EUTHANASIA AND

PHYSICIAN-ASSISTED PHIL 2306

SUICIDE

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 THE CASE OF TERRI SCHIAVO
(2005)
For fi fteen years, Terry S chiav o existed betw een life and d eath
in tha t shad ow land called a persistent ve getative state, a
p la ce w here she w as w akeful but w ithout awa rene ss or any
p urp oseful behavior. S evere brain damag e had left her there,
with v ir tually no c hance of recovery. And all the w hile, a s torm
of ca ustic de bate sw irled around her, reaching its greatest
streng th in the las t few da ys b efore her d eath on March 3 1,
2 00 5. In 1 99 0 her heart had stopp ed b riefl y b ecaus e of a
chemical imb alance, leav ing her b rain da mag ed and in a
twilig ht state, kept aliv e b y a feed ing tube. She had left no
living w ill, no w ritten rec ord of her w is hes s hould s he b ecome
ind efi nitely incap acitated . H er hus band, Mic hael Schiav o,
insisted that Terri ha d told him once that she w ould p refer
d ea th to b eing kep t a live w ith machines. H er pa rents rejected
his cla im and d emand ed that Terri be kep t alive, holding out
hop e that w ith prop er care s he mig ht recove r (Vaug hn, p .
2 91 ).

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 EUTHANASIA

Euthanasia: from the Greek meaning good death. In

English, it has come to be understood as easy death.

Euthanasia: directly or indirectly bringing about the

death of another person for that persons sake
(Vaughn, p. 295).

Advance directives: a legal document allowing

physicians to withhold or withdraw treatments if a
patient becomes terminally ill and unable to express
his or her wishes (Vaughn, p. 295).
1. Living will
2. Power of attorney for health care

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 TYPES OF EUTHANASIA

Euthanasia

Passive Active
euthanasia euthanasia

Nonvolunta Nonvolunta
Voluntary Voluntary
ry ry

Involunta Involunta
ry ry
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 ACTIVE EUTHANASIA VS.
PASSIVE EUTHANASIA
Types of euthanasia: what kinds of means
produce death?
Active euthanasia: euthanasia performed by taking
direct action to cause someones death (Vaughn, p.
295).
Example: a physician injects a patient with a life-ending
medication.
Not legal anywhere in the US. Legal in The Netherlands.
Passive euthanasia: euthanasia performed by
withholding or withdrawing measures necessary for
sustaining life (Vaughn, p. 295).
Example: removing a dying individual off of life-support
(e.g., respirator).
Legal in the US and regularly practiced. We all have a
legally protected right to passive euthanasia.
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 DIFFERENT DEGREES OF
VOLUNTARINESS
Active and passive euthanasia can have various
degrees of consent/freedom/voluntariness motivating
ones decision to pursue euthanasia.
Voluntary: the dying individual has consented to
euthanasia, whether passive or active euthanasia.
Non-voluntary: the dying individual has not consented to
euthanasia. We do not know what the dying individual
wants, and she is incapacitated to tell us. Therefore, a
surrogate decision maker decides in favor of euthanasia in
non-voluntary cases of euthanasia.
Involuntary: the dying individual has not consented to
euthanasia AND the dying individual WANTS to livewe
know she does not want to be euthanized (whether
passively or actively). Yet, she is euthanized despite
wanting to live.

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 DIFFERENT EXAMPLES OF
EUTHANASIA
Active euthanasia: a physician provides a dying
patient with a life-ending injection.
Voluntary active euthanasia
Nonvoluntary active euthanasia
Involuntary active euthanasia

Passive euthanasia: a physician removes a dying

patient from a respirator.
Voluntary passive euthanasia
Nonvoluntary passive euthanasia
Involuntary passive euthanasia

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 EUTHANASIA VS. PHYSICIAN-
ASSISTED SUICIDE (PAS)
PAS is not the same as euthanasia.

With euthanasia, the last causal step that leads to death is

performed by some individual other than the dying person.

With PAS, the last causal step that leads to death is

performed by the dying person herself.

PAS is legal in Oregon (since 1997) and Washington (since

2008) and recently decriminalized in Montana (2009).

PAS in OR and WA: a physician is allowed to prescribe a

competent, terminally ill (6 months or less to live) state
resident with a prescription for sleeping pills. It is then up
to the patient to take the pills herself in order to end her
life. 8
 MORAL THEORIES AND
ASSISTANCE IN DYING
1. Kant: personhood and the second formulation of the
CI

2. Utilitarianism: act utilitarian analysis and rule

utilitarian analysis (slippery slope concern).

3. Natural law theory: morally wrong because

intentionally aiming to produce death is contrary to
our moral obligation to preserve life.

4. Virtue ethics: mixed responses are possible. Are

there virtues specifi c to physicians?

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 MORAL PRINCIPLES:
AUTONOMY AND BENEFICENCE
Autonomy (self-determination ): autonomy is the moral
prin cip le that states : we ought to allow competen t, rational
in dividuals the freedom to live th eir lives according to th eir
values.
Does this include allowing individuals to say when their life is over?

Ben efi cence: benefi cence is th e moral principle that states:

w e ought to promote th e well-being or welfare of others.
Applied to euthanasia, it says that if we are in a position to ease the
agony of another, and we can do so without excessive cost to
ourselves, we should try to render aid (Vaughn, p. 298).
Special moral obligations incurred because of ones professional
positionas in being a physician.

These principles are often used together in argu ments in

favor of volun tary active eu thanas ia (VAE).

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 THE ARGUMENT IN FAVOR OF VAE
(VAUGHN, P. 298)
1. Competent persons have a right of self-determination (as
long as exercising this right does not violate others
rights).
2. The right of self-determination includes the right of
competent persons to decide the manner of their dying
and to choose active (voluntary) euthanasia.
3. We have an obligation to help others in serious distress or
peril (if we are in a position to help without great risk to
ourselves ).
4. This duty of benefi cence includes the duty, under
appropriate conditions to ease the pain and suff ering of
competent dying persons by performing active (voluntary)
euthanasia.
5. Therefore, active voluntary euthanasia for competent
dying persons is permissible.

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 SOME ARGUMENTS AGAINST VAE

1. Slippery slope argument

2. Trust between patients and physicians can be

undermined.

3. VAE is contrary to the ethical standards of medicine.

4. VAE plays God.

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