Active euthanasia
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
Euthanasia
Characterized as directly or indirectly bringing about the death of another person for that person’s sake
Involuntary euthanasia
Bringing about someone’s death against her will or without asking for her consent while she is competent to decide
Nonvoluntary euthanasia
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
Passive euthanasia
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
Physician-assisted suicide
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
Voluntary euthanasia
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
Distinction between active and passive euthanasia
Characterized as directly or indirectly bring- ing about the death of another person for that person’s sake
Active voluntary
Directly causing death (mercy killing) with the consent of the patient
Active nonvoluntary
Directly causing death (mercy killing) without the consent of the patient
Passive voluntary
Withholding or withdrawing life-sustaining measures with the consent of the patient
Passive nonvoluntary
Withholding or withdrawing life-sustaining measures without the consent of the patient
Nancy Cruzan
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
Whole brain view of death
Individual should be judged dead when all brain functions permanently cease
Higher brain view of death
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
Arguments to support active voluntary euthanasia
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
Arguments to oppose active voluntary euthanasia
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)
Distinctions between types of euthanasia
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
Bad consequences of active euthanasia
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)
Oregon’s Death with Dignity Act (DWDA)
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
Classic utilitarianism perspective
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
Preference utilitarian perspective
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
Rule utilitarian perspective
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
Natural law
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
Kantianism
Suicide is prohibited because it treats persons as mere things and obliterates personhood
Death
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
Beneficence
Right action of providers should be oriented to the patient’s benefit
Non-maleficence
Right action is governed by doctors’ oath to do no harm and avoid necessary risk
Utility
Maximize good outcomes and minimize undesirable ones
Terri Schiavo
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
Hilly Bosscher
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