Dr. Jacquelyn A.K. Kegley California State University U.S.A.

Some Basic Rights The right to life- a natural/human right; a claim right? Is it absolute? The right to life- a natural/human right; a claim right? Is it absolute? Definition of “life”- quality, quantity Definition of “life”- quality, quantity Right to free choice- informed consent, intentionality, proxy.- who can make decisions for others? Right to free choice- informed consent, intentionality, proxy.- who can make decisions for others? Beneficence- in the “best interests” of another- who can make this choice? Beneficence- in the “best interests” of another- who can make this choice?

Euthanasia- the Concept Physician acts on behalf of the patient either in accordance with patient’s wishes or paternalistically. Physician acts on behalf of the patient either in accordance with patient’s wishes or paternalistically. Death- intended. Death- intended. “Passive”- letting die; nature takes course; omission. “Passive”- letting die; nature takes course; omission. “Active”- using some means to hasten or cause death. “Active”- using some means to hasten or cause death.

Physician-Assisted Suicide The act is chosen and performed by the person, assisted by the physician. The act is chosen and performed by the person, assisted by the physician. Provides a prescription. Provides a prescription.

Physician-Assisted Suicide Oregon Law six month prognosis verified by 2 nd opinion; request in writing; repeat 15 days; “rational”; not depressed; can ingest medicine.

The Legal Arguments Arguments were presented by various groups to the Supreme Court when the issue was presented to them.

Philosophers’ Amicus Brief Every competent person has right to make “momentous” personal decisions which invoke fundamental religious/philosophical convictions about life and its value for self.” Every competent person has right to make “momentous” personal decisions which invoke fundamental religious/philosophical convictions about life and its value for self.” State CAN protect against impulsive, uninformed decisions through reasonable demonstration. State CAN protect against impulsive, uninformed decisions through reasonable demonstration.

COALITION OF HOSPICE PROFESSIONALS BRIEF Removing ban on PAS will enhance the opportunity for advanced hospice care for all because regulations of PAS would mandate that all palliative measures be exhausted as a condition precedent to assisted suicide. Removing ban on PAS will enhance the opportunity for advanced hospice care for all because regulations of PAS would mandate that all palliative measures be exhausted as a condition precedent to assisted suicide. “Terminal sedation”- no evidence not painful. “Terminal sedation”- no evidence not painful.

Legal Precedents Liberty Right- Decisions Liberty Right- Decisions Casey v U.S.- “the heart of liberty is the right to define one’s own concept of existence, of the meaning of the universe and of the mystery of human life.” Casey v U.S.- “the heart of liberty is the right to define one’s own concept of existence, of the meaning of the universe and of the mystery of human life.” W.Va. v Bd. Ed.- fixed constitutional constellation- state cannot prescribe what shall be orthodox- W.Va. v Bd. Ed.- fixed constitutional constellation- state cannot prescribe what shall be orthodox-

RIGHT TO WITHDRAW TREATMENT Karen Quinlan (1976)-”right of terminally ill (or surrogates) to refuse particularly “burdensome” treatment. Karen Quinlan (1976)-”right of terminally ill (or surrogates) to refuse particularly “burdensome” treatment. Cruzan v. Dept. Missouri Health (1990)- implied that state must allow individuals to make these decisions through advance directives or proxy. Cruzan v. Dept. Missouri Health (1990)- implied that state must allow individuals to make these decisions through advance directives or proxy. Cruzan- can withdraw artificial nutrition and hydration. Cruzan- can withdraw artificial nutrition and hydration.

Right to Refuse Treatment McKay v. Bergstredt (Nev. 1990)- young severe, spinal cord injury; quadriplegic, ventilator dependent. “Competent patient refusing/with-drawing- must be examined by two non-attending physicians to determine mental competence; if understands prognosis & treatment options; free of coercion or pressure in making decision. McKay v. Bergstredt (Nev. 1990)- young severe, spinal cord injury; quadriplegic, ventilator dependent. “Competent patient refusing/with-drawing- must be examined by two non-attending physicians to determine mental competence; if understands prognosis & treatment options; free of coercion or pressure in making decision.

Arguments for PAS Basic liberty right of persons- Casey v. U.S.- right to define one’s own concept of existence; meaning. Momentous personal decision.

Utilitarian- Suffering The Key Utilitarian- Suffering The Key Emphasis is on relief of suffering and the principle of utility- to increase the amount of happiness or to decrease the amount of misery. Emphasis is on relief of suffering and the principle of utility- to increase the amount of happiness or to decrease the amount of misery. The policy of killing, at their own request, hopelessly ill patients who are suffering great pain would decrease the amount of misery in the world. The policy of killing, at their own request, hopelessly ill patients who are suffering great pain would decrease the amount of misery in the world. Therefore such a social policy is morally right. Therefore such a social policy is morally right. It is also correct if it promotes the best interests of everyone. It is also correct if it promotes the best interests of everyone.

Arguments Against PAS Annihilates basis for autonomy- kills SUBJECT. Autonomy as only good- trumps all others. Assistance violates physician’s intrinsic duty to promote health.

Slippery Slope Argument Impossible to limit a right to assisted suicide in an acceptable way, once the right is recognized. Impossible to limit a right to assisted suicide in an acceptable way, once the right is recognized. Contra- State can override a right to protect person from irrevocable mistake; procedures already established in McKay v Berstedt Contra- State can override a right to protect person from irrevocable mistake; procedures already established in McKay v Berstedt

New Framework Would Focus on virtues of compassion & respectfulness. Person not just as rational. Physician to assist –health and life “for something.” Suffering as broader concept.

False Cartesian Medicine “Lived body” not “machine.” Suffering via body, via relations with others and via powers of the self. Frustration of self’s goals, plans and will.

Fours Levels-Self/Suffering Embodied action- access, movement, action in world. Intersubjective life- roles and responsibilities, relations. Will- lifestyle, plan, goals. Universal- meaning of life.

Pain- Reduction of Self More attention to pain and to palliative measures. Must see pain in relation to the total personality of the individual in question to really address the problem.

Reductionistic Ethics Exclusive focus on rational agent; autonomy; negative rights such as informed consent and right to refuse treatment. Compassion not in picture.

Problems with Autonomy Ignores persons as social beings whose actions take place in a complex physical, social environment. Ignores power relations and vulnerability and dependence.

Autonomy-Obey Doctor Conflict with what “medicine deems correct.”-negative right. Dax Case- though deemed competent and rational- challenged-ignored full range of his suffering.

Human self-as relational Self-consciousness dependent on social contrast; others. Knowledge of external dependent on others. Importance of ethnic, cultural, gender perspectives on health.

Self- temporal & historical Person as future-oriented; growth, change, history. Self as “narrative.”-Process of self interpretation; other- interpretation. As “text” there is no closure.

Objective & Technological Conflict- autonomy suggests that you are a “director of your own death” and yet “death” is viewed by medicine as that to be fought with every tool. Person gets lost in this battle.

Move to New Viewpoint Physician as nature’s assistant; medicine as “art.” Virtue-based ethics. Humility- recognize limits. Prudence- practical wisdom.

Compassion as a virtue Compassion includes rational. Three beliefs: (1) possibilities of self similar to those of the sufferer; (2)suffering is serious;(3) suffering not caused by the sufferer’s own actions.

Respect as a Key Virtue Respect is based on a common human vulnerability and dependency. “All of us, as humans, have the capacity to suffer and in this sense gain our equality.”