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The Morality of Suicide and Euthanasia


... terminal sedation, ... Hospice and palliative care Aggressive pain-killing medications Sitting with the dying Euthanasia Brain death is defined as the ... – PowerPoint PPT presentation

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Title: The Morality of Suicide and Euthanasia

The Morality of Suicide and Euthanasia
Distinction between concept and criteria
  • The concept of death
  • Criteria of death refers to the evidence that
    indicates that someone is dead
  • Cardiopulmonary criterion irreversible cessation
    of cardiopulmonary functions
  • Brain-death criterion

Physician assisted suicide and voluntary
  • Physician-assisted suicide when a patient
    ingests a lethal substance provided by the
    physician for that purpose
  • Voluntary euthanasia the physician administering
    the lethal substance
  • Is there a moral difference between the two?
  • Does, in the former case, the physician kill the
    patient, while in the latter, the patient kills

Ordinary and Extraordinary Care
  • Has its origins in Roman Catholic moral theology,
    where it is employed to distinguish between
    obligatory careordinary and care that may be
    permissibly forgoneextraordinary.
  • has been criticized as being unclear and
    resulting in confusion and controversy about how
    it should be applied (U.S. President's

Ordinary and Extraordinary Care
  • The distinction used to mark the difference
    between statistically usual and statistically
    unusual care, between noninvasive and highly
    invasive treatments, and between treatments that
    employ low- and high-technology interventions
  • The correct understanding of the traditional
    distinction is the difference between treatment
    that is beneficial and treatment that is unduly
    burdensome (or without benefit) to a patient.

Facts and Assumptions
  • Public opinion
  • Medicine American Medical Associations ethical
  • the physician should not intentionally cause
  • Religion
  • Law

Facts and Assumptions
  • Four Kinds of End-of-Life Treatment
  • Pain and suffering
  • Pain management
  • Competency
  • Persistent Vegetative State
  • Whole-Brain-Death

  • Four forms of treatment of patients near death
    that have received special attention are
  • resuscitation,
  • artificial nutrition and hydration,
  • terminal sedation,
  • futile treatment

Pain and Suffering
  • 70-90 of advanced cancer patients have sever
    pain that requires the use of opioid drugs
  • 90 - 95 of patients can have their pain
  • 5 have excruciating and intractable pain at the
    end of life
  • Options
  • Continue to offer morphine (ineffective)
  • Kill patient (illegal and immoral)
  • Offer palliative sedation

Compassion for Suffering
  • The larger question in many of these situations
    is how do we respond to suffering?
  • Hospice and palliative care
  • Aggressive pain-killing medications
  • Sitting with the dying
  • Euthanasia

Brain Death
  • Brain death is defined as the irreversible
    cessation of all the functions of the entire
    brain, including the brainstem. If the brain can
    be viewed simplistically as consisting of two
    partsthe cerebral hemispheres (higher centers)
    and the brainstem (lower centers)brain death is
    defined as the destruction of the entire brain,
    both the cerebral hemispheres and the brainstem.
  • In contrast, in the permanent vegetative state
    (PVS) the cerebral hemispheres are damaged
    extensively and permanently but the brainstem is
    relatively intact

PVS patients
  • The vegetative state is characterized by the loss
    of all higher brain functions, with relative
    sparing of brainstem functions. Because brainstem
    functions are still present, the arousal
    mechanisms contained in the brainstem are
    relatively intact and the patient therefore is
    not in a coma. The patient has sleep/wake cycles
    but at no time manifests any signs of
    consciousness, awareness, voluntary interaction
    with the environment, or purposeful movements.
    Thus, the patient can be awake but is always
    unaware a mindless wakefulness.

  • The vegetative state is considered persistent
    when it is present longer than one month in the
    acute form and permanent when the condition
    becomes irreversible.
  • The exact prevalence is unknown, but it is
    estimated that in the United States there are
    approximately 10,000 to 25,000 adults and 4,000
    to 10,000 children in a vegetative state
    (Multi-Society Task Force on PVS).

Terri Schiavo
  • The Terri Schiavo case is, so far, the most
    famous and notorious end-of-life case of the
    twenty-first century.

Schiavo Autopsy
  • The Schiavo autopsy, released June 15 2005,
    showed severe and irreversible brain damage
  • Brain half its usual size
  • Damaged in almost all regions, including that
    region which controls vision

Competent Patient
  • ethical and legal doctrine of informed consent
  • The doctrine of informed consent
  • requires that treatment not be administered
    without the informed and voluntary consent of a
    competent patient
  • promotes the well-being of patients while
    respecting their self-determination or autonomy
  • provides especially strong support for patients
    deciding about life-sustaining treatment

Incompetent Patient
  • another person must decide for them about life
    support treatment
  • turning to a close family member of the patient,
    when one is available
  • How should a surrogate make life-sustaining-treatm
    ent decisions for an incompetent patient?

  • There are three standards for a surrogate's
  • advance directive (e.g., a "living will" or a
    "durable power of attorney for healthcare")
  • the "substituted judgment" standard
  • the "best-interest" standard

Intentionally Causing Death and Letting Die
  • Physician gives a lethal injection to the patient
  • Physician assists a patient with suicide
  • Physician gives a dying patient medication needed
    for pain relief although the drugs will hasten
  • Physician withdraws nutrition and hydration
    through tubes or lines
  • Physician withdraws needed life-sustaining
  • Physician withholds nutrition or life-suistaining

Moral Reasoning
  • Various degrees of causing death
  • Active euthanasia
  • Assisted suicide
  • Pain medication so heavy it shortens life
  • Withdrawal of needed life-sustaining treatment
  • Withdrawal of medical nutrition and hydration

The Morality of Taking Life
  • Moral conceptions regarding taking life and
    killing may be divided into
  • goal-based,
  • duty-based, and
  • rights-based

Goal-Based View
  • A goal-based position (utilitarianism) prohibits
    taking life when doing so fails to maximize the
    goals or consequences the position holds to be
    valuable, for example, human happiness or the
    satisfaction of people's desires
  • This position not only permits but requires
    taking an innocent person's life when doing so
    will produce the greatest balance of benefits
    over harms

Duty-Based Position
  • Taking life is wrong because it violates a
    fundamental moral duty not to take innocent human
    life intentionally.
  • This view looks not to the consequences produced
    by a particular killing but to the action itself,
    which is prohibited by the duty not to kill.

Rights-Based View
  • Taking human life is morally wrong because it
    violates a basic moral right not to be killed.
  • killing harms its victims because it denies them
    their future, together with all that they wanted
    to pursue or achieve in that future.
  • It wrongs its victims by taking from them without
    their consent what is rightfully theirstheir

Intended versus Foreseen but Unintended Taking of
  • the distinction is central to the Roman Catholic
    doctrine of double effect
  • Double effect refers to actions that may have two
    effects, one that is directly intended and the
    other one only indirectly intended or foreseen.

  • In treating a dying cancer patient's pain, it may
    seem clear that the physician's primary or direct
    intention is to treat the pain
  • The earlier death from respiratory depression
    caused by the morphine the physician prescribes
    to treat the pain is, at most, a secondary or
    indirect intention, or more accurately, a
    fore-seen but unintended consequence.

Killing and Allowing to Die
  • Killing is usually distinguished from allowing to
    die by establishing whether something was done,
    or not done, that resulted in death.
  • A person who kills performs an action that causes
    a person to die in a way and at a time that the
    person would not otherwise have died.
  • The claim is that the mere fact that one doing is
    a killing, while the other is an allowing to die,
    does not make one morally better or worse than
    the other, or make one morally justified or
    permissible when the other is not. This is
    compatible with saying that a particular killing,
    all things considered, is morally worse than, or
    not as bad as, a particular allowing to die
    because of other differences between the two,
    such as the motives of the agents or the presence
    or absence of the consent of the victim.

Not Starting Treatment and Stopping Treatment
  • When a decision is made not to initiate some form
    of life-sustaining treatment, such as kidney
    dialysis or support, and the patient dies as a
    result, this is commonly understood to be an
    omission and so an allowing to die
  • But what of stopping life supportfor example,
    stopping respirator support at the persistent,
    voluntary request of a clearly competent and
    respirator-dependent patient who is terminally
    ill and undergoing suffering that cannot be
    adequately relieved? If such action is taken by
    the physician with the intent of respecting the
    patient's right to decide about his or her
    treatment, most people would consider it a
    morally justified instance of allowing the
    patient to die. If only killing, but not allowing
    to die, is prohibited, then stopping life support
    and not starting it are both allowing to die and
    morally permitted.