Lecture Notes for Sept 24, 2008

Assisted Death Terms -euthanasia= eu (good) & thantos (death) -suicide -physicians- assisted death Some important distinctions -active euthanasia- causing death usually by administration of a drug -passive euthanasia- withholding or withdrawing life sustaining treatment -voluntary euthanasia- passive or active performed at the request of a competent patient -nonvoluntary euthanasi-performed to be in the best interest of the patient who is incompetent -involuntary euthanasia- the patient states clearly they do no want euthanasia, but are euthanized anyway Standards of Death -Traditional (heart/lung)- heart not beating, you're not breathing -whole brain-there is no activity in the entire brain -higher brain-if the higher brain is dead, while the body remains alive; the individual is gone forever -Personhood-if you're a person, unable to enact w/environment, not able to recognize people, there is a sense that the person they once were is dead Related Concepts -coma loss of consciousness PVS: persitant vegetative state: 4 or more weeks without sensory, cognitive, or emotional experience -minimally consciousness state: some episodic awareness Oregon "Death with Dignity" Law 1994 -Two physicians must certify that the patient has 6 months or less to live -Patient must make 2 requests (48 hours apart) for VAE in writing -Patient must be referred for counseling if needed -Patient can terminate the request at anytime Dutch Law -patient-initated request -patient competent -patient understanding of diagnosis, prognosis, and treatment options -enduring decision -unbearable suffering -consult with two physicians -termination in a medically appropriate manner -file government report James Rachels "Active and Passive" Thesis: Active euthanasia is morally permissable under conditions when passive euthanasia is morally permissable and the patient wants active euthanasia Background The AMA allows passive euthanasia "cessation of extraordinary means") but not active euthanasia ("intentional terminination of life") -intentional termination is contrary" that for which the medical profession stands" -It is wrong the suffering of dying patients -Competent patients have a right to refuse treatment Rachels argues: A. The AMA's position is sloppy; cessation of extraordinary means" is as "intentional" as "intentional life termination" both result in patient death B. The values that justify passive euthanasia justifies active, when that patient prefers the active -being "allowed" to die can be painful, & take time; contradicts commitment to compassion -if the patient can choose to refuse life sustaining treatment Killing is ont morally worse than letting die -Smith & Jones -Annette's example If euthanasia is appropriate in one case, it is morally permissable for a patient to choose active or passive euthanasia.