Ethics at the End of Life Flashcards
Fire requirements of the doctrine of double effect
First, the act must lead to something which is morally good (or at least neutral).
Second, this good effect must be intended.
Third, the bad effect must be merely foreseen, but not intended.
Fourth, the bad effect must not be a means to the good effect.
Fifth, there must be proportionality (i.e. the good effect must outweigh the bad effect).
The Doctrine of Double Effect deals with. . .
. . . making decisions intended for the benefit of a patient that may also invoke some harm on the patient.
Most states ___ physician-assisted death.
Most states prohibit physician-assisted death.
Empirical studies in the US show that physician assisted death . . .
. . . does happen in the US underground, but goes unprosecuted as long as it is unreported.
Last-resort alternatives to PAD
- Allowing patients to voluntarily stop eating and drinking
- Sedating patients to unconsciousness
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___ should be the standard of care for suffering at the end of life.
State-of-the-art palliative care should be the standard of care for suffering at the end of life.
PAD should only be considered if a palliative care approach has already been tried and failed.
The Supreme Court’s stance on PAD is that. . .
. . . there is no constitutional right to PAD, and thus it is delegated to state’s rights and jurisdiction.
PAD and voluntary elective euthanasia have been practiced for over 30 years and are explicitely legal in ____.
PAD and voluntary elective euthanasia have been practiced for over 30 years and are explicitely legal in the Netherlands.
Takeaway from Karen Ann Quinlan case
Upheld the argument that there is a viable legal distinction between ordinary and extraordinary means to sustain life. Also resulted in the courts advocating for investing some decision-making authority in hospital ethics committees, which is the main reason why most hopsitals today have them.
Takeaway from Nancy Cruzen case
Took decision making authority away from families for incompetent patients. It required “clear and convincing evidence” of the patient’s wishes to refuse life-sustaining treatment for incompetent patients, such as a living will.
Upheld that competent patients have a “constitutionally protected liberty interest in refusing unwanted medical treatment” under the due process clause.
The courts also called for greater protections for incompetent patients. Thus, this case encouraged the development of advance directives that appoint a patient advocate or proxy.
Takeaway from Washington v Glucksberg case
Upheld the constitutionality of a Washington state law prohibiting PAD.
The Court held that the right to assisted suicide is not a fundamental liberty interest protected by the Due Process Clause since its practice has been, and continues to be, offensive to our national traditions and practices.
Takeaway from Vacco v Quill case
Upheld the constitutionality of a New York state ban prohibiting PAD.
The challenge was in respect to the Equal Protections Clause of the 14th ammendment, in relation to the possibility of different protections for competent and incompetent terminally ill patients.
The Court held that New York’s ban was rationally related to the state’s legitimate interest in protecting medical ethics, preventing euthanasia, shielding the disabled and terminally ill from prejudice which might encourage them to end their lives, and, above all, the preservation of human life. The Court also distinguished between the refusal of lifesaving treatment and assisted suicide, by noting that the latter involves the criminal elements of causation and intent.
This upheld the precedent that no matter how noble a physician’s motives may be, he may not deliberately cause, hasten, or aid a patient’s death.
Different constitutional claims challenged in Washington v Glucksberg and Vacco v Quill
Washington v Glucksberg: Due Process Clause of 14th ammendment
Vacco v Quill: Equal Protections Clause of 14th ammendment
