Ethical Issues of Life and Death

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Ethical Issues of Life and Death

• Chan Ho Mun, Ph.D.
• Associate Professor of Philosophy
• Department of Public and Social Administration
• City University of Hong Kong
• June 22, 2006

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Issues

• Abortion
• Suicide
• Euthanasia
• Physician Assisted Suicide
• Advance refusal of treatments (Advance directives)

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Methodology

• Top-down approach You start with a defense of
  some principles or abstract ideas, and then apply
  them to analyze an ethical issue.
• Bottom-up approach Compare like with like or
  identify the difference among cases.
• A Combined approach
• Critical thinking is essential

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Top-down Approach

• A principle-based argument against abortion
• Fetuses are members of the human species. All
  human are of equal moral worth and have the equal
  right to live. So abortion is morally wrong.

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• Objection
• Why should we count fetuses as humans? The major
  premise of pro-choice argument is that fetuses
  are not humans. So they do not possess the right
  to life.
• Both sides accept the sanctity of human lives,
  but the issue cannot be resolved solely by
  appealing to this principle.

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Bottom-up Approach

• A defense of abortion
• Thomsons People-seeds argument Imagine that
  people-seeds can drift in the air like pollen and
  take root in your carpet or upholstery. The
  person-plant does not have a right to the use of
  your house though you voluntarily open windows,
  knowingly keep carpet and upholstered furniture,
  and your window screens have defects.

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• An argument against abortion (Marquis)
• Killing someone is morally wrong because it
  causes her premature death. It deprives her of a
  future like ours (FLO)
• Abortion is similar to killing someone in the
  sense that it deprives the fetus of an FLO. So
  it is morally wrong.

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The Importance of Critical Thinking

• Principles can be inconsistent, and resolution is
  needed when conflicts arise.
• Arguments from analogy are defeasible Though the
  similarity between two cases can lead support to
  a certain conclusion, their difference may
  undermine the strengthen of the analogy.

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Three Guiding Moral Principles

• Principle of the sanctity of life Life itself
  has intrinsic value in the sense that the mere
  existence of a life in itself has a value that is
  independent of its quality.
• Principle of autonomy People have the right to
  choose how they want to live their livies instead
  of being forced to subject to the will of others.

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• The welfare principle Human actions should
  always seek to promote human interests and
  well-being, and should always try to reduce pain
  and sufferings.

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The Crux of the Problem

• The three principles are not necessarily
  consistent. How to resolve the tension among them
  when conflicts arise?
• Four approaches
• Euthanasia
• Physician assisted suicide
• Pro-life approach
• Advance directives

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Euthanasia

• 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 intentionally.
• Supporters of euthanasia believe that the
  intrinsic value of life can be overridden by the
  principle of autonomy and the welfare principle.

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Voluntary, Involuntary, and Non-voluntary
Euthanasia

• Voluntary euthanasia The patient chooses it.
• Involuntary euthanasia It is offered against the
  wish of the patient.
• Non-voluntary euthanasia It is offered to the
  patient who has not expressed his/her prior
  preference before s/he loses the decisional
  capacity or is never able to make such an
  expression.

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Active and Passive Euthanasia

• Active euthanasia An active measure, such a
  lethal injection, is used to terminate the life
  of a patient.
• Passive euthanasia A deliberate attempt of not
  saving the life of a patient.
• Is the moral difference between active and
  passive euthanasia significant?
• James Rachels They either stand or fall together.

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Physician Assisted Suicide (PAS)

• The justification is the same as euthanasia.
• The doctor involved cannot be said to have killed
  the patient.

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Utilitarian Argument Against Euthanasia and PAS

• Whose welfare? Social or individual?
• Some people may feel being pressured to choose
  euthanasia or PAS.
• Non-voluntary or even involuntary euthanasia will
  become more widespread.
• Palliative care and hospice services will become
  less developed.
• Less incentive to invent or develop more
  effective treatment for the terminally ill.

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A Pro-life Approach

• The intrinsic value of life is absolute. It can
  override the principle of autonomy and the
  welfare principle.
• The health care profession is obliged to fight
  death to the very end.
• Withdrawing/withholding life-sustaining treatment
  is morally wrong if the life of a patient can be
  prolonged.
• Suicide is morally wrong and should even be
  regarded as a criminal offence.

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Suicide Do we have a right to die?

• It is not a criminal offence. It was
  decriminalized years ago, so strictly speaking,
  people do have some liberty to terminate their
  own lives.
• Yet they do not have to right to do so. Aiding
  and better of suicide are regarded as criminal
  offences. Trying to stop someone to kill
  him/herself does not constitute a violation of
  his/her basic rights.

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• Suicide is moral permissible, desirable, or even
  obligatory in some special circumstances in the
  East Asian cultures. Yet the rationale cannot be
  used to justify physical assisted suicide.
• So is the intrinsic value of life absolute?

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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.

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• Patients can use advance directives to express
  their advance refusal of treatment before they
  lose their decisional capacity.
• This approach tries to pay due respect to all the
  three guiding moral principles.

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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.

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• 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 them.

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Is It a Violation of the Principle 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 not saving
  the patient or hastening his/her death.

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• The provision of life-sustaining treatment to a
  dying patient may only prolong the dying process,
  but saving a drowning person will not have this
  consequence.

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References

• Chan, Ho Mun, Euthanasia Can Life Become not
  Worth Living, in Julia Tao and Hektor H T Yan
  (eds), Meaning of life. Singapore McGraw Hill
  Education, 2006, pp.263-282
• Chan, Ho Mun, Sharing Death and Dying Advance
  Directives, Autonomy and the Family Bioethics,
  Vol. 18, No. 2, 2004, pp.87-103.
• Chan, Ho Mun, Informed Consent Hong Kong Style
  An Instance of Moderate Familism, Journal of
  Medicine and Philosophy, Vol. 29, No. 2, 2004,
  pp.195-206.

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• Chan, Ho Mun, Euthanasia, Individual Choice and
  the Family A Hong Kong Perspective, in H. T.
  Engelhardt, Jr. and L. M. Rasmussen (eds.),
  Bioethics and Moral Content National Traditions
  of Health Care Morality, Dordrecht, Netherlands
  Kluwer Academic Publishers, 2002, pp. 165-190.
• ??? ????????????????, ??????III4
  (2001?12?)?45-55?
• ??????? ?????????????????????????1997??137-1
  55.

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• Marquis, Don, An Argument that Abortion is
  Wrong, in Hugh LaFollette (ed.) Ethics in
  Practice An Anthology, Oxford Blackwell, 2002,
  pp. 83-93.
• Rachels, James, Active and Passive Euthanasia,
  in Helga Kuhse and Peter Singer (eds.),
  Bioethics, Oxford Blackwell, 1999, pp. 227-230.
• Thomson, Judith Javis, A Defense of Abortion,
  in Hugh LaFollette (ed.) Ethics in Practice An
  Anthology, Oxford Blackwell, 2002, pp. 63-71.