In the chapter “A History of Ideas Concerning the Morality of Suicide, AssistedSuicide and Voluntary Euthanasia” author Craig Paterson explores questions concerning the legitimacy of the practices of suicide, assistedsuicide, and voluntary euthanasia. The aim of this article is of identifying some of the main historical protagonists, and delineating some of the key arguments that have been used for the acceptance or rejection of these practices.
The article examines from an historical perspective some of the key ideas used in contemporary bioethics debates both for and against the practices of assistedsuicide and euthanasia. Key thinkers examined--spanning the Ancient, Medieval and Modern periods--include Plato, Aristotle, Augustine, Aquinas, Hume, Kant, and Mill. The article concludes with a synthesizing summary of key ideas that oppose or defend assistedsuicide and euthanasia.
As medical technology advances and severely injured or ill people can be kept alive and functioning long beyond what was previously medically possible, the debate surrounding the ethics of end-of-life care and quality-of-life issues has grown more urgent. In this lucid and vigorous book, Craig Paterson discusses assistedsuicide and euthanasia from a fully fledged but non-dogmatic secular natural law perspective. He rehabilitates and revitalises the natural law approach to moral reasoning by developing a pluralistic account of just (...) why we are required by practical rationality to respect and not violate key demands generated by the primary goods of persons, especially human life. Important issues that shape the moral quality of an action are explained and analysed: intention/foresight; action/omission; action/consequences; killing/letting die; innocence/non-innocence; person/non-person. Paterson defends the central normative proposition that ‘it is always a serious moral wrong to intentionally kill an innocent human person, whether self or another, notwithstanding any further appeal to consequences or motive’. (shrink)
But as Harvard ethicist Arthur J. Dyck shows in this powerful work, there are solid moral and practical bases for the existing laws against assistedsuicide in ...
Contributors explore the social, medical, and ethical dilemma of assistedsuicide in this revised edition that includes international as well as domestic viewpoints. The federal government's continued challenges to Oregon's Death with Dignity Act, the disabled community's response to assistedsuicide, and the slippery slope argument are all examined.
Chapter one argues for the important contribution that a natural law based framework can make towards an analysis and assessment of key controversies surrounding the practices of suicide, assistedsuicide, and voluntary euthanasia. The second chapter considers a number of historical contributions to the debate. The third chapter takes up the modern context of ideas that have increasingly come to the fore in shaping the 'push' for reform. Particular areas focused upon include the value of human life, (...) the value of personal autonomy, and the rejection of double effect reasoning. Chapter four engages in the task of pointing out structural weakness in utilitarianism and deontology. The thesis argues that major systemic weaknesses in both approaches can be overcome by a teleology of basic human goods. John Finnis' work becomes the underpinning of subsequent applied natural law analysis. Chapter five proceeds to argue for the defence of the intrinsic good of human life from direct attack. The thesis holds out for the proposition "that it is always a serious moral wrong to intentionally kill a human person, whether self or another, regardless of a further appeal to consequences or motive." In support of this, it defends the validity of double effect reasoning as an indispensable part of applied moral decision making. Chapter six critically assesses the arguments of anti-perfectionists that it is not the business of the state to enforce deep or substantive conceptions of the 'good life.' The chapter moves on to argue that the natural law conception of the person in society, centred on the common good, provides a solid framework for assessing both the justification for, as well as the limits on, the role of the state to use its power to legally impose certain moral standards. Chapter seven addresses the concrete relationship between natural law and legal policy by exploring the issue of assistedsuicide in the constitutional context of the United States.
Debate about physician-assistedsuicide has typically focused on the values of autonomy and patient well-being. Margaret Battin, Rosamond Rhodes and Anita Silvers note that both those in favour of legalizing physician-assistedsuicide and those who want this activity to be legally prohibited claim these values in support of their case. This is understandable, even reasonable, given the importance of these values in bioethics. However, these are not the only moral values there are. The purpose of this (...) paper is to examine physician-assistedsuicide on the basis of the values of equality and justice. In particular, I evaluate two arguments that invoke equality, one in favour of physician-assistedsuicide, one against it, and I argue that a convincing equality-based argument in support of physician-assistedsuicide is available. I conclude by showing how an equality-based perspective transforms some secondary features of debate about this issue. (shrink)
In this article, I argue that depression and suicide are natural kinds insofar as they are classes of abnormal behavior underwritten by sets of stable biological mechanisms. In particular, depression and suicide are neurobiological kinds characterized by disturbances in serotonin functioning that affect various brain areas (i.e., the amygdala, anterior cingulate, prefrontal cortex, and hippocampus). The significance of this argument is that the natural (biological) basis of depression and suicide allows for reliable projectable inferences (i.e., predictions) to (...) be made about individual members of a kind. In the context of assistedsuicide, inferences about the decision-making capacity of depressed individuals seeking physician-assistedsuicide are of special interest. I examine evidence that depression can hamper the decision-making capacity of individuals seeking assistedsuicide and discuss some implications. (shrink)
Euthanasia and physician assisted-suicide are terms used to describe the process in which a doctor of a sick or disabled individual engages in an activity which directly or indirectly leads to their death. This behavior is engaged by the healthcare provider based on their humanistic desire to end suffering and pain. The psychiatrist's involvement may be requested in several distinct situations including evaluation of patient capacity when an appeal for euthanasia is requested on grounds of terminal somatic illness (...) or when the patient is requesting euthanasia due to mental suffering. We compare attitudes of 49 psychiatrists towards euthanasia and assistedsuicide with a group of 54 other physicians by means of a questionnaire describing different patients, who either requested physician-assistedsuicide or in whom euthanasia as a treatment option was considered, followed by a set of questions relating to euthanasia implementation. When controlled for religious practice, psychiatrists expressed more conservative views regarding euthanasia than did physicians from other medical specialties. Similarly female physicians and orthodox physicians indicated more conservative views. Differences may be due to factors inherent in subspecialty education. We suggest that in light of the unique complexity and context of patient euthanasia requests, based on their training and professional expertise psychiatrists are well suited to take a prominent role in evaluating such requests to die and making a decision as to the relative importance of competing variables. (shrink)
It has been argued that voluntary euthanasia (VE) and physician-assistedsuicide (PAS) are morally wrong. Yet, a gravely suffering patient might insist that he has a moral right to the procedures even if they were morally wrong. There are also philosophers who maintain that an agent can have a moral right to do something that is morally wrong. In this article, I assess the view that a suffering patient can have a moral right to VE and PAS despite (...) the moral wrongness of the procedures in light of the main argument for a moral right to do wrong found in recent philosophical literature. I maintain that the argument does not provide adequate support for such a right to VE and PAS. (shrink)
Guidelines provided by the Director of Public Prosecutions suggest that anyone assisting another to commit suicide in England and Wales, or elsewhere, will not be prosecuted provided there are no self-seeking motives and no active encouragement. This reflects the position in Switzerland. There, however, no difference is made between assistance and inducement. In addition, the Swiss approach makes it possible to establish organisations to assist the suicides of both their citizens and foreign visitors. It should not be assumed that (...) this approach is without controversy in Switzerland. Proposals for reform continue to be debated there, not least because of the concern about some of the actual practices of certain end-of-life organisations. It is likely that a few English citizens will continue to avail themselves of these services in Switzerland if they cannot find the help they require here. This paper explores the legitimacy of the current restrictive position adopted towards assistedsuicide in England. It argues that the provisions within the guidelines prohibiting organisations that assist suicides, leaves some without the help they need. While legislative decriminalisation of assistedsuicide and the establishment of state-sponsored suicide centres would represent the most permissive regime, this paper proposes that this would be a step too far. The preference here is for decriminalisation but adopting a ‘middle way’ between the two extremes: the more permissive approach provided by the ‘Swiss model’ is one that could be employed here, albeit within a more robust regulatory regime. (shrink)
The 1998 elections were held just about two weeks ago.1 All across the country, Americans went to the polls to vote for Senators, Representatives to the House, Governors, and local officials. In many states they were also given the opportunity to vote on a wide variety of ballot questions, and among these ballot questions several concerned physician assistedsuicide.
abstract Many have held that there is some kind of incompatibility between a commitment to good end-of-life care and the legalization of physician-assistedsuicide. This opposition to physician-assistedsuicide encompasses a cluster of different claims. In this essay I try to clarify some of the most important of these claims and show that they do not stand up well to conceptual and empirical scrutiny.
In this article, I shall present three arguments for thc pcrmissibility 0f physician-assistedsuicide (PAS), and then examine several objections 0f 21 "K21nti2m" and non-Kantian nature against them. These are really 0bjcctions against certain types of suicide. I shall focus 0n active PAS (eg., when 21 patient takes 21 lethal drug given by E1 physician, in which case both thc physician and patient are active). I shall assume the patient is 21 competent, responsible, rational agent, who gives (...) his being in physical discomfort (pain, nausea, ctc.) as thc reason for intending his death. I am assuming, therefore, thc pain while 21 sourcc of suffering docs not undermine his rational agency in 21 way that threatens responsibility for choice.] Current legal proposals for permitting PAS focus 0n procedures.. (shrink)
This essay first discusses the three major arguments in favor of euthanasia and physician-assisted-suicide in contemporary Western society, viz ., the arguments of mercy, preventing indignity, and individual autonomy. It then articulates both Confucian consonance and dissonance to them. The first two arguments make use of Confucian discussions on suicide whereas the last argument appeals to Confucian social-political thought. It concludes that from the Confucian moral perspectives, none of the three arguments is fully convincing.
: In this essay, I examine the arguments against physician-assistedsuicide (PAS) Susan Wolf offers in her essay, "Gender, Feminism, and Death: Physician-AssistedSuicide and Euthanasia." I argue that Wolf's analysis of PAS, while timely and instructive in many ways, does not require that feminists reject policy approaches that might permit PAS. The essay concludes with reflections on the relationship between feminism and questions of agency, especially women's agency.
In the first part of this article, I raisequestions about Dworkin''s theory of theintrinsic value of life and about the adequacyof his proposal to understand abortion in termsof different ways of valuing life. In thesecond part of the article, I consider hisargument in ``The Philosophers'' Brief on AssistedSuicide'''', which claims that the distinctionbetween killing and letting die is morallyirrelevant, the distinction between intendingand foreseeing death can be morally relevantbut is not always so. I argue that thekilling/letting die distinction can be (...) relevantin the context of assistedsuicide, but alsoshow when it is not. Then I consider why theintention/foresight distinction can be morallyirrelevant and conclude by presenting analternative argument for physician-assistedsuicide. (shrink)
It is plausible that what possible courses of action patients may legitimately expect their physicians to take is ultimately determined by what medicine as a profession is supposed to do and, consequently, that we can determine the moral acceptability of voluntary euthanasia and physician-assistedsuicide on the basis of identifying the proper goals of medicine. This article examines the main ways of defining the proper goals of medicine found in the recent bioethics literature and argues that they cannot (...) provide a clear answer to the question of whether or not voluntary euthanasia and physician-assistedsuicide are morally acceptable. It is suggested that to find a plausible answer to this question and to complete the task of defining the proper goals of medicine, we must determine what is the best philosophical theory about the nature of prudential value. (shrink)
This paper looks at the ambiguities which PAS (physician assistedsuicide) and voluntary active euthanasia (VAE ) present to the patient, his or her loved ones and the health-care team. The author pleads for a greater emphasis on humanizing the experience of the dying so that a team can meet their physical, emotional and spiritual needs.
The ethical problems surrounding voluntary assistedsuicide remain formidable, and are unlikely to be resolved in pluralist societies. An examination of historical attitudes to suicide suggests that modernity has inherited a formidable complex of religious and moral attitudes to suicide, whether assisted or not. Advocates usually invoke the ending of intolerable suffering as one justification for euthanasia of this kind. This does not provide an adequate justification by itself, because there are (at least theoretically) methods (...) which would relieve suffering without causing the physical death of the suffering person. Carried to extremes, these methods would finish the life worth living, but leave a being which was technically alive. Such acts, however, would provide no moral escape, since they would create beings without meaning. Arguments seeking to justify ending the lives of others need some grounding in concepts of the meaning of a life. The euthanasia discourse therefore needs to take at least some account of the meaning we construct for our lives and the lives of others. (shrink)
This paper evaluates the arguments against physician assistedsuicide which contend that it violates the integrity of medicine and the physician-patient relation; i.e. that it contradicts the goal of seeking health and healing, violates an absolute prohibition against killing, and undermines the patient's trust in the physician. These arguments against physician assistedsuicide (1) misuse notions of teleology and teleological explanation; (2) rely on inappropriate notions of "ideal medicine", for which death is a defeat; (3) turn (...) on a highly selective reading for the Hippocratic tradition; and (4) are unacceptably paternalistic. Keywords: Hippocratic ethics, integrity in medicine, physician assistedsuicide, physician-patient relation CiteULike Connotea Del.icio.us What's this? (shrink)
Since 1998, physician-assistedsuicide has been legal in the American state of Oregon. In this paper, I defend Oregon’s physician-assistedsuicide (PAS) law against two of the most common objections raised against it. First, I try to show that it is not intrinsically wrong for someone with a terminal disease to kill herself. Second, I try to show that it is not intrinsically wrong for physicians to assist someone with a terminal disease who has reasonable grounds (...) for wanting to kill herself. (shrink)
All too often in applied ethics debates, there is a danger that a lack of analytical clarity and precision in the use of key terms serves to cloud and confuse the real nature of the debate being undertaken. A particular area of concern in my analysis of the bioethics literature has been the uses to which the key terms "suicide," "assistedsuicide," and "euthanasia" are put. The modest aim of this article is to render a contribution to (...) the applied ethics debate on these topics by seeking to delimit the scope and meaning of these terms. The criteria of specificity, non-arbitrariness, consistency (between various terms), and the avoidance of strong pejorative presuppositions, supply the main standards guiding my adoption of usages. (shrink)
Respect for autonomy is typically considered a key reason for allowing physician assistedsuicide 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 assistedsuicide 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 assistedsuicide 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 assistedsuicide or euthanasia always is impermissible. (shrink)
Dutch euthanasia and physician-assistedsuicide stand on the eve of important legal changes. In the summer of 1999, a new government bill concerning euthanasia and physician-assistedsuicide was sent to Parliament for discussion. This bill legally embodies a ground for exemption from punishment for physicians who conduct euthanasia or physician-assistedsuicide and comply with certain requirements. On November 28, 2000, the Dutch parliament approved an adapted version of this bill. Since the approval by the (...) Dutch Senate can be regarded as a formality, it is expected that the bill will come into force in the course of this year (2001). In this paper we discuss these new developments. (shrink)
``What Does a Right to Physician-AssistedSuicide (PAS) Legallyentail?''''Much of the bioethics literature focuses on the morality ofPAS but ignores the legal implications of the conclusions thereby wrought. Specifically, what does a legal right toPAS entail both on the part of the physician and the patient? Iargue that we must begin by distinguishing a right to PAS qua``external'''' to a particular physician-patient relationship from a right to PAS qua ``internal'''' to a particular physician-patientrelationship. The former constitutes a negative (...) claim right inrem that prohibits outside interference with the exercise of aright to PAS while the latter can provide the patient witha positive claim right in personam to obligatory assistancefrom his physician. Importantly, I argue that the creation of sucha patient right, however, originates with the physician who may exercise an unqualified right of first refusal prior to promisingto help her patient commit suicide. In doing so, I hope to establishthat explicit physician promises of assistance in dying shouldbecome legally binding. As such, current PAS law in both theNetherlands and Oregon is in need of substantive modification. (shrink)
In this paper I use William James's understanding of significance in life to show that for certain patients euthanasia and assistedsuicide can be importantly meaningful acts that family, friends, and health care professionals must acknowledge and even, at times, aid in bringing to fruition. Dying with meaning is transformative. It reshapes the lives of others that are left behind, giving to their lives new groundings by engaging them in the meaning of dying for us. For the patient, (...) dying with meaning takes the seemingly formless void in the abyss of death and gives it a significant purpose in the last stages of life itself; it turns potential nothingness into actual significance. To the extent that we outsiders do not help the dying, we condemn terminally ill patients to a meaningless existence until they die. (shrink)
The relatively new practice of continuous sedation at the end of life (CS) is increasingly being debated in the clinical and ethical literature. This practice received much attention when a U.S. Supreme Court ruling noted that the availability of CS made legalization of physician-assistedsuicide (PAS) unnecessary, as CS could alleviate even the most severe suffering. This view has been widely adopted. In this article, we perform an in-depth analysis of four versions of this ?argument of preferable alternative.? (...) Our goal is to determine the extent to which CS can be considered to be an alternative to PAS and to identify the grounds, if any, on which CS may be ethically preferable to PAS. (shrink)
A review of the literature was conducted to better understand the (potential) role of mental health professionals in physician-assistedsuicide. Numerous studies indicate that depression is one of the most commonly encountered psychiatric illnesses in primary care settings. Yet, depression consistently goes undetected and undiagnosed by nonpsychiatrically trained primary care physicians. Noting the well-studied link between depression and suicide, it is necessary to question giving sole responsibility of assisting patients in making end-of-life treatment decisions to these physicians. (...) Unfortunately, the use of mental health consultation by these physicians is not a common occurrence. Greater involvement of mental health professionals in this emerging and debated area is advocated. Beyond describing mental health professionals' role in the assessment of patient competency or decision making capacity, other areas of potential involvement are described. A discussion of ethical principles relevant to this area follows, along with comments on the training necessary to adequately serve patient needs. (shrink)
Some disability rights (DR) advocates oppose physician-assistedsuicide (PAS) laws like Oregon’s on the grounds that they reflect ableist prejudice: how else can their limit on PAS eligibility to the terminally ill be explained? The paper answers this DR objection. It concedes that the limit in question cannot be defended on soft paternalist grounds, and offers a hard paternalist defense of it. The DR objection makes two mistakes: it overlooks the possibility of a hard paternalist defense of the (...) limit, and it confuses terminal illness, which is at best one type of disability, with disability itself. (shrink)
Practices such as physician assistedsuicide, even if legal, engender a range of moral conflicts to which many are oblivious. A recent proposal for physician assistedsuicide provides an example by calling upon physicians opposed to suicide to refer patients to other, more sympathetic, physicians. However, the proposal does not address the moral concerns of those physicians for whom such referral would be morally objectionable. Keywords: collaboration, euthanasia, intrinsic evil, material cooperation, projects, referral, toleration CiteULike (...) Connotea Del.icio.us What's this? (shrink)
Rawls’s theory of justice is capable of providing an important contribution to the question of physician-assistedsuicide (PAS). PAS should be guaranteed as a right to make decisions in accordance with the conception of the good the individual formulates as a rational being. This defense is supported, therefore, by a Kantian premise. But it is also possible to oppose this kind of proposal by relying on differentaspects of Kant’s theory, i.e. on some variant of the famous argument against (...)suicide based on the means/end formulation of the categorical imperative. In this paper, I try to show that these attempts are not well founded, and that the Rawlsian appeal to the Kantian tradition divulges better perspectives. I also try to add considerations inspired by contextualist epistemology to the Rawlsian appeal to the burdens ofjudgment. (shrink)
Objectives: The aims of this study were to: (1) investigate patients’ views on euthanasia and physician-assistedsuicide (PAS), and (2) examine the impact of question wording and patients’ own definitions on their responses. Design: Cross-sectional survey of consecutive patients with cancer. Setting: Newcastle (Australia) Mater Hospital Outpatients Clinic. Participants: Patients over 18 years of age, attending the clinic for follow-up consultation or treatment by a medical oncologist, radiation oncologist or haematologist. Main Outcome Measures: Face-to-face patient interviews were conducted (...) examining attitudes to euthanasia and PAS. Results: 236 patients with cancer (24% participation rate; 87% consent rate) were interviewed. Though the majority of participants supported the idea of euthanasia, patient views varied significantly according to question wording and their own understanding of the definition of euthanasia. Conclusions: Researchers need to be circumspect about framing and interpreting questions about support of ‘euthanasia’, as the term can mean different things to different people, and response may depend upon the specifics of the question asked. (shrink)
The leaders of many prominent health and mental health organizations have issued policy statements about the appropriateness of members of their professions being involved in assistedsuicide, whether assistedsuicide is ever an acceptable option for people, and what roles a professional can or should play when a client is considering assistedsuicide. This article argues that only the latter focus-providing suggestions about how a professional can assist a person considering hastening death-is appropriate for (...) an organization whose members are clinical practitioners rather than theorists. The former 2 positions, it is contended, are merely political posturing and are counterproductive to providing proper care to clients in need. (shrink)
Physician-AssistedSuicide: Views of Swiss Health Care Professionals Content Type Journal Article DOI 10.1007/s11673-010-9246-2 Authors Eliane Pfister, Institute of Biomedical Ethics, University of Zurich, CH-8032 Zurich, Switzerland Nikola Biller-Andorno, Institute of Biomedical Ethics, University of Zurich, CH-8032 Zurich, Switzerland Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 7 Journal Issue Volume 7, Number 3.
Leon Kass's often-cited essay, Death with Dignity and the Sanctity of Life, provides the basis for a case study in the rhetorical function of definition in debates concerning bioethics. The study examines the way a particular definition of human dignity is used to maintain an advantage of power in the debate over the morality of physician-assistedsuicide. It also considers sources of human dignity that are deflected from attention by the rhetoric of Kass's formulation.
In this paper the author argues that a narrative approach to understanding assistedsuicide has been compromised by the notion that all narratives must be both coherent and unified. He asks what we are to do with those narratives that cannot seem to cohere or be other than full of disunity? Is suicide the only way to make meaning out of suffering? He then proposes that the narrative found in the Gospel of Mark leads Christians to a (...) life in hope and compassion in spite of apparent incoherence and disunity and threats of abandonment and suffering. (shrink)
Gibson, Robin The concept of dying by euthanasia and indeed physician-assistedsuicide is a highly emotive one. Assisted dying arouses intense feelings both in favour and against. The prospect of enduring a long drawn out dying process generates both fear and apprehension in both terminally ill and chronically ill patients. Many of them wish to choose the time and manner of their death. On the other side, passionate, mainly religious groups have campaigned long and hard to deny (...) suffering people assistance to die. As the law currently stands in Australia, there is a complete ban on both euthanasia and assistance in suicide. Even following a request by a patient, a medical practitioner who directly takes the life of his or her patient, can be charged with murder or manslaughter. Despite the repeal of laws that forbade committing or attempting to commit suicide, laws still exist which proscribe the provision of assistance to another to commit or attempt to commit suicide. (shrink)
A distinction is commonly drawn between continuous sedation until death and physician-assistedsuicide/euthanasia. Only the latter is found to involve killing, whereas the former eludes such characterization. I argue that continuous sedation until death is equivalent to physician-assistedsuicide/euthanasia in that both involve killing. This is established by first defining and clarifying palliative sedation therapies in general and continuous sedation until death in particular. A case study analysis and a look at current practices are provided. This (...) is followed by a defense of arguments in favor of definitions of death centering on higher brain (neocortical) functioning rather than on whole brain or cardiopulmonary functioning. It is then shown that continuous sedation until death simulates higher brain definitions of death by eliminating consciousness. Appeals to reversibility and double effect fail to establish any distinguishing characteristics between the simulation of death that occurs in continuous sedation until death and the death that occurs as a result of physician-assistedsuicide/euthanasia. Concluding remarks clarify the moral ramifications of these findings. (shrink)
In an age of rapid advances inlife-prolonging treatment, patients and caregivers areincreasingly facing tensions in making end-of-lifedecisions. An examination of the history of healthcare in the United States reveals technological,economic, and medical factors that have contributed tothe problems of terminal care and consequently to themovement of assistedsuicide. The movement has itsroots in at least two fundamental perceptions andexpectations. In the age of technological medicineenergized by the profit motive, dying comes at a highprice in suffering and in personal (...) economic loss. Thefailure to provide affordable resources for terminalcare is the result of the marketplace in health care. The medical profession has been painfully slow inresponding to the challenges of terminal care, mainlybecause of the pressures of the marketplace and lackof adequate training. This has occurred at a time ofrapid advances in life-sustaining treatment and ofexpanding public awareness of personal rights underthe law. Overly aggressive treatment in the finalstages of terminal illness has enhanced anxieties overa painfully prolonged and expensive dying. Thesefactors have promoted the movement to assistedsuicide. In the U.S. debate of the issues, ethiciststend to argue abstractly without examiningadequately the context of terminal care that is thehealth care system. It is a system in dire need of areform that will remove it from the marketplace. (shrink)
Brussen, Kerri Anne This paper is a brief history of suicide, euthanasia, and physician assistedsuicide in the United States of America which aims to provide an understanding of the continued and persistent effort in the USA to legalise physician assistedsuicide. Oregon and Washington State Dying with Dignity Laws are reviewed as examples of legalised physician assistedsuicide.
In the United States, judicialrulings that unrealistically addressed the complexityof cases and demonstrated limited understanding ofprinciples, helped to create a legal quagmire whichlegislatures had to confront. Moreover, thelegislative response was often slow and inadequate interms of both the scope and clarity of the laws. However, since the 1970s, progress has been made onmany fronts, particularly in regard to advancedirectives dealing with end-of-life decisions. Thedebate over physician-assistedsuicide has spawned arepetition of moral and legal arguments. Thoseagainst legalization have failed (...) to make a realisticappraisal of the dilemmas facing patients and theirfamilies in an age of technological medicine deliveredin the context of the marketplace. The underlyingproblem is a system in dire need of reform that willno longer treat health care as a commodity of themarketplace and provide universal health care. Terminal care as an integral part of health care willsubstantially benefit from such reforms because amajor obstacle to comprehensive palliative care is thecondition of the present system. (shrink)
Fundamental principles : the nature of the dispute -- Types of euthanasia -- Psychiatric assistedsuicide -- Neonates -- Incompetent adults -- Human life is sacred -- The slippery slope -- Medical views -- Four methods of easing death and their effect on doctors -- Looking further ahead.
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, assistedsuicide, and voluntary euthanasia -- The cultural pressures for change -- 2. The value of human life -- 3. The morality of acts of killing -- 4. Slippery slopes.
Margaret Pabst Battin has established a reputation as one of the top philosophers working in bioethics today. This work is a sequel to Battin's 1994 volume The Least Worst Death. The last ten years have seen fast-moving developments in end-of-life issues, from the legalization of physician-assistedsuicide in Oregon and the Netherlands to furor over proposed restrictions of scheduled drugs used for causing death, and the development of "NuTech" methods of assistance in dying. Battin's new collection covers a (...) remarkably wide range of end-of-life topics, including suicide prevention, AIDS, suicide bombing, serpent-handling and other religious practices that pose a risk of death, genetic prognostication, suicide in old age, global justice and the "duty to die," and suicide, physician-assistedsuicide, and euthanasia, in both American and international contexts. As with the earlier volume, these new essays are theoretically adroit but draw richly from historical sources, fictional techniques, and ample factual material. (shrink)
Proponents of the legalization of assistedsuicide often appeal to our supposed right to "die with dignity" to defend their case. I examine and assess different notions of "dignity" that are operating in many arguments for the legalization of assistedsuicide, and I find them all to be deficient. I then consider an alternative conception of dignity that is based on Aristotle's conception of the conditions on the best life. I conclude that, while such a conception (...) of dignity fits best with our intuitions about the conditions under which a life has dignity, it supports the legalization of assistedsuicide only under very limited circumstances. (shrink)
Opponents of physician-assistedsuicide (PAS) maintain that physician withdrawal-of-life-sustaining-treatment cannot be morally equated to voluntary active euthanasia. PAS opponents generally distinguish these two kinds of act by positing a possible moral distinction between killing and allowing-to-die, ceteris paribus. While that distinction continues to be widely accepted in the public discourse, it has been more controversial among philosophers. Some ethicist PAS advocates are so certain that the distinction is invalid that they describe PAS opponents who hold to the distinction (...) as in the grip of ‘moral fictions’. The author contends that such a diagnosis is too hasty. The possibility of a moral distinction between active euthanasia and allowing-to-die has not been closed off by the argumentative strategies employed by these PAS advocates, including the contrasting cases strategy and the assimilation of doing and allowing to a common sense notion of causation. The philosophical debate over the doing/allowing distinction remains inconclusive, but physicians and others who rely upon that distinction in thinking about the ethics of end-of-life care need not give up on it in response to these arguments. (shrink)
The nationally-famous advocate of physician-assistedsuicide did not die by his own hand. Dr. Jack Kevorkian died the old-fashioned way in America: in a hospital, with multiple disorders undercutting his life. Kevorkian took up interest in assistedsuicide early in his medical career, and he wanted prisoners on death row to volunteer for experiments just before their execution. Kevorkian saw individual consent as the wheel, axle, and grease for all decisions in these matters. He helped many (...) people die, but it is unclear what moral principle guided his decisions to say yes and no to requests for help in dying. His spree in helping people die came to an end, when he himself injected a man with a lethal substance. Because of his single-minded focus on the value of assistedsuicide and experimentation before execution, he had little impact on the broader ethical analysis of assisted-suicide and the rights of prisoners. He leaves little legacy in ethics for the analysis of assisted-suicide or in vivo experimentation. (shrink)
This paper introduces a series of papers dealing with the topic of euthanasia as an introduction to a variety of attitudes by health-care professionals and philosophers interested in this issue. The lead in paperâand really the lead in ideaâstresses the fact that what we are discussing concerns only a minority of people lucky enough to live in conditions of acceptable sanitation and who have access to medical care. The topic of euthanasia and PAS really has three questions: (1) is killing (...) another ever ethically acceptable; (2) is the participation of health professionals ethically different and (3) is it wiser to permit and set criteria (being fully aware of some dangers that lurk in such a move) or to forbid (knowing that it will occur clandestinely and uncontrolled). This paper takes no definite stand although it is very troubled by useless suffering (not only pain) by many who would wish their life and with it their suffering ended. (shrink)
