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Jonathan Hughes

The ethics rather than the law:

Questions:

1) Is it permissible? 2) Should if be legalised? 3) If it were to be legalised? What should be the role of HCPs?

Definitions

'The intentional bringing about of a death of a person, for that person's own benefit'

By definition it is beneficent - it's for their good. So a death for the benefit of someone else/for society, wouldn't be euthanasia. It's not about the character of the death either (gentle/painless/etc).

McMahan argues the intent is important, and could say that a killing for an expected benefit that doesn't emerge wouldn't be euthanasia, or an unintended benefit from killing either.

Subdivisions

Active vs Passive One

Active One: Bringing about the death of a person for their own sake by an ACT

Passive One: Bringing about the death of a person for their own sake by an OMISSION

But what about withdrawal of life support? As that's an act, is that active euthanasia?

Killing vs Letting Die

If we define killing and letting die as:

Killing: Causing a death

Letting Die: Not preventing a death. Or removing an obstacle to a pre-existing cause of death (where the agent has put the obstacle in place)

Active vs Passive Two

We can redefine it as?

Active Two: Killing for their own sake Passive Two: Letting die for their own sake

Does Passive Euthanasia Exist?

The argument is that treatments are withheld because of complying with patients wish, or due to futility of treatment.

However, if the patient were to desire death, and the medic complys with their wish, that sounds a lot like passive euthanasia still!

Autonomy in Euthanasia

Voluntary vs Non-Voluntary vs Involuntary

V - Patient is competent and requests - following autonomy NV - Patient is not competent to request it/consent to it - there is no autonomy to violate IV - Patient is competent and does not request it, or refuses it - there is a violation of autonomy

Assisted Suicide

Someone kills themselves, with the help of another person

(Suicide Act 1961 specified it's illegal to aid/abet/counsel someone in committing suicide)

That definition of help though is so vague! What counts as help?

The boundaries between assisted suiced and euthanasia are vague, so what is the moral difference between the two?

Assisted Dying

Even more vague. Probably Assisted Suicide + Euthanasia.

It does remove the question of whether the patient had an active role in it or not.

Traditional Distinctions

Act-Omissions Distinction: Generally held to have moral weight but not always to hold moral weight DDE: Distinction between events by the intention of the actor. "Bad" acts become "Good" acts with "Good" intentions. The "Bad" outcome can be forseen, but not intended. But the boundary between intent and forseeing is difficult.

Arguments in Favour

Beneficence (The obligation to do good)

  • Obligation to prevent avoidable suffering (this might favour active euthanasia in some situations, an obligation to die quickly/painlessly)
  • It's beneficent to remove fear from patients, allowing the option of euthanasia if they want it

  • It may result in prolonged life, allowing people to continue longer, as they don't have to worry about not being physically able to do it

  • It's not an argument that doctors must always do it to reduce suffering, there are other competing factors (like autonomy)

Different types of beneficence:

  • Specific Beneficence - Duty to do good to specific patients
  • General Beneficence - Duty to do good to society as a whole

Autonomy

  • Respecting a patients autonomous wish to end their own life

Two different forms here:

  • Patient refusal of life prolonging treatment
  • Patient requesting life ending treatment

This is for folk with competence, but there can also be advance directives. That's still autonomous, but the autonomy was in advance? Can be argued its that or in best interests.

Justice

  • Why should a person who is not able-bodied, be denied the right to take their own life like an able-bodied person could?
  • Why should people have the right to end their life by declining further treatment, have the right to die when someone who isn't on treatment can't also request something that brings about their death?

Arguments Against

See Handout