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56 Cards in this Set

  • Front
  • Back
Active euthanasia
Killing
Passive euthanasia
Allowing to die
Voluntary euthanasia
Proceeds in response to the informed request of a competent patient
Nonvoluntary euthanasia
Involves an individual who is incompetent to give consent
Involuntary euthanasia
acting against the will or, at any rate, without the permission of a competent person
What are the 2 types of Advanced Directives?
Instructional Directive (Living Will)

Proxy Directive (Durable power of attorney for health care)
Instructional Advanced Directive
specifies instructions about his/her care in the event that decision-making capacity is lost. When dealing specifically with a patient's wishes regarding life-sustaining treatment in various possible circumstances, is commonly called a LIVING WILL.
Proxy Directive
A person specifies a substitute decision maker to make health-care decisions for him or her in the event that decision-making capacity is lost. The legal mechanism for executing a proxy directive is often called a DURABLE POWER OF ATTORNEY FOR HEALTH CARE.
Arguments on moral legitimacy of active euthanasia
1. Killing an innocent person is intrinsically wrong.
2. Killing is incompatible with the professional responsibility of the physician.
3. Any systematic acceptance of active euthanasia would lead to detrimental social consequences (via a lessening of respect for human life) (most emphasized in discussions concerning the legalization of active euthanasia).
Arguments on moral legitimacy of voluntary active euthanasia - 2 arguments
1. It is cruel and inhumane to refuse the plea of a terminally ill person for his or her life to be mercifully ended in order to avoid future suffering and/or indignity.
2. Individual choice should be respected to the extent that it does not result in harm to others. Since no one is harmed, at least in typical caes, by terminally ill patients' undergoing active euthanasia, a decision to have one's life ended in this fashion should be respected.
James Rachels
moral legitimacy of ACTIVE EUTHANASIA
* one of his central claims is that there is no morally significant distinction between killing and allowing to die.
Daniel Callahan
defends the logical and moral importance of the distinction between killing and allowing to die.
* opposed to active euthanasia and argues that killing patients is incompatible with the role of the physician in society.
- power of physician must be used "only to cure or comfort, never to kill"
Dan W. Brock
moral legitimacy of VOLUNTARY ACTIVE EUTHANASIA
- appeals to the centrality of 2 fundamental values
1. Individual autonomy (self-determination).
2. Individual well-being.
- rejects the idea that active euthanasia is incompatible with the fundamental professional commitments of a physician.
Those who argue FOR the moral legitimacy of ACTIVE EUTHANASIA
- emphasize considerations for humaneness
Those who argue FOR the moral legitimacy of VOLUNTARY ACTIVE EUTHANASIA
- humanitarian appeal
- appeal to the primacy (first or foremost importance) of individual autonomy
SUICIDE
Intentional termination of one's own life
Arguments against suicide
- Religiously based
- Philosophical
Saint Thomas Aquinas' arguments on morality of suicide
Suicide is to be condemned because:
1. It violates our duty to God.
2. It violates the natural law.
3. It injures the community.
Rationality of suicide
Clearly many suicides are irrational - the product of disordered thinking.
- Sometimes asserted is necesssarily irrational and thus a symptom of mental illness and incompetence.
In other words, it is impossible for a competent adult to have a suicidal intention.
- Some philosophers and psychiatrist believe this to be an implausible contention. i.e. case of terminally ill patient experience intense suffering with no realistic prospect of relief. If it is correct to say that such a person is better off dead, then it is hard to deny that suicide could be a rational choice.
Physician-Assisted Suicide typically involves a physician in one or both of the following roles:
1. providing information to a patient about how to commit suicide in an effective manner.
2. providing the means necessary for an effective suicide (most commonly by writing a prescription for a lethal amt of medication).

Other modes of physician assistance may include:
1, providing moral support for the patient's decision.
2. "supervising" the actual suicide.
3. helping the patient carry out the necessary physical actions (i.e. a very frail patient may need physical assistance just to take pills).
PHYSICIAN-ASSISTED SUICIDE

VOLUNTARY ACTIVE EUTHANASIA
physician plays an active role in bringing about the death of a patient.

Ultimate causal agency:
- In voluntary active euthanasia, the physician ultimately kills the patient
- In physician-assisted suicide, the patient ultimately kills him/herself, albeit with the assistance of physician.
Washington Vs. Glucksberg
1997
U.S. Supreme Court unanimously upheld the constitutionality of state statutes prohibiting physician assistance in suicide.

rejected claim that the Due Process Clause of the 14th Amendment encompasses a fundamental right to physician-assisted suicide.
Vacco vs. Quill
Court rejected claim that the Equal Protective Clause of the 14th Amendment is violated by a state prohibiting physician-assisted suicide while at the same time permitting the withdrawal of life-sustaining treatment.
** the court explicitly committed itself to the legitimacy and importance of drawing a distinction between assisting suicide and withdrawing life-sustaining treatment.
Washington vs. Glucksberg
Vacco vs. Quill
Votes were 9-0
Court not nearly so unified on the construction of the underlying issues as these unanimous votes might suggest.
- Court's underlying fragmentation of viewpoint is reflected in a host of concurring opinions generated by the cases.
- Chief Justice William H. Rehnquist wrote "Opinion of the Court" in each of the cases, only 4 other justices actually concurred incl. Justice Sandra Day O'Connor
Stephen G. Potts
Does not necessarily object to individual acts of voluntary active euthanasia.
- but still stands opposed to any social policy that would permit its practice.
Adverse social consequences of legalization of voluntary active euthanasia
- elleged that vulnerable persons would be subject to abuse
- a disincentive for the availability of supportive services for the dying would be created
- public trust and confidence in physicians would be undermined
"Slippery Slope" argument
The legalization of voluntary active euthanasia would lead us down a slippery slope in the legalization of nonvoluntary (and perhaps involuntary) euthanasia.
David T. Watts
Timothy Howell
Two physicians recommend the legalization of PHYSICIAN-ASSISTED SUICIDE (believe that there is far less risk of abuse) - although they do not favor allowing a physician to "supervise" or directly aid a patient in committing suicide
- would restrict physicians to providing information about suicide and writing prescription for a lethal amount of medication.
Franklin G. Miller
Diane E. Meier
Since terminally ill patients are already free to refuse nutrition and hydration, and thereby bring about death, there is no compelling need to legalize physician-assisted suicide (or voluntary active euthanasia).
Oregon Death and Dignity Act
- November 1994 voters approved ballot initiative 51-49
- Went into effect October 27, 1997
- survived 2nd referendum in Nov. 1997, 60 to 40.
- Permits Oregon physicians to prescribe lethal drugs for Oregon adult residents who are terminally ill and who want to end their own lives
Oregon Death and Dignity Act
What are eligibility requirements?
physician must determine that patient has a terminal disease - a diagnosis entailing that the patient is expected to die within 6 months - and a consulting physician must confirm the diagnosis
Oregon Death and Dignity Act
What other requirements are stipulated? - PATIENT
1. Patient must make initial oral request, reiterate oral request after 15 days, also submit written request supported by 2 witnesses.
Oregon Death and Dignity Act
What other requirements are stipulated? - PHYSICIAN
1. Before writing prescription, the attending physician must wait at least 15 days after the patient's initial request and at least 48 hours after the written request.
2. Attending physician must fully inform the patient about the diagnosis, prognosis, and feasible alternatives including comfort care, hospice care and pain control.
3. Both attending and consulting physician must certify that the patient is "capable" (i.e. has decision-making capacity), is acting voluntarily, and has made an informed choice.
4. If either physician believes that the patient's judgment might be impaired (e.g. by depression), the patient must be referred for counseling.
Gonzales v. Oregon 2006
Bush administration contended that physicians in Oregon who prescribe lethal drugs for the purpose of assisting suicide are in violation of the Controlled Substances Act, but the Court rejected this claim and upheld the Oregon law.
Dutch system of voluntary active euthanasia
- requirement that active voluntary euthanasia be available only if the patient is experiencing unbearable suffering (with no prospect for improvement), but no requirement that the patient be terminally ill.

- explicit accceptancel of an advance-directive principle - that is active euthanasia may be provided for patients who have become incompetent but who had clearly expressed their request for active euthanasia in a written delaration while competent.
Voluntary active euthanasia and physician-assisted suicide were formally legalized in the Netherlands with what act? In what year?
Dutch Termination of Life on Request and Assisted Suicide Act (TLRASA)

2002
The TLRASA stipulates that:
any physician who properly conforms to "due care criteria" in the provision of VAE/PAS and promptly reports to a regional review committee any case in which VAE or PAS has been provided will be immune from prosecution.
In order to comply with the due care criteria, the TLRASA specifies that the physician must:
a) be satisfied that the pt has made a voluntary and carefully considered request.
b) be satisfied that the suffering was unbearable and that there was no prospect for improvement
c) have informed the pt about his situation and his prospects
d) have come to the conclusion, together with the pt, that there is no reasonable alternative in light of the pt's situation
e) have consulted at least one other, independent physician, who must have seen the pt and given a written opinion on the due care criteria referred to in a-d above and f) have terminated the pt's life or provided assistance with suicide with due medical care and attention
TLRASA allows for possibility of VAE/PAS in minor -
minor at least 12 years old who is deemed to be capable of making a reasonable appraisal of his own interests
- requests from 16-17 year olds can be complied with but only on the condition of consultation with parents or guardian although parental/guardian approval is not required.
- requests from 12-15 year olds can also be complied with but only on the condition of parental/guardian consent.
Proponents of legalization of VAE/PAS are somewhat wary of Dutch mode, why?
Believe that it does not incorporate adequate safeguards against abuse or, at any rate, that it would not provide adequate safeguards within the framework of American society.
Daniel Callahan
3 perspectives
valid distinction between killing and allowing to die - defends distinction by reference to 3 overlapping perspectives - metaphysical, moral and medical
Callahan's metaphysical perspective
emphasizes that the external world is distinct from the self and has its own causal dynamism
Callahan's moral perspective
emphasizes the difference between physical causality and moral culpability
Callahan's medical perspective
insists that killing patients is incompatible with the role of the physician in society
James Rachels
identifies the "conventional doctrine" on the morality of euthanasia as the doctrine that allows passive euthanasia but does not allow active euthanasia.
James Rachels argues that conventional doctrine may be challeneged for 4 reasons. What are they?
1. active euthanasia is in many cases more humane than passive euthanasia.
2. the conventional doctrine leads to decisions concerning life and death on irrelevant grounds.
3. the doctrine rests on a distinction between killing and letting die that itself has no moral importance.
4. the most common argument in favor of the doctrine is invalud.
Distinction between active and passive euthanasia
crucial in medical ethics
- the idea that it is permissable, at least in some cases, to withhold treatment and allow a patient to die, but it is never permissable to take any direct action designed to kill the patient.

This doctrine seems to be accepted by most doctors, and it is endorsed in a statement adopted by House of Delegates of the American Medical Association on Dec. 4, 1973.
Statement adopted by House of Delegates of the AMA on Dec. 4, 1973
(withhold treatment and allow patient to die, but never permissable to take any direct action designed to kill the patient)
The intentional termination of the life of 1 human being by another, mercy killing, is contrary to that for which the medical profession stands and is contrary to the policy of the AMA.

The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family. The advice and judgment of the physician should be freely available to the patient and/or his immediate family.
Arguments against the "conventional doctrine"
- process of being "allowed to die" can be relatively slow and painful, whereas being given a lethal injection is relatively quick and painless.
- the conventional doctrine leads to decisions concerning life and death made on irrelevant grounds
James Rachels
Active and Passive Euthanasia
Daniel Callahan
Killing and Allowing to Die
Dan W. Brock
Voluntary Active Euthanasia
Stephen G. Potts
Objects to the Institutionalization of Euthanasia
- endorses the "right to die" but insists that this right does not entail the right to receive assistance in suicide or the right to be killed.
Risks of Institutionalization
- potential effects of a legalized practice of euthanasia.
1. Reduced pressure to imrpove curative or symptomatic treatment.
2. Abandonment of hope.
3. Increased fear of hospitals and doctors.
4. Difficulties of oversight and regulation.
5. Pressure on the patient.
6. Conflict with Aims of Medicine.
7. Dangers of Society Acceptance.
8. The Slippery Slope.
9. Costs and Benefits
Potts - CULL mode - What is it?
If developments in terminal care can be represented by a progression from the CURE mode of medical care to the CARE mode, enacting voluntary euthanasia legislation would permit a further progression to the KILL mode. The slippery slope argument represents the fear that, if this step is taken, then it will be difficult to avoid a further progression to the CULL mode.
Potts CULL mode
CURE - central aim of medicine
CARE - central aim of terminal care once patients are beyond cure
KILL - aim of the proponents of euthanasia for those patients beyond cure and not helped by care
CULL - the feared result of weakening the prohibition on euthanasia