1 III Euthanasia

2 Some Background: Oregon’s “Death with Dignity” Act It is possible in Oregon for a terminally-ill patient to get a prescription to kill him or herself (beginning 1997). Patient must be: -18 years of age or older; -a resident of Oregon; -capable of making and communicating health care decisions for him/herself; and -diagnosed with a terminal illness that will lead to death within six (6) months. (Note: Oregon law doesn’t require that the patient be suffering). As of 2006, 292 total deaths have resulted from this act (including 3 between 18 and 34). Many more recipients of the medication to end lives than recipients who took the medication.

3 Some Background: Oregon’s “Death with Dignity” Act (cont’d) Most prominent reasons patients cited for wanting to end their lives include: -Loss of autonomy (87%) -Loss of ability to engage in enjoyable activities (87%) -Loss of dignity (80%) -Loss of control of bodily functions (57%) -Burden on family/friends/caregivers (38%) -Inadequate pain control or concern about it (26%) -Financial implications of treatment (2%) The average time between digestion of life-ending medication and unconsciousness was 5 minutes. The average time between digestion of life-ending medication and death was 25 minutes.

4 Some Background: The Hemlock Society Founded in 1980, making it the oldest organization of its kind in North America. 45,000 members. Advocates legal change and distributes how to die information. Publishes “how-to” suicide guides, including founder Derek Humphry’s best-seller Final Exit, with sales exceeding 1,000,000 copies.

5 Doerflinger’s Project Doerflinger objects to the permissibility of assisted suicide (including active euthanasia) on two bases: Richard Doerflinger: “Assisted Suicide: Pro- Choice or Anti-Life?” 1)The standard pro-choice appeal to autonomy is at odds with itself. 2)Pro-choice advocates fail to appreciate the risks of a slippery slope towards allowing wrongful practices of killing.

6 Assisted Suicide vs. Respect for Life Claim from assisted-suicide advocates: A life of suffering “racked with pain” is “not the kind of life we cherish.” (256) Doerflinger notes (and such advocates would agree) that this proposal is incompatible with the conviction that human life is of intrinsic worth. Problem: “If society is to help terminally ill patients to commit suicide because it agrees that death is objectively preferable to a life of hardship, it will be difficult to draw the line at the seriously ill or even at circumstances where the victim requests death.” (256-7)

7 Assisted Suicide vs. Respect for Life (cont’d) Autonomy Argument They claim that suicide is the “ultimate” exercise of self- determination, and thus deserves not only respect, but the assistance of others. On this principle, the Hemlock Society and others advocate a constitutional “right to die.” Some assisted-suicide advocates claim that we should respect the wishes of such patients because humanity or personhood has a dignity that demands respect for individual freedom.

8 Life vs. Freedom The autonomy-based approach departs from American traditions on liberty in one fundamental respect: The inalienable human rights described in the Declaration of Independence are: “life, liberty, and the pursuit of happiness.” These seem to be in order of priority: -Liberty allows for the pursuit of happiness. -Life allows for liberty. “Safeguards against the deliberate destruction of life are thus seen as necessary to protect freedom and all other rights.” (257) On this view, suicide is not the ultimate exercise of freedom, but its self-contradiction. -By destroying life, one destroys all future freedoms. -“If life is more basic than freedom, society best serves freedom by discouraging rather than assisting self- destruction.” (257)

9 Life vs. Freedom (cont’d) Objection #1: The person who ends his life has not truly suffered loss of freedom. Unlike a slave, he doesn’t have to live with his loss of freedom. To say that a slave is worse off than a corpse is to say limited freedom is worse than no freedom, which seems inconsistent with the “pro-choice” position. Objection #2: Assisted suicide is only being offered to those who can no longer meaningfully exercise other freedoms. Even the painfully bedridden have some freedom.

10 Life vs. Freedom (cont’d) Advocates of assisted suicide tend to prioritize the avoidance of suffering over and above freedom. Freedom (and life itself) is viewed as instrumental to the value of happiness (the avoidance of suffering). On this system, someone who is suffering and yet chooses to live will be seen as irrational. Under the Oregon Act, one can be given a lethal prescription if they have only six months to live, but not if they have seven months to live. If suffering avoidance is our primary interest, wouldn’t it be better to allow this practice earlier rather than later?

11 Slippery Slopes, Loose Cannons “Contingent factors in the contemporary situation may make it virtually inevitable in practice […] that removal of the taboo against assisted suicide will lead to the destructive expansions of the right to kill the innocent.” (258) Elderly and disabled patients are often invited to see themselves as useless burdens on younger generations. Society seems to say, ‘You can continue to live if you want, but the rest of us have no real interest in your survival.’

12 Slippery Slopes, Loose Cannons (cont’d) Health Care Crisis With assisted suicide seen as a viable option for those requiring expensive health care, health care providers will have an incentive to make this option more attractive. -Life-extending care of the terminally-ill will be increasingly seen as elective, and society may become less willing to provide funds for such care. -Pressure to accept death will grow accordingly.

13 Slippery Slopes, Loose Cannons (cont’d) Legal Doctrines Where courts have recognized a right to refuse treatment, they have concluded it is unjust to deny this right to the mentally incompetent. -In such cases, such a right may be exercised by a legal guardian. -Once assisted suicide is established as a right, courts will almost certainly pass the right to the guardians of the mentally incompetent. -This would almost certainly lead to legalized cases of nonvoluntary (if not involuntary), active euthanasia.

14 Slippery Slopes, Loose Cannons (cont’d) Definitions of “Terminal Illness” The Hemlock Society wishes to offer assisted suicide only to those suffering from terminal illness. But what qualifies as a “terminal illness”? -Derek Humphry says “two and a half million people alone are dying of Alzheimer’s disease.” -Dutch courts found the paralysis of a quadriplegic woman qualified as a terminal illness as paralyzed patients “have difficulty swallowing and could die from aspirating their food at any time.” -Diabetics risk death without the life-preserving treatment of insulin. -Some courts already see comatose and vegetative states as terminal because patients in such states cannot feed themselves.

15 Slippery Slopes, Loose Cannons (cont’d) Disabilities Definitions of terminal illness could foreseeably come to encompass severe physical or mental disabilities. While we don’t want to say people with such disabilities have “lives not worth living,” our prejudices against people with such disabilities may lead such people to believe their lives are meaningless. Character of the Medical Profession Physicians resist giving lethal injections because of legal and societal sanctions. “To allow killing by physicians in certain circumstances may create a new lobby of physicians in favor of expanding medical killing.” (260)

16 Slippery Slopes, Loose Cannons (cont’d) Human Will to Power Human beings are tempted to enjoy exercising power over others. -Ending another person’s life is the ultimate exercise of that power. -Once the taboo against killing is lifted, it becomes progressively easier to channel one’s aggressive instincts into the destruction of life in other contexts.

17 Discussion  At the end of the article, Doerflinger notes his “loose cannon” arguments are not conclusive. How convincing are they? Is the burden of proof on him or on his opponents?  How should we define “terminal illness”? Does it have something to do with our old issue of “extraordinary means”?