely abuses of
  euthanasia though, Pellegrinos view is that the
  doctor has an obligation to alleviate or
  eliminate suffering so that the patient could
  experience a good death, and she must reject
  euthanasia since that eliminates the prospect of
  a good death and distorts the healing
  relationship between doctor and patient.