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Voluntary Active Euthanasia and Physician-Assisted Suicide.docx

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University of Toronto Scarborough
Kelin Emmett

Bioethics for Clinicians: Euthanasia and Assisted Suicide by James Lavery, Bernard Dickens, Joseph Boyle, and Peter Singer WHAT ARE EUTHANASIA AND ASSISTED SUICIDE? Euthanasia is a deliberate act taken by a person with the intention of ending the life of another person to relieve their suffering where the act is the cause of death. Euthanasia may be voluntary, involuntary, or nonvoluntary, depending on (a) the competence of the recipient, (b) the act-wish consistency, and (c) recipient awareness. WHY ARE EUTHANASIA AND ASSISTED SUICIDE IMPORTANT? Ethics There is considerable disagreement about whether euthanasia and assisted suicide are ethically distinct from decisions to forgo life-sustaining treatments. At the heart of the debate is the ethical significance given to the intentions of the actor. Supporters of euthanasia reject that there is an ethical distinction between these acts and acts of forgoing life-sustaining. Opponents of euthanasia claim that death is a predictable consequence of the morally justified withdrawal of life-sustaining treatment. Although they recognize the importance of self-determination, they see this right as irrelevant to social policy. Supporters of euthanasia believe that these acts benefit terminally ill patients by relieving their suffering. Law The Criminal Code of Canada prohibits euthanasia under its homicide provisions. The consent of the person whose death is intended does not alter the criminal nature of these acts. However, despite the reaffirmation by the court, there has been a clear trend toward leniency at laying charges. Policy The CMA continues to uphold the position that members should not participate in euthanasia and assisted suicide. Empirical Studies In Canada, more than 75% of the general public support voluntary euthanasia and assisted suicide in the case of patients who are unlikely to recover from their illness. But roughly equal numbers oppose these practices for patients with reversible conditions, elderly disabled people, and elderly people with only minor ailments. Results of a survey indicate that 24% of Canadian physicians would be willing to practise euthanasia, and 23% would be willing to assist if these acts were legal. Active and Passive Euthanasia by James Rachels The statement adopted by the American Medical Association in 1973: “The intentional termination of the life of one human being by another is contrary to that which the medical profession stands for. The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family. The advice and judgment of the physician should be freely available to the patient and/or his immediate family” The author proposes that if the doctor is focused on a humanitarian effort, then VAE is not an inhumane way to relieve the patient‟s suffering. In some cases, doctors refusing to inject lethal substances to end the misery of the patient have acted in a non-humanitarian way by withdrawing treatment and prolonging suffering. He says that this presents a good ground for rejecting the doctrine that there is a moral distinction between killing and letting die. One reason why so many people think that there is an important moral difference between active and passive euthanasia is that they think killing someone is morally worse than letting someone die. The Smith and Jones example illustrates that there is no moral distinction between killing and letting die. The bare difference between killing and letting die does not make a moral difference. If a doctor lets a patient die, he is in the same “moral boat” as a doctor who gives a lethal injection. Many people find this hard to accept because many cases of killing are clearly impermissible. One hardly hears of cases of letting die except when the humanitarian efforts of a doctor are deemed futile.Media portrayals of killing and letting die place them in a negative and positive light,respectively. However, it doesn‟t mean that one is worse than the other, but that other factors contribute to the different attitudes. The acts and omissions distinction draws a number of points. The first is that it is not exactly correct to say that in passive euthanasia the doctor does nothing. In either case, an action is performed. The decision to let a patient die is subject to the moral appraisal in the same way that a decision to kill him would be subject to moral appraisal: it may be wise or unwise. In either case, the doctor has decided that death is no greater evil than continued existence. Voluntary Active Euthanasia by Dan W. Brock The prominent debate in biomedical ethics surrounds that of forgoing life-sustaining treatment. This has led to the author supporting both VAE and physician-assisted suicide. In the recent bioethics literature some have endorsed physician-assisted suicide but not euthanasia. Are they sufficiently different that the moral arguments for one often do not apply to the other? The only difference that need exist between the two is the person who actually administers the lethal dose. In each, the physician plays a necessary role. However, it might be held that the moral difference is that in euthanasia the physician kills the patient, but in PAS, the patient kills themself. THE CENTRAL ETHICAL ARGUMENT FOR VOLUNTARY ACTIVE EUTHANASIA The central ethical argument for euthanasia is centred on two fundamental ethical values. These values are autonomy and individual well-being. Autonomy is valuable because it permits people to live in accordance with their own conception of a good life. In exercising self-determination, people take responsibility for their lives. Thus, most people are very concerned about the nature of the last stage of their lives because of their desire to maintain dignity and control during this period. Individual well-being is another main value that supports euthanasia. It might seem that individual well-being conflicts with a person‟s self-determination when the person requests euthanasia. Life itself is a central good for persons. But when a competent patient decides to forgo life-sustaining treatment, they have decided that the best life possible for them is worse than no life at all. The value of self-determination does not entitle patients to compel physicians to act contrary to their own moral or professional values. If performing euthanasia became legally permissible but conflicted with a physician‟s professional responsibilities, the care of a patient who requested euthanasia should be transferred to another. Most opponents do not deny that self- determination and well-being support euthanasia in some cases. EUTHANASIA IS THE DELIBERATE KILLING OF AN INNOCENT The claim that any individual instance of euthanasia is a case of deliberate killing of an innocent person is correct. Euthanasia is clearly killing, and the patient‟s death is deliberate even if the physician‟s actions are in respect to the patient‟s wishes. In the context of medicine, the ethical prohibition against deliberately killing the innocent derives some of its plausibility from the belief that nothing in the currently accepted practice of medicine is deliberate killing. The belief that doctors do not in fact kill requires the corollary belief that forgoing life-sustaining tx is not killing. The difference between a greedy son and a physician is that: (1) the physician acts with the patient‟s consent whereas the son does not, (2) the physician acts with a good motive, and (3) the physician acts in a social role. Both the physician and the greedy son act in a manner intended to cause death, do cause death, and so both kill. There are two other reasons why the conclusion that stopping life support is killing is resisted. The first reason is that killing is often understood as unjustified causing of death. Ki
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