Euthanasia

Question 1

Define euthanasia

Answer 1

Euthanasia may be defined as intentionally bringing about the death of another individual, by act or omission, for the sake of the one who is to die.

Notice that euthanasia must be intended death for the benefit of the one who dies. Death that resulted by accident, or was done for other reasons (like to get rid of an annoying relative!) is not euthanasia. Note further, that euthanasia is different from physician-assisted suicide. In the latter, the patient kills herself with the assistance of her physician (who may have provided the patient with a lethal drug); in the former, one individual intentionally and directly ends the life of another individual.

Question 2

Distinguish 6 different kinds of euthanasia

Answer 2

• Euthanasia can be performed actively or passively.
  
  • Active euthanasia is when one intentionally causes the other individual to die for that individual’s own good.
  • Passive euthanasia is when one intentionally allows another individual to die for that individual’s own good.
• Euthanasia may be voluntary, non-voluntary, or involuntary.
  
  • Voluntary euthanasia is when the person consents to be euthanized (consent may be given at the time euthanasia is to be performed, or it may have been in the past through an advance directive).
  • Non-voluntary euthanasia is when the individual lacks the capacity to consent.
  • Involuntary euthanasia is when the individual is competent to consent but that consent is not obtained.

Question 3

Explain the difference between active euthanasia and physician assisted suicide

Answer 3

Euthanasia is different from physician-assisted suicide. In the latter, the patient kills herself with the assistance of her physician (who may have provided the patient with a lethal drug); in the former, one individual intentionally and directly ends the life of another individual.

Question 4

Explain the Sanctity of Life Argument against active euthanasia

Answer 4

It is wrong to intentionally kill an innocent human being.

• Frequently overlooked features of the Sanctity of Life objection to active euthanasia:
  
  • (1) it applies only to human life;
  • (2) it typically is said to apply only to innocent human life; and
  • (3) it assumes that if a life is sacred it is always wrong to end it.

Question 5

Explain the Playing God Argument in support of the Sanctity of Human Life Principle.

Explain a problem with this principle.

Answer 5

One argument against active euthanasia and in support of the Sanctity of Human Life principle is the Playing God Argument.

The idea is that our life belongs to God and so only God should be able to make life and death decisions.

Active euthanasia makes a life and death decision, and so active euthanasia is wrong.

• This argument looks like it has several problems even for people who do believe in God. This is because the claim that only God can make life and death decisions is vulnerable to clear counterexamples. Such counterexamples include:
  
  • Saving a person’s life - say pulling someone from the water who is drowning - is playing God, but that is not wrong. Indeed, much of modern medicine involves making life and death decisions, and yet is not wrong.
  • Sacrificing your life to save the lives of others is to make a life and death decision, and thus to play God, but is certainly not wrong.

Question 6

Explain the Kantian argument in support of the Sanctity of Human Life Principle.

What is a concern with this principle?

Answer 6

Kant argues that rational nature (the ability to make one’s own decisions) is of ultimate value and must always be respected. He, therefore, opposed suicide on the grounds that the person who kills himself treats himself merely as a means, and thereby does not respect his own rational nature. (The idea appears to be that the person who commits suicide destroys his ability to make his own decisions, and thus destroys his rational nature.) This line of reasoning could be extended to active euthanasia: when one kills another person, one destroys that person’s rational nature, and thus does something that is always morally forbidden.

• Even if it is always wrong to treat rational beings merely as a means, this would not rule out all cases of active euthanasia, since some cases of active euthanasia are not performed on rational beings, e.g., on very young, severely disabled children.
• It also seems false that it is always wrong to destroy rational nature.

Question 7

Explain the cases of the incompetent plague victim and the petrol lorry driver and how they are used as counterexamples to the Sanctity of Human Life Principle

Answer 7

• A petrol lorry driver gets into an accident and is trapped in his vehicle as flames begin to engulf him. He screams for someone to kill him, so that he does not have to roast to death. A bystander, understanding the situation, takes action and ends the petrol lorry driver’s life. Does the bystander act permissibly? It seems so. And if that is the case, then we have a clear counterexample to the Sanctity of Life principle. For the petrol lorry driver is an innocent person who is permissibly killed by another person.
• Suppose that a totally incompetent patient has been infected with an incurable disease that is easily spread, and that the patient has escaped custody and is running toward a crowd. Now, suppose a police officer shoots and kills that patient to avert what could be a global disaster, a plague. In this case it would be permissible to kill an innocent human being so as to avoid a worldwide plague, and so the sanctity of innocent human life principle must be false.

Question 8

Give the argument against AE that is based on the claim that intentional killing is worse than intentional letting die

Answer 8

1. AE involves intentionally killing while PE merely involves intending to let die.
2. It is always much worse to intentionally kill than to intentionally let die.
3. Therefore AE is always much worse than letting die.

Question 9

Explain the case of Smith and Jones that Rachels uses to refute the claim that intentional killing is, in itself, worse than intentional letting die

Answer 9

• Smith intentionally killed the child, while Jones ‘merely’ let the child die.
  
  • First, both men acted from the same motive - personal gain.
  • Second, the results of their conduct were the same (their cousin is dead and they got the money)
  • Third, Jones could not plead in his defece with the moral reasoning, ‘After all, I didnt kill the child. I only stood there and let him die’, since this is obviously a ‘grostesque perversion’ as James Rachels puts it.
• “Thus, it seems that when we are careful not to smuggle in any further differences which prejudice the issue, the bare difference between killing and letting die does not itself make any difference to the morality of actions concerning life and death. I will call this the ‘Bare Difference Argument’.” - James Rachel pg 113)

Question 10

Evaluate the effectiveness of Rachels’ controlled experiment

Answer 10

• Ease of rescue of the child versus the terminal nature of diseases
  
  • It would seem bizarre to argue that someone should either ‘let die’ a child, or kill a person, on the grounds of ending suffering that could be cured by an act of profound simplicity. Hardly does this properly portray the real incident of medical ‘letting die’ scenarios, for instead of events with such an ease of cure, we approach cases whereas the incidents are mostly terminal in nature.
• Malicious intent of obvious villains versus benevolent action of physicians

Question 11

Explain McMahan’s view of the moral significance of the killing vs letting die distinction, and what this means for active vs passive euthanasia.

Answer 11

Because, in cases of euthanasia, death is beneficial rather than harmful, active euthanasia should in general be better or more imperative than passive euthanasia.

But is it true that killing is always worse than letting die? After all, letting die can be a slow, undignified, and painful process, while actively killing the person can be quick and merciful. So perhaps we could deny premise 2? We could say that killing is not always worse than letting die, for instance, it may not be worse than letting die when it is more merciful and when it is freely chosen by the one who is to die.

Jeff McMahan builds on this point. He argues that the idea that killing is morally worse than letting die is based on the idea that it is morally worse to cause a harm than to allow a harm to occur. McMahan does not question that basic idea; instead, he notes that in a genuine case of euthanasia, the end result is a benefit and not a harm. Moreover, if it is worse to cause a harm than to merely allow a harm, then it should be better to produce a good result than merely to allow one to occur. And if this is right, then active euthanasia should be preferred to passive euthanasia since the former involves an agent producing a good rather than merely allowing a good to occur. Thus he writes, “Because, in cases of euthanasia, death is beneficial rather than harmful, active euthanasia should in general be better or more imperative than passive euthanasia…” (The Ethics of Killing, 461).

Question 12

Present the autonomy/best interest argument for VAE

Illustrate this argument with examples

Consider and evaluate possible objections to this argument

Answer 12

1. Acts that are freely chosen by a competent person and that are in that person’s best interest, and which do not violate the rights or set back the important interests of others are morally permissible to perform.
2. In some cases, VAE is freely chosen by a competent person, is in that person’s best interest, and does not violate the rights or set back the important interests of others.

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3. Therefore, in these cases, VAE is morally permissible to perform.

Example: A case of VAE that would arguably satisfy these conditions of permissibility is Tim Regan’s (discussed in the text). Respect for Mr. Regan’s right to self-determination spoke in favour of him being euthanized, given his clearly expressed preference to die. Compassion, too, spoke in favour of his euthanasia as opposed to him being required to waste away in a manner which he felt to be undignified. Further, the doctor’s decision to euthanize him did not setback any other people’s rights or important interests, and so his euthanasia was morally permissible.

Objection: Morevoer, the moral principle in premise 1 could be defeated if one could come up with a clear counterexample. Can you think of a clear counterexample to premise 1? How about this? Imagine a case of private, consensual incest, say between 2 adult brothers. (I make it same sex incest only to avoid worries about unintended pregnancies resulting in genetically-damaged offspring.) Would the first premise imply that this (very rare) case of incest is morally permissible? If so, do you think that this would be a decisive counterexample to premise 1? If so, you must reject this argument for the moral permissibility of VAE.

Question 13

Present the best interest argument for NAE

Illustrate this argument with examples

Consider and evaluate possible objections to this argument

Answer 13

1. When dealing with individuals who are not competent (and who will never be competent) to make their own health care decisions, it is morally permissible to act in that non-competent individual’s best interest provided that no one’s rights are violated.
2. In some cases (like Tracy’s) NAE is in the best interest of the individual who is to die, and can be done without violating anyone else’s rights.

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3. Therefore, in these cases, NAE is morally permissible.

Example: Tracy Latimer was actively euthanized by her father when she was twelve years old. Tracy suffered from cerebral palsy and severe mental and physical disabilities caused by oxygen deprivation at birth. She had little or no voluntary control of her muscles, wore diapers, and could not walk or talk. Tracy was in constant pain, and was required to have several surgeries over her short life. Not wanting Tracy to have to go through more pain and another surgery to repair a dislocated hip, Robert killed her by placing her in his truck and connecting a hose from the truck’s exhaust pipe to the cab. Robert was motivated by love for Tracy and a desire to end her pain. He described the medical treatments Tracy had undergone and was scheduled to undergo as “mutilation and torture”. Doctors at his trial noted that the care given by her family had been excellent. And the Supreme Court judgment of 1997 noted, “It is undisputed that Tracy was in constant pain.” (After an extended legal battle, Robert was eventually sentenced to life in prison for 2nd degree murder, with no chance of parole before ten years. He was released in 2008. He continues to maintain that he did the right thing in euthanizing his daughter.)

Objection: Philippa Foot denies that NAE can be done without violating someone’s rights, because NAE always violates the right to life of the one who is killed. The reason one might think this is because one might think that someone like Tracy has a right to life, and that one can only lose that right by voluntarily giving it up. Since Tracy does not (because she cannot) waive her right to life, it remains in effect. To kill her then, even if it benefits her is wrong, because it violates her right to life.

Question 14

Explain the main argument for legalizing active euthanasia

Answer 14

1. The autonomous choices of competent individuals should be legally permitted unless there is a very compelling reason to prohibit those choices.
2. VAE is autonomously chosen and there is no compelling reason to prohibit these choices.
3. Therefore, VAE should be legally permitted.

Question 15

Give the basic form of a slippery slope argument.

Answer 15

A slippery slope argument has the following form:

1. X may be permissible.
2. If X is permitted to be practiced, then Y is very likely to occur.
3. Y would be very objectionable.

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4. Therefore, X should not be practiced.

Question 16

Explain the various kinds of slippery slope arguments against legalizing active euthanasia

Explain how defenders of legalization counter the slope arguments

Answer 16

The idea behind a slippery slope argument is that while VAE may be okay if done properly, the acceptance of VAE as a practice will lead to bad results, such as wrongful killing. Given the dangers of these bad results. Opponents argue we ought not allow the practice of VAE in the first place. Margaret Pabst-Battin helpfully distinguishes between three sources of possible abuses (or misuses): institutional abuse, professional abuse and interpersonal abuse.

Consider first, institutional abuse. Here the concern is that the way medical care is delivered, and the way society is organized, will lead to wrongful killings of people in the name of VAE. A shortage of beds, equipment, and staffing, for example, may make it such that doctors are pressured to encourage patients to opt for euthanasia when in fact other options were available. A lack of adequate support systems, or in the United States the lack of health insurance, may pressure patients who are left to fend for themselves to request euthanasia, when in fact they do not freely choose it, or when their lives could be very worth living.

These sorts of institutional concerns help to buttress the concerns of professional and interpersonal abuse. For example, doctors who are unable to care for all of their patients, may be led to pressure or unduly persuade some of their sicker or older patients to request euthanasia, when in fact the concern is more with caring for other patients than with that particular patient’s best interests. Moreover, such pressures could lead to a relaxation in the standards of what could count as a life not worth living, and so people could end up being killed whose lives are well worth living.

Finally, VAE is vulnerable to interpersonal abuse. This too is in part because of institutional pressures. A family member may pressure or unduly persuade an ailing relative to request euthanasia, only because that family member lacks the resources to properly care for their relative. Or, people that are poor may end up requesting euthanasia, not because they think it is in their interest to die, but because they do not want to be a burden on family members.

There are, of course, many other concerns with legalizing VAE. The general point that opponents of VAE are making however, is quite clear. VAE is bad social policy because it is too likely to be abused, and mistakes are too likely to happen. Instead, opponents of VAE do well to argue that patients should be given good comfort care so that the number of people needing or wanting active euthanasia is kept to a minimum.

Those who wish to defend the legal acceptability of VAE need to respond to these serious concerns of abuse. Perhaps the most promising line of defense is to say that these serious concerns can be greatly mitigated by introducing carefully targeted safeguards. For example, to protect patient autonomy, and to reduce the likelihood of undue pressures (be they professional, institutional, or interpersonal), supporters of legalized VAE could require at least two medical opinions, strict documentation, institutional review of all euthanasia requests, and psychological counseling, prior to carrying out VAE. Such safeguards, as well as others, could help ensure that the patient who is to be euthanized is both choosing autonomously and expected to have a life that is not worth living.

It must be admitted, however, that such safeguards won’t be perfect, and that mistakes and abuse will still happen. But, while this is true, it is not clear that this is enough to demonstrate that VAE should be prohibited. After all, virtually all social policies have mistakes, sometimes fatal mistakes, and yet are deemed acceptable, if the benefits are thought to outweigh the cost. For instance, the automobile results in many thousands of needless (sometimes wrongful) deaths each year in Canada, but is still not prohibited. Instead, we think that we should regulate the use of automobiles (licensing drivers, developing rules of the road, having police to enforce them, etc.), and then allow them because their benefit outweighs their cost. Likewise, even if VAE is liable to some misuse and abuse, despite the presence of safeguards, we may still well judge that the benefits (in terms of respect for autonomy and reduction of harm/suffering) outweigh its tragic costs.

Supporters of legalized VAE will also point out that there are dangers in not legalizing the practice. For, even if it is illegal, euthanasia still happens, especially since many of the institutional, professional and interpersonal pressures still exist regardless of the legal status of active euthanasia. Given this, supporters of legalizing VAE may point out that the risk of wrongful or mistaken killing in the name of euthanasia might actually be reduced if it were legalized and carefully regulated.

Finally, supporters of legalized VAE may think that current Canadian law does not go far enough. It requires, for instance, that the person be competent at the time of the decision to be euthanized. This “safeguard” leads some people, like Tim Regan, to request and receive AE before they really want it or need it. Also, one might think that AE should also be available to those younger than 18 or who are unable to consent. Indeed, legal challenges to the restrictiveness of current law are in the works.