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Lec 16 - Nov 21.doc

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Donald Ainslie

Limits to Informed Consent: Physician Assisted Suicide NOVEMBER 21, 2011 “Euthanasia” - Eu (well) + Thanatos (death) - is a sloppy word, its the same word used as euphony .. Etc - its a bad word bc it gets used in some many different ways - there is a distinction btw: - Active vs. Passive (Let someone die by not giving them a treatment) euthanasia - Killing vs. Letting Die - Voluntary vs. Involuntary - V = whtere the killing or letting die is at the patients request or able to make that re- quest, or if its involuntary - All 4 cut across one another Passive Involuntary Euthanasia “Pulling the plug” - you have the plug pulled of all keeping you alive - Invol bc you cant make the decision and passive but removing something that will make u die. • Used to be thought to conflict with principle of nonmaleficence - (4 principles of medi- cal ethics) - it used it not be acceptable eon the part of hp bc it would harm the patients causing them to die • Now recognized to be legitimate in SOME circumstances. I.e. You only need temporary support of something knowing may recover and someone pulls the plug - if it were something that was put forwards in a past direction Ie wrote a will that if ever on a ventilator dont want to live, you can put in directions as when you are no lonher competent using your own CD • Can also be illegitimate - if a nurse decides, letting die bc • “Futility” - in HC ethics, HP would want to treat professional no matter what, had to go to court to not have the treatment done, there was a reaction when the CD came out, but with rlg commitments and bioethics of everday life, keep you alive not matter what, but for a doctor they would say thats Futile, in an attempt to say they know best and and whats best is to not give the treatment which is Futile. Passive Voluntary Euthanasia - passive not being killed directly but you are refusing treatment and vol that you are a compe- tent decision maker = LEGIT Refusing life-sustaining treatment • Can be legitimate • Can it be illegitimate when chosen by an autonomous person? Hard to say that it would be Active Involuntary Euthanasia Active= a killing i.e. An injection & invol = not asking that it be done to your = MURDER Some cases are clearly wrong: murder - some cases where its a human thing to do, i.e. Putting a animal to sleep we think its the human thing to do to inject them with something that cases ther death BUT we dont think that for human beings, if someone cant make a decision i.e. Final stages of a disease or an old age, and it may be justified? Is the sufficient to say that we shoul dmake human animals stay alive until their last gasp Controversy: • Compare treatment of pets • Terminal sedation: someone who is dying is giving drugs and be sedated and no longer giv- en food or drink and thus they die - its considered justified, depending on who makes the deci- sion and the facts of the case, but if you are competent to make that decision you are knowledge- able enough to make the decision and a doc cant do anything againt their will, but who makes the decision to put under sedation and not feed you etc **Active Voluntary Euthanasia Act - killing Vol - free choice = Physician-assisted suicide (a suicide, not eu- thanasia, bc its done by the person in ?) - main person doing it is the patient. • Intense controversy in past 20 years • Kevorkian - doc who hooked ppl up to the mechines to help you die • Netherlands - holand has it • Current “Select Committee on Dying with Dignity” in Quebec; Sue Rodriguez (was the focus of intense debate that lead to the supreme court) • Diagnosed with ALS (“Lou Gehrig’s Disease”) in 1991 at age 40; • Requested to the courts that law against assisted suicide be struck down • Lost in BC Court of Appeal and SCC •Killed herself illegally, with physician assistance, in 1994 s. 241 of the Criminal Code Everyone who (a) counsels a person to commit suicide, or (b) aids or abets a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offense and liable to imprison- ment. NB:Attempted suicide decriminalized in 1972 The Rodriguez Case • 5-4 decision to sustain s. 241 • Sopinka (with La Forest, Gonthier, Iacobucci, and Major) • CJ Lamer dissenting, with separate dissents by McLachlin (with L’Heureux- Dubé) and Cory McLachlin (she is not done when she does section 7 analysis and also has to look at s.1) • Appeals to Morgentaler, using s.7*** (short answer) to argue that s.241 violates Char- ter • “security of the person” limited • Such limits do not comport with PFJ • Arbitrarily “s
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