The Treatment That Leaves Something to Luck

  • Nafsika Athanassoulis

Abstract

Decisions at the end of life are particularly difficult and a huge number of factors can go towards justifying or unjustifying a particular course of action. In this chapter I want to focus in on what is becoming a legally accepted practice and ask whether a distinction which seems to underlie the legal principle can in fact be supported on good philosophical grounds. The distinction relates to allowing incompetent patients to die and the difference between such omissions and directly killing similar patients. The discussion also has implications for the related issue of respecting the right of competent patients to refuse treatment/have treatment withdrawn and how respect for this right compares with cases where competent patients request assistance in dying.

Keywords

Pneumonia Guaran 

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Notes

  1. 2.
    The case, Re B, is described in detail in J. K. Mason and R. A. McCall Smith (1999) Law and Medical Ethics (London: Reed Elsevier), pp. 371–2.Google Scholar
  2. 3.
    L. J. Templeman, All England Law Reports, 1990, 927 at 929, cited in Mason and McCall Smith, Law and Medical Ethics, p. 371.Google Scholar
  3. 6.
    I take it that McMahan makes a similar point in his discussion of the doctrine of the sanctity of life, as well as offering convincing arguments for rejecting the doctrine itself, J. McMahan (2002) The Ethics of Killing (New York: Oxford University Press), pp. 466–7.CrossRefGoogle Scholar
  4. 8.
    The case is discussed in J. Thomas and W. Waluchow (2002) Well and Good (Ontario: Broadview Press).Google Scholar
  5. 9.
    B. Williams (1981) Moral Luck (Cambridge: Cambridge University Press).CrossRefGoogle Scholar
  6. 10.
    P. Singer (1979) Practical Ethics (Cambridge: Cambridge University Press).Google Scholar
  7. 11.
    This seems to me to be the force of Kuhse’s defence of Rachels when she brings up the example of the bystander who kills the truck driver rather than watch him die slowly in the fire. H. Kuhse (1999) ‘Why Killing is not always Worse — and Sometimes Better — than Letting Die’, in H. Kuhse and P. Singer, Bioethics: an Anthology (Oxford: Blackwell).Google Scholar
  8. 12.
    In what follows and specifically in making claims about the relationship between omissions and agency as well as how omissions should be understood within a context I am arguing for a specific interpretation of omissions, following J. Feinberg (1984) Harm to Others (New York: Oxford University Press)Google Scholar
  9. 12.
    P. Smith (1984) ‘Allowing, Refraining and Failing: the Structure of Omissions’, Philosophical Studies, 45; and (1990) ‘Contemplating Failure’, Philosophical Studies, 59.Google Scholar
  10. 13.
    A. Donogan (1977) The Theory of Morality (Chicago: Chicago University Press), pp. 42–3.Google Scholar
  11. 14.
    F. Kamm (1992) ‘Non-Consequentialism, the Person as an End-in-Itself and the Significance of Status’, Philosophy and Public Affairs, 21(4), p. 377.Google Scholar
  12. 15.
    J. McMahan (1994) ‘Revising the Doctrine of Double Effect’, Journal of Applied Philosophy, 11(2), p. 205.CrossRefGoogle Scholar
  13. 16.
    I have argued for this in detail in N. Athanassoulis (2005) Morality, Moral Luck and Responsibility: Fortune’s Web (Basingstoke: Palgrave Macmillan).CrossRefGoogle Scholar

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© Nafsika Athanassoulis 2005

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  • Nafsika Athanassoulis

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