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Mid-Term 2 review.docx

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University of Ottawa
Iva Apostolova

PHI 2396—Bioethics: Mid-term 2 Lectures Euthanasia October 4th, 2013 James Rachels Very few places in world that allow active euthanasia In Canada: • Euthanasia and assisted suicide not decriminalized • Most recent bill was Private members bill in 2010—defeated in House Bill C562:An individual seeking assisted suicide must: 1. Be at least 18 2. Be experiencing "severe physical or mental pain without any prospect of relief" or be terminally ill 3. While appearing lucid, must request 2 times 10 days apart 4. Must express in writing when not lucid The person who is assisting must: 1. Be a medical practitioner or be assisted by one 2. Receive confirmation of diagnosis from one or two other medical practitioners 3. be entitled by law to provide health services or be assisted by one who is 4. act as directed by the individual 5. provide the corner a copy of the diagnosis from 1 or 2 medical practitioners In 2007 76% or respondents say they are in favour of the right to die Factors: • Access and costs of palliative care • change in life expectancy • new methods of assisted suicide James Rachels: "Active and passive Euthanasia" Main argument: • there really isn't a distinction between passive and active euthanasia from a moral point of view • So if we allow passive euthanasia, we should allow active as well Rachels: the medical community, as well as society in general seems to accept passive euthanasia as legally and morally permissible Passive euthanasia: cessation of treatment which will prolong the life of a seriously ill patient Justification: • Some patients suffer intolerable, debilitating pain • Have extremely low quality of life • They often anticipate the inevitable with horror (Sue Rodriguez) • They Deserve to die with dignity and be relieved of their existence Rachels: if we accept passive euthanasia as both legally and morally permissible, then we shouldn't have problems with active either Active Euthanasia: intentionally ending the life of the patient with a lethal dose of barbiturates How people argue for passive and against active: • passive is "letting someone die" while active is "killing someone" • Since killing is wrong, active is wrong Rachels does not dispute the legal grounds for euthanasia • For him there is no moral distinction between "killing" and "letting die" in context or euthanasia Doctor's in either situation has decided to do it out of compassion and humane grounds If eventually the disease turns out to be curable, then in both situations it would be regrettable Often, "letting someone die" is more cruel, as it is accompanied by more suffering The problems: when we talk about active and passive we tend to mix two different questions: 1. is it better from a moral point of view to let someone die and the actual cases of killing a. analysis of this question leads to conclusion that there is no distinction 2. Killing as a bad thing a. outside context of Euthanasia actual cases of killing a lot more horrible than cases of letting die b. main reason = bias Rachels: if we look at bare cases of "letting die" and "killing's" without the accompanying bias they are on the same grounds Most common moral objection is that the doctor has done something to cause death: • Rachels response: in both situations doctor actively does something Overall conclusion: medical practitioners should stick to legal consequences of performing active or passive euthanasia, but they should not suggest or add any moral weight to the distinction between active and passive. Euthanasia October 22nd, 2013 Daniel Callahan Callahan: therefore four groups of arguments in favour of euthanasia which he will argue against: 1. Self-Determination a. Self-determination/autonomy: a universal ethical principle (remember deontology) b. In virtue of this principle, if someone decides that her life is no longer good, she could terminate it c. Callahan: in the case of assisted suicide (euthanasia) self-determination doesn't hold any more. It involves many actors, and should be viewed as a community decision. d. Suffering: i. Suffering is a function of the values of individuals it is not merely a physical state e. By consenting to be killed, we give the right to a doctor to be the judge of not only our physical condition but our values 2. No moral distinction between active and passive a. Callahan: Rachels confused about causality and culpability i. we confuse the cause of death (the reality) with the moral judgment of it (culpability) b. when physician gives lethal injection she is causing the death of the patient c. passive is not d. Use word "kill" metaphorically in passive e. In active word "kill" is very literal f. If we justify passive and active euthanasia we give doctors power of gods—pass moral verdicts on whose life is worthy 3. consequences of legalization: a. 3 big ones: i. proof of abuse in Netherlands (non-voluntary)—No empirical evidence ii. "unbearable suffering" which justifies the legalization of active is vague and practically indefinable iii. Moral logic of euthanasia contains the ingredients for abuse b. Therefore Euthanasia is justified on the grounds of self-determination in combination with suffering c. Sees that as problematic: i. Why should it be limited to suffering?—suffering not necessary for euthanasia to occur ii. Self-determination presupposes that euthanasia is only accessible to competent individuals 1. So incompetent patients (those with down syndrome, etc.) should suffer more than competent patients as they will be refused access to euthanasia 4. Euthanasia and the medical practice a. Callahan: life and death are philosophical questions, not medical questions b. suffering is not part of human condition/human nature c. When medicine tries to resolve questions of life and death, it over-steps its boundaries Callahan's overall conclusion: when self-determination runs amok, what we get is the moral and legal permissibility of euthanasia. Euthanasia October 25th, 2013 Dan Brock Four types of euthanasia: 1. Active Voluntary—generating most controversy 2. Active non-voluntary 3. Passive voluntary 4. passive non-voluntary Brock: agrees with Rachels—in both passive and active voluntary euthanasia the physician takes active role • Important: decisions lies entirely with patients Supporters of voluntary: society founded upon autonomy and individual well-being, are in agreement with euthanasia The worry: at the time of the decision is that the individual may be in a state of mind that may interfere with the autonomous and informed nature of such a decision Possible good consequences of legalizing euthanasia: 1. respect right of autonomy in competent individuals 2. legalizing euthanasia will benefit a much larger group of individuals—all suffering from intolerable pain 3. once we accept death as a fact of life, it is import to live and die with dignity Potential bad consequences of legalizing euthanasia: 1. The trust in physicians will decrease or erode 2. it will weaken society's commitment to provide optimal care for dying patients 3. it will threaten the securing of rights of patients and their surrogate to make decisions about and refusing life-sustaining treatment 4. euthanasia might weaken the general legal prohibition of homicide Brock rejects these four as empirically unsubstantiated 5. if euthanasia is an option to solve one's serious health problems, when some one's serious health problems, when
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