physician-assisted suicide and euthanasia ii arguments worth considering
TRANSCRIPT
Physician-Assisted Suicide and Euthanasia II
Arguments Worth Considering
A Divisive Debate
Polls: Position on abortion strongly predicts position on PAS/VAE
Polls: “Religiosity” strongly predicts opposition to PAS/VAE
Significant drop in support in minority communities vs. whites
Good arguments?
Debate seems to make little progress; same charges repeated
Few authors as honest and candid as Kamisar: try hard to identify the strongest reasons in opposition to one’s own position and deal frankly with them
Concerns Worth Hearing
Minority communities Disability rights community Still: must be careful not to
stereotype all as agreeing
Minority concerns
Lack of trust in medical establishment “How come we have had unmet health
care needs in our neighborhood for years, and when you finally show up, it’s to advocate our right to die?”
Disability Concerns
Distrust of medical establishment– Good will toward persons with disabilities– Ability to make accurate prognoses
Allowing person to die because of a disability sends “wrong message”
Concerns with Concerns
Objections apply equally to forgoing treatment, PAS, VAE
Does this position require that persons with disabilities devote their lives and health to “the cause” and not their own goals and needs?
NYSTF Position Paper
“Safeguards” of proponents assumes ideal conditions– Choice of medical care options– Adequate pain management, hospice– Quick access to expert psychiatric care– Basic social support: housing, family, etc.
Too many today lack some or all of these
“Anti-Hospice” Argument
Claim: Allowing PAS will reduce felt need to fund and expand hospice programs
With less availability of hospice will have even more people in future seeking PAS (vicious cycle)
“Anti-Hospice” Argument-?
Data from Oregon show major expansion of hospice
Most proposals to legalize PAS call for more, not less use of hospice as part of “safeguards”
Hospice programs per se do not prevent all requests for PAS (Oregon)
“Quill’s Paradox”
T. Quill: May reduce the number of patients seeking PAS by openly permitting PAS
Claim: Today many terminal patients commit suicide privately because they know physicians cannot legally help them
“Quill’s Paradox”-- cont.
If PAS legal, patients might seek physician’s assistance
Physician could then identify and treat depression, uncontrolled pain, etc.
Treatment of these problems may reduce continued requests for death by as much as 8 of 9 (Netherlands)
Argument from Frequency
Best data show that legal prohibition does not eliminate PAS/VAE
We have little way of knowing whether more “abuses” occur because PAS/VAE is underground practice
Philosophers: unfairness-- well-connected get PAS/VAE whether legal or illegal
Medicalization Argument Claim: A major problem in society today
is expecting medical technology to solve problems which are really social problems (“medicalization”)
Legalized PAS is a way of inappropriately “medicalizing” dying, when real comfort comes from social, emotional, and spiritual support and “working thru”
Medicalization Argument-- II
Common for PAS advocates to cite loss of control of dying process in hospital, etc. as reason
But legalizing PAS with stringent safeguards places control of the process largely in hands of physicians
Inconsistency, or hidden motive?
Medicalization Argument- III
If I had to commit suicide all by myself, as way out of terminal illness, I might reaonably shrink from the act
BUT if I can use the physician as a symbol of “blessing” or “sanitizing” the process I may be encouraged to go thru with it
Medicalization: Rebuttal
If I try to commit suicide on my own I may botch it, or else use messy means which will traumatize family
Wishing to avoid suffering and leaving cruel memories among my family are hardly bad reasons to seek physicians’ help
Chabot Case
Netherlands Dr. Chabot consulted 8 colleagues
before assisting suicide of Mrs. B who was incurably depressed and begged for help to die
Court: Technically guilty because none of 8 actually interviewed patient
Court: Mental illness = physical
Chabot Case-- Concerns
Did Dr. Chabot truly believe that suicide was the best medical option for Mrs. B?
If not did Mrs. B in effect blackmail Chabot into PAS by her threats to commit suicide on her own?
Shows major division between “civil rights” and “physician discretion”
Hardwig: Sympathetic View
Traditional wisdom (autonomy): Worry if patient wishes to die because feels a burden to family
Could be a sign of coercion or undue influence
My decision to die ought to reflect my individual best interests not concerns of family
Hardwig: Sympathetic View- II
Hardwig: This view portrays family as fundamental conflict of interest rather than loving unit on which all of us depend
Truth is that a chronically ill elderly person can be a severe burden
Hardwig: Sympathetic View III
Case from Moyers: Woman promised mother never to put in nursing home
In caring for mother at home woman lost job, home, car, insurance
If mother could have predicted, should she have extracted promise?
Hardwig: If I did that to my family, maybe it would be wrong