Unit 3: Chapter 10

• Involve performing an action that directly causes someone to die—what most people think of as “mercy killing.”

  • Giving a patient a lethal injection to end his suffering, then, is a case of active euthanasia

Characterized as directly or indirectly bringing about the death of another person for that person’s sake

Bringing about someone’s death against her will or without asking for her consent while she is competent to decide

• Both illegal and morally impermissible

• Performed when patients are not competent to choose death for themselves and have not previously disclosed their preference (Incompetent patients include not only incapacitated adults but infants and small children as well.)

• In these circumstances, the patient’s family, physician, or other officially designated persons decide for the patient

• Allowing someone to die by not doing something that would prolong life, either by not providing a treatment that would keep the patient alive or halting a life-sustaining process f

  • It includes removing a patient’s feeding tube or ventilator, failing to perform necessary surgery, and refraining from giving life-saving antibiotics

A patient takes his own life with the aid of a physician; the physician will prescribe drugs or describe a method of suicide but the act itself is done by the patient

• Situations in which competent patients voluntarily request or agree to euthanasia, communicating their wishes either while competent or through instructions to be followed if they become incompetent (if they fall into a persistent vegetative state, for example)

• Patients can indicate what is to be done in incompetence by formulating an advance directive—usually, a living will or a document designating a surrogate, or proxy, to act on their behalf

Characterized as directly or indirectly bring- ing about the death of another person for that person’s sake

Directly causing death (mercy killing) with the consent of the patient

Directly causing death (mercy killing) without the consent of the patient

Withholding or withdrawing life-sustaining measures with the consent of the patient

Withholding or withdrawing life-sustaining measures without the consent of the patient

• In 1990, Supreme Court issued a ruling for an individual’s “right to die”

• Question involved whether to remove a feeding tube from Nancy Cruz, who had been left in a persistent vegetative state after a terrible car crash

• Nancy’s parents wanted to remove the feeding tube, as Nancy had mentioned once that she would not want to be kept alive

  • But she had no living will or other explicit instructions, so authorities in the state of Missouri sought to block the removal of the feeding tube

• The Court held that Missouri had a legitimate interest in demanding “clear and convincing evidence” of an incompetent individual’s preferences

  • Court effectively ruled against the Cruzans

  • Eventually, after 8 years, Missouri stopped opposing Cruzan’s efforts and declared evidence of Nancy’s intent was sufficiently convincingly

• The Court found that competent individuals have a constitutionally guaranteed “liberty interest” in refusing medical treatment, even when refusing could bring about their death

• And for the first time, it acknowledged that if a person became incompetent, this right could be exercised through a living will or by a designated surrogate

  • States could still restrict this liberty interest, however, if a person’s refusal of treatment was not stated clearly or strongly enough

Individual should be judged dead when all brain functions permanently cease

• Individual should be considered dead when the higher brain operations responsible for consciousness permanently shut down

  • Dead when they are no longer persons, regardless of what physiological activity persists

    • No longer persons when consciousness permanently terminates

• Principle of autonomy: a person’s inherent right of self-determination

  • Respecting autonomous persons means respecting their autonomous choices, including the choice to end their lives in their own way

• Principle of beneficence, or mercy: if we are in a position to relieve the severe suffering of another without excessive cost to ourselves, we have a duty to do so

  • To refuse would be cruel, inhumane, and wrong

• Killing a person is morally worse than letting that person die

  • Killing is wrong; letting die is permissible

    • Killing involves a person causing the death of another person (murder), while letting die is a matter of allowing nature to do its work (e.g. disease)

• Intending someone’s death vs not intending but foreseeing it

  • Difference is emphasized in the doctrine of double effect

    • It is wrong to intentionally harm someone (cause death) to produce a good result (release from suffering), but it is permissible to do something intended to produce a good result (release from suffering), even if the action leads to unintended but foreseen harm (death)

      • Difference is that in the former, a bad thing is directly intended; in the latter, a bad thing is not intended, only foreseen

        • Though it brings into question, is death harm if a patient is in great pain and consents to death

• Allowing active euthanasia or physician-assisted suicide will inevitably lead to heinous extensions or perversions of the original practice

  • (e.g. lead to nonvoluntary euthanasia to outright involuntary forms of killing; nurses will become increasingly willing to give lethal injections to people who are elderly, mentally ill, chronically ill, uninsured, and disabled)

• Terminally ill adults may get prescriptions from their physicians for lethal drugs and self-administer them

• To request a prescription,

  • An adult (18 years of age or older)

  • A resident of Oregon

  • Capable (defined as able to make and communicate health care decisions)

  • Diagnosed with a terminal illness that will lead to death within six months

• Judge the issues by how much happiness various actions might produce for everyone involved

  • Could be for

    • Euthanasia or assisted suicide for someone suffering horrible, inescapable pain might be permissible because ending life would bring about the most net happiness

  • Could be against

    • With other factors, such as the psychological, social, and financial impact on the patient’s family, friends, and caregivers the answer could come out against euthanasia

• Holding that right actions are those that satisfy more of a person’s preferences overall

  • Killing is bad when it prevents someone from satisfying his own preferences; it can be good when more of the person’s future preferences will be frustrated than satisfied

• Most slippery-slope arguments are essentially rule-utilitarian, asserting that a general policy of authorized killing will, step by step, take society down a path to awful consequences

• Outcomes to be avoided include…

  • Increases in nonvoluntary or involuntary euthanasia

  • Erosion of respect for the medical profession

  • Weakening of society’s abhorrence of homicide

• Condemns active and passive euthanasia BUT with qualifications

  • Directly intending to bring about a person’s death to end suffering is prohibited, but the doctrine of double effect permits actions that have unintended but fatal results

    • Doctrine would not allow doctors to give high-dose analgesics to put patients out of their misery, but it would sanction their doing the same thing with the intention of easing pain though death is foreseen

• Under Catholic principles there is no obligation to use every means possible to prolong a person’s life in every case

• Suicide is prohibited because it treats persons as mere things and obliterates personhood

• Traditionally understood as the cessation of breathing and heartbeat, but medical advances have rendered this notion problematic

  • Whole brain view is now the standard

    • Individuals in persistent vegetative states with some brain activity must be considered alive

  • Higher brain standard

    • Asserts that individuals are dead when the higher brain functions responsible for consciousness permanently close down

    • Those in persistent vegetative states whose higher brain functions have irreversibly ceased are dead

Right action of providers should be oriented to the patient’s benefit

Right action is governed by doctors’ oath to do no harm and avoid necessary risk

Maximize good outcomes and minimize undesirable ones

• Terri sustained irreversible brain damage and went into a persistent vegetative state, where she lost all consciousness

• Her husband became her legal guardian

  • He claimed that she had stated she would not want her life to be artificially sustained and asked to remove her feeding tube (which was against her parent’s wishes)

• Courts sided with Mr. Schiavo and permitted for her feeding tube to be removed

• Diagnosed with severe depression, experiencing intense, long-term psychic suffering that was unbearable and without real chances of improving (she refused treatment)

• She presented the reasons for her decision for assisted suicide clearly and consistently, fully showing her comprehension of the situation and the consequences of the decision

• The Appeal Court acquitted the physician and convicted him on the grounds that therapy was not attempted before he resorted to suicide

  • He, ultimately, was given no punishment

• Courts ruled that assisted suicide can be justifiable if there is no somatic origin for the suffering and it is not terminal

  • Additionally, a person suffering psychologically can be considered competent to request euthanasia; however, the suffering cannot be considered irremediable until treatment has been attempted