1 assisted suicide and euthanasia michael wassenaar, phd february 16, 2012
TRANSCRIPT
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Assisted Suicide and EuthanasiaMichael Wassenaar, PhDFebruary 16, 2012
Goals
Identify arguments on both sides of ethical debate
Understand significant ethical distinctions
Practice respectful conversation
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Withholding/withdrawing life support
No ethically relevant distinction between withholding and withdrawing.
Both are question of harms and benefits.
W/w life support is not assisted suicide or euthanasia.
Intention matters: intention is not to kill, but to prevent harm and allow disease/condition to run its course
Killing vs. letting die
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“[W]hen a patient refuses life-sustaining medical treatment, he dies from an underlying fatal disease or pathology; but if a patient ingests lethal medication prescribed by a physician, he is killed by that medication.”
US Supreme Court, Vacco v. Quill, 1997
The principle of double effect
Is it ever morally acceptable to administer a drug that may hasten the patient’s death?
Does this count as assisted suicide?
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Principle of double effect
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ACT
EFFECT 1(intended)
EFFECT 2(unintended)
Principle of double effect: there is a morally significant difference between A-E1 and A-E2.
Principle of double effect
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Administration of IV morphine
Relieve symptoms
Hasten death
Continuous deep sedation
Evidence suggests CDS hastens death
Does the principle of double effect apply?
It depends: Is unconsciousness, or death, the means to symptom relief?
If death is intended as the means, then it counts as killing (ie, double effect does not exonerate).
Palliative vs. terminal sedation
Terminology
Suicide: Intentionally ending one’s own life
Assisted suicide: Clinician assists patient to perform an act that is intended to end his/her life
Euthanasia: Clinician acts intentionally to end a patient’s life
■ From the Greek: eu (good) + thanatos (death)
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Historical context
■ Ancient Greece and Rome tended to be tolerant
■ Hippocrates represented the minority view:
■ “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect” (Hippocratic Oath)
■ Historically, Christianity opposed suicide and endorsed Hippocratic view
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Contemporary context
■ Legal in 6 countries: Albania, Switzerland, Belgium, Netherlands, Luxembourg, Columbia
■ Legal in 3 US states: Oregon (1994), Washington (2008), Montana (2009)
■ Between 1994 and 2010, there were 75+ legislative bills to legalize assisted suicide in at least 21 states
■ AMA, ACP, ASIM do not support legalization
■ MedScape.com survey, 2010 “Should physician-assisted suicide be allowed in some
situations?”Yes: 45.8% No: 40.7% It depends: 13.5%
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Motivations
Loss of autonomy
Loss of dignity
Inadequate pain/symptom control
Depression
Abandonment
Burden on family
Self-image
Prospect of long-term care
Finances
In Oregon
Oregon Death with Dignity Act passed in 1994, implemented in 1997.
Safeguards: Terminally ill (6 month prognosis) Mentally competent Confirmed by a second opinion Waiting period of two weeks
Lower rates than rest of nation (?)
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Main arguments: Pro
Killing is not always murder (e.g. self-defense, warfare, capital punishment).
Respects the patient’s autonomy.
Relieves the patient’s suffering.
Safeguards can mitigate abuse.
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Main arguments: Con
It is not our right
Corrupts traditional role of health provider
Erodes trust
Risks abuse
Slippery slope
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Ethical vs. Legal
If one believes assisted suicide may be justified in some cases, it does not necessarily mean it should be legal.
Recall utilitarianism: What would the consequences be if something became a general rule?
How to respond?
Clarify the Request
Determine the Root Causes
Affirm Your Commitment to Care for the Patient
Address the Root Causes of the Request
Educate the Patient About Legal Alternatives for Control and Comfort
Consult With Colleagues
17Source: Endlink Resources for End of Life Care Education. http://endoflife.northwestern.edu/eolc_physician_assisted_suicide_debate.cfm