Teaching notes from LTCi, Siliguri

1. Arguing for autonomy [freedom
from external control,
independence] - the law usually
protects the rights of the individual in
their private decisions, marriage, family,
child rearing, abortion etc. all reflect
their own values - in the USA this is
called “the right to privacy”. This
should be extended to the choice of
when to end one’s own life - it is a
private and personal decision - it should
reflect personal views, especially
relating to a person who is terminally ill
and wants to die.
Wednesday 21 September 2011

2. Rae’s response- you cannot put illegal
drugs into your body or use prostitutes.
If there is a conflict of your rights
against those of society - usually society
wins. If we open up to euthanasia then
we can harm others at the end of life -
in Netherlands evidence suggests that
ill people are being administered
euthanasia against their will - yet those
advocating PAS/E all agree non
voluntary use is immoral. So arguing for
autonomy is in fact harming others -
and so the reality of harm overrides the
right to privacy / personal choice.
Wednesday 21 September 2011

3. Rae’s response- you cannot put illegal
drugs into your body or use prostitutes.
If there is a conflict of your rights
against those of society - usually society
wins. If we open up to euthanasia then
we can harm others at the end of life -
in Netherlands evidence suggests that
ill people are being administered
euthanasia against their will - yet those
advocating PAS/E all agree non
voluntary use is immoral. So arguing for
autonomy is in fact harming others -
and so the reality of harm overrides the
right to privacy / personal choice.
Wednesday 21 September 2011

4. If the right to die is based on personal
autonomy then we should all have it - it
is a universal right of all to choose when
and how we die. Even advocate of PAS/
E say this option should be limited.
The idea of autonomy does not fit into
a Christian worldview - Heb 9:27 -
God has appointed the time for each
man to die (Ecc 3:2). God is sovereign
in our life and he has appointed such
moments. In many Western nations
there has been a long Christian, and
theological, tradition which has held to
this idea of God being sovereign over
death.
Wednesday 21 September 2011

5. Euthanasia is not a violation f the
Hippocratic oath - you say that
doctors should respect life and take an
oath to protect it - Kevorkian responds
by saying this applies to abortions yet
many are performed each year. Added
to which the Hippocratic oath is not
taken really seriously now in medical
training, and if Hippocrates had known
in his day what we do today he might
have thought differently - now we know
of more people spending long periods
of life in increasingly poor life quality
circumstances.
Wednesday 21 September 2011

6. Euthanasia is not a violation f the
Hippocratic oath - you say that
doctors should respect life and take an
oath to protect it - Kevorkian responds
by saying this applies to abortions yet
Rae responds - if Hippocrates had
many are performed each year. Added
known of our ability to manage and
to which the Hippocratic oath is not
relieve pain he would have seen this as
taken really seriously now in medical
part of his brief to alleviate suffering
training, and if Hippocrates had known
without having to resort to PAS/E.
in his day what we do today he might
have thought differently - now we know
of more people spending long periods
of life in increasingly poor life quality
circumstances.
Wednesday 21 September 2011

7. Euthanasia is not a violation f the
Hippocratic oath - you say that
doctors should respect life and take an
oath to protect it - Kevorkian responds
by saying this applies to abortions yet
Rae responds - if Hippocrates had
many are performed each year. Added
known of our ability to manage and
to which the Hippocratic oath is not
relieve pain he would have seen this as
taken really seriously now in medical
part of his brief to alleviate suffering
training, and if Hippocrates had known
without having to resort to PAS/E.
in his day what we do today he might
have thought differently - now we know
of more people spending long periods
of life in increasingly poor life quality
circumstances.
Wednesday 21 September 2011

8. Hurricane Katrina and Euthanasia
“Critica!y i! patients, too unstable to be moved or transported were
“euthanized,” that is, put to death. Physicians a!egedly had
discussions about administering fatal doses of morphine, and then
apparently made the decision to give lethal injections to patients.
They felt it was more compassionate to ki! them rather than leave
them alone and unattended, as temperatures soared over a hundred,
water flooded the hospital, and sanitation systems broke down. It
appeared there was some merit to the a!egations, and Louisiana’s
attorney general, Charles Foti, ca!ed for a complete investigation of
the facts surrounding the possible euthanasia of critica!y i! patients
The coroner stated that the bodies of the patients were badly
decomposed, making the causes of their deaths difficult to determine.”
Wednesday 21 September 2011

9. There is no morally relevant difference
between killing and allowing to die -
whats the difference between turning off
life support and killing someone?
Kevorkian might cite moral philosopher
James Rachels who suggested this
situation:
- A man will inherit a fortune if his nephew
dies
- situation 1 the uncle goes into the
bathroom and drowns the nephew
- situation 2 the uncle goes into the
bathroom after the nephew has hit his
head and is lying unconscious under the
water
Wednesday 21 September 2011

10. In both cases the uncle is equally
responsible for the nephews death -
there is no difference between allowing
the boy to die and actively killing him.
Rachels applies this to the end of life
and says there is no difference between
PAS/E and terminating life support.
Rae’s response - the action of the
uncle is morally outrageous in both
cases - so much so that any fine
distinctions are then overlooked - this
is called the sledgehammer effect,
where essential distinctions are masked
by transferring the idea from one
situation to another.
Wednesday 21 September 2011

11. More important is the fact that intent
has not been addressed in a moral act.
Rae suggests that it is different to offer
a gift rather than a bribe - the amount
of money offered might be he same but
it can be offered for vastly different
reasons - it is the intent of the person
that is questioned.
Rachels also talks of two grandchildren
going to visit an elderly sick
grandparent - one goes out of care and
concern, the other to ensure a place in
the will, both do the same thing it is
only their character that is different.
Wednesday 21 September 2011

12. Rae suggests these are two
fundamentally different acts - one goes
to cheer up a sick old lady, the other
simply for future material gain. The
intent determines the morality of the
actions. What has to be decided is are
actions and intent linked - in which
case Rachels argument fails - or does
intent not reveal character? Intent has
to mark a moral distinction between
killing and allowing someone to die -
the result of actions might be the same
but intent is crucial. PAS/E aims to
cause a patient to die.
Wednesday 21 September 2011

13. The cause of death also has to be
addressed - is it the underlying
disease, where removal of
treatment simply allows the
disease to take its course -
palliative care (relieving pain
without acting on the underlying
cause) is provided here to prevent
undue suffering. In PAS/E the
doctors action cause the death of
the patient. Thus the two actions
are very different.
Wednesday 21 September 2011

14. Euthanasia does not always involve
killing a person - the distinction is
made between biological (physical
existence) and biographical life
(events which make life meaningful) - so
a person can be so ill or life so impaired
that in effect “life has gone from them”,
the body is there but the person is gone
- this is applied to unborn, handicapped
and end of life issues. So PAS/E in this
case is not killing a person - and not
violating a command not to kill! In
essence the argument is that
biographical life has ceased to exist.
Wednesday 21 September 2011

15. Euthanasia does not always involve
killing a person - the distinction is
made between biological (physical
existence) and biographical life
(events which make life meaningful) - so
a person can be so ill or life so impaired
that in effect “life has gone from them”,
the body is there but the person is gone
- this is applied to unborn, handicapped
and end of life issues. So PAS/E in this
case is not killing a person - and not
violating a command not to kill! In
essence the argument is that
biographical life has ceased to exist.
Wednesday 21 September 2011

16. Rae responds - biographical life is
based on biological, it presupposes it -
both aspects are essential to being a
human being - so personhood is not lost
just because the capacity to exercise an
ability is lost - losing the function of an
arm is not the same as having it
amputated.
If biographical life is what gives us value
then when it is lost we can strip the
person of all rights - start taking their
organs, experiment on them, even bury
them?
And following on, surely permission
would not be needed for PAS/E? It
becomes involuntary.
Wednesday 21 September 2011