Abstract
We will take as our definition of “euthanasia” the providing of death for the patient for the sake of, or upon the request of, the patient. In doing so, we will include in our discussion the withdrawal of life-support systems and measures with the intent of letting the patient die, as well as the withholding of life-support systems or measures, and the administering of drugs or procedures with the intention of causing death.
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Notes
Cf. James Rachels, Active and Passive Euthanasia, New England Journal of Medicine, 292 (January 1975), pp. 78–80.
More correctly, we should distinguish the legal concept of “competence” from the psychiatric concept of “capacity.” “Competency” is a legal rather than a medical or philosophical term, and is really decided by the courts. We will use the term “competent” here for the sake of simplicity. See Chapters 2 and 5 for a fuller discussion.
e.g., a terminally ill patient is in unmanageable pain. He requires constant attention by staff, and an enormous amount of expenditure of money and hospital resources. Other patients with better prognoses are suffering as a result of the time, attention, and resources spent on this patient. He prefers to hang on. However, the staff decides that everyone (including the patient) would be better off if he were dead.
See section on “Voluntary Passive Euthanasia” in this chapter.
e.g., Current Opinions of the Judicial Council of the American Medical Association, pp. 9-10.
Discussion of Roe v. Wade in Chapter 3.
Kant argued strongly against suicide, partly on the grounds that it was an abandonment of one’s duties towards one’s own person. However, Kant wrote before our modern medical technology, and it would seem compatible with Kant to say that a person who was falling into a state in which he could no longer perform his duties to himself or others could not be said to be “abandoning” his duties.
The reader is referred to Chapters 1 and 4 for a fuller discussion of “extraordinary” and “ordinary” means.
In certain cases, it may not even make sense to speak about either “harm” or “benefit” to the patient. It is certainly doubtful that a “brain-dead” patient could be either harmed or benefited by anything that is done to him. It is probably doubtful that patients who are in persistent vegetative states could be either harmed or benefitted. c.f. Chapter 3.
In re Conroy, No. A-108 (N.J. Sup. Ct. Jan. 17, 1985).
e.g., President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment (Washington, D.C: U.S. Government Printing Office, 1983), esp. pp. 87–89.
The assumption here is that there both are and ought to be regular discussions with the patient about his treatment.
The first sense is also beginning to be used by persons in regard to their treatment wishes if and when they were to become incompetent as a result of psychosis. This is the so-called “Ulysses Contract,” after the episode in the Odyssey in which Odysseus (Ulysses), knowing he would be enthralled by the song of the Sirens, but wanting to hear them, ordered his men to tie him to the mast and ignore any command that he might give while under the Sirens’ spell. The concept was first proposed by Thomas Szasz. Thomas S. Szasz. The Psychiatric Will—A New Mechanism for Protecting Persons against ‘Psychosis’ and Psychiatry. American Psychologist, 37 (July 1982), 767-770.
Cf. Chapter 2.
Society for the Right to Die. The Physician and the Hopelessly Ill Patient, (New York: Society for the Right to Die, 1985), p. 86.
This section should be read in conjunction with Chapter 2, “Informed Consent and the Right to Refuse Treatment.”
Cf. Chapter 3. “Personhood and the Right to Life.”
e.g., Deciding to Forego Life-Sustaining Treatment, op. cit. pp. 275-299.
Referral to an ethics committee may be mandatory in some hospitals.
In re Quinlan, 70 N.J. 10, 355 A. 2d 647 (1976).
case reference.
See Chapter 5, “Psychiatric Ethics.”
The reader should also refer to Chapter 2 and Chapter 5.
“Quality of life” may be more applicable to those cases in which “endurance” is no longer an issue. That is, the brain-dead patient and the patient in deep irreversible coma may be said to have no quality of life.
It is important for the reader to read this section in conjunction with Chapter 3, “Personhood and the Right to Life.”
“Defective neonate” is taken here to include very premature infants and infants with severe congenital problems as well as those with severe genetic defects.
For reasons that were mainly procedural, having to do with the lack of hearings prior to the directive, as well as a ruling that the directive was “arbitrary.”
These considerations are, in fact, primary in a utilitarian analysis. However, it would seem that, at the least, the contractual relationship of patient-physician weighs heavily in favor of placing the obligation towards the patient as first.
Cf. Chapter 3, “Personhood and the Right to Life.”
Cf. Chapter 2, “Informed Consent and the Right to Refuse Treatment.”
Cf. Chapter 3, “Personhood and the Right to Life.”
Current Opinions of the Judicial Council of the American Medical Association, op. cit., p. 9.
e.g., The Hemlock Society.
An elderly retired nurse suffering from a terminal illness requested her physician to give her a lethal dose of drugs. After discussion with the patient and her brother, the physician gave her the drugs and turned himself in to the police, presumably to begin a test case. The physician was eventually found innocent.
Although courts are sometimes lenient in their treatment of family members convicted of active euthanasia.
Bibliography
Beauchamp, Tom and Seymour Perlin. Ethical Issues in Death and Dying. Englewood Cliffs: Prentice-Hall, 1978.
In re Quinlan, 70 N.J. 10, 355 A. 2d 647 (1976).
Ladd, John (Ed.). Ethical Issues Relating to Life and Death. New York: Oxford University Press, 1979.
President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forego Life-Sustaining Treatment. Washington, D.C.: U.S. Government Printing Office, 1983.
Society for the Right to Die. The Physician and the Hopelessly Ill Patient. New York: Society for the Right to Die, 1985.
Steinbock, Bonnie. Killing and Letting Die. Englewood Cliffs: Prentice-Hall, 1980.
Szasz, Thomas A. The Psychiatric Will—A New Mechanism for Protecting Persons against “Psychosis” and Psychiatry. American Psychologist, 37 July, 1982: 767–770.
The Hastings Center. Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying. Briarcliff Manor, N.Y.: The Hastings Center, 1987.
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Kantor, J.E. (1989). Euthanasia. In: Medical Ethics for Physicians-in-Training. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1672-3_4
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