November 13, 2009
NURSING ETHICS – LECTURE 9
I – Introduction
• The last several weeks we have been using theoretical frameworks to
analyze particular concepts and issues that arise in healthcare.
• We have thus far looked at the concepts of veracity, informed consent,
confidentiality, and justice.
• We have also looked at the issues of public health, distributive justice,
and genetic testing.
• This week we’ll look at another important ethical issue that arises in
the provision of healthcare: euthanasia.
II – Euthanasia: The Issue
• Euthanasia is traditionally defined as a ‘mercy killing’.
• It involves scenarios whereby one person takes the life of another for
some beneficent reason.
• Euthanasia: the killing of one person by another for beneficent
reasons, or for reasons which will promote the good of the person
being killed or some other set of persons.
• Euthanasia is obviously an important ethical issue that arises in the
provision of healthcare.
-Are they any situations in which a doctor, nurse, or other healthcare
practitioner should be allowed to perform euthanasia on a patient?
-Are physician-assisted or nurse-assisted suicides ever ethically
• As we will see, a wide variety of practical, rational, and other
considerations are relevant to answering these kinds of questions.
III – Different Types of Euthanasia
• Broadly speaking, euthanasia involves the killing of one person by
another for beneficent reasons.
• There are two distinctions we need draw with respect to different
kinds of euthanasia.
(1) Voluntary and involuntary euthanasia.
(2) Active and passive killing.
(1) Voluntary euthanasia and involuntary euthanasia.
• The killing of another person for beneficent reasons may be done
voluntarily on involuntarily.
-Voluntary euthanasia: killing another person beneficently with that
person’s permission, consent, or agreement.
-Involuntary euthanasia: killing another person beneficently without
that person’s permission, consent, or agreement.
• This is an important distinction because it is thought by many that if
euthanasia is morally justified in any situation it must be in situations
where the person being killed has given consent.
• If one has given consent, and they are suffering irremediably of
chronic or fatal illness, perhaps it is morally justified for a healthcare
practitioner to kill them.
• But is it ever morally justified to kill someone without their
• Perhaps not.
• Certainly not when they are mentally competent and have patently
refused to be euthanized.
• But perhaps there might be certain situations in which it is
E.G.: someone is comatosed, brain-dead, with little to no chance for
-Perhaps euthanasia might be morally justified for this person (even if
they haven’t given consent and are unable to) on beneficent grounds:
e.g., to relieve the suffering of the patient’s family, to save money,
-This is a tricky case.
(2) Active and passive killing.
• Active killing: performing a specific action which brings about a
• Passive killing: failing to perform a certain action which is needed to
keep a person alive.
E.G.: a doctor might refuse to continue to use extraordinary measures
such as large doses of medication to keep a patient alive.
• This distinction is also described by some bioethicists as that between
‘killing’ and ‘letting die’.
• The distinction between passive and active killing i