Philosophy 2073F/G Lecture Notes - Lecture 5: Fot, Fetus, Equal Protection Clause

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1. Review
Having settled on a working definition of death (i.e., the cessation of neurological
functioning and/or the essential functions of an organism) and a provisional account of
the value of death (it is bad owing to the loss it imposes), our readings for the last couple
of weeks have been devoted to trying to explain why killing is wrong.
Those articles have focused, in particular, on two ‘grey’ examples of killing as a means
of providing that explanation, i.e., abortion and euthanasia.
So Thomson argued that killing a fetus is not wrong because the fetus has no right to
require the mother to allow the use of her body.
Marquis argued that killing a fetus is wrong because it deprives the fetus of a future-like-
ours…
Killing adult humans is wrong because doing so deprives them of a future they are
entitled to and, inasmuch as a fetus also has a possibly valuable future, any deprivation
thereof is wrong.
Sinott-Armstrong argued that Marquis’ account of the wrongness of killing is not the best
explanation of its wrongness; following more in the vein of Thomson, Sinott-Armstrong
maintains the wrongness of killing only occurs when the victim had the proper moral
standing (a right) against being so killed.
Finally, Rachels argued that the distinction drawn by the AMA prohibition of assisted
suicide between passive and active euthanasia is not a relevant distinction for the purpose
of setting out the wrongness of killing… if one is wrong, then so is the other and vice
versa.
3. RachelsMercy Killing is No different than Letting a Person Die
(Active euthanasia is the same as passive euthanasia)
The Point:
The AMA endorses the view that ‘mercy killing’ is ‘contrary to that for which the
medical profession stands’, but it also acknowledges that discontinuing extraordinary
treatment when death is inevitable is acceptable
o A law for doctors….tells doctors what they can and cant do in terms of euthanasia
o There is an inconsistency in the policy; you draw a distinction between actively
killing someone and passively letting someone…make it sound like those two
things are morally different
The problem is that there is no moral difference between actively killing, and passively
letting someone die. In fact, letting someone die could often be worse.
o Passive euthanasia is worse…this can lead to greater pain
o The use of extraordinary treatment to keep you alive is up to you
o This is suggesting that letting someone die is not morally as bad as actively killing
someone
o Ex. You kill a dog to put them out of their misery (the human society) but doing
this to people is wrong
Consider a patient dying of incurable cancer; continued treatment will only prolong a
painful existence, so the patient and family request that the treatment be discontinued.
o AMA says they can choose not to have any more treatment…this will prolong
agony that they are experiencing. We could provide them with something lethal
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It follows that the decision to ‘let the patient die’ by withholding treatment will end the
pain, but the reality is that pain would come to an end much sooner if a lethal injection
were administered.
What about Down’s syndrome babies that are allowed to die because of intestinal
obstructions? These two examples suggest ‘letting die’ is often worse than actively
killing.
o How can you say that allowing this baby to die a painful death is more humane
than giving a lethal injection?
The ‘active/passive’ distinction is also problematic because it leads to decisions of life
and death being made on irrelevant grounds.
In the case of the baby with Down’s syndrome, we are not allowing the baby to die
because it has an intestinal blockage, but because it has Down’s syndrome.
o Drawing the distinction between active and passive euthanasia because it leads to
the decisions of life and death being made on irrelevant grounds
o This shows that the baby who is dying because the baby has an intestinal
blockage, they’re letting the baby die because it has Down syndrome. They aren’t
making the decision on the relevant grounds. It is a simple procedure that would
be done immediately on a normal baby
o It fails to capture our intuition (ex. Strangling someone vs. seeing someone get hit
by a car…this captures our intuition about active vs. passive)
What about the general intuition that killing is just worse than simply letting someone
die? Consider the following example:
Smith drowns his six year old cousin in his bathtub to gain a large inheritance. Jones
intends to kill his cousin but when he enters the bathroom his cousin slips in the bathtub
and hits his head; Jones watches him drown… is there really any difference between what
Smith and Jones have done?
o This is the main argument is showing that there is no difference. This intuition
that killing is worse than letting someone die is a flawed intuition.
o There are lots of circumstances where taking action and omitting action are just as
bad…ex. Telling someone a lie vs. failing to tell someone the truth (leaving out a
part)
What this contrast shows is that owing to their shared motives, there is no morally
relevant difference between Smith actively killing his cousin and Jones letting his die.
It should also be noticed that passively ‘letting die’ is not passive; the doctor actively
does something, namely, he withholds treatment and lets the person die.
o Passively letting someone die isn’t actually passive…you have decided to not do
something to end up in a result…this is still an action!
o There is no morally relevant difference between the two.
o It si wrong than for the AMA to draw a distinction between actively killing and
passively letting someone die on the grounds that one is more morally correct
than the other…they might even have it backwards
Granted, this may be a different type of action but still, if the doctor ‘passively’ withheld
treatment to gain a large inheritance, we would still think the doctor guilty of murder, like
Jones.
It follows that in some cases physicians should be permitted to take active steps to bring
about the end of a person’s life.
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If we’ve already agreed that death would be better than life, does it really matter how that
is brought about? In fact, if we’re trying to bring about an end to a patient’s suffering,
shouldn’t we do so as quickly as possible?
o Once you’ve decided that death is the appropriate solution, does it really matter
how youre life is brought to an end? Rachels says that there is a difference, but
the difference doesn’t reflect the policy the AMA has adopted. Why? Because
letting someone die is gonna be more painful than actively killing
4. SteinbockThe AMA Does Not Distinguish between Active and Passive Euthanasia
The Point:
The AMA statement does not support a distinction between active and passive
euthanasia; the statement disallows ‘the intentional termination of life’ whether active or
passive.
o She argues that Rachels has misinterpreted the AMA document
The statement does allow for the ‘cessation of the employment of extraordinary means…’
to prolong life. But this is not the same as passive euthanasia, and Rachels’ mistake is to
claim that it is.
o The distinction between ordinary and extraordinary
o Both passive and active are wrong according to the AMA, but rachels got stuck
on the extraordinary means of treatment
Rachels thinks that the AMA statement denies that the cessation of treatment is the
intentional termination of life; but surely there can be instances when the cessation of
treatment is not intended to bring about the end of life.
o Cessation of treatment is always intended to bring about death. It is a product of a
patients right to their body.
Here are two examples:
Sometimes the cessation of treatment is the result of having a duty to respect the patient’s
right to refuse treatment.
Everyone has a legally protected right to be free from unwanted physical contact (i.e., to
be free from battery), so we can’t be forced to undergo treatment.
o This is not I have a right to be die, it’s a right of unwanted physical contact
But the right to refuse treatment has nothing to do with whether we ought to have a right
to kill ourselves…. that would have to be a different right. So, if a patient refuses
treatment, then treatment has been ended to respect their right, not to kill them.
o It might end up with your death but it is not about the right to die
o Cessation of treatment does not mean we are letting you die, it means we are
respecting your rights to your body
Another time when treatment is ended for a reason other than bringing about the
patient’s death is when “continued treatment has little chance of improving the patient’s
condition and brings greater discomfort than relief”(p. 487).
o It will lead o greater discomfort with no chance of relief (ex. Cancer pts; chemo
and radiation is painful and you may die anyways)
The decision to stop here is concerned with providing the most appropriate treatment for
the patient at the time. To continue would constitute ‘extraordinary means’ of prolonging
life.
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