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Euthanasia and Physician-Assisted Suicide

Defining Terms

1. Termination of life support (TLS): withdrawing or witholding medical treatment for a patient in order to allow the patient to die.

2. Physician-assisted suicide: typically where a physician provides medication by which the patient can take his/her own life.

3. Euthanasia: "good death," where a physician or medical professional has a direct hand in the killing of the patient (i.e. lethal injection).

More Terms

More Terms

Ordinary means of treatment: course of treatment for a disease that offers reasonable hope of benefit without being too difficult for the patient to handle, i.e. antibiotics to cure an infection.

Extraordinary means: courses of treatment that offer little hope of recovery for the patient and place extremely high or undue burdens on him/her.

Typically, ordinary means are seen as morally obligatory treatments and extraordinary means are not

Living will/advance directive: decisions a patient makes on treatment before becoming seriously ill. Typically, someone designated with power of attorney will make decisions on the basis of the living will when the patient is no longer able to.

Do Not Resuscitate (DNR): advance directive telling doctors not to resuscitate a patient in the case of a heart attack.

Competence: level of a patient's ability to understand treatment options and give informed consent to an option that is being chosen.

Legal Background

Karen Ann Quinlan (1975-76)

  • Result: families can remove a respirator based on right to privacy if the patient had indicated previously that they would not want to be on life support.

Nancy Cruzan (1990)

  • Result: feeding tubes can be removed if the patient has previously indicated they did not want to be kept alive by them.

Washington v. Glucksberg (1997)

  • There is a difference between assisting suicide and withdrawing life support.
  • There is no constitutional right to die.
  • States can make their own decisions on physician-assisted suicide.

Termination of

Life Support

Journal #28

Case 8.1: Your Father's Living Will

Your elderly father has recently been diagnosed with terminal lung cancer. His doctors estimate that he has roughly a year left to live before the cancer will overtake him. He is wisely using this as an opportunity to think about what kinds of treatements he wants or wants to refuse as the cancer takes its course. He has seen a number of his friends die on life support in hospitals and wants to make sure that he doesn't die that way. He is asking you to be his medical decision maker should he lose the ability to make those decisions for himself. Specifically, he does not want to be put on ventilator support, especially if it looks like he cannot be weaned off of it. You realize that means that he may die sooner than if he were on such support, and you wonder if you can do that, given your strong view of the sanctity of life. It feels as if you would be killing your dad if you authorized the witholding or withdrawal of ventilator support.

Answer questions 1-3 on p. 243 in the textbook for this journal entry.

Each answer should be a minimum of 3 sentences.

Ethics of TLS

Ethics of TLS

In the discussion about ethics and the termination of life support, a distinction is often made between withdrawing and withholding treatments:

  • Ethically, if it is acceptable to withdraw treatment, then it is also acceptable to withhold that same treatment.
  • Withdrawing treatments is often much more difficult emotionally, however, as the family and medical personel may feel personally responsible for bringing about the patient's death. The question is, are they?

Ethics of TLS

  • When a treatment is removed for acceptable reasons, the physician does not intentionally cause the patient’s death.

  • Removal of life support does not constitute euthanasia or assisted suicide.

  • Terminating life support is not “playing God” for the simple reason, that in legitimate circumstances, terminating life support does not cause death: it merely allows the disease to take its natural course.

Ethics of TLS

Removal/termination of life support should meet at least one of the following criteria:

1. A competent adult patient requests it in an advanced directive.

2. The treatment would be futile or of no benefit to patient.

3. The burden to the patient outweighs the benefit.

What do you think about removing food and water?

Arguments for Assisted Suicide/Euthanasia

What kinds of arguments exist in favor of physician assisted suicide?

Arguments for Assisted Suicide/Euthanasia

Jack Kevorkian

Journal #29 (4/11)

Journal #29

Write at least 5 sentences in response to the Dr. Kevorkian interview we watched in class. What do you think of Kevorkian? What arguments does he make and are you convinced at all by his arguments? How might you respond to some of his claims if you disagree? How does religion play into the interview? (You don't need to answer all these questions, they're just to get you thinking.)

Arguments for PAS/euthanasia

Arguments for PAS/euthanasia

The Argument from Mercy

  • It is merciful to end the life of a patient that is suffering and wants to die.
  • We do this to animals, why not humans?
  • You probably wouldn't want to undergo severe suffering at the end of your life, so what gives you the right to ask someone else to do so?

Arguments for PAS/Euthanasia

The Argument from Utility

  • Physician assisted suicide accomplishes the most good for the greatest number:
  • The patient's suffering ends
  • The family doesn't need to pay for expensive end of life treatments
  • The family can start to grieve and move on
  • The medical personnel can focus resources, both emotional and physical, on other patients who have a chance of living

Arguments for PAS/Euthanasia

The Argument from Autonomy

  • Individuals should have the right to decide what to do with their own lives, it's not the government or the public's place to step in.
  • If other areas of great importance (abortion and birth control, birth methods, child-rearing, marriage, etc.) are protected by rights to privacy and personal choice, why shouldn't the right to die be as well?

Arguments for PAS/Euthanasia

Euthanasia doesn't violate the hippocratic oath

  • Though some may argue that euthanasia/PAS violates the Hippocratic Oath that physicians are bound by to help patients and respect their dignity, euthanasia supporters would argue that euthanasia is true to the Hippocratic Oath in that it does help patients, it just does so by killing them.
  • One may also argue that physicians aren't formally bound to adhere to the Hippocratic Oath, and therefore may use their best judgment in certain cases.

Arguments for PAS/Euthanasia

There is no significant moral difference between killing and allowing to die.

  • James Rachels' uncle/nephew analogy
  • The result is the same in the case of terminating life support and in the case of PAS/euthanasia--the patient dies. They aren't significantly morally different.

Arguments for PAS/Euthanasia

Euthanasia doesn't always involve killing a person.

  • There is a difference between biological life and biographical life--one's personhood is attached to biographical life, meaning a life that is coherent and therefore worth living.
  • Elderly people who are severely demented or debilitated can no longer be properly called "persons."
  • This is similar to arguments against the personhood of the unborn child.
  • If this is true, euthanasia isn't actually killing a person.

Journal #31 (4/17)

Looking at pp. 224-234, summarize how Rae responds to each of the arguments in favor of euthanasia and physician-assisted suicide. After you've summarized Rae's response, write whether or not you find each argument sufficient. If you don't, explain why.

1. The argument from mercy (p. 225-227)

2. The argument from utility (p. 227)

3. The argument from autonomy (p. 227-229)

4. Euthanasia doesn't violate the hippocratic oath (p. 229-230)

5. There is no morally relevant difference between killing and allowing to die (p. 230-232)

6. Euthanasia doesn't always involve killing a person (p. 232-234)

Discussion:

Is there a morally relevant difference between killing someone and allowing someone to die?

"Even though the result is the same, the intent is critical in justifying the termination of life support and raising questions about the legitimacy of physician-assisted suicide/euthanasia. The intent in the termination of life-sustaining treatment is not necessarily that the patient dies...most patients who desire to stop such treatments do not want to die; they simply want to live out their remaining days without dependence on medical technoogy that will not change the downward course of their disease and may be more burdensome than beneficial. Although it is true that in many cases the patient will die soon after termination of life support, it is usually not the intent. By contrast, the intent in physician-assisted suicide/euthanasia is clearly to cause the patient to die." (Rae, 232)

Christian Ethics

& Dying Well

What aspects of Christian ethics might a theology of death and dying include?

Christian Ethics and Dying Well

Death and Christian Ethics

Journal Entry #30

How much have you thought about death in your own life? Based on the Griffiths article, do you think you have thought about death in ways that are unhealthy or perhaps even un-Christian? How could you adjust your thoughts on death to better reflect a proper Christian response to death? How might this affect our perspective on physician-assisted suicide and euthanasia? (7 sentence minimum)

Discuss these questions in groups

1. How does Griffiths propose that Christians should think about death? Do you agree or disagree with his main point?

2. What are the problems with “death-seeking” on one hand, and with “death-avoidance” on the other for Christians?

3. What are Griffiths’ four recommendations for Christian practices that will help them to think and prepare well for death?

Paul Griffiths - "Defending Life by Embracing Death"

  • "To overlook that death is a horror to be lamented easily leads to support for suicide, euthanasia, or the refusal of medical treatment to those who might benefit from it. To overlook the view that death is a friend to be welcomed suggests a blindness to life eternal on postponing death at all costs and for as long as possible." (20)

"The pre-Transition life span unveils a creature: a being with limits, whose life belongs to God. The hard part of this reality is mortality--and inevitable dying is as hard today as ever. This is what the stark limitations on survival made clear but what today's death-marginalizing life expectancy has obscured: we are fundamentally limited creatures who depend on God, and that will never change. The converse of knowing this, however, is the inescapable quality of "miracle" that attaches to life: the miracle is love, which is about giving the self over in the face of limits and mortality. It is impossible to understand the cross of Christ apart from grasping this fact about ourselves. For only to creatures, existing as a divine gift, can the cross be given as the font of fruitfulness. Only mortal creatures can understand how birth and death constitute the place of generation."

- Ephraim Radner

Paul Griffiths - "Defending Life by Embracing Death"

  • "Syntactical rules for Christian thought":
  • Death's inevitability and imminence are always matters for simultaneous rejoicing and lament.
  • Christians should seek a balance between avoiding death at all costs and unhealthy desire to die.
  • The length of one's life has no final significance, only living a good life and dying a good death.

"Death, the Catholic theologian Karl Rahner insisted, is a theological claim. He was thinking of the theoretical possibility that human beings might one day so advance their technologically driven extensions of the life span that "dying" would simply recede as a necessary part of human existence. To say that our deaths are "simply" or "purely" or "essentially" part of who we are is thus to claim something that goes beyond theoretical reason and actually engages our faith. (This is an important claim, since it points to the way that contemporary discussions about technological interventions in human life are in fact religious ones not simply utilitarian in nature.) There is something important here to grasp: part of our Christian vocation is to proclaim the reality of death itself. Nothing could be more revelatory of contemporary forgetfulness--or faithfulness--that the disappearance of this proclamation from Christian teachers and preachers as a central part of the gospel they announce. The tradition of memento mori--"remember that you must die"--was not merely a medieval invention. It stands as a central scriptural focus (e.g., Ps 39:6; Luke 12:20). For to proclaim death, at least in its central aspect of our existence, is to return always to the form of our being as creatures. To announce our creaturehood is to proclaim God."

-Ephraim Radner

Christian Ethics and Dying Well

Createdness and givenness

  • Because humans are creatures, created by God, our lives and our bodies are not our own.
  • Life is given to us by God as a gift, we cannot decide when it begins, nor when it ends, it is pure grace.
  • Thus, to decide to end one's live via suicide is going beyond the authority that we have as creatures, it is doing violence to the gift that God has given, and making a decision that belongs ultimately to the Creator, not the creature.
  • Death is in some real sense a reminder of our "createdness" and our limitations as creatures.
  • Our dignity, therefore, comes from creation in God's image, not our abilities or even our quality of life.

Christian Ethics and Dying Well

On Suffering

  • It is no part of traditional Christian thought to assume that suffering is to be avoided at all costs, or that it is meaningless.
  • Euthanasia and PAS are attempts to eradicate suffering by killing the sufferer herself, but they don't necessarily square with a Christian account of suffering.
  • While suffering should never be sought out, Christians have always affirmed that suffering is a part of the Christian life, and is ultimately unavoidable.
  • There may be a sense in which suffering allows us to live with Christ in a way that those who don't suffer may not know him.

Christian Ethics and Dying Well

Jesus, Death, and Suffering

  • Perhaps it is best here to take our cues from Jesus...
  • Though doesn't want to suffer and certainly doesn't seek it out, he ultimately submits to the will of the Father and goes to the cross, taking on the suffering and sin of the whole world in his crucifixion.

"The “craft of suffering,"...is the straightforward, steady learning to live with Jesus. Such a life will be filled with pain...At root, though, living just this inevitably painful life with this Jesus is to fashion a good life, ultimately a beautiful life. Yes: a painful life lived with Jesus is indeed “beautiful”; it is, after all, God’s life. Ultimately, it is all about knowing Christ: being taken to him, living with him, learning from him, dwelling within him, and being transformed by the gift of his self. Suffering and Christ — that is entry into God."

- Ephraim Radner

Christian Ethics and Dying Well

Suffering, Resurrection and Hope

  • Ultimately, the Christian testimony in the face of suffering is one of hope.
  • In the face of death and great suffering, there is hope in Christ that our suffering is not meaningless, death is not final, and that we will be raised to new life in Christ where there will be no more suffering and no more pain.
  • This means we need not always resist death, knowing that to live is Christ, but to die is gain, and to be in the presence of Christ, and ultimately to be made new in resurrection life.

Virtues for Dying Well

Virtues to die well, (Ars moriendi)

1. Instead of losing faith, focus on the faith of Jesus.

2. Instead of despair, hope in the resurrection of the body and the life of the world to come.

3. Instead of impatience, charity, love, and patience.

4. Instead of pride in autonomy and independence, humility through dependency.

5. Instead of greed, generosity in letting go in peace.

6. Instead of cowardice, courage in the face of death.

"Precisely because death will not have the last word, we need not always resist it. And because the triumph over death is finally not a technological victory, but a divine victory, we will resist not only the commendation of death but also the medicalization of dying."

Practices for Dying Well in the Church

1. We are not meant to die alone--care and concern for the elderly

2. Visit the sick and dying, death and dying should be public acts

3. Make death more visible

4. Include symbols of death in Christian life

5. Funeral practices of celebration and lament

6. Be careful with language about death and dying

Secular/Pragmatic case

The more pragmatic case against physician-assisted suicide and euthanasia is comprised of one main argument and supplemented by four others:

  • The main argument is that PAS and euthanasia involve killing innocent people. For many, this is sufficient to the discussion. Under no circumstances should innocent individuals be killed by another. Doing so is equivalent to murder.

The four supporting arguments are:

1. Assisting in the death of another is playing God.

2. For all we know, suffering may be redemptive in the life of the patient and others.

3. Misdiagnoses are possible and actual.

4. Deaths are likely to move from voluntary to involuntary euthanasia.

A Pragmatic Case Against PAS/Euthanasia

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