Euthanasia - issues

1.Does your life belong to anyone or anything?

2.Is there a difference between a doctor actively killing a patient or allowing their patient top die by withdrawing or withholding treatment?

The Sanctity of Life and Euthanasia

• Human life is said to be intrinsically valuable (the Latin word ‘sanctus’ means ‘sacred’, ‘inviolable’, ‘holy’):

Why is this being challenged today?

1. It is therefore wrong intentionally to take an innocent human life.2. All human lives are of equal value, irrespective of age or condition.3. In medical ethics, a moral distinction is made between intentional killing, which is regarded as morally wrong, and allowing a patient to die when further treatment is seen as futile.

Challenges to the Sanctity of Life

• The decline of religious authority and belief in divine creation

• The belief that human beings should have moral autonomy –

• It is possible to prolong life without guaranteeing quality of life

• Advanced medical technology has blurred the boundaries between life and death.

• Some philosophers argue that we should distinguish between the biological category ‘human being’ and the psychological category of ‘person’. They argue that ‘person’ rather than ‘human being’ is the morally significant category.

Immanuel Kant• Kant believed that human

beings deserve absolute respect because they have rational autonomy. This is what makes human beings Godlike.

• Unlike rocks and thunderstorms, human beings have the ability to think and decide for themselves what they will do.

• Treating someone no differently than we would an object (as a means to an end) is to act immorally and irrationally.

Still trying to smile

Jeremy Bentham (1748-1832)

• “The question is not, Can they reason? Nor, Can they talk? But, Can they suffer?”

• Bentham denies the Kantian view that rational autonomy is the basis of our moral standing. He argues that what matters is the ability to experience pleasure and pain.

• On his view, pleasure is intrinsically good and pain is intrinsically bad. The world is better when there is additional pleasure and worse when there is more pain, and it doesn’t matter who or what is having that experience.

Dr Jack KervorkianDr Jack Kervorkian is well known in the United States for his practice of assisted suicide.

In 1990 he assisted Janet Adkins to die. Since then he claims to have assisted in over 100 deaths. He has been tried three times by the US courts and acquitted in all three cases by juries.

• Did Dr Kevorkian do the right thing?• Give your opinions with reasons.

Harold Shipman

To think about

• Is there a difference in the two cases?

Euthanasia and the Law in the UKEuthanasia“When life is taken deliberately, the appropriate charge is murder. Thus, if a doctor responds to a request from a patient to end his life and administers a lethal injection, the doctor will have acted with the necessary mens rea for murder (mens rea is the mental element required for conviction of a crime. It makes no difference from the legal point of view that the patient gave their consent. Consent is no defence to a charge of murder, or indeed to the infliction of any substantial physical injury on another. Nor does the doctor’s motive make any difference; the fact that this was a case of ‘mercy killing’ does not affect the status of the act as one of murder …”

Withdrawing treatment“The criminal law does not require doctors to persist in the treatment of a patient when no medical purpose is served by such persistence”

Assisted SuicideIn England, suicide was a crime until the passage of the Suicide Act 1961. This legislation decriminalised suicide (which could obviously only be prosecuted as an attempted crime), but retained the criminal prohibition of aiding and abetting suicide. This means that a doctor who responds to a direct request of a patient to prescibe drugs which he knows the patient intends to use to take his life will be committing an offence under this statute … It is certainly the case that suicide has not been a crime in Scotland – at least in modern times – and, therefore, it is difficult to see how there could be a conviction for being art and part guilty (the Scottish term for accomplice liability) to a non-existent crime. This does not preclude, however, charging a person who assists suicide with a common law crime, such as that of recklessly endangering life.

(Alexander McCall Smith, British Medical Bulletin, 1996)

Around the world• The only four places that today openly and legally authorize

active assistance in dying for patients, are:• Oregon (since l997, physician-assisted suicide); • Switzerland (1941, physician and non-physician assisted

suicide); • Belgium (2002, permits 'euthanasia’); • Netherlands (voluntary euthanasia and physician-assisted

suicide lawful since April 2002 but permitted by the courts since l984).

Each of the following conditions must be fulfilled:• The patient’s suffering is unbearable with no prospect of improvement.• The patient’s request for euthanasia must be voluntary and persist

over time (the request cannot be granted when under the influence of others, psychological illness or drugs)

• The patient must be fully aware of his/her condition, prospects and options.

• There must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above.

• The death must be carried out in a medically appropriate fashion by the doctor.

• The patient is at least 12 years old (patients between 12 and 16 years of age require the consent of their parents)

This is Terri Schiavo.

She died in 2005 after a long legal battle between her husband and her parents.

This photo was taken in 1990, shortly after a chemical imbalance caused Terri's heart to stop beating, cut off oxygen to her brain and left her severely brain-damaged.

Terri was in a vegetative state for 15 years.

In this photo she gets a kiss from her mother, Mary Schindler.

He attempted to get Terri's feeding tube removed for seven years, after he came to believe that she would never recover.

Terri's husband, Michael Schiavo, says she told him once that she would not want to be kept alive artificially.

Bob and Mary Schindler, Terri's parents, went to court to try to fight Michael’s efforts to let her die.

Under American law Terri’s husband was her legal guardian.

Demonstrators cover their mouths with tape, which they say represents the silencing of Terri Schiavo, in a protest outside the hospice where Terri was a patient.

During this time her parents continued to try to get the legal decision to remove her feeding tube overturned.

Terri’s feeding tube was removed on 18th March 2005.

She died 13 days later.

Terri spent the last 15 years of her life connected to a feeding tube in what doctors described as a persistent vegetative state.

Terri Schiavo 1963 – 2005

Part 1

• In pairs discuss these points. Write the answers in your jotter

1. Why did her husband want to remove the feeding tube?

2. Why did her parents not want it removed?

3. “You saw a murder, all who denied her right to live are accomplices.” What does this statement mean?

4. Do you agree with it?, explain your answer.

Individual Task

• Put a title “Case Study: Terri Schiavo” and then answer these questions as fully as you can.

1. Apart from Terri herself, who else was affected by this case? Make a list. How far do you think that the views of the people on your list should have be taken into account? Explain.

2. Do you think that the decision that was finally made (withdrawing Terri’s feeding tube) was the right decision? Give reasons.

3. Think about how the decision was made. Do you think that the courts should decide cases like this? Give reasons.

BMA Guidelines• In 2006, BMA members voting at the annual meeting made

clear that the majority oppose euthanasia legislation.• The BMA’s policy is that assisting patients to die prematurely is

not part of the moral ethos or the primary goal of medicine and, if allowed, could impact detrimentally on how doctors relate to their own role and to their patients.

• Although the BMA respects the concept of individual autonomy, it argues that there are limits to what patients can choose if their choice will inevitably impact on other people.

• If assisted dying were an option, patients might feel obliged to choose it for the wrong reasons, such as if they were worried about being a burden or concerned about the financial implications of a long terminal illness.

• The concept of assisted dying could weaken society’s prohibition on intentional killing and undermine safeguards against non-voluntary euthanasia of people who are both seriously ill and mentally impaired.

• An urgent and continuing matter of concern remains the uneven availability of good quality palliative care. In 2005, the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill was critical of the gaps in palliative care provision.

The Principle of Double Effect

• The principle of double effect makes a distinction between deaths that are directly intended and deaths that are merely foreseen.

• It is not permissible for a doctor to administer a large dose of morphine with the intention of hastening death.

• It is permissible for a doctor to administer a large dose of morphine with the intention of relieving pain (if that is the only way to relieve pain), even if they foresee the hastening of the patient’s death.

• If safer drugs were available, they would be used: pain would be controlled and life would not be shortened.

Homework

• http://www.bbc.co.uk/ethics/euthanasia/

• Go to the website and take notes on types of euthanasia and pro and anti Euthanasia arguments. For Thursday