Online research in philosophy

1. The traditional position and the pressures for change. The Western legal tradition -- The Christian ethical hinterland -- The exceptional value of human life -- The justification of taking human life -- Suicide -- Christian ethics, assisted suicide, and voluntary euthanasia -- The cultural pressures for change -- 2. The value of human life -- 3. The morality of acts of killing -- 4. Slippery slopes.

This article deals with the euthanasia debate in light of new life-sustaining technologies such as the left ventricular assist device (LVAD). The question arises: does the switching off of a LVAD by a doctor upon the request of a patient amount to active or passive euthanasia, i.e. to ‘killing’ or to ‘letting die’? The answer hinges on whether the device is to be regarded as a proper part of the patient's body or as something external. We usually regard the switching off of an internal device as killing, whereas the deactivation of an external device is seen as ‘letting die’. The case is notoriously difficult to decide for hybrid devices such as LVADs, which are partly inside and partly outside the patient's body. Additionally, on a methodological level, I will argue that the ‘ontological’ arguments from analogy given for both sides are problematic. Given the impasse facing the ontological arguments, complementary phenomenological arguments deserve closer inspection. In particular, we should consider whether phenomenologically the LVAD is perceived as a body part or as an external device. I will support the thesis that the deactivation of a LVAD is to be regarded as passive euthanasia if the device is not perceived by the patient as a part of the body proper.

The Hasting Center's, "Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying" (1987), outlines a position on assisted suicide that I argue is contradictory. On one hand the guidelines offers a position on human dignity and autonomy that accords competent patients the right to intentionally kill themselves by requesting doctors to terminate life-support. Yet, on the other hand, the guidelines argue that terminating life-support upon request is not ever the moral equivalent of doctored-assisted suicide, and granting the right to the former does not grant a right to the latter. In this paper I argue that in some circumstances a right to obligate your doctor to pull the plug on life-support is morally equivalent to the right to obligate your doctor to assist you in dying by more direct means, e.g. administering a lethal dose of medication. If the fundamental values of autonomy, self-determination, and human dignity justify this right in the one case, they eo ipso justify this right in the other. Both circumstances are subject to the same potential abuse, so citing such potential abuse does not defeat granting an autonomy right in either case.

During the summer of 1999, twenty-eight interviews with some of the leading authorities on the euthanasia policy were conducted in the Netherlands. They were asked about cases of non-voluntary (when patients are incompetent) and involuntary euthanasia (when patients are competent and made no request to die). This study reports the main findings, showing that most respondents are quite complacent with regard to breaches of the guideline that speaks ofthe patient’s consent as prerequisite to performance of euthanasia.

Margaret Otlowski investigates the complex and controversial issue of active voluntary euthanasia. She critically examines the criminal law prohibition of medically administered active voluntary euthanasia in common law jurisdictions, and carefully looks at the situation as handled in practice. The evidence of patient demands for active euthanasia and the willingness of some doctors to respond to patients' requests is explored, and an argument for reform of the law is made with reference to the position in the Netherlands (where active voluntary euthanasia is now openly practiced).

This is an extensive critical review of Euthanasia in International and Comparative Perspective. My Review is divided into five parts. First, I outline the book's strengths. I proceed by speaking of the need for clear and cohesive terminology. I then discuss end-of-life decision-making in some of the countries: Belgium, The Netherlands, and the State of Oregon in the United States, all allow PAS. Belgium and The Netherlands also allow euthanasia. I also discuss Israel's Dying Patient Law,13 enacted by the Knesset on December 5, 2005. Finally, I make some suggestions for improvement, including a detailed proposal for PAS which I conceive to be the best policy when balancing one against the other the autonomy of the patient, on the one hand, and the safeguards against abuse when life might be considered too lightly, on the other. Indeed, the main difference between euthanasia and PAS is that in euthanasia, it is the physician who makes the final act of taking patient's life, whereas in PAS it is the patient who takes his or her life. In euthanasia, the physician has control over the process. In PAS, the physician controls the procedure up until the last act. The patient has control over the very act of suicide.

Respect for autonomy is typically considered a key reason for allowing physician assisted suicide and euthanasia. However, several recent papers have claimed this to be grounded in a misconception of the normative relevance of autonomy. It has been argued that autonomy is properly conceived of as a value, and that this makes assisted suicide as well as euthanasia wrong, since they destroy the autonomy of the patient. This paper evaluates this line of reasoning by investigating the conception of valuable autonomy. Starting off from the current debate in end-of-life care, two different interpretations of how autonomy is valuable is discussed. According to one interpretation, autonomy is a personal prudential value, which may provide a reason why euthanasia and assisted suicide might be against a patient’s best interests. According to a second interpretation, inspired by Kantian ethics, being autonomous is unconditionally valuable, which may imply a duty to preserve autonomy. We argue that both lines of reasoning have limitations when it comes to situations relevant for end-of life care. It is concluded that neither way of reasoning can be used to show that assisted suicide or euthanasia always is impermissible.

This paper re-evaluates euthanasia and assisted suicide from the perspective of eudaimonia, the ancient Greek conception of happiness across one’s whole life. It is argued that one cannot be said to have fully flourished or had a truly happy life if one’s death is preceded by a period of unbearable pain or suffering that one cannot avoid without assistance in ending one’s life. While death is to be accepted as part of life, it should not be left to nature to dictate the way we die, and it is fundamentally unjust to grant people liberal latitude in how they live their lives while granting them little control over the conclusion of their life narratives. Three objections to this position are considered and rejected; the paper also offers an explanation of why we think killing can be a benefit. Ultimately, euthanasia may be necessary in some cases in order to achieve eudaimonia.

During the summer of 1999, twenty-eight interviews with some of the leading authorities on the euthanasia policy were conducted in the Netherlands. They were asked about cases of non-voluntary (when patients are incompetent) and involuntary euthanasia (when patients are competent and made no request to die). This study reports the main findings, showing that most respondents are quite complacent with regard to breaches of the guideline that speaks ofthe patient’s consent as prerequisite to performance of euthanasia.

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of (late onset) Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care.