Transcript 10-17 - Michigan State University

Physician-Assisted
Suicide and Euthanasia I
Definitions: PAS
 Patient commits suicide
 Reason is due to incurable medical problem
 Physician provides patient with the means
to commit suicide
 Physician knows and intends that patient
will use means for that purpose
 Physician does nothing directly to cause
death
PAS Spectrum
 Physician provides patient with the
knowledge of how to commit suicide, gives
no medication, etc.
 Physician writes prescription for necessary
drug
 Physician is present, hooks up necessary
apparatus, patient “pushes button”
Voluntary Active Euthanasia
(VAE)
 Physician directly administers lethal drug to
patient
 Patient dies as a result
 Purpose is “merciful” (patient suffers from
incurable medical condition)
 Patient is fully competent
 Patient has requested euthanasia
Euthanasia (“good death”)
VOLUNTARY
ACTIVE
(VAE)
Voluntary
Passive
(Forgoing
treatment)
NONVOLUNTARY
ACTIVE
INVOLUNTARY
ACTIVE
(CLEARLY
HOMICIDE)
Nonvoluntary Involuntary
Passive
Passive
(Forgoing
(might be
treatment)
homicide)
Legal status
 VAE


Illegal in US, most countries
Legally permitted in The Netherlands
 PAS




Illegal in Michigan, most states
Legal in Oregon only
Proposal on ballot in Maine
Legally permitted in Netherlands, Germany
Ethical Positions on PAS/VAE
 Pro


Respect individual autonomy
Duty to relieve suffering
 Con


Wrongness of health professional causing death
Negative social consequences of policy
(“slippery slope”)
Ethical positions: Pro
 “Civil Rights”-- Basic right of autonomous
adult to choose “time and manner of one’s
own death”
 “Physician discretion”-- Usually wrong to
hasten death; in extreme cases physicians
may make exception if voluntary choice
and irremediable suffering
Ethical positions: Con
 In principle opposition


Suicide or killing is always wrong
Always wrong for health professional to kill or
aid death
 “Slippery slope”-- Maybe individual cases
in which justified; but too many risks as
general public policy
Drawing the Line
 AMA, US Courts: OK to forgo treatment;
PAS, VAE are wrong
 Oregon: PAS is permissible within strict
safeguards; VAE is wrong
 Netherlands: PAS, VAE are OK,
nonvoluntary or involuntary active
euthanasia is wrong
Borderline Cases
 Janet Adkins cannot reach the button; asks
Dr. Kevorkian’s assistance
 Terminal sedation


Patient put in deep coma with no food,
respiration
Promised not to awaken from coma
 Stopping eating and drinking


Patient intends to die
Physician assists
M. Benjamin’s Bus Route
Treat all
aggressively
Eliminate social
undesirables
Forgo- patient
values
Nonvoluntary,
great suffering
Forgoterminal
PAS
VAE
Bus Route Analogy
 The quicker you get off the bus, the more
friends you leave behind
 The longer you stay on the bus, the more
undesirable the neighborhood
 Same reasons to keep riding to this stop also
argue for staying on the bus just one more
stop-- and so on
 (Almost) no one wants to go to end of line