Putting euthanasia in contextPutting euthanasia in context- contentious social-ethical values - contentious social-ethical values issues:issues:
• AbortionAbortion
• Access to healthcareAccess to healthcare
• Armed conflictArmed conflict
• Capital punishmentCapital punishment
• Euthanasia and physician-assisted suicideEuthanasia and physician-assisted suicide
• Human embryo stem cell researchHuman embryo stem cell research
• Legalizing marihuana & hard/soft on crimeLegalizing marihuana & hard/soft on crime
• Same–sex marriageSame–sex marriage
Euthanasia is an Euthanasia is an importantimportant test test case…case…
• because because everyoneeveryone personally relatespersonally relates to deathto death
• euthanasiaeuthanasia has has powerful impact on powerful impact on
personal and societal valuespersonal and societal values
• euthanasia and PAS treated euthanasia and PAS treated together together
re most ethical aspectsre most ethical aspects
Advocates argue euthanasia Advocates argue euthanasia is:is:• a minor changea minor change• ““doing good”doing good”• respecting people and their rightsrespecting people and their rights• relieving sufferingrelieving suffering• compassionate and mercifulcompassionate and merciful• just an additional optionjust an additional option
Are they correct?Are they correct?
To answer…To answer…
have to look at euthanasia onhave to look at euthanasia on
individualindividual
institutionalinstitutional
andand
societal levels societal levels
i.e. euthanasia as part of a larger i.e. euthanasia as part of a larger wholewhole
Two major reasons against Two major reasons against euthanasia and euthanasia and
• Principle-based reasonPrinciple-based reason: : wrong to intentionally kill another personwrong to intentionally kill another person
(except in self-defence). (except in self-defence). • Utilitarian-based reasonUtilitarian-based reason: :
harms and risks legalizing euthanasia and harms and risks legalizing euthanasia and PAS to individuals, society, and medicinePAS to individuals, society, and medicine
far outweigh any far outweigh any benefits.benefits.
• When personal and societal values consistent, When personal and societal values consistent, widely shared and based on shared religion, widely shared and based on shared religion, case against euthanasiacase against euthanasia was was simplesimple: : God commanded "thou shalt not kill". God commanded "thou shalt not kill".
• In secular society based on intense In secular society based on intense
individualism, individualism, case for euthanasiacase for euthanasia is is simplesimple: : Individuals have right to choose Individuals have right to choose manner, manner, time and place of time and place of death.death.
• In contrast, in such societies In contrast, in such societies
case against euthanasia iscase against euthanasia is complexcomplex..
Definitions and language …Definitions and language …
• Physician-assisted deathPhysician-assisted death
- we all want such assistance- we all want such assistance
• Definitions a source of Definitions a source of confusionconfusion
in euthanasia debate in euthanasia debate
- some confusion deliberately engendered - some confusion deliberately engendered
by euthanasia advocates as strategyby euthanasia advocates as strategy
Definitions and language …Definitions and language …
• Euthanasia isEuthanasia is deliberate actdeliberate act causing death causing death undertaken with undertaken with primary intentionprimary intention of ending of ending
lifelife in order to in order to relieve sufferingrelieve suffering. .
• Euthanasia is notEuthanasia is not justified justified withdrawing or withholding withdrawing or withholding
treatmenttreatment to allow to dieto allow to die
provision of provision of pain reliefpain relief, even if could shorten , even if could shorten life, life, provided is necessaryprovided is necessary
Confusing euthanasia and Confusing euthanasia and palliative care…palliative care…
• Difference in kind not degree Difference in kind not degree between killing and allowing to between killing and allowing to diedie
• Euthanasia is not just another Euthanasia is not just another
““act of good palliative act of good palliative care”care”
What are the secular arguments What are the secular arguments against euthanasia and PAS?against euthanasia and PAS?
i)i)Impact on society...Impact on society...
• Legalising euthanasia would Legalising euthanasia would damagedamage important, foundational important, foundational societal values and symbols that societal values and symbols that uphold uphold
respect for human liferespect for human life. .
i)i) Impact on society... Impact on society...
• If euthanasia involved, how we die If euthanasia involved, how we die cannot be cannot be just a private matterjust a private matter of self-determination of self-determination and personal beliefs, because euthanasia "is an and personal beliefs, because euthanasia "is an act that requires two people to make it possible act that requires two people to make it possible and a complicit society to make it acceptable”.and a complicit society to make it acceptable”.
Daniel CallahanDaniel Callahan
• ““The The prohibitionprohibition on intentionally on intentionally killing killing is the is the cornerstone of law and human cornerstone of law and human relationshipsrelationships, emphasising our basic equality”., emphasising our basic equality”.
House of LordsHouse of Lords
i) Impact on society...i) Impact on society...
• Medicine and lawMedicine and law are are principal principal institutionsinstitutions that that maintain respect for maintain respect for human lifehuman life in a secular, pluralistic society in a secular, pluralistic society
• Legalizing euthanasia involves and Legalizing euthanasia involves and harms both harms both
changing norm we must not kill each other changing norm we must not kill each other would seriously damage their capacity to would seriously damage their capacity to carry the value of respect for human life.carry the value of respect for human life.
i) Impact on society...i) Impact on society...
• To To legalise euthanasialegalise euthanasia is is
to to change way we change way we understand understand
ourselvesourselves
human life human life
and its meaning. and its meaning.
i) Impact on society...i) Impact on society...
To explain need to paint much larger picture:To explain need to paint much larger picture:• We create We create values and find meaning in lifevalues and find meaning in life by by
buying into a "buying into a "shared storyshared story" " - a societal-cultural paradigm- a societal-cultural paradigm
. . • Humans have always Humans have always focused that storyfocused that story on the on the
two great events of each life, two great events of each life, birth and deathbirth and death. .
• Even in a secular society - indeed, more than in a Even in a secular society - indeed, more than in a religious one - that religious one - that story muststory must encompassencompass, , create space forcreate space for and and protect protect
the "human spirit". the "human spirit".
i) Impact on society...i) Impact on society...
• Human spiritHuman spirit does not mean anything religious does not mean anything religious (although it can accommodate religious beliefs). (although it can accommodate religious beliefs).
Rather, it is Rather, it is the intangible, invisible, the intangible, invisible, immeasurable reality that we need to find immeasurable reality that we need to find meaning in life and make life worth living - meaning in life and make life worth living - that deeply intuitive sense of relatedness that deeply intuitive sense of relatedness or connectedness to others, the world, and or connectedness to others, the world, and the universe in which we live.the universe in which we live.
i) Impact on society...i) Impact on society...
There are two views of human life and, There are two views of human life and, therefore, death: therefore, death:
• We are simply "We are simply "gene machinesgene machines”: ”: ““when we are past our "best before" date, when we are past our "best before" date, we we should be checked out as quickly, should be checked out as quickly, cheaply cheaply and efficiently as possible”. and efficiently as possible”.
- that favours - that favours euthanasia. euthanasia.
• Other view sees a Other view sees a mystery in human mystery in human deathdeath, because it sees a , because it sees a mystery in mystery in human lifehuman life, which does not require any , which does not require any belief in the supernatural.belief in the supernatural.
i) Impact on society...i) Impact on society...
• EuthanasiaEuthanasia is a " is a "gene machinegene machine" " responseresponse. .
• Converts Converts mystery of death to problem of mystery of death to problem of deathdeath
to which we seek a to which we seek a technological technological solutionsolution
– – a lethal injection a lethal injection
• Post-modern societies Post-modern societies uncomfortable with uncomfortable with mysterymystery, especially if generates , especially if generates
intense free-floating anxiety and intense free-floating anxiety and fear fear
– – as death does. as death does.
i) Impact on society...i) Impact on society...
• We seek We seek controlcontrol over that over that fear fear - - terror-managementterror-management
• Euthanasia such a mechanismEuthanasia such a mechanism: : Can’t avoid cause of fear - death Can’t avoid cause of fear - death
– – but control manner, time and but control manner, time and place of deathplace of death
- allows us to feel have - allows us to feel have death under control.death under control.
i) Impact on society...i) Impact on society...
• Research shows marker for people wanting Research shows marker for people wanting euthanasia is state psychiatrists call euthanasia is state psychiatrists call hopelessness (hopelessness (different from depression) - different from depression) - these people have nothing to look forward tothese people have nothing to look forward to
• Hope is a Hope is a sense of connectionsense of connection to the to the futurefuture
““hope is the oxygen of the human spirithope is the oxygen of the human spirit”.”.
i) Impact on society...i) Impact on society...
• Hope can be elicited by a sense of Hope can be elicited by a sense of connection to a connection to a very immediate futurevery immediate future
• People People need hopeneed hope if they are if they are
to experienceto experience dying dying
as the final great act of lifeas the final great act of life
• Euthanasia Euthanasia negatesnegates that possibility that possibility
i) Impact on society...i) Impact on society...
• PragmaticPragmatic, but very important, , but very important, objectionobjection to legalizing euthanasia is to legalizing euthanasia is abuse cannot be preventedabuse cannot be prevented, as , as the Netherlands shows. the Netherlands shows.
• This evidence caused This evidence caused some some euthanasia advocates to believe euthanasia advocates to believe it cannot be safely legalizedit cannot be safely legalized and and have spoken against doing so.have spoken against doing so.
i) Impact on society...i) Impact on society...
• To assess impact, in practice, of To assess impact, in practice, of legalising euthanasia look at it in legalising euthanasia look at it in context in which would operate: context in which would operate:
Combination of an Combination of an
ageing population, ageing population,
scarce healthcare resources scarce healthcare resources and and euthanasia euthanasia
would be a lethal one.would be a lethal one.
ii)Impact on medicine and ii)Impact on medicine and nursing…nursing…• Euthanasia advocates argue in support of Euthanasia advocates argue in support of
legalisationlegalisation physiciansphysicians are are secretly carrying it outsecretly carrying it out
• StudiesStudies purporting to establish that purporting to establish that severely severely criticised:criticised: respondents did respondents did not distinguishnot distinguish between between actions primarily intended to shorten life actions primarily intended to shorten life
- - euthanasiaeuthanasia and other acts or omissions with no such and other acts or omissions with no such intention intention
- - pain-relief or refusals of treatmentpain-relief or refusals of treatment
ii)Impact on medicine and ii)Impact on medicine and nursing…nursing…
• Even ifEven if studies studies accurateaccurate, fact , fact physicians are secretly carrying out physicians are secretly carrying out euthanasia does euthanasia does not mean it is rightnot mean it is right. .
• Further, if physicians were Further, if physicians were presently presently ignoring lawignoring law against murder, against murder, why why would they would they obey guidelinesobey guidelines for for voluntary euthanasia?voluntary euthanasia?
ii)Impact on medicine and ii)Impact on medicine and nursing…nursing…• Euthanasia…Euthanasia…
""places the very soul of medicine on trialplaces the very soul of medicine on trial““
• Physicians' Physicians' absolute repugnance to killingabsolute repugnance to killing people people necessary to maintainingnecessary to maintaining people's people's and society's and society's trusttrust. .
• True, in part, because True, in part, because physicians have physicians have opportunities to killopportunities to kill not open to other not open to other peoplepeople
ii)Impact on medicine and ii)Impact on medicine and nursing…nursing…• How would legalising euthanasia affect How would legalising euthanasia affect
medical and nursing educationmedical and nursing education? ?
• What What impactimpact would physician role models would physician role models carrying out euthanasia have on carrying out euthanasia have on medical medical students and young physiciansstudents and young physicians? ?
• Would we devote time to Would we devote time to teaching teaching students how to administer deathstudents how to administer death through lethal injection? through lethal injection?
ii)Impact on medicine and ii)Impact on medicine and nursing…nursing…
• Would they be Would they be brutalised or ethically brutalised or ethically desensitiseddesensitised? ?
• Do we adequately Do we adequately teach pain-relief teach pain-relief treatmenttreatment at present? at present?
• Would euthanasia be a Would euthanasia be a required required procedureprocedure??
Would be very Would be very difficult to communicatedifficult to communicate to to future physicians and nurses a future physicians and nurses a repugnance repugnance to killingto killing in context of legalised euthanasia. in context of legalised euthanasia.
ii)Impact on medicine and ii)Impact on medicine and nursing…nursing…
• Physicians and nurses need a Physicians and nurses need a clear lineclear line that that powerfully manifests to them, their patients, and powerfully manifests to them, their patients, and society that society that they do not inflict deaththey do not inflict death
• Both their patients and the public need to Both their patients and the public need to know know with absolute certaintywith absolute certainty - and be able to trust - - and be able to trust - that is the casethat is the case. .
• Anything Anything blursblurs that line, that line, damagesdamages that trust, or that trust, or makes physicians makes physicians less sensitiveless sensitive to primary to primary obligations to protect life is obligations to protect life is unacceptableunacceptable. .
Legalizing euthanasia would do all of theseLegalizing euthanasia would do all of these
ii) Impact on medicine and nursing…ii) Impact on medicine and nursing…
• Harms to medicine harm societyHarms to medicine harm societyneed to need to protectprotect healthcare institutions healthcare institutions
because arebecause are value-creatingvalue-creating
value-carryingvalue-carrying
consensus-formingconsensus-forming
Conclusion…Conclusion…
• Euthanasia and PAS are simplistic, wrong and Euthanasia and PAS are simplistic, wrong and dangerous responses to the complex reality of dangerous responses to the complex reality of human death.human death.
• They involve taking people who are at their weakest They involve taking people who are at their weakest
and most vulnerable, who fear loss of control or and most vulnerable, who fear loss of control or isolation and abandonment - who are in a state of isolation and abandonment - who are in a state of intense "pre-mortem loneliness" - and placing them intense "pre-mortem loneliness" - and placing them in a situation where they believe their only in a situation where they believe their only alternative is to be killed or kill themselves.alternative is to be killed or kill themselves.
Conclusion…Conclusion…
THE EUTHANASIA DEBATE THE EUTHANASIA DEBATE IMPLICATESIMPLICATES::
• meaning of human lifemeaning of human life
• respect for human liferespect for human life
• ““ethical and legal tones” of societiesethical and legal tones” of societies
• features of our societal paradigmsfeatures of our societal paradigms
- local to global- local to global
• the society of the future the society of the future
Conclusion…Conclusion…
• How a society treats its weakest, most in How a society treats its weakest, most in need, most vulnerable members best tests need, most vulnerable members best tests its its moral and ethical tone. moral and ethical tone.
• To set a present and future moral tone that To set a present and future moral tone that protects individualsprotects individuals and societyand society, upholds , upholds the fundamental value of the fundamental value of respect for liferespect for life, , and promotes rather than destroys our and promotes rather than destroys our capacities and opportunities capacities and opportunities to search for for meaning in lifemeaning in life, , we must reject we must reject euthanasiaeuthanasia..
THREE "WORLD VIEWS" COMPETING AS THREE "WORLD VIEWS" COMPETING AS BASIS FOR NEW SOCIETAL PARADIGM BASIS FOR NEW SOCIETAL PARADIGM
i)i) “PURE” SCIENCE“PURE” SCIENCE VIEW VIEW•• we are highly complex biological machines we are highly complex biological machines
• • combines combines respect for sciencerespect for science with with respect for the human spirit respect for the human spirit - - requires drawing lines in “grey areas”requires drawing lines in “grey areas”
• • basic questionbasic question
IS IT INHERENTLY WRONG TO KILL IS IT INHERENTLY WRONG TO KILL ANOTHER?ANOTHER?
: EXCLUDES EUTHANASIA: EXCLUDES EUTHANASIA
Conclusion…Conclusion…
• Nancy Crick, a 69-year-old Australian Nancy Crick, a 69-year-old Australian grandmother, committed suicide in the grandmother, committed suicide in the presence of over 20 people, eight of whom presence of over 20 people, eight of whom were members of the Australian Voluntary were members of the Australian Voluntary Euthanasia Society. She explained: Euthanasia Society. She explained: "I don't "I don't want to die alone."want to die alone."
• Another option for Mrs Crick (if she had been Another option for Mrs Crick (if she had been terminally ill – she was not) should have been terminally ill – she was not) should have been to die naturally with people who cared for her to die naturally with people who cared for her present and good palliative care.present and good palliative care.
Conclusion…Conclusion…
• Of people who requested assisted suicide Of people who requested assisted suicide under Oregon's under Oregon's Death with Dignity ActDeath with Dignity Act (which allows physicians to prescribe (which allows physicians to prescribe lethal medication), 46% changed their lethal medication), 46% changed their minds after significant palliative-care minds after significant palliative-care interventions (relief of pain and other interventions (relief of pain and other symptoms), but only 15% of those who did symptoms), but only 15% of those who did not receive such interventions did so.not receive such interventions did so.
