Abstract
In this paper I discuss moral justifications for withholding therapeutic procedures when it is known that persons will die as a result. These justifications are commonly used both for cessation of the procedures and for withholding all use of therapy. I construe all such acts as instances of euthanasia.1
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Euthanasia is a word that can be used in a variety of ways. I believe, however, that a descriptive, non-value-laden definition can be provided. Arnold Davidson and I have argued for the following definition of euthanasia in “The Definition of Euthanasia,” The Journal of Medicine and Philosophy 4 (1979), pp. 294–312:
The death of a human being A is an instance of euthanasia if and only if: (1) A’s death is intended by at least one other human being, B, where B is either the cause of death or a causally relevant feature of the event resulting in death (whether by action or by omission); (2) there is either sufficient current evidence for B to believe that A is acutely suffering or irreversibly comatose, or there is sufficient current evidence related to A’s present condition such that one or more known causal laws supports B’s belief that A will be in a condition of acute suffering or irreversible comatoseness; (3)(a) B’s primary reason for intending A’s death is cessation of A’s (actual or predicted future) suffering or irreversible comatoseness, where B does not intend A’s death for a different primary reason, though there may be other relevant reasons, and (b) there is sufficient current evidence for either A or B that the causal means to A’s death will not produce any more suffering than would be produced for A if B were not to intervene; (4) the causal means to the event of A’s death are chosen by A or B to be as painless as possible, unless either A or B has an overriding reason for a more painful causal means, where the reason for choosing the latter causal means does not conflict with the evidence in 3b; (5) A is a nonfetal organism.
The full AMA statement appeared as follows: “The intentional termination of the life of one human being by another—mercy killing—is contrary to that for which the medical profession stands and is contrary to the policy of the American Medical Association. The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family. The advice and judgment of the physician should be freely available to the patient and/or his immediate family.”
Judge Muir, In the Matter of Karen Quinlan, Vol. I. Arlington, VA: University Publications of America, 1976.
Rachels, James. “Active and Passive Euthanasia,” New England Journal of Medicine 292 (January 9, 1975 ): pp. 78–80.
Reprinted in Beauchamp, Tom L., and Walters, LeRoy. Contemporary Issues in Bioethics. Encino, Calif.: Dickenson, 1977, Chapter 4.
Cf. the cases in “Informed Consent and the Dying Patient,” Yale Law Journal (1974), pp. 1658 (fn. 139), 1660.
Whether consent is informed and rational is, of course, often difficult of ascertainment. This problem, including mention of conditions under which a patient request ought to be refused, are interestingly discussed in Kenny F. Hegland, “Unauthorized Rendition of Lifesaving Medical Treatment,” in California Law Review 53 (August 1965). Cf. esp. pp. 864f, 877.
Byrn, op citp. 33. Also, the issues are nicely presented in In re Osborne. On some interpretations of the decision in Georgetown College the verdict was reached as much on grounds of questionable competence as on the utilitarian grounds I have cited.
Cantor, Norman. “A Patient’s Decision to Decline Life-Saving Medical Treatment: Bodily Integrity Versus the Preservation of Life,” Rutgers Law Review 26 (1973): pp. 228, 251–254.
Hegland takes the view that society has sufficient interest in the life of the patient in this case to “deny him a legal right to refuse lifesaving treatment,” California Law Review 53 (August 1965) p. 872.
A case that I regard as paternalistic and unjustifiable for this reason is John F. Kennedy Hospital v. Heston 58 N.J. 576, 279 A.2d 670 (1971). A clear reversal of this way of thinking is the appellate court decision in In re Estate of Brooks 32 111. 2d 361, 205 N. E. 2d 435 (1965), though the latter preceded the former by six years. In the former case, see esp. pp. 584f, and in the latter esp. pp. 440ff.
In Katz, Jay, ed. Experimentation with Human Beings. New York: Russell Sage Foundation, 1972, p. 709.
Canterbury v. Spence 464 F 2d 772 (1972). Though the formulation in this case is close to my third condition, I would lay emphasis on suffering rather than on so flexible a word as “harm.”
Superintendent of Belchertown v. Saikewicz, Mass. 370 N.E. 2d 417 (1977).
I might add, as an addendum to this analysis, that it could be questioned whether cessation is a justifiable means in some cases, since the argument I previously adduced in Section II, when coupled with the argument here in Section III, would lead to the conclusion that in some cases an active means is preferable to a passive means. If so, a fourth condition would be needed specifying that active means should be used if a passive means would produce greater suffering or harm for the patient than would be produced by cessation of the therapy. This proposal, however, cannot be easily formulated without careful qualifications, since it could easily lead to a requirement of murder for an insufficient reason.
A case of thoroughly irresponsible use is found in “Long-Term Dialysis Programs: New Selection Criteria, New Problems,” The Hastings Center Report 6 (June 1976), p. 9.
This conclusion does not entail the existence of a “right to die.” This peculiar “right” seems to me to carry dangerous breadth of application, and I would be opposed to my arguments being used to support arguments for such a right.
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Beauchcamp, T.L. (1962). The Moral Justification for Withholding Heroic Procedures. In: Bell, N.K. (eds) Who Decides?. Contemporary Issues in Biomedicine, Ethics, and Society. Humana Press. https://doi.org/10.1007/978-1-4612-5823-0_12
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