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Euthanasia

 
Picture of John Haines
Euthanasia
by John Haines - Thursday, 12 July 2007, 6:41 PM
 
I do not believe that the current prohibition against euthanasia ought to be loosened or repealed. The bioethicist John Arras writes that there is a distinction between the morality of individual acts and the wisdom of social policy. In my view, the relevant question is not whether a given person is justified in seeking euthanasia (probably more accurate to say physician-assisted suicide) or indeed, whether the practice is morally justifiable in some cases. Rather, the question is the impact that a change in the law would have on society, in particular, how society might then look upon the weak and the vulnerable who, if now viewed as merely burdensome, might well be subjected to coercion.

The force of Arras’ argument is not necessarily that euthanasia is wrong on deontological grounds, i.e., because killing is wrong, but rather, that it is pernicious because it causes consequences antithetic to what its supporters claim: viz., that it yields less relief of suffering, less patient autonomy, corrupts the practice of medicine, and causes a decline in the quality of palliative care.

Of these, I believe that the “corruption” argument carries particular weight, since proponents of PAS like Ronald Dworkin (who coauthored the well-known “Physicians’ Brief”) seek to artificially constrain (in my view) the scope of a physician’s responsibility within the context of a physician-as-agent argument. The social consequences of PAS, let alone outright euthanasia, are antagonistic to society’s interests since any killing of a patient by a physician inexorably undermines the role of the physician as healer. Arras argues, I believe correctly, that the social risks of legalization are serious and highly predictable.

Another bioethicist, Hilary Bok, answers Dworkin by stating that physicians are indeed agents for their patients, but that this agency is bound by a professional conscience that has rejected the killing of dying patients overwhelmingly and across generations. Trying to undermine this with an autonomy argument, I find, impoverishes our common understanding of society’s interest in protecting the integrity of the medical profession.

More generally, the capacity to commit suicide does not imply a moral or legal right to do so. The fact that we no longer punish suicide, or attempted suicide, as a criminal matter does not mean that we approve of these acts, or recognize that notions like “self-determination” and “personal autonomy” extend this far; nor that society’s interest in preserving life is somehow diminished.
Picture of Patrick Heavey
Re: Euthanasia
by Patrick Heavey - Friday, 13 July 2007, 5:19 PM
 
Well said, John.

As for the question on my 75 year-old self - hopefully I wouldn't wish for euthanasia; certainly not in those circumstances. What about when the suffering gets really extreme? I understand how someone like Diane Petty would seek to end her life, & don't think she can be condemned for it. It's natural to try to escape suffering. But it doesn't follow from that that assisted suicide or euthanasia should be legalised & provided for in the health service; to accept that devalues the dignity of human life. Where would the slippery slope end - a Logan's Run scenario?
Picture of Patrick Heavey
Re: Euthanasia
by Patrick Heavey - Friday, 13 July 2007, 5:19 PM
 
I'm reposting this story about Piergiorgio Welby, which I posted a few weeks ago, as it's relevant here. It broadens the discussion somewhat - as to whether a person should be forced to stay alive against his will using life support machines. Much as I'm against euthanasia, I wouldn't go so far as to insist on that.


Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/world/europe/6207857.stm
Published: 2006/12/24 13:43:02 GMT

Hundreds attend Italian's funeral


Hundreds of people have attended a lay funeral for an Italian man whose death sparked a euthanasia row and a Church refusal to grant a religious service.

Piergiorgio Welby, 60, died in Rome on Wednesday when a doctor turned off his life support machine at his request.

His funeral was held in a square in front of his local parish church.

Church officials rejected the family's request for a funeral there, saying Mr Welby had gone against Catholic teaching by expressing a desire to die.

The funeral was attended by members of non-Catholic denominations and supporters of the small Radical Party, which has campaigned for Mr Welby's right to die.

They applauded when Mr Welby's coffin was taken onto a platform, while loudspeakers played a recording of Vivaldi's Four Seasons.

Landmark case

Many Catholic parishioners who had attended mass in the church stayed on for the funeral in the square.

Some told reporters the priest ought to be ashamed of himself for refusing to officiate.

Mr Welby was suffering from muscular dystrophy. His breathing tube had had kept him alive for nine years, and his condition had worsened in recent weeks.

In a Christmas Eve address at the Vatican, Pope Benedict XVI spoke about the sanctity of live.

"The birth of Christ helps us to understand how much value human life has, the life of every human being, from its first instant to its natural sunset," he said.

Father Marco Fibbi, a spokesman for the Rome vicar's office, said the decision not to allow a religious funeral would send a clear signal to Catholics that Mr Welby's actions were not acceptable.

The doctor who turned off the life support machine has denied that his act constitutes euthanasia - illegal in mainly Catholic Italy.

Dr Mario Riccio said he had fulfilled the patient's legal right to refuse treatment.

A judge had ruled that Mr Welby had the constitutional right to have his life support machine switched off but doctors would be legally obliged to resuscitate him.

Euthanasia and doctor-assisted suicide have been legalised in the Netherlands, Belgium, Switzerland, but remain illegal in much of the rest of the world.

Picture of Dimitrios Kellis
Re: Euthanasia
by Dimitrios Kellis - Sunday, 15 July 2007, 1:42 AM
 
I would agree with both John and Patrick about the present legislation.
Regarding my being 75 y-o situation, I would still consider euthanasia inappropriate. I tend to believe that there is a very thin line between two very different conditions concerning ones disposition towards euthanasia. The one refers to an act of literally salvaging ones self from a debilitating state of such a degree that no particular element of conscious awareness verifying a minimum of dignity in life, is left. The other reflects a condition that despite of the hardship or the impairment, it is an act of selfishness.
It may seem paradoxical to say that the act of ending ones self is actually selfish. Still, starting from the fact that in similarly difficult situations, there are people who would make a stand and fight while others would simply flee in order to avoid confrontation, it wouldn't be, in my view, inconceivable to admit that the ultimate act of fleeing could in some cases be identical to the desire for euthanasia.
I would admit that I'm very much concerned about whether people who would agree with euthanasia ( especially those among them, for whom euthanasia is not a current issue or option), are fully aware of what it really signifies. They tend to unify the desire of ones own ability to decide over his life. But euthanasia in my opinion, is a widely variable concept in matters of its justification. For some it may be the way of dealing with defeat. For others the last remaining means to terminate suffering. For others an act of avoiding a state of personal humiliation.
In my opinion, granting people the ability to decide their own death cannot be based on laws that would just reflect their right to choose or defend their personal desires. People may very well have the right to preserve their dignity, their integrity and their freedom of choice. What they may not yet have though, is the ability, or better the wisdom to unify all the reasons as well as the highly variable degree of their justification, for making ultimately terminating decisions.
Picture of Iris Chan
Re: Euthanasia
by Iris Chan - Sunday, 15 July 2007, 4:35 AM
 

I think the law should be changed to allow euthanasia. When people are unable to live independently, they lose human dignity of living. Their daily life including eating, toileting etc need the help of others. Their quality of life is toally affected. Besides, it is a also burden for those helpers. So I favour the slogan of live with dgnity and die with dignity. 

Human should be given the right to self-deterination. Having euthanasia may be treated as selfish to escape from suffering. But on the other hand, they are also being considerate for themselves and also helpers.

Iris

Picture of Marianne Talbot
Re: Euthanasia
by Marianne Talbot - Sunday, 15 July 2007, 12:37 PM
 

Hi everyone,

A very interesting discussion. (John and Dimitrios – your postings are too long! Mind you I can talk!).

Iris, my mum is in need of help with all the things you mention. I am the carer that provides this help (usually). But my mum adores life and I wouldn’t think of saying that the fact she is in the condition she in in means she should end it. But I expect you’d acknowledge this?

And nor is this to say that I wouldn’t end it for her if the time had come – i.e. if she stopped adoring life. But if I did do this I would then ring the police and admit to having committed a crime. I would be quite happy to undergo whatever punishment the law decreed I should face.

So it is possible perhaps to accept that one can believe individual acts of euthanasia are right without thinking that the law should condone them.

In other words John is right to say that there is a distinction between individual acts and the rules that govern social policy. This is the old ‘type/token’ debate. If you are making rules (as you must be in public policy) then you are essentially considering actions as action-types. If you are considering individual actions, you (might be) considering tokens.

The job of a hospital ethicist or a legislator of any kind is to consider actions as types and to ban them or ehort them by rule. The job of the individual or an individual doctor or scientist is to consider a given token act.

The decision-making processes are quite different. This is partly because those making type decisions usually have lots of time, they have no particular patient to worry about, and they have no emotional angst. The individuals will have to make their decisions quickly (usually) and they are in full emotional angst (and possibly surrounded by others who are also in full emotional flow).

To conflate these two different types of decision-making is to risk getting very confused.

So John you are right: it might be morally permissible in the case of an individual to aloow euthanasia, yet not morally permissible to pass a law permitting it. I agree with your claim this is hugely important.

In effect we might be faced with the choice between hypocrisy (maintaining a law against whilst admitting individual acts) or risk of a slippery slope abolishing the law against because of the permissibility of individual acts.

I can see that both John and Patrick would go for the former. (Thanks for reposting the story Patrick).

Why, Dimitrios do you think that an individual’s decision to end their life is essentially an act of selfishness? I agree that different individuals respond in different ways, but this isn’t enough to mean that one of these ways is necessarily selfish. Even if a desire to die is a desire to feel why does that (necessarily) make it selfish?

And actually even if it does why should that make it wrong? Maybe sometimes it is permissible to be selfish?

Marianne

Picture of Dimitrios Kellis
Re: Euthanasia
by Dimitrios Kellis - Monday, 16 July 2007, 9:03 PM
 
Pain and suffering tolerance, emotional reaction to distress and incapacitation, the concept of the ways under which human dignity can be affected may all be reasons that could lead to the desire to end ones own life.

Good medical practice (gmp) dictates that people who are actually dying, must be afforded the same respect and standard of care as all the rest. To provide the option of euthanasia we should have prior to this, fulfilled all the requirements of gmp. The second step requires the assessment of the patients capacity to make informed decisions. Step number three is the best interests principle ( which includes the decision process about the overall number of options that can reasonably be considered as being in the best interests of a patient depending on a constellation of clinical, cultural and religious criteria)
Selfishness, would in my view be, the condition under which despite fulfilling the baseline of standards previously mentioned, the options that one chooses for themselves (or others for him/her), are mainly based on preference. Preference is a very well respected element but the assessment of whether it is a well grounded and reasonable one too, that extends far beyond the subjective states of emotional reaction to distress or not, is a highly complicated task.

I totally agree with the 'ones desire to die' being in some cases a 'desire to feel'. I also understand and respect ones potential inability to withstand the distress and/or the impairment of a condition. But I definitely consider ones 'personal' decision to die, totally individualized. On such a ground, assessments and consents may acquire a substantial and much more humanitarian dimension. I wouldn't believe in a general person specification process that would decide who could be considered as being a candidate for euthanasia.

Selfishness was meant as a concept or a latent drive in general decision making, which I believe is inappropriate. I didn't mean that a person whos condition or choice has been substantially expressed, reasoned and based on the unanimously agreed standards of gmp, should in any way be considered selfish.
Picture of Marianne Talbot
Re: Euthanasia
by Marianne Talbot - Tuesday, 17 July 2007, 7:51 AM
 

But you did imply that it would always be selfish to prefer to die, and that's what I was questioning.

M

Picture of Dimitrios Kellis
Re: Euthanasia
by Dimitrios Kellis - Tuesday, 17 July 2007, 3:53 PM
 
Ehm...I didn't manage to escape from it. Yes I actually do believe so but its based on personal experience. Personal experience of people who struggle to overcome illness in a heroic way, putting aside all fear and summoning every bit of mental and emotional power to do so. People who cope with rejection, disability, pain, and who above all bestow life with their strong desire and respect. They are not people who enjoy life. They suffer every moment of it. Nevertheless they don't give up, they accept the hardship and fight through it till the end, whatever this is. Above all they're people of ultimate courage, utmost dignity (despite of the drawbacks of their disability) and respect for themselves and for life.

Then, there comes a time that I'm supposed to think about people who express without even casting a second thought, a quick decision about supporting euthanasia. People who in advance (of any hardship or impairment concenring them) declare their 'right' to defy, reject and terminate a life of pain, suffering or terminal illness. People who are willing to make such a decision for themselves or for others who don't, as they say, have the ability of self-assessment, who easily proclaim loss of human dignity in the light of a disability. Who even pretend they know better how other people would be feeling when going through suffering. Well...I'm terribly sorry but although I know that every case has it's own details and uniqueness, although I know that every person really has the right to decide about his/her life, I can't help comparing those people with the former. I can't help admitting how slack they seem to me.

I find extremely hard to accept euthanasia. Maybe it's my profession. Maybe its the fact that putting someone out of his misery always entails admitting that misery or even taking it for granted. I feel like the last person who would write side by side the words misery and life, no matter what.
Picture of Marianne Talbot
Re: Euthanasia
by Marianne Talbot - Tuesday, 17 July 2007, 4:45 PM
 

It is because every case has it's own unique character that we might want to distinguish between rules about euthanasia and acts of euthanasia - deciding perhaps that although individual acts are acceptable (perhaps) the law that disbars it is also a good one.

Or some variation on this theme. The fact is that the type-token distinction here is crucial (see some of the other postings).

M