PH258 – Medical Ethics

1. PH258 – Medical Ethics

2. Agenda • CLASSIC CASES, Chapter 1 – Requests to Die: Elizabeth Bouvia and Larry McAfee • CLASSIC CASES, Chapter 2 – Comas: Karen Quinlan, Nancy Cruzan, and Terri Schiavo

3. Requests to Die: Elizabeth Bouvia and Larry McAfee Elizabeth Bouvia – totally paralyzed from cerebral palsy; no use of legs; partial use of one arm; mentally competent Requested to die in hospital Initially denied – Chicken Little argument

4. Chicken Little Defense If Elizabeth Bouvia is given right to terminate her life, then other disabled people might also ask for this option

5. Later given the right to terminate her life Changed her mind Five years before the Nancy Cruzan US Supreme Court decision, Bouvia won right to terminate her life. Elizabeth Bouvia case – show effects of long-standing abuse of people with disabilities

6. Larry Mcafee – paralyzed from a motorcycle accident Requested to die In 1989, he won the right to termination Yet he decided to live. Bouvia and Mcaffee given three options:

7. Dax Cowart – burns over 2/3 of his body Requested to terminate Initially refused. Later given right to termination Yet he decided to live. Adaption effect (p. 16)

8. Historical Views of Suicide • Ancient Greek • Plato • Aristotle • Stoic View • Seneca • Marcus Aurelius

9. Judaic and Christian Views of Suicide Old Testament – suicide of Saul – 1st king of Israel by prophet Samuel – routed Philistines and others – later usurped Samuel – accused of stealing war booty and not killing a captured king of the Amalekites – was later routed by Philistine forces – 3 sons killed in battle – committed suicide – body was recovered through daring raid from his soldiers – buried with honor

10. New Testament – suicide of Judas Iscariot Conflicting accounts Gospel of Matthew – betrays Jesus – later returned the 30 silver coins – hanged himself Acts of the Apostles – keeps the money – buys a farm – falls down in the field – disemboweled Gospel of Judas – not part of Bible – Jesus asks Judas to hand him over

11. St. Augustine - against suicide St. Thomas Aquinas – suicide – a sin • No chance for repentance • Life is gift from God • Robs children of their parents • Unnatural

12. Michel de Montaine - “If we have learned how to live properly and calmly, we will know how to die in the same manner.”

13. Baruch Spinoza – “A free man, that is to say, a man who lives according the dictates of reason alone, is not led by the fear of death.”

14. John Donne – “When the [terminal] disease would not reduces us, [God] sent a second and worse affliction, ignorant and torturing physicians.”

15. David Hume – favors suicide – if someone’s health is failing, letting it happen is following causal laws Audacious to think our life – or death – influences the vast universe To kill oneself is only to stop doing good

16. Immanuel Kant - against suicide Suicide cannot be universalized – ‘Act so that your action becomes a universal law.’ (categorical imperative) Suicide does not treat another (in this case, oneself) as an end – ‘Treat each person as an end in himself, never merely as a means.’

17. Immanual Kant (continued) Suicide is a form of disrespect to oneself. This could lead to disrespect others. Humans as ‘sentinels on earth’ – we are God’s property

18. John Stuart Mill “Over himself, over his own body and mind, the individual is sovereign.”

19. What qualifies as a suicide?

20. Elizabeth Bouvia, Larry McAfee, Dax Cowart: Assisted suicide Rule of Rescue operative

21. http://www.npr.org/2011/06/16/137217016/the-nation-keeping-the-right-to-die-alivehttp://www.npr.org/2011/06/16/137217016/the-nation-keeping-the-right-to-die-alive