1. Euthanasia Part I Ethics Dr. Jason M. Chang

2. Euthanasia Directly or indirectly bringing about the death of another person for the person’s sake Examples of euthanasia o Administering lethal injection or drug dosage o Removing feeding tube or respirator o Choosing not to perform necessary surgery

3. Active vs. Passive Active Euthanasia Performing an action that directly causes death (“killing”) E.g., Giving the patient a lethal injection Passive Euthanasia Allowing death by withholding or withdrawing treatment (“letting die”) E.g., Removing a feeding tube or respirator, choosing not to perform necessary surgery

4. Voluntary vs. Involuntary Voluntary Euthanasia Killing patient or letting patient die Patient voluntarily requests euthanasia either at the time while competent or through prior instructions Involuntary Euthanasia Killing patient or letting patient die Patient not competent to choose death and have not previously disclosed instructions

5. Types of Euthanasia TYPEDESCRIPTION Active voluntaryDirectly causing death at the patient’s request Active non-voluntaryDirectly causing death without the consent of the patient Passive voluntaryWithholding or withdrawing treatment at the patient’s request Passive non-voluntaryWithholding or withdrawing treatment without consent of patient

6. Physician Assisted Suicide Physician prescribes drugs and explains to patient method of suicide Patient (not the doctor) performs the final act of death Technically not classified as “euthanasia”

7. Physician Assisted Suicide Physician prescribes drugs and explains to patient method of suicide Patient (not the doctor) performs the final act of death Technically not classified as “euthanasia”

8. Justifying Voluntary Passive Euthanasia Doctor’s duty – to care for their patients to the best of their ability. Q  On what basis is letting a patient die by withholding or withdrawing treatment morally permissible?

9. Informed Consent A physician must obtain informed consent of a patient prior to any substantial intervention This requirement generally holds even in cases in which substantial intervention is necessary for the prolonging or saving of the patient’s life

10. Respect for Autonomy Persons have a right to self-determination Value of autonomy enshrined in our law o First Amendment o Roe v. Wade o Lawrence v. Texas o Casey v. Planned Parenthood o Obtaining informed consent in medical context reflects our respect for patient autonomy

11. Respect for Autonomy Does the right to self- determination provide the basis for a right to die via active means?

12. “The Philosophers’ Brief” Amici curiae brief in Vacco v. Quill (1997) Background for Vacco v. Quill o New York enacts prohibition against physician-assisted suicide o Many physicians in New York file suit o Court of Appeals finds New York law unconstitutional o U.S. Supreme Court hears case o Issue: Whether a New York’s ban on physician-assisted suicide is constitutional

13. “The Philosophers’ Brief” Major points: 1. Importance of right to self-determination in our moral tradition 2. Right to self-determination provides basis for right to die

14. “The Philosophers’ Brief” Major points: 3. Previous Supreme Court cases provide basis for right to die 4. Denying right to die amounts to imposing a certain morality on citizens

15. Active vs. Passive: Why the Discrepancy? American Medical Association’s (AMA) policy “The intentional termination of the life of one human being by another – mercy killing – is contrary to that for which the medical profession stands and is contrary to the policy of the American Medical Association […] The cessation of employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is immanent is the decision of the patient and/or immediate family.” (AMA, Opinions of Judicial Council, 1973)

16. Active vs. Passive: Why the Discrepancy? “The State has reaffirmed the line between ‘killing’ and ‘letting die’ ” -U.S. Supreme Court, Vacco v. Quill Q  Is there a morally relevant difference between killing and letting die?

17. Bibliography Lewis Vaughn. “Euthanasia and Assisted Suicide”, in Contemporary Moral Arguments, 2 nd edition, Oxford, (2013), 264-268