Bioethics Euthanasia Flashcards
Euthanasia
Euthanasia: Meaning of the Word
eu: good
thanatos: death
“painlessly” bringing about the death of a person who is suffering from a terminal or incurable disease or condition
more recently expanded to anyone who wants to die for basically any reason, or to people who others wish to die
Four Categories
Active
taking direct action to bring about a patient’s death
Voluntary
intentionally bringing about the death of a competent patient at his or her request
Passive
withholding or withdrawing medical treatment, resulting in a person’s death
Involuntary
causing the death of someone who does not consent
(see next slide)
Euthanasia
Active
Active involuntary: giving an incompetent person, such as an infant or person in coma, a lethal injection
Active voluntary: “physician-assisted suicide,” administering lethal injection at a person’s request
Passive
Passive involuntary:
withholding life support or medical treatment from an incompetent person
Passive voluntary:
withholding life support or medical treatment at the patient’s direct request of indirectly through living will
Voluntary euthanasia requires “competency”
Competent: rational and able to make own health care decisions
“The distinction between passive and active euthanasia is less straightforward since it often depends on the intention of the person carrying out the action.”
Some claim that “passive euthanasia” is not actually euthanasia since it does not involve intentional killing, but it is withholding treatment. By “treatment,” however, we should make a distinction between medical treatment and food/water/oxygen, which are essential to all life.
The text focuses on active euthanasia.
We will consider the morality of active euthanasia: taking direct action to bring about a patient’s death (whether voluntary or involuntary).
Let’s watch this. Probably, many of us have known people who were in situations like this. I certainly have.
https://youtu.be/p7RQL8ATEUA
This video is pretty cheesy, but the story is amazing:
https://youtu.be/3NQ_EPw73_c
Philosophies/Philosophers on Euthanasia
Primarily influenced by Greek, Jewish, and Christian ideas
Greeks: health=human ideal
Human worth and social usefulness depended on one’s state of health, so chronically ill people or people deemed subpar=expendable
Organization Not Dead Yet: http://notdeadyet.org/
https://youtu.be/T7rBmQQA38w
Greeks on Health and Able-Bodiedness
Plato: favored euthanasia of deformed and sickly infants because they would be a burden on the polis (infanticide)
Stoics: Humans ought to quit life nobly when they are no longer socially useful (same as John Hardwig’s “Duty to Die”)
Aristotle: Willful euthanasia is wrong. Virtue requires we face death bravely, not cowardly running from suffering.
Pythagoreans: wrote Hippocratic Oath, opposed euthanasia. Humans are divine possessions, life is inherently sacred.
Hippocratic Oath
“Never will I give a deadly drug, not even if I am asked for one, nor will I give any advice tending in that direction.”
Hebrews/Jewish Tradition
Humans are created by God and sustained by Him. Our lives are not our own, just as the rest of creation does not belong to us, but we are stewards of it. Humans are forbidden to take their own lives or the lives of others. Human life has inherent value. It is never utilitarian, it is an end in itself. Death should never be hastened. Physicians who hasten death are murderers.
https://www.biblegateway.com/passage/?search=genesis+2%3A2-27&version=NABRE
Similarly, Muslims tend to agree that taking life interferes with God’s will, but the Koran does provide various scenarios in which taking the life of another human is acceptable.
Job 1:21
“Naked I came forth from my mother’s womb, and naked shall I go back there.
The Lord gave and the Lord has taken away; blessed be the name of the Lord!”
Right, Job on the Dunghill, Carrasco
https://es.wikipedia.org/wiki/Archivo:Gonzalo_Carrasco_-Job_on_the_Dunghill-_Google_Art_Project.jpg
Buddhists
Self-willed death, even in cases of suffering and pain, violates the principle of the sanctity of life.
Suffering=dukkha=dissatisfaction
Suffering is an opportunity to work out bad karma.
A person who assists in suicide or euthanasia will be negatively karmically affected by this.
https://youtu.be/TK-MbNj83NM
Hinduism has a similar perspective.
St. Thomas Aquinas
Suicide is unnatural and immoral:
Everything naturally loves itself, therefore everything naturally wants to continue to exist (live).
Every part belongs to a whole, as in community. Killing oneself injures the whole community.
Life is God’s gift. Humans are subject to God’s power, and God alone gives and takes life. Anyone who takes his own life sins against God, because our lives belong to him.
Christianity
Using the model of the crucified Christ, Christians emphasize the redemptive aspect of suffering. In conforming with Christ’s sufferings, humans unite themselves to him. Also, the more we suffer and the “smaller” we become, the more we depend on God.
https://youtu.be/tR25hk8NVio
https://youtu.be/7QpGxtXpEYA?t=75 (I edited this down a bit to make it shorter. He explains a little about redemptive suffering.)
John Locke
Locke regarded suicide as cowardly, contrary to nature and opposed to the commandments of God.
opposed active euthanasia
morally acceptable to withhold or discontinue treatment that is prolonging the dying process.
Immanuel Kant
Suicide and voluntary euthanasia=immoral
Does not fulfill the requirements of the categorical imperative because it involves a contradiction: exercising our autonomy to destroy our autonomy by destroying ourselves.
People who want to end their lives also show a lack of respect for themselves by viewing their lives as a means only rather than as an end itself.
Disability
“Disability” has long been viewed as a sufficient reason to kill a person, in many times and in many cultures. In Nazi Germany, those considered “disabled” or “mentally ill” were murdered first. The Nazis considered this “granting a mercy death.”
Please explore these important links, which detail how “euthanasia” of children. People with “disabilities” were declared “worthless life.” Watch this:
https://encyclopedia.ushmm.org/content/en/oral-history/benno-mueller-hill-antje-kosemund-paul-eggert-and-elvira-manthey-describe-the-euthanasia-program?parent=en%2F4032
https://www.ushmm.org/collections/bibliography/people-with-disabilities#h126
https://www.ushmm.org/information/exhibitions/online-exhibitions/special-focus/nazi-persecution-of-the-disabled
https://encyclopedia.ushmm.org/content/en/article/euthanasia-program
Mental Illness
Mental illness has historically been confused with developmental differences/neurodiversity. Only a couple of decades ago, for example, autism was referred to as “juvenile schizophrenia” and considered a mental illness, which it is not.
Mental illness has also been wrongly associated with violent crime. In reality, 96% of violent crimes in the U.S. are perpetrated by people who are not mentally ill.
People who have “mental illness” have been considered burdensome and less human. They are perceived as lacking the potential to learn or be socially productive. They have been subject to institutionalization without treatment (warehousing), abuse, and socially-sanctioned murder/euthanasia. That includes cultures as widely varying as indigenous cultures and ancient cultures around the world, Nazi Germany, Stalinist Russia, and twentieth-century America.
Principle of Double Effect
Roman Catholic Church position, originated with St. Thomas Aquinas in Summa Theologica.
If an act has two effects, one intended (to end pain and suffering) and the other unintended (death), terminating treatment may be morally permissible if it is the only way to bring about the intended effect.
https://plato.stanford.edu/entries/double-effect/
https://en.wikipedia.org/wiki/Principle_of_double_effect
Public Opinion
According to text, “Public opinion began shifting in favor of legalized euthanasia in the early 1970s.” By 2005, U.S. had 75% acceptance of the idea of euthanasia. Text implies there was a rise with the Terri Schiavo case.
Support for “physician-assisted suicide” is lower and has been on the decline, at 45% in 2011.
Support for both is high in Western Europe. Canada has recently begun the process legalizing euthanasia of children without the parental consent.
China
Support for euthanasia is high in China.
China has a history of euthanizing female children. Femicide is so extreme that there is a severe population imbalance.
Euthanasia is illegal in China.
Note: Japan’s Shinto influence makes self-willed death more culturally acceptable there.
Watch these:
https://www.cnn.com/videos/world/2015/08/05/intv-china-baby-pleitgen-amanpour-xinran.cnn
https://youtu.be/PsRrNpTdims
Islam=“Submission”
Text quotes “Do not take life, which Allah made sacred, other than in the course of justice.” (17:33) Key lies in the last phrase, “in the course of justice.” Many surahs in the Qur’an call for aggression against unbelievers, so there is not a consistent ethic here. Qur’an is not like many other forms of sacred literature because (1) it came into being at once and (2) is predominantly one type of literature, which is directives. For example:
9:5. Then when the Sacred Months have passed, then kill the Mushrikun [unbelievers] wherever you find them, and capture them and besiege them, and prepare for them each and every ambush. If they repent and perform As-Salat [Islamic ritual prayers], and give Zakat [alms], then leave their way free. Verily, Allah is Oft-Forgiving, Most Merciful.
There are many others. Prominent among them are 8:39, 9:29, 9:33, etc.
Text clarification
Text states “Judaism and Roman Catholicism, as well as some other Christian denominations, also prohibit euthanasia. However, some Catholics support euthanasia in cases of unremitting and severe pain or irreversible brain damage.” (The last part of this statement is untrue.)
Some liberal Protestants are not opposed to active euthanasia.
Not all Catholics are “Roman Catholics.” (There are 24 Catholic Churches, including the Ruthenian, Ukrainian, Russian, Maronite, Syro-Malabar, etc.) However, all Catholic Churches oppose active euthanasia in all circumstances.
Any Catholic who favors active euthanasia for any reason is in opposition to Catholic teaching on euthanasia an in no way represents the Church or its historical/contemporary teaching on the dignity of the human person from conception to natural death.
Legislation
1976 California Natural Death Act was the first law in the U.S. to address the issue of decision making on the part of incompetent individuals. The act allows adults under certain circumstances to make decisions in advance about the kind of treatment they would receive at the end of their lives. (text)
Living wills or “advance directives” are directions regarding one’s medical care or durable power of attorney for health care. Approximately 29% of Americans have prepared one.
Cruzan v. Director, Missouri Department of Health
1990: US Supreme Court ruled that every competent individual has a constitutional liberty right to be free of unwanted medical treatment if there is “clear and convincing evidence” of the patient’s desire to have the medical treatment withdrawn.” SCOTUS left it up to the states to decide for incompetent individuals. (text)
What problems do we see here? What could happen?
Oregon: 1994 “Death with Dignity Act”
Legalized euthanasia under certain conditions
Took effect in 1997 following lengthy court appeals process
Challenged 2002 (AG John Ashcroft), 2006, went to SC
Requirements:
Patients must be in final six months of terminal illness
Patients must make two oral requests and one written request to die, separated by two week period
Patients must be mentally competent to make decision
Two doctors must confirm diagnosis
What problems could exist? What could go wrong?
“Physician-Assisted Suicide”
Permitted only in Oregon, Washington, Montana (as of date of publication)
Legal in Canada, Netherlands, Switzerland, Luxembourg, Thailand, Belgium, etc.
Some think law in Netherlands is too lenient, possibility for abuse.
Unlike in Oregon, Netherlands physicians aren’t required to determine if patient is of sound mind or competent to make decision. At least half were suffering from serious depression or dementia when request occurred. Children who are “hopelessly ill” or handicapped are targeted for euthanasia in Netherlands. They have gone down the slippery slope, as have some other countries. Canada’s runaway train, killing the poor, disabled, etc.
“Physician-Assisted Suicide”
type of active euthanasia in which a physician assists the patient in bringing about his or her death
What is problematic about this idea?
U.S. States that Allow Medical Suicide as of 1/2023
California
Colorado
Hawaii
Maine
Montana
New Jersey
New Mexico
Oregon
Vermont
Washington
Washington D.C.
Currently, only Vermont and Oregon allow nonresidents.
“Physician-Assisted Suicide”
Dr. Jack Kevorkian, “Dr. Death,” “assisted” in the deaths of 130 people whom he hardly knew. Sentenced by Michigan judge in 1999 to 10-25 in prison for second-degree murder. Released on parole in 2007, died 2011. Sparked intense debate over morality of “physician-assisted suicide.”
Surgeon General C. Everett Koop denounced him as “a serial killer who should be put away.” right, with “death machine”
https://www.oregonlive.com/portland/index.ssf/2014/10/portland_woman_uses_suicide_ma.html
https://www.oregonlive.com/pacific-northwest-news/index.ssf/2011/06/washington_woman_who_witnessed_jack_kevorkians_first_assisted_suicide_recalls_her_friend_janet_adkin.html
https://www.nytimes.com/1990/06/06/us/doctor-tells-of-first-death-using-his-suicide-device.html
https://www.nytimes.com/1996/01/30/us/kevorkian-attends-another-death-woman-s-body-is-left-in-van.html
http://articles.latimes.com/1990-06-14/news/mn-248_1_janet-adkins
Hospice: What is it?
A setting for terminally ill patients that provides palliative care and companionship so they can live the last days of their lives as fully and pain-free as possible
https://www.slideshare.net/TheMesotheliomaCenter/am-i-ready-for-hospice-care
Hospice: What is it? Breakdown
Setting: Hospice can be a physical place or a philosophy of/approach to care (or both). Hospice can happen in a hospice location, such as a hospice floor of a hospital or a building that is a hospice center, or it can happen in the home. Hospice workers can come into the patient’s home.
Check out this beautiful article/slideshow of photos: https://www.nextavenue.org/hospice-photography-legacy-families/
Hospice: What is it? Breakdown
Terminally ill: having a disease that cannot be cured and that will ultimately lead to death
From the Latin, terminus, boundary/limit
From the Roman god of boundary markers, Terminus
https://en.wikipedia.org/wiki/Terminus_(god)
https://en.wiktionary.org/wiki/terminus
Hospice: What is it? Breakdown
Palliative: pain relief, comfort, compassion, goal-setting, planning (focus is not on curing)
Interesting article by hospice doctor describing what hospice is and is not: http://www.nuemblog.com/blog/palliative-care
Information from photo
This chart shows what palliative care is. One does not need to be in hospice to receive palliative care. Palliative care should be received by all patients because it will help them live full, happier lives and give meaning to their continued existence.
Hospice: What is it? Breakdown
Companionship: focus is on building relationships between family, friends, and even hospice workers
Photo credit: Amanda Reseburg
