Phil exam 4 Flashcards
Active euthanasia:
Agent (oneself or another) provides
effective treatment to cause and
hasten death
Passive euthanasia:
Agent refuses / withdraws / withholds
life-sustaining treatment and allows
patient to die by “letting nature take its
course
modes of euthanasia (vin mode)
- Voluntary euthanasia
- Nonvoluntary euthanasia
- Involuntary euthanasia
varieties of euthanasia (variety of vans can be active or passive)
- Voluntary passive euthanasia
- Nonvoluntary passive euthanasia
- Voluntary active euthanasia
- Nonvoluntary active euthanasia
currently legal euthanasia
“voluntary passive euthanasia” is accepted as morally / ethically legitimate in the U.S, as is “nonvoluntary passive euthanasia,” within the confines of substituted judgment and/or decisions made in best interests of paCent.
reasons to support active euthanasia (Ha)
Humanitarian grounds: AE may be the most
merciful and humane approach to relieving
paCent suffering, vs. letting-die.
Appeal to patient autonomy: Honoring a
competent patient’s request for AE, in view
of patient’s suffering, is a perfect expression
of respect for the other’s autonomy
case against AE
- AE is murder of an innocent person and
inherently wrong. - AE lies well outside the scope of a physician’s
professional role, purposes, and responsibilities. - Social policy allowing voluntary AE would
have disastrous side consequences (devaluation
of human life; social reluctance to provide lifesustaining treatment, pressure to accept AE;
slippery slope to nonvoluntary or involuntary
AE)
James Rachels: He proposes that…(Rachel is good this time)
active euthanasia should be accepted as morally
legitimate:
– Because: There is no morally significant
distinction between active and passive
euthanasia;
– That is, actively killing and allowing-to-die
achieve same result: one intends a
hastened death in either case
james rachels con’t (Rachels motives were good, and AE is better than PE)
And because: the moral value of the act lies
not in its outcome but in its motive (selfish
gains vs. humanitarian interests);
– Thus, if passive euthanasia is morally
acceptable, then we should also accept
active euthanasia when properly motivated;
– In fact, in many cases, AE might be more
humane and effective than PE—quick and
painless end, vs. protracted and difficult
allowing-to-die;
– And AE pays more complete respect to
patient autonomy
Daniel Callahan (Daniel the D)
Argues against the moral legitimacy of active euthanasia:
– The distinction between active killing and
passive letting-die is morally significant,
contra Rachels
Daniel Callahan - Metaphysical reason (self is not master in metaphysical)
To ignore the
distinction between killing and letting die
wrongly assumes that the Self is responsible
for all things, and “has become master of
everything within and outside of the self”
Daniel Callahan - moral reason (D says you’re responsible)
Rachels views PE as being
equivalent to AE, in terms of our moral
culpability for causing a death by passive
means. Yet, this view neglects the
difference between what causes death and
who’s at fault for it. Physical causality is
one thing; moral culpability is another.
Thus, just because we allow someone to die
(from natural causes) it doesn’t mean we’re
morally culpable, as we would be in a case
of actively killing that person.
daniel callahan - medical reason (medical is doctor)
Physicians should not be placed in a position to kill paCents by active means; this is a misuse of their expertise and abilities: “only to cure or comfort, never to kill.
physician assisted suicide
AKA “Aid in dying”: Intentional termination
of one’s life by active means, with the
assistance of a physician who provides
information, means of death, or both.
• Versus active euthanasia: In AE, physician
would perform the acCon that causes death
(e.g., administer an injection of life-ending
med’s); in PAS, the patient performs that
acCon, using means and/or information
provided by physician.
key points - euthanasia (strongest argument FOR euthanasia is…)
• Passive euthanasia (both voluntary and
nonvoluntary) is legal.
• The strongest argument for active voluntary
euthanasia is derived from the principle of
autonomy.
• Those who oppose euthanasia often draw a
sharp distinction between killing and letting
die
Brock - 2 ethical values
same two
fundamental ethical values supporting the
consensus on patient’s rights to decide
about life-sustaining treatment also support
the ethical permissibility of euthanasia.
Brock - self-determination
It is a person’s interest in making
important decisions about their own lives
for themselves in accordance to one’s own
values and/or conceptions of the good life.
It also has to do with being left free to act
on one’s own decisions
self determination entails…(Brock)
taking responsibility for one’s own life and for the type of person they will become. It also includes a high view of human dignity as it pertains to a person’s capacity to direct their own lives.
Brock - pluralism (no one answer)
For many patients near death, maintaining
the quality of one’s life, avoiding great
suffering, maintaining one’s dignity, and
insuring that others remember us as we wish
them…But there is no…objectively correct
answer for everyone as to when…one’s life
becomes all things considered a burden and
unwanted.
Brock - a fundamental value (fundamental in SD)
Brock thinks that if self determination is a fundamental value, then it is especially important that individuals control the manner, circumstances, and timing of their own death.
Brock - individual wellbeing (wellbeing is a burden)
Life itself is commonly taken to be a central good. But when life is no longer considered a benefit by the patient, but now has become a burden. The same judgment underlies a request from euthanasia: continued life is seen by the patient as no longer a benefit, but now a burden.
arguments against Brock (ethics and legality)
1) In any individual case where considerations of the patient’s SD and well-being do support euthanasia, it is nevertheless always ethically wrong. 2) In some individual cases euthanasia may not be ethically wrong, but, nonetheless, public and legal policy should never permit it
response to argument that euthanasia is always killing (waiving that right)
The right not to be killed, like other rights, should be waivable when the person makes a competent decision that continued life is no longer wanted or a good, but instead worse than no further life at all. In this view, euthanasia is properly understood as a case of a person having waived his or her right not to be killed
response to argument that euthanasia should never be legalized
1. If euthanasia were permitted it would be possible to respect SD. 2. Polls show that many people would support the legalization of euthanasia to have more control. 3.If euthanasia were permitted, then those with untreatable severe pain could benefit. 4. If euthanasia were permitted and death accepted, then it is more humane to end life quickly and peacefully, when that is what the patient wants.
argument against the legalization of euthanasia - Brock
1. It is incompatible with a doctor’s commitment as healers to protect patients. 2. It would weaken society’s commitment to provide optimal care for dying patients. 3. It could threaten the rights of patients or their surrogates to decide about and to refuse LST. 4. A few others but the more serious one is the “Slipper Slope” objection.
gay-williams - natural inclination
“natural inclination to continue living.” Furthermore, such a practice is opposed to our own self-interest and is a risky step on a slippery slope leading to widespread abuse.
gay-williams - principles (human nature)
P1 All euthanasia is acting against our human nature. P2 All acting against our human nature is a denial of our human dignity. P3 All denial of our human dignity is morally wrong. C Thus, all euthanasia is morally wrong
gay-williams on dignity (seek dignity to the end, gay)
Our dignity comes from seeking our ends…[euthanasia] denies our basic human character and requires that we regard ourselves or others as something less than fully human.”
gay-williams self-interest
P1 All euthanasia is action containing the possibility that we will work against our own interests. P2 All action containing the possibility that we will work against our own interests is morally wrong. C Thus, all euthanasia is morally wrong.
gay-williams - practical effects argument (practically would never happen)
P1 All cases of euthanasia are cases that could have a corrupting influence on doctors and nurses. P2 All cases that could have a corrupting influence on doctors and nurses are morally wrong. C Thus, all cases of euthanasia are morally wrong.
The Uniform Determination of Death Act
(UDDA) - definition
is the current federal law
outlining the definition and criteria of legal,
clinical death. State laws adhere, and specify
testing protocols, etc.
two criteria of UDDA (death)
cardiopulmonary and neurological (“cardiac
death” and “brain death”), as sufficient
conditions for pronouncement of death. These criteria derive from the definition of
“death”
as
“the cessation of functioning of
the organism as a whole
Cardiopulmonary criterion:
“Permanent
cessation of heart-lung functions” indicates
death (UDDA).
- Traditional criterion, traditionally viewed as
both a necessary and sufficient condition to
pronounce death: Anyone lacking CP
func.on is dead, and anyone with CP
func.on is alive…
“Brain Death” or “Whole Brain Death” as specified by the Uniform Determination of Death Act (UDDA):
- “An individual who has sustained either
(1) irreversible cessation of circulatory and
respiratory functions, or (2) irreversible
cessation of all functions of the entire
brain, including the brainstem, is dead.
–Various testing protocols, by state: test for
coma; absence of brain stem reflexes; apnea
test; flat EEG of x minutes, y times in 24 hour
period; etc.
– Even if PT possesses sustained
cardiopulmonary functions, via ventilator
and allied technologies, she is…
pronounced
dead if the neuro criterion is satisfied by
specified tests.
(Either criterion is sufficient
criteria for death - organ donation (heart or brain death)
At this point, if organ-donation consent is provided, organ procurement may proceed by “heart-beating donor” or “Donation after Brain Death (DBD)” protocols
whole brain position (whole brain is whole event)
Death is essentially what we recognize it
to be in common usage; technical or
theoretical definition must not stray too far;
– Death must be a unitary and complete
event, not a process and Death is a biological, vs. socio-cultural
phenomenon;
– “Death” applies only to higher vertebrates
and
– only to organisms, vs. persons;
–Death is irreversible.
“higher brain dead” patient may
retain CP function (“breathe on her own”),
but with the permanent loss of
consciousness, subjectivity, the individual,
as
“a being like you or me,” is dead: no
longer exists
implications for higher brain dead transplants
donor PT might be candidate for DCD (donation after cardiac death), but only abdominal organs are typically procured, and DCD donations are less viable than DBD (donation after brain death) donations
Whole brain” position (the whole brain is just an organism)
Death is a physical event that occurs in an organism, not to be confused with the “death of the person
–Higher brain position
The ongoing
function of an organism is irrelevant to
the loss of existence of the person, “the
being like you or me,” : Death is the
nonexistence of me (vs. my body)…
karen ann quinlan (quinlan is lower)
“lower” brain activity was
recorded; condition did not satisfy
criterion of whole brain death. Dad won in court and ventilator was removed.
Nancy cruzan (cruise to advanced directives)
Missouri
Supreme Court overturned trial court
authorization: placed severe restrictions on
surrogate family-members making decisions
on behalf of incompetent patients, requiring
“clear and convincing” evidence of patient’s
preferences, such as living will. Physicians and family testified and feeding tube was removed. She started movement for advanced directives.
Terri Schiavo
husband wanted tube removed, parents did not. Husband won.
DNR/DNAR Orders (“Do not Resuscitate”/Do
Not Attempt Resuscitation”
• No medical benefit; physician may
decide alone;
• Poor quality of life after CPR; patient
consult/consent needed;
• Poor quality of life before CPR; patient
consult/consent needed
2 kinds of advanced directives (PI directive)
proxy directive and instructional directive
Instructional directives:
Competent person specifies instructions
about her care in the event that decision making capacity is lost; when directed to
issues of LST specifically, often called a
“living will.
Proxy directive:
Competent person specifies a substitute
decision maker (i.e. a health-care agent)
to make health care decisions for her in
the event that decision-making capacity
is lost
Substituted-judgment standard:
Proxy is
expected to represent and uphold the
patient’s expressed preferences, values,
and desires, to the extent known;
Best-interests standard
When patient’s preferences are not clearly known, expectation that proxy will exercise judgments that defend the best interests of the patient for whom she is speaking.
POLST (polstergeist w/ the doc)
Physician Orders for Life-Sustaining Treatment
• CA legislation, 2009, establishing POLST as
recognized legal documentation of patient-physician
planning
• POLST, unlike advanced directive, is signed by both
patient and physician and constitutes ongoing
medical orders
• POLST incorporates advanced directives and
establishes different levels of preferred care
medical futility - principle (medically futile w/out ben & mal)
No obligation to provide a futile treatment (as an expression of beneficence), and every obligation not to provide one, if harms outweigh benefits (nonmaleficence).
physiological futility
Treatment is futile if “physiological systems
have deteriorated so drastically that no known
medical intervention can reverse the
decline.
quantitative futility (the quantity is low)
A judgment that a treatment has an
unacceptably low statistical probability of
producing a given effect: it’s futile because
“Chances are, it won’t work.”
qualitative futility (low quality)
A judgment that the effect produced by a
treatment is of low or no value in and of
itself, in the context of this PT’s condition
(relative to broader goals of treatment): it’s
futile because “Even if it will work, it won’t
do any good.”
Libertarian - rationing
Focuses on rights to social and
economic liberty, emphasizing fair
procedures rather than substantive
outcomes.
Communitarian - rationing
These rely on practices that
have evolved through the
traditions of a community
egalitarian - rationing
These focus on how some people fare relative to others, and that a situation is just when there is equal access to certain goods, when access is necessary to meet people’s claims of need, and when these claims are given equal weight across people. (see John Rawls)
QALYs can be criticized…
on the ground that
they fail to consider the needs and values of
the lives of the elderly and the disabled.
The United Network for Organ Sharing (UNOS)
has devised a point system that incorporates
considerations of both fairness and efficiency
in the allocation of organs. The aim is respect
people’s claims of need for organs, while at
the same time promoting good outcomes of
transplantation. (Note: “Autonomy cannot be
separated from responsibility.
two-tiered healthcare
Fairness is giving more weight to stronger
claims of need, and pertains to a decent
minimum of care (DMC), not optimal care.
Glannon thinks that if people have reached a
DMC, then they would have no moral claim to
receive the same care as those who can
purchase additional care above the level
Glannon on rationing (Glannon is fairly efficient)
fair and efficient health care system
must be more sensitive to the needs of the
elderly and the disabled. But no health care
system can meet everyone’s claims of need.”
Medical rationing needs to reasonably balance
between fairness and efficiency
Brock - active euthanasia is definitely killing - so why isn’t it wrong? (good consent isn’t wrong)
You have patient consent and you have good intentions
