Medical
Ethics
Fall 2011
Philosophy 2440
Prof. Robert N. Johnson
Sunday, October 30, 2011
Utilitarianism and
Voluntary Euthanasia
Hentoff: Physicians are bad at
palliative care.
The only meaningful difference
between terminal sedation and
euthanasia is that the former
takes longer.
Utilitarianism and
Voluntary Euthanasia
Some who want euthanasia
are not in pain: Nausea,
breathlessness, tiredness, lack
of dignity.
Utilitarianism and
Voluntary Euthanasia
If patients can rationally opt
for refusing life support or
pain medication that will
shorten life, they are rational
enough to choose voluntary
euthanasia.
Utilitarianism and
Voluntary Euthanasia
Slippery Slope Argument:
If minor harm A occurs, then a
series of events will occur
culminating in major harm Z.
Utilitarianism and
Voluntary Euthanasia
“Legalizing VE will lead to
involuntary euthanasia.”
Utilitarianism and
Voluntary Euthanasia
Evidence? No reports of such
in Oregon since 1997.
Utilitarianism and
Voluntary Euthanasia
Evidence?
In Holland there was a slight
rise initially in involuntary
euthanasia.
Did legalization lead to this?
Utilitarianism and
Voluntary Euthanasia
Evidence?
A similar study of a later
period showed no rise,
however.
Utilitarianism and
Voluntary Euthanasia
Evidence?
Also, involuntary euthanasia
has gone down in Australia
and Belgium, suggesting the
effect is quite the opposite.
When is a person dead?
1. Permanent cessation of heart
and lungs?
2. Permanent cessation of all
brain functions?
3. Permanent cessation of
higher brain function?
4. Cessation of personhood?
Universal Determination of
Death Act: 1 or 2.
99% of declarations are on the
basis of 1.
PVS is 3.
When is a person dead?
Determining death:
Reversible coma (Fugu,
curare)?
Brain stem tests: CO2
reflect, gag reflex, pupil
contraction, „doll eyes‟.
MRI, EEG, CT scans
When is a person dead?
PVS
1. Undamaged brain stem.
2. Cannot think or act
intentionally.
3. Can breath, blink, have sleep
cycles, their muscles
respond.
4. Quinlan, Schaivo cases
5. Require total care: $ 100,000
a year
6. About 50 thousand cases in
the US.
When is a person dead?
PVS is unlikely to change the
medical definition of death to
loss of higher brain function.
Dementia is unlikely to change
the definition to „loss of
personhood‟.
So „legal‟ death is cessation of
cardiopulmonary or total brain
function.
But this is ethics. Is the law
always moral?
Assisted Suicide
1) Is suicide ever morally
permissible? Under what
conditions?
2) Is assisted suicide ever
morally permissible? Under
what conditions?
3) Is physician assisted suicide
(PAS) ever morally
permissible? Under what
conditions?
4) Should PAS be made legal?