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Dan W Brock - VAE.docx

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Kelin Emmett

Dan W. Brock: VoluntaryActive Euthanasia • Brocks believes that it is possible to identify an emerging consensus that competent patients, or the surrogates of incompetent patients, should be permitted to weigh the benefits and burdens of alternative treatments, including the alternative of no treatment, according to the patient’s vales, and either to refuse any treatment or to select from among available alternative treatments • Paradigm case of physician assisted suicide is a patient’s ending his or her life with a lethal dose of a medication requested of and provided by a physician for that purpose  Patient + physician kill the patient • Paradigm case of voluntary active euthanasia is a physician’s administering the lethal dose, often because the patient is unable to do so  Only difference between the two paradigms are the person who actually administers the lethal dose. In each case, the physician plays an active and necessary casual role  In both the patient acts last in the sense of retaining the right to change their mind until the point at which the lethal process becomes irreversible • Voluntary euthanasia: clearly competent patient makes a fully voluntary and persistent request for aid in dying • Involuntary euthanasia: competent patient explicitly refuses or opposes receiving euthanasia • Nonvoluntary euthanasia: incompetent and unable to express their wishes about euthanasia, will be considered here only as potential unwanted side effects of permitting voluntary euthanasia • The same two fundamental ethical values for life-sustaining treatments also support the ethical permissibility of euthanasia  Self-determination/autonomy and individual well-being • Self-determination in regards to euthanasia is people’s interest in making important decisions about their lives for themselves according to their own values or conceptions of a good life, and in being left free to act on those decisions • Exercising self-determination presupposes some minimum of decision-making capacities or competence, which thus limits the scope of euthanasia supported by self- determination; it cannot justifiably be administered • If self-determination is a fundamental value, then the great variability among people on this question makes it especially important that individuals control the many, circumstances, and timing of their dying and death • If they find out that the patient is incompetent, the VAE is not possible • Two kinds of arguments against it: 1. Considerations of the patient’s self-determination and well-being do support euthanasia, it is nevertheless always ethically wring or impermissible  Focuses on features of any individual case of euthanasia 2. Euthanasia may not be ethically wrong, but maintains nonetheless that public and legal policy should never permit it  Focuses on social or legal policy • In a case of euthanasia the patient’s death is deliberate or intended even if in both the physician’s ultimate end may be respecting the patient’s wishes  The physician acts with the patient’s consent whereas the son does not  The physician acts with a good motive, to respect the patient’s wishes and self- determination, whereas the son acts with a bad motive, to protect his own inheritance  Physician acts in a social role through which he is legally authorized to carry out the patient’s wishes regarding treatment whereas the son has no such authorization  Removing this artificial intervention is then viewed as standing aside and allowing the patient to die of her underlying disease • The characterization as allowing to die is meant to shift felt responsibility away from the agent, the physician, and to the lethal disease process • Physician and family have to understand that it is the patient’s decision and consent to stopping treatment that limits their responsibility for the patient’s death and that shifts that responsibility to the patient • Wrongful killing deprives a person of a valued future, and of all the person wanted and planned to do in that future. Euthanasia is properly understood as a case of a person having waived their right not to be killed • Two kinds of disagreement about the consequences for public policy permitting euthanasia 1. Empirical or factual disagreement about what the consequences would be due to lack of firm data on the issue 2. Moral disagreements about the relative importance of different effects • No single, well-specified policy proposal for legalizing euthanasia on which policy assessments can focus • If euthanasia were permitted it would be possible to respect the self-determination of competent patients who want it, but now cannot get it because of its illegality • One important factor substantially affecting the number of persons who would seek euthanasia is the extent to which an alternative is available • The legalization of euthanasia can be thought of as a kind of insurance policy against being forced to endure a protracted dying process that one has come to find burdensome and unwanted, especially when there is no life-sustaining treatment to forgo • Legalization of euthanasia concerns patients whose dying is filled with sever and unrelievable pain of suffering. It is crucial to distinguish pain that could be adequately relieved with modern methods of pain control, though it in fact is not, from pain that is relievable only by death • The relief of pain and suffering has long been, quite properly, one of the central goals of medicine. Those cases in which pain could be effectively relieved, but in face is not, should only count significantly in favour of legalizing euthanasia if all reasonable efforts to change pain management techniques have been tried and have failed • Once death has been accepted, it is often more humane to end life quickly and peacefully, when that is what the patient wants • Euthanasia will be a more humane death than what they have often experienced with other loved ones and might otherwise expect for themselves • Potential bad consequences of permitting euthanasia  Permitting physicians to perform euthanasia, it is said, would be incompatible with their fundamental moral and professional commitment as healers to care for patients and to protect life. Patients might lose trust in their physicians  If active is restricted to cases in which it is truly voluntary, then no patient should fear getting it unless they have voluntarily requested it  Patients trust of their physicians could be increased, not eroded, by knowledge that physicians will provide aid in
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