EUTHANASIA

1
EUTHANASIA
Edvard Munch, Death in the Sickroom,1895
2
Doctors Must Not Kill
Edmund D. Pellegrino
3
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.

4
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.

5
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.

6
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.

7
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.

8
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.

9
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?

10
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.

11
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.

12
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?

13
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.

14
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.

15
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.

16
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?

17
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?

18
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.

19
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.

20
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.

21
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.

22
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.

23
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.

24
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.

25
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.

27
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.

28
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.

29
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.

30
VOLUNTARY ACTIVE EUTHANASIA
Dan W. Brock
31
V.A.E. AND P.A.S. I

• Brock thinks that both euthanasia and physician
  assisted suicide are morally permissible.
• Remember that voluntary active euthanasia
  (v.a.e.) is when the doctor intentionally kills a
  terminally ill patient with the patients
  consent.
• In physician assisted suicide (p.a.s.) the
  patient kills herself with the assistance of the
  doctor, the doctor does not act directly to kill
  the patient.

32
V.A.E. AND P.A.S. II

• In physician assisted suicide, the patient is the
  one who directly ends her own life.
• An example of physician assisted suicide is when
  a patient ends her life with a drug that the
  doctor prescribes.
• In voluntary active euthanasia, the doctor
  directly kills the patient at the request of the
  patient.
• In voluntary active euthanasia the doctor or a
  medical assistant acting on the doctors orders
  administers the drug to the patient.

33
V.A.E. AND P.A.S. III

• In both euthanasia and assisted suicide the
  choice of death rests fully with the patient.
  In each case the patient acts last in the sense
  of retaining the right to change his or her
  mind.
• And in each case the doctor is directly involved,
  and plays an active and necessary causal role.
• In fact, for Brock, the only difference that
  need exist between the two v.a.e. and p.a.s. is
  the person who actually administers the dose -
  the physician or the patient.
• Brock wants to know then how there could be a
  substantial moral difference between the two
  v.a.e. and p.a.s. based only on this small
  difference in the part played by the physician in
  the causal process resulting in death?

34
V.A.E. AND P.A.S. IV

• Thus Brock wonders why some people think that
  there is a major moral difference here between
  euthanasia and assisted suicide since the doctor
  is necessarily and actively involved in both
  cases.
• Some might respond that the moral difference is
  clear since in euthanasia the doctor kills the
  patient, while in p.a.s the patient kills the
  patient, with, of course, the doctors
  assistance.
• But Brock says that this is misleading at best.
• Its misleading because in p.a.s the doctor and
  patient together kill the patient. And they do
  it together since the patient cannot kill himself
  without the doctors help.

35
V.A.E. AND P.A.S. V

• Brock points out that, if a doctor gave a patient
  a lethal dose of medication with full knowledge
  that the patient will use it to kill someone
  else, we would hold the doctor responsible for a
  wrongful death.
• So if the doctor gives his patient a lethal drug
  with the full knowledge that he will use it to
  kill himself then he is also responsible for the
  death of the patient.
• And Brock says that if it is really the case that
  there is no significant difference between
  euthanasia and p.a.s, then why should people be
  in favor of one and not the other?
• Accordingly, a law which permitted p.a.s. on
  moral grounds ought also to permit euthanasia on
  moral grounds.

36
THE CENTRAL ARGUMENT FOR EUTHANASIA

• Brock will focus on voluntary active euthanasia
  only, which I will call euthanasia for short.
• The argument for euthanasia comes typically from
  two fundamental moral points regarding persons
• 1. The right to self-determination the right of
  autonomy.
• 2. The right to well-being.
• A persons right to self-determination is his or
  her right to make free choices about his or her
  life to the extent that such choices do not
  interfere with someone elses right to
  self-determination.
• And a persons right to well-being includes the
  right not to suffer, physically, psychologically,
  or both.

37
SELF-DETERMINATION I

• Self-determination in regard to euthanasia means
  that a terminally ill patient whose suffering
  only death will end has the right to decide about
  her own life.
• Thus a person suffering from a terminal illness
  should be free to make up her own mind about her
  future in relation to that illness.
• We take self-determination to be a good thing,
  and we take suffering to be a bad thing.

38
SELF-DETERMINATION II

• Brock says that By self-determination as it
  bears on euthanasia, I mean peoples interest in
  making important decisions about their lives for
  themselves according to their values or
  conceptions of a good life, and in being left
  free to act on those decisions.
• For Brock, self-determination is both valuable
  and a central aspect of human dignity.
• Basing euthanasia on the right of
  self-determination means that people must have
  the ability to decide for themselves.

39
SELF-DETERMINATION III

• Basing euthanasia on the right of
  self-determination also presupposes some minimum
  of decision-making capacities or competence . . .
  and cannot justifiably be administered, for
  example, in cases of serious dementia or
  treatable clinical depression.
• Those in favor of euthanasia would say the right
  to self-determination extends to a persons right
  to decide about her own death.
• For them, we ought to have the right to
  discontinue our lives when faced with terminal
  suffering.

40
SELF-DETERMINATION IV

• People have a natural fear of suffering and a
  fear of losing dignity due to illness, and
  euthanasia would give them an option then to
  avoid both.
• However, Brock says that everyone has to decide
  for himself, and that people and life are
  complicated enough that there is no single
  objectively correct answer for everyone about
  how much suffering you can take, and about when
  loss of dignity will occur.
• Accordingly, where euthanasia may be proper for
  some it may not be for others, and this is why
  the emphasis is on euthanasia being voluntary.
• Because people are so different, and the right of
  self-determination is so important, it is
  especially important that terminally ill people
  are able to control the manner, circumstances,
  and timing of their dying and death.

41
WELL-BEING

• We think that life is good and death is evil,
  but, more particularly, we think that a healthy
  life is good and that suffering is an evil. And
  we think that everyone has a right to well-being
  - that no one should suffer who does not have to.
• Proponents of euthanasia say that, since everyone
  has a right to well-being, and a right to
  self-determination, when someone loses her
  feeling of well-being when life becomes an
  unbearable burden and when a life of suffering
  is worse than no further life at all, then a
  person has the right to end her suffering through
  death.
• Again, Brock says that there is no objective
  standard about what constitutes an unbearable
  life, but only the competent patients judgement
  of whether continued life is no longer a
  benefit.

42
PHYSICIANS AND EUTHANASIA

• Brock says that a persons right to
  self-determination cannot be used to compel
  doctors to practice euthanasia or p.a.s.
• If a doctor objects to either on moral grounds,
  then she cannot be forced to participate in
  bringing about the death of the patient.
• That is, the doctors right of self-determination
  also has to be respected.
• Even if euthanasia becomes legal, a doctor who
  objects to it need not be involved, and his role
  can be taken by another willing physician.

43
ARGUMENTS AGAINST EUTHANASIA

• Two main arguments against euthanasia cited by
  Brock are
• 1. The deliberate killing of an innocent person
  is always ethically wrong.
• 2. Perhaps euthanasia is morally acceptable in
  certain cases, but it ought not to be legally
  permitted since it will be abused, and so the bad
  consequences will outweigh the good. Slippery
  slope.

44
DELIBERATE KILLING OF AN INNOCENT PERSON I

• Opponents of euthanasia say that euthanasia is
  the deliberate killing of an innocent person, and
  they object to euthanasia because they think that
  this deliberate killing is always immoral.
• Brock says that they are right that euthanasia is
  the deliberate killing of an innocent person.
• The killing is done deliberately at the patients
  request to end her suffering, and the person is
  not guilty of any crime or wrongdoing in virtue
  of being terminally ill and suffering.

45
DELIBERATE KILLING OF AN INNOCENT PERSON II

• The question of the morality of euthanasia then
  concerns whether or not the deliberate killing of
  an innocent person is always wrong.
• If it is then euthanasia is immoral.
• If it is not then euthanasia may be permissible,
  at least in some cases.

46
KILLING AND ALLOWING TO DIE I

• While some think that voluntary active euthanasia
  is wrong, they do not think that deliberately
  allowing a person to die, or passive euthanasia
  is wrong.
• Thus, allowing someone to die by deliberately
  withholding life sustaining treatment is thought
  to be morally acceptable and different from
  euthanasia, because in allowing to die you are
  allowing the disease to kill the patient and so
  the doctor is not killing the patient.
• But Brock says that this view is confused and
  mistaken.
• See Brocks example on pp. 188-189.

47
KILLING AND ALLOWING TO DIE II

• The idea here is that the same physical actions
  are performed by the greedy son as by the
  compassionate physician. If the sons action is
  killing why is not the doctors?
• Brock understands that there is a difference of
  intention here, and that both the intention and
  other considerations make us think that there is
  a moral difference here.
• For instance, the doctor acts with the patients
  consent, has a good motive - ending suffering -
  and is performing a social role for which he is
  legally authorized.
• On the other hand, the son acts without the
  patients consent, with a bad motive - greed -
  and is not performing a social role for which he
  is legally authorized.

48
KILLING AND ALLOWING TO DIE III

• Brocks point is that these things show that what
  the doctor did to the patient and what the son
  did are morally different - one is moral and the
  other is immoral - but what the example does not
  show is that the son killed the patient while
  the doctor allowed her to die.
• For Brock, even if we suppose that killing is
  worse than allowing to die, and that withdrawing
  life support is allowing to die, while euthanasia
  is killing, it need not follow that euthanasia is
  morally wrong.

49
WHY IS KILLING WRONG I?

• Brock asks just what is it that makes the
  deliberate killing of an innocent person wrong?
• He thinks that a good answer is that killing
  deprives a person of the possibility of having a
  valuable future. Don Marquis uses this as an
  argument against abortion.
• Every innocent person has a right to the
  possibility of a valuable future, and as killing
  deprives a person of this right, killing is
  wrong. Another way to put this is people have a
  moral right not to be killed.

50
WHY IS KILLING WRONG II?

• People are a kind of being which can have a sense
  of the future, can plan for the future, and can
  see life in the future as something which they
  value and can anticipate taking pleasure in.
• But making plans for and valuing the future
  presupposes the continued existence of the life
  whose plans and valuing they are.
• If that life is ended so is the possibility of
  realizing those plans, and so ends the
  possibility of value to be realized in the
  future.

51
WHY IS KILLING WRONG III?

• Killing frustrates a persons plans and ends her
  dreams of a good future.
• Death is an evil because in death you give up
  everything.
• Thus an act which deliberately causes a persons
  death is seen as an evil because it is the cause
  of an evil.
• And so people have a moral right not to be
  killed, not to have the possibility of a good
  future interfered with.

52
WRONGFUL KILLING AND EUTHANASIA I

• Whereas deliberate killing of an innocent person
  may seem to rule out euthanasia as immoral, it
  does not necessarily. This is because what makes
  deliberate killing wrong is its depriving a
  person of a valuable future.
• If the person has no prospect of a good future,
  then killing her at her request need not be
  morally wrong.
• A terminally ill patients future may be worse
  than no future at all because of the promise of
  suffering which will characterize that future.

53
WRONGFUL KILLING AND EUTHANASIA II

• As much as we think that people have a right to a
  good future, we also think that everyone has a
  right to well-being and hence a right not to
  suffer.
• For Brock, a persons right not to be killed can
  be waived by that person. Thus a person can give
  up her right not to be killed in favor of her
  right not to suffer.
• Euthanasia then can be seen as morally acceptable
  since the terminally ill patient chooses to give
  up her right not to be killed. She deliberately
  chooses euthanasia since she sees death as the
  only means of ending her suffering.

54
RELIGION AND EUTHANASIA

• Brock says that many people who feel squeamish
  about euthanasia, even when they agree about the
  evil of suffering, are uncomfortable about
  euthanasia due to religious reasons.
• However, for Brock, the question of euthanasia
  concerns the moral correctness or incorrectness
  of adopting euthanasia as public policy - of
  making it legal or not - and he thinks that such
  public policy cannot be grounded on religion in a
  free society.
• We live in a pluralistic society which consists
  of many people who accept and others who reject
  religion, and we have to recognize the strong
  commitment we have to freedom of belief.

55
EUTHANASIA AND PUBLIC POLICY

• Brock recognizes that it is one thing to talk of
  the morality of euthanasia in individual cases
  where it is requested by a dying patient, and it
  is another to talk of legalizing euthanasia.
• And here it is pertinent to recognize that, in
  addition to saying that the deliberate killing of
  an innocent person is always wrong, the second
  main argument against euthanasia is that the bad
  consequences of making it legal would outweigh
  the good consequences.
• Brock notes that there are two kinds of
  disagreement about this second argument
  empirical or factual disagreement about what the
  consequences would be and moral disagreements
  about the relative importance of different
  effects of legalizing euthanasia.

56
POTENTIAL GOOD CONSEQUENCES OF PERMITTING
EUTHANASIA
57
THE RIGHT TO SELF DETERMINATION

• A first good consequence of permitting euthanasia
  would enable us to respect the right to
  self-determination of competent patients who ask
  for it.
• But Brock notes that the opponent of euthanasia
  could ask here whether we need to respect the
  right to self-determination in every case, or
  might some other ethical principles override it?
• If the opponent says that the deliberate killing
  of another person is always wrong, then this
  moral law could override the right to
  self-determination.
• On the other hand, if a competent person can
  waive his right to be killed in favor of his
  right not to suffer, then the right not to suffer
  coupled with the right of self-determination
  could override morally the principle which says
  that the deliberate killing of an innocent person
  is always wrong.

58
DESIRE FOR EUTHANASIA AS AN OPTION

• When we ask about instituting euthanasia as
  public policy we would have to ask how many
  people are likely to want it, and the answer to
  this will depend to the extent to which the
  illness is treatable, or the extent to which the
  suffering is manageable. That is, the question
  will concern is euthanasia the only option?
• Brock thinks that the number of people in the U.
  S. who would want euthanasia is probably
  relatively small, but thinks that it should be
  available for those who would choose it.

59
SATISFYING THE MAJORITY

• A second good consequence of permitting
  euthanasia would be giving the majority what they
  want. This is because polls show that most
  Americans want the option of euthanasia even if
  they would not choose it for themselves when the
  time came.
• Most people think that a person has the right to
  choose euthanasia, and making euthanasia legal
  would reinforce the perception of this moral
  right.
• Thus it would be reassuring to people to know
  that euthanasia is an option, should they need
  it.
• Brock says that this would make euthanasia a
  kind of insurance policy against the threat of
  interminable suffering.

60
RELEASE FROM SUFFERING AND AGONY I

• The third good consequence of legalizing
  euthanasia, according to Brock, is its
  elimination of horrible suffering when nothing
  else will take it away, and he suggests that the
  sad fact is that many patients suffer needlessly
  for physicians fear of hastening the patients
  death. This would not be a fear if euthanasia
  were legal.
• The argument for euthanasia as the only means of
  eliminating pain or other kind of terrible
  suffering is the argument from compassion or
  mercy.

61
RELEASE FROM SUFFERING AND AGONY II

• Brock says that in talk of pain we must
  distinguish between pain that is treatable by
  medication and pain that is not, or pain which
  only death will remove.
• Brock recognizes that the argument for euthanasia
  based on the elimination of pain loses much of
  its force if the pain can be managed without
  death - even at the cost of making the patient
  comatose. (Presumably the patient could not die
  Pellegrinos good death if comatose)
• Thus the argument from compassion can be met if
  the suffering can be ended without killing the
  patient. Here then the argument in favor of
  euthanasia from suffering would depend on there
  being kinds of suffering which only death can
  eliminate.

62
RELEASE FROM SUFFERING AND AGONY III

• Brock mentions psychological pain or suffering in
  addition to physical pain, and notes that the
  knowledge of how to treat this is much more
  limited.
• Thus an argument from compassion for the
  suffering patient can be made for euthanasia
  where the psychological suffering is unbearable,
  and death is the only means of eradicating this
  suffering.
• And if this kind of suffering is less treatable,
  then patients suffering psychological pain might
  be more in need of euthanasia than others.

63
HUMANITY

• A final good consequence of euthanasia is that
  ending life quickly and painlessly is more humane
  than a prolonged death which involves pain and
  suffering.
• Brock asks, dont we think that people who die
  quickly or in their sleep are lucky?
• A psychological factor here is that we care how
  people remember us, and we dont want to be
  remembered as sick and suffering. Thus a
  debilitating disease can rob us of our dignity.
• For the patient who wants it, euthanasia can be a
  quick and peaceful end to life which will give
  some dignity and allow her loved ones to remember
  her as she was in better times.

64
POTENTIAL BAD CONSEQUENCES OF PERMITTING
EUTHANASIA
65
DOCTORS MUST NOT KILL

• A first potential bad consequence of legalizing
  euthanasia is that permitting doctors to perform
  euthanasia is incompatible with their
  professional and moral commitment to heal and
  care for patients rather than to kill them.
  (Pellegrino.)
• Permitting doctors to practice euthanasia would
  remove the trust between doctor and patient and
  distort the trust which the patient has in the
  doctor. (Pellegrino.)
• Patients then could no longer be sure that their
  doctor was not giving them a drug which will kill
  them rather than reduce pain, and the patients
  trust of his doctor would be eroded.

66
BROCKS RESPONSE I

• Brock wonders how legitimate this concern is.
  How can a patient have a fear about the nature of
  a certain drug when she has asked for the doctor
  to perform euthanasia?
• If euthanasia is restricted to cases which are
  strictly voluntary, then how can a patient who
  has not requested euthanasia fear anything?
• In fact, Brock thinks that a patients trust of
  her physician could actually be increased.
• Trust would be increased if euthanasia were legal
  since then a suffering patient would know that
  she could request it if needed, and could trust
  that her doctor would honor her request.

67
BROCKS RESPONSE II

• Brock says recall what the two main arguments for
  euthanasia are
• 1. The patients right of self-determination.
• 2. The patients right to well-being.
• Brock says that doctors who respected these two
  basic rights would not be changing the moral
  character of medicine. Rather, respect for these
  two values will support doctors who practice
  euthanasia when requested by competent patients.
• For Brock, what is morally suspect is practice of
  medicine without regard for these two basic
  patient rights.

68
THE VALUE OF HEALTH CARE

• A second bad consequence of euthanasia is that it
  could weaken societys commitment to provide the
  best care for patients that is possible.
• Because health care is expensive, some might see
  euthanasia as a cheaper alternative to costly
  care, and we might use abuse euthanasia when
  other more costly care is available.

69
BROCKS RESPONSE

• There is little evidence that patients right to
  refuse treatment - passive euthanasia - has
  caused patients to receive worse care. And if
  the possibility of passive euthanasia has not
  caused the quality of health care to go down,
  then why should active euthanasia?
• In addition, Brock thinks that very few people
  would choose euthanasia even if it were
  available.
• Thus permitting euthanasia should not interfere
  with the high quality of health care that we have
  without euthanasia.

70
PRESSURE TO CHOOSE EUTHANASIA

• A third bad consequence of euthanasia mentioned
  by Brock is due to David Velleman, who says that
  making a new option or choice available to
  people can sometimes make them worse off.
• The choice of euthanasia could mean that some
  people who do not really want to choose
  euthanasia will be led to choose it by others who
  see it as the best option for them.
• If euthanasia were not legal, then this option
  would not exist and the dying patient would not
  have to consider it. However, if euthanasia is
  an option, then the choice of it can make the
  person who does not want it worse off if she
  thinks that she ought to choose it because others
  want her to choose it.
• Velleman does not see this as an argument to
  outlaw euthanasia, but only to restrict it to
  those who genuinely want it for unmistakable and
  overpowering reasons.

71
BROCKS RESPONSE I

• Brock wonders whether it is true that people
  would be made worse off by having the choice of
  euthanasia. He says that polls show that most
  people want the option and so think that they
  would be made better off and not worse off by
  having the choice.
• He also maintains that, if giving people the
  option of euthanasia is a possibly harmful choice
  for them, then so could be the option of passive
  euthanasia - refusing life-sustaining treatment.
• However, there is no evidence that this has been
  a bad option for people.

72
BROCKS RESPONSE II

• Also, because the conditions for wanting or not
  wanting euthanasia are so wide and varied, it is
  not advisable to restrict it in the way that
  Velleman suggests.
• It is not advisable since then euthanasia could
  be denied to people who really want it.
• Brock To permit it only in cases where
  virtually everyone would want it would be to deny
  it to most who would want it.

73
THE PROHIBITION OF HOMICIDE

• The American College Dictionary defines homicide
  as the killing of one human being by another,
  and Brock says that This prohibition is so
  fundamental to civilized society, it is argued,
  that we should do nothing that erodes it.
• Because legalizing euthanasia could be seen to
  erode the general prohibition of homicide, it
  could be taken to be a fourth possible bad
  consequence of euthanasia.

74
BROCKS RESPONSE I

• Because, according to Brock, stopping life
  support is killing the patient in most cases,
  then permitting this kind of killing could
  already be seen to have weakened the prohibition
  of homicide.
• However, Brock recognizes that most people, as
  well as the courts, have not seen passive
  euthanasia as killing, and so it would not really
  figure in here as a weakening of the prohibition
  of homicide.
• Passive euthanasia has been thought acceptable on
  grounds of the rights to privacy and
  self-determination and has not been looked at as
  an exception to homicide laws, but Brock says
  that the same fundamental right of
  self-determination applies to euthanasia.
• After all, in euthanasia the patient consents to
  his killing, whereas in other cases of homicide
  he does not.

75
BROCKS RESPONSE II

• Both murder and euthanasia are kinds of homicide,
  kinds of deliberate killing of one innocent human
  by another. However, they differ in that, in
  euthanasia but not in murder, the person who is
  killed gives his consent to be killed. Thus
  there is self-determination in euthanasia but not
  in murder.
• And Brock says that If procedures can be
  designed that clearly establish the voluntariness
  of the persons request of euthanasia, it would
  under those procedures represent a carefully
  circumscribed qualification on the legal
  prohibition of homicide.

76
ABUSE OF A GOOD THING

• The final potential bad consequence of permitting
  euthanasia even for those cases in which it is
  unequivocally voluntary and the patient finds his
  or her condition unbearable, is that euthanasia
  would inevitably lead to abuse in being performed
  in cases where patient consent is not given and
  may not be desired.
• This is the slippery slope argument which says
  that people will abuse a good thing, and because
  active voluntary euthanasia will lead to
  nonvoluntary and even involuntary euthanasia, it
  should not be permitted in any case.

77
BROCKS RESPONSE I

• Although Brock thinks that this objection is the
  most serious objection to euthanasia, he also
  thinks that the strength of such slippery slope
  arguments can be doubted and are hard to
  evaluate.
• When all else fails, the conservative objector to
  euthanasia simply says that it will end up being
  applied to people who have not asked for it, and
  because it will end up being so applied it should
  not be legalized in the first place.

78
BROCKS RESPONSE II

• For Brock, whereas one must admit that abuses of
  euthanasia are possible, that is not enough to
  prohibit it if it is otherwise morally justified.
  
• What has to be assessed is how likely the abuses
  are.
• Euthanasia would be abused if the conditions for
  granting euthanasia to a patient are not
  satisfied.
• Most specifically, if the patients consent has
  not been given, or if her consent has been forced
  through persuasion.

79
BROCKS RESPONSE III

• However, unless opponents of euthanasia can
  provide good data to support their view of likely
  abuses there is little reason to consider them.
• The extent to which abuses are likely depend on
  the rules and procedures which are put in place
  to prevent such abuses from occurring.
• See Brocks four guidelines to avoid abuses on
  p. 196.
• The idea of the safeguards is to ensure that it
  is the patient who makes the choice, and the
  choice is informed by accurate medical
  information.

80
BROCKS RESPONSE IV

• At the same time that we want rules which will
  help to avoid abuses, we do not want to make them
  so strict that voluntary active euthanasia will
  be impossible to get for someone who wants it.
• Life is such that some abuses are likely to
  occur, but abuses can be minimized by ongoing
  reviews of cases of euthanasia which have
  occurred.

81
NONVOLUNTARY ACTIVE EUTHANASIA I

• Brock thinks that a system can be constructed
  where it will make involuntary active euthanasia
  rare or unlikely, but he says that legalization
  of voluntary active euthanasia could very well
  make nonvoluntary euthanasia likely.
• Thus, where we cannot get a patients consent,
  due to coma for instance, we may be tempted to
  legalize nonvoluntary euthanasia.
• Here the right to choose euthanasia would be
  given to a person who can act on behalf of the
  patient - such as a family member. And the
  person who chooses for the incompetent patient is
  supposed to choose as the patient would have
  chosen if able to do so.

82
NONVOLUNTARY ACTIVE EUTHANASIA II

• The reasoning behind allowing nonvoluntary
  euthanasia is that it seems unreasonable to
  continue life-sustaining treatment that the
  patient would not have wanted just because the
  patient now lacks the capacity to tell us that.
• As it is now, patient surrogates will often
  refuse life-sustaining treatment when they know
  that is what the patient would have wanted, and
  such a wish could extend from voluntary to
  nonvoluntary euthanasia.
• As Brock says, why continue to force unwanted
  life on patients just because they have now lost
  the capacity to request euthanasia from us?

83
NONVOLUNTARY ACTIVE EUTHANASIA III

• Of course, the courts can still restrict
  euthanasia to voluntary only, as they have in
  Holland.
• Nonvoluntary euthanasia can be fairly clear cut
  where a patient has made her wishes known ahead
  of time, but, for those who have not, Brock says
  that the potential for abuse is clearly there if
  nonvoluntary euthanasia is legalized.
• Thus for nonvoluntary euthanasia the important
  thing for avoiding abuse is to make sure that
  rules are in place for surrogates acting on
  behalf of incapacitated patients.

84
NONVOLUNTARY ACTIVE EUTHANASIA IV

• Rules which are in place which authorize others
  to act on the patients behalf when the patient
  herself has given such authorization can protect
  us from sliding down the slippery slope from
  voluntary to nonvoluntary euthanasia.
• Brock ends by saying that the issues concerning
  euthanasia are complex, but he thinks that the
  arguments in favor of permitting it are stronger
  than the arguments against it.