PHIL 235 Lecture Notes - Lecture 7: Euthanasia, Unintended Consequences, Principle Of Double Effect
14 May 2018
School
Department
Course
Professor
5.1 → Readings 1
Fisher
End-of-Life Decision-Making
• Today’s technology can keep patients alive much longer than nature would have
typically allowed, forcing some patients to endure significantly longer periods of
debilitation, as well as physical and emotional suffering, before death occurs.
• They are not independent, dependency on others increases and they can
experience a loss of dignity
• A protracted period of debilitation at the end of life takes a heavy physical,
emotional, and financial toll on the patient and her family while increasing the
burden on health care resources.
• Treatment cab seem futile if it only extends a life of suffering
• The patient or his surrogate may determine that a death with dignity, occurring in
the time, manner, and setting of his own choosing, surrounded by his loved ones,
is in his best interests.
• The patient or surrogate may seek “the good death”—what the ancient Greeks
called “euthanasia”—or may ask for assistance to commit suicide with the help of
a knowledgeable medical professional
• Little available of this in Canada
• Suicide → occurs when the patient acts to end his own life, either on his own or
with the help of another, such as a relative, friend, or medical professional → the
patient must be the one who takes the measures necessary to intentionally end his
life: the patient may, for instance, have been provided with a prescription for
lethal drugs by a physician, but for suicide to occur, the patient himself must be
the one who willingly puts the drug in his mouth.
• Suicide is not a criminal act but does not allow anyone to counsel committing
suicide or assist in the act
• Sometimes the best option is death
• Aside from personal religious beliefs that might influence one’s moral views, the
moral basis for allowing suicide rests on respect for the autonomy of the mentally
mature, competent individual. It is her life to live and lose: she is the only one
who experiences it directly and who can say with certainty whether it is a life of
value or not.
• Swiss law does not require that assistance to commit suicide be given by an HCP,
nor does it require that patients be citizens of Switzerland.3 Foreigners may enter
the country, receive a lethal prescription, and commit suicide with the help of the
Swiss organization Dignitas. Swiss law does not even require that the patient be
terminally ill to receive a request for suicide medication.4
• Physician-assisted suicide= voluntary suicide by a patient performed with the
assistance of a physician, who typically provides the means to end the patient’s
life, such as prescription for a lethal dosage of medicine.
find more resources at oneclass.com
find more resources at oneclass.com
• In addition, the moral arguments in favour of assisted suicide tend to reflect
compassion for the patient who lacks knowledge of or access to the means to
commit suicide, or the capacity to use that means (for example, the ability to lift a
spoon or to swallow). Around the world, the overriding moral and legal objection
to assisted suicide is typically the same: the danger of coercion is too great to
allow it
• At most vulnerable, some people might feel compelled to participate in this by
manipulation of HCP or relatives who want to gain an inheritance
• Patient will no logger trust HCP to treat them, weaker-willed patients can feel like
a burden on the health care system will be coerced into committing suicide
• The fear is that if we allow health care providers to participate in the deaths of
patients—even if only by writing a prescription for a lethal drug—then we will
have taken the first step down the slippery slope to abuse
• Slippery slope reasoning= arguments against a particular action on the grounds
that the action, once taken, will lead inevitably to similar but increasingly less
desirable actions until the bottom of the “slippery slope” is reached where very
harmful actions are allowed.
• Euthanasia occurs when a patient’s life ends either because of HCP actions or
because the HCP has removed or refused to provide life-sustaining treatment in
order to allow death to occur, in both cases for merciful reasons. Euthanasia may
thus be described as either “active” or “passive,” depending on the role the HCP
plays in the process.
• Active euthanasia= the use, for merciful reasons, of direct actions to bring about a
patient’s death; examples include giving the patient a lethal injection
• Passive euthanasia= the withholding or withdrawing, for merciful reasons, of life
extending medical treatment to allow death to occur from natural causes
• Euthanasia both passive and active can be subdivided into 3 categories
1. Voluntary → competent patient requests either that the health care provider
provide treatment to end his life or that the HCP withhold/withdraw treatment,
leading to death.
2. Nonvoluntary → he patient is not competent and a surrogate decision-maker
requests either withholding/withdrawing treatment or giving a lethal injection.
3. Involuntary → a patient who is competent and does not want to die is either
killed or has his treatment withheld/withdrawn, resulting in death, without his
consent.
• Active Euthanasia is not allowed in Canada because of its believed social harm
• Substituted judgement= the principle used by surrogate decision-makers and
health care providers to make decisions for the non-competent patient based on
what the patient would have wanted if he were able to decide for himself
find more resources at oneclass.com
find more resources at oneclass.com
• Terminal Sedation= The use of high doses of pain medication to treat a
patients suffering at the end of his natural life, with the awareness that
such high dosages will hurry the patient’s death by reducing
respiration and heart rate
→ HCPs are motivated by their obligation of beneficence to
relieve the patient’s suffering, an obligation they fulfill by
providing the pain medication; death is merely the unintended
consequence of their efforts to fulfill that obligation.
→ this justification invokes the doctrine of double
effect= which states that where an action has two
effects, one intended and the other not, the agent is
considered responsible only for the intended
consequence, not for the unintended one.
→ some critics claim that if death is a foreseen outcome of HCP
actions, then the HCPs are responsible for any steps they take that
lead to that outcome, whether it was directly intended or not.
→ kind of the same as active euthanasia
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Hcps are motivated by their obligation of beneficence to relieve the patient"s suffering, an obligation they fulfill by providing the pain medication; death is merely the unintended consequence of their efforts to fulfill that obligation. This justification invokes the doctrine of double effect= which states that where an action has two effects, one intended and the other not, the agent is considered responsible only for the intended consequence, not for the unintended one. Some critics claim that if death is a foreseen outcome of hcp actions, then the hcps are responsible for any steps they take that lead to that outcome, whether it was directly intended or not. Kind of the same as active euthanasia. A conceptual and ethical analysis: a right to accept or refuse treatments if they are offered by physicians does not entail a right to demand or receive treatments that physicians are unwilling to offer.
