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Physician-Assisted Suicide and Euthanasia II Arguments Worth Considering
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A Divisive Debate n Polls: Position on abortion strongly predicts position on PAS/VAE n Polls: “Religiosity” strongly predicts opposition to PAS/VAE n Significant drop in support in minority communities vs. whites
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Good arguments? n Debate seems to make little progress; same charges repeated n Few authors as honest and candid as Kamisar: try hard to identify the strongest reasons in opposition to one’s own position and deal frankly with them
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Concerns Worth Hearing n Minority communities n Disability rights community n Still: must be careful not to stereotype all as agreeing
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Minority concerns n Lack of trust in medical establishment n “How come we have had unmet health care needs in our neighborhood for years, and when you finally show up, it’s to advocate our right to die?”
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Disability Concerns n Distrust of medical establishment –Good will toward persons with disabilities –Ability to make accurate prognoses n Allowing person to die because of a disability sends “wrong message”
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Concerns with Concerns n Objections apply equally to forgoing treatment, PAS, VAE n Does this position require that persons with disabilities devote their lives and health to “the cause” and not their own goals and needs?
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NYSTF Position Paper n “Safeguards” of proponents assumes ideal conditions –Choice of medical care options –Adequate pain management, hospice –Quick access to expert psychiatric care –Basic social support: housing, family, etc. n Too many today lack some or all of these
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“Anti-Hospice” Argument n Claim: Allowing PAS will reduce felt need to fund and expand hospice programs n With less availability of hospice will have even more people in future seeking PAS (vicious cycle)
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“Anti-Hospice” Argument-? n Data from Oregon show major expansion of hospice n Most proposals to legalize PAS call for more, not less use of hospice as part of “safeguards” n Hospice programs per se do not prevent all requests for PAS (Oregon)
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“Quill’s Paradox” n T. Quill: May reduce the number of patients seeking PAS by openly permitting PAS n Claim: Today many terminal patients commit suicide privately because they know physicians cannot legally help them
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“Quill’s Paradox”-- cont. n If PAS legal, patients might seek physician’s assistance n Physician could then identify and treat depression, uncontrolled pain, etc. n Treatment of these problems may reduce continued requests for death by as much as 8 of 9 (Netherlands)
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Argument from Frequency n Best data show that legal prohibition does not eliminate PAS/VAE n We have little way of knowing whether more “abuses” occur because PAS/VAE is underground practice n Philosophers: unfairness-- well- connected get PAS/VAE whether legal or illegal
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Medicalization Argument n Claim: A major problem in society today is expecting medical technology to solve problems which are really social problems (“medicalization”) n Legalized PAS is a way of inappropriately “medicalizing” dying, when real comfort comes from social, emotional, and spiritual support and “working thru”
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Medicalization Argument-- II n Common for PAS advocates to cite loss of control of dying process in hospital, etc. as reason n But legalizing PAS with stringent safeguards places control of the process largely in hands of physicians n Inconsistency, or hidden motive?
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Medicalization Argument- III n If I had to commit suicide all by myself, as way out of terminal illness, I might reaonably shrink from the act n BUT if I can use the physician as a symbol of “blessing” or “sanitizing” the process I may be encouraged to go thru with it
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Medicalization: Rebuttal n If I try to commit suicide on my own I may botch it, or else use messy means which will traumatize family n Wishing to avoid suffering and leaving cruel memories among my family are hardly bad reasons to seek physicians’ help
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Chabot Case n Netherlands n Dr. Chabot consulted 8 colleagues before assisting suicide of Mrs. B who was incurably depressed and begged for help to die n Court: Technically guilty because none of 8 actually interviewed patient n Court: Mental illness = physical
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Chabot Case-- Concerns n Did Dr. Chabot truly believe that suicide was the best medical option for Mrs. B? n If not did Mrs. B in effect blackmail Chabot into PAS by her threats to commit suicide on her own? n Shows major division between “civil rights” and “physician discretion”
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Hardwig: Sympathetic View n Traditional wisdom (autonomy): Worry if patient wishes to die because feels a burden to family n Could be a sign of coercion or undue influence n My decision to die ought to reflect my individual best interests not concerns of family
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Hardwig: Sympathetic View- II n Hardwig: This view portrays family as fundamental conflict of interest rather than loving unit on which all of us depend n Truth is that a chronically ill elderly person can be a severe burden
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Hardwig: Sympathetic View III n Case from Moyers: Woman promised mother never to put in nursing home n In caring for mother at home woman lost job, home, car, insurance n If mother could have predicted, should she have extracted promise? n Hardwig: If I did that to my family, maybe it would be wrong
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