EuthanasiaEuthanasiaDecisions at the end of life

What is Euthanasia?What is Euthanasia?

Euthanasia means “a good death,”or “dying well.”

◦What is a good death? Peaceful Painless Lucid With loved ones gathered around

Some Initial DistinctionsSome Initial Distinctions

Active vs. Passive Euthanasia

Voluntary, Non-voluntary, and Involuntary Euthanasia

Assisted vs. Unassisted Euthanasia

Active vs. Passive EuthanasiaActive vs. Passive EuthanasiaActive euthanasia occurs in those

instances in which someone takes active means, such as a lethal injection, to bring about someone’s death;

Passive euthanasia occurs in those instances in which someone simply refuses to intervene in order to prevent someone’s death.

Criticisms of the Active/Passive Criticisms of the Active/Passive Distinction in EuthanasiaDistinction in Euthanasia

◦Vague dividing line between active and passive, depending on notion of “normal care”

◦Principle of double effect

◦Does passive euthanasia sometimes cause more suffering?

Compassion for SufferingCompassion for Suffering

◦The most important question when lives are ending is: how do we respond to suffering? Hospice and palliative care Aggressive pain-killing medications Sitting with the dying Euthanasia

The Sanctity of LifeThe Sanctity of Life

Life is a gift from God Respect for life is paramountImportance of personhoodThe approach of Natural LawImportance of ministering to the sick

and dying See life as “priceless” (Kant)Respect for life once the dying

process has begun

The Quality of LifeThe Quality of Life

Peter Singer – low quality of life justifies ending a life

BUT what is quality of life – is it more than can be judged medically?

Would extraordinary means improve the quality of life of a patient?

Refusal of medical treatment

The Right to DieThe Right to Die

◦Do we have a right to die? ◦Negative right (others may not interfere) ◦Positive right (others must help) ◦Do we own our own bodies and our lives?

If we do own our own bodies, does that give us the right to do whatever we want with them?

◦Isn’t it cruel to let people suffer pointlessly?

Two ethical approachesTwo ethical approaches

A Utilitarian approach, which emphasises consequences

A Kantian approach, which emphasises autonomy, rights, and respect

The Utilitarian The Utilitarian approachapproach

Goes back at least to Goes back at least to JJeremy Benthameremy Bentham (1748 – 1832) and (1748 – 1832) and John Stuart MillJohn Stuart Mill (1806-73) (1806-73)

The greatest good The greatest good for the greatest for the greatest number number

Main TenetsMain Tenets

Morality is a matter of consequences We must count the consequences for

everyone Everyone’s suffering counts equally We must always act in a way that

produces the greatest overall good consequences and least overall bad consequences.

The CalculusThe Calculus

Morality becomes a matter of mathematics, calculating and weighing consequences

Key insight: consequences matterThe dream: bring certainty to ethics

What is a good death?What is a good death?Jeremy Bentham

Hedonistic utilitarians: a good death is a painless death.

John Stuart MillEudaimonistic utilitarians: a good death is a happy death.

Euthanasia and personal Euthanasia and personal autonomyautonomyJohn Stuart Mill – in matters

which do not concern others, individuals should have full autonomy

Should a competent adult be allowed to decide the time and circumstances of their death?

The Kantian ModelThe Kantian Model

Central insight: people cannot be treated like mere things. ◦Key notions:

Autonomy & Dignity Respect Rights

Autonomy & RespectAutonomy & Respect

◦Kant felt that human beings were distinctive: they have the ability to reason and the ability to decide on the basis of that reasoning.

◦Autonomy = freedom + reason

◦Autonomy for Kant is the ability to impose reason freely on oneself.

Protecting AutonomyProtecting Autonomy

Advanced Directives are designed to protect the autonomy of patients

They derive directly from a Kantian view of what is morally important.

Autonomy: Who Decides?Autonomy: Who Decides?

Kantians emphasize the importance of a patient’s right to decide

Utilitarians look only at consequences – but it can justify too much, as there is no protection for the minority or safeguarding of the individual’s rights

ConclusionConclusion

Many of the ethical disagreements about end-of-life decisions can be seen as resulting from differing ethical frameworks, especially Kantian vs. Utilitarian.

or Quality of Life vs. Sanctity of Life