Euthanasia and Public Policy

1. Euthanasia and Public Policy Dr. Schmid, Ph.D. Philosophy and Religion, UNCW

2. Philosophical Conversation:“General guidelines” Say what you think Opinion + reasons Confidentiality Criticism vs. disrespect Truth vs. agreement Principle of Epistemic Openness: presumption of possible error, even ignorance Philosophical examination= to test our own as well as others’ beliefs: are our reasons sound?

3. Proponents are concerned about • To many, this woman is already ‘dead’ in the sense of having no remaining quality of life. They believe that her loved ones should have the right to end her persistent vegetative state and she should have the right to die with dignity.

4. Opponents are concerned about • To others, this woman is someone’s beloved mother or grandmother. They fear that a culture of death (euthanasia and abortion) – which denies the sanctity of life – will lead to a society where she is nothing more than a financial burden we’re not willing to take on.

5. Important Concepts • Euthanasia: active/passive • Extraordinary means • Intentional killing (“double effect”) • Persisting Vegetative State • Physician Assisted Suicide • Palliative care/sedation • Informed consent • Quality of life • Natural will • Death with dignity • Slippery slope • Utilitarian : greater good • Individual/Family/Society • Kantian ethics • Autonomy/treating persons as ends in themselves • Self-ownership & “inalienable rights” • Religious pluralism • Moral pluralism • Legitimate boundaries of state power

6. Famous Cases Fictional – Whose life is it, anyway? - 1981 Karen Ann Quinlan - 1985 Nancy Cruzan - 1990 Jack Kevorkian - 1999 Terry Schiavo - 2001 Dr. Anna Pou - 2005 Chantal Sebire (France) - 2008

7. Whose life is it, anyway? • Ken Harrison is an artist who makes sculptures. One day he is involved in a car accident, and is paralyzed from his neck. All he can do is talk and move his eyes. After three years, he decides he wants to die. In hospital he makes friends with some of the staff, who support him when he goes to trial to be allowed to die. Should it be allowed?

8. Karen Ann Quinlan (1954-85) • After overdosing on drugs and alcohol at a party, Quinlan lapsed into a persistent vegetative state (PVS). After being kept alive on a ventilator for several months, her parents requested the hospital discontinue active care and allow her to die (passive euthanasia). The hospital refused, there were subsequent legal battles, and the courts eventually ruled in her parents' favor. But after taken off mechanical ventilation in1976, ‘she’ lived on for almost a decade until her death in 1985.

9. Nancy Cruzan (1957-1990) • After an automobile accident in 1987 left her in a PVS, her family petitioned in courts for three years, as far as the U.S. Supreme Court (Cruzan v. Director, Missouri Department of Health), to have her feeding tube removed. The Court initially denied the family's request, citing lack of evidence of Cruzan's wishes. The family's request was ultimately granted by providing additional evidence.

10. Jack Kevorkian (1928-2011) • Between 1990 -1998, Kevorkian assisted in the deaths of 133 terminally ill people by attaching the individual to a euthanasia device he had made. • In 1998 on 60 Minutes, Kevorkian aired a video of himself giving a lethal injection, for which he was found guilty of second-degree homicide in Michigan in 1999. • In 2008, Kevorkian was released after serving eight years of a 10-to-25-year prison sentence. He died this June.

11. Terry Schiavo (1954-85) • Terri collapsed in 1990 and was diagnosed as being in a persistent (PVS). • In 1998 Terri's husband petitioned to remove her feeding tube pursuant to Florida law; he was opposed by Terri's parents, who argued Terri was conscious. • The court determined Terri would not wish to continue life-prolonging measures. In April, 2001 her feeding tube was removed, only to be reinserted a few days later. • Over the next 4 years, various politicians and activists (including the pro-life movement), became involved in the case, and March 2005 Pres. Bush signed legislation to keep her alive. • The local court's decision to disconnect Terri was carried out on March 18, 2005.

12. Dr. Anna Pou - Katrina • Dr. Pou was arrested for having euthanized between 8-12 patients at New Orleans Memorial Hospital,during the crisis caused by Katrina in August, 2005. • Over 20 patients were later found with lethal doses of morphine in them, though this had not been prescribed; one patient, Emmett Everett, was alert and at NOMH for a bowel obstruction (non-life threatening). Witnesses said Pou administered the lethal drugs because Everett was a paraplegic and weighed over 300 lbs.; she didn't think the staff could reasonably evacuate him. • After a public outcry, Dr. Pou was not brought to trial, and the AG who indicted her was defeated in the next election.

13. Decision at N.O. Memorial Influencing factors • Collapse of law and order • Need for swift evacuation, risk if not • Difficulty of moving • Hospital vs. non-hospital patients? • Terminal illnesses • Triage mentality?

14. Chantal Sebire (1955-2008) • A mother of three, she was diagnosed in 2000 with a rare form of cancer, which in time burrowed through her sinuses, nasal cavities and eye socket, leaving her severely disfigured. She also lost her sight, taste, and smelland suffered severe pain that she refused to relieve with morphine due to its side effects. • In 2008 she made a public appeal to the French president, Nicolas Sarkozy, to allow her to die through euthanasia, stating that “One would not allow an animal to go through what I have endured.” In March, 2008, she lost her case, the magistrate noting that French law does not allow a doctor to end a patient's life. • Shortly after the decision, she was found dead in her home, as a result of drugs she almost certainly obtained illegally from a physician.

15. Current Law Active euthanasia (“intentional killing”) is illegal in every U.S. state but Oregon and Washington. Suicide, however, has been de-criminalized in every state. Passive euthanasia (“not continuing or providing extraordinary means”) where patients have indicated the desire for a “natural death,” is legal and widely practiced both in the US and other countries. The Netherlands was the first European state to permit PAS; now a growing number do. Gonzales vs. Oregon (2006): U.S. Supreme Court decided 6-3 not to prohibit doctors in Oregon from prescribing lethal drugs. Debate focused on issues of federal vs. state’s rights; Scalia argued in dissent: “If the term 'legitimate medical purpose' has any meaning, it surely excludes the prescription of drugs to produce death.”

17. What should you do? • Your patient, Mr. Jones, 80, has terminal cancer and will die within days. If you do not raise the level of medication to higher levels, he will be in severe pain. But if you raise the level, the dosage will cause him to lapse into a coma, and he will die.

18. What should you do? • Mr. Mahoud, 40, has ALS and is expected to die within the next year. He is not yet in extreme pain, but has become physically disabled and does not want to “slide into a coma or indignity.” He has asked you to assist him by providing a lethal drug. His family is opposed.

19. What should you do? • Ms. Jones, 60, has terminal stomach cancer and will die within weeks. You have raised the level of her medication to where she is barely conscious, but still in severe pain. Her family has asked you to give her a lethal injection, and let her “die with dignity; this is what she would want.”

20. What should you do? • Linnette has been born with a severe case of spina bifida. She would live 3-5 years, in severe pain or sedation to deal with the pain (attaining some consciousness). Her mother wants you to “end her agony,” the dad thinks it is morally wrong. You could act to relieve the spinal pressure, but very likely it would kill her.

21. Political Philosophy and Euthanasia

22. Arguments for and against • Suicide is a personal right; it may be the only way to die with dignity, before incapacitation and/or terrible pain. • Often, there is only increasing harm if you do not practice active or passive euthanasia. • Euthanasia can be administered through hospital ethics committees that adjudicate quality of life and consent issues in a fair and humane manner.. • Active euthanasia is intrinsically wrong and a violation of the sanctity of life. • Choosing suicide is a way of avoiding loss of control; palliative care can manage pain. • Legalizing euthanasia will  thousands of killings @ year. Together with the $ interest insurance and families may have, this will  de-humanizing consequences for society.

23. Rachel’s argument • “Killing is not necessarily morally worse than letting someone die. Suppose Smith wanted his uncle’s inheritance and went to drown him in the bath. But when he went in, Ben had slipped under the water, unconscious. Would it not be equally wrong for him to withhold aide?”

24. Steinbock’s argument • “The decision not to operate need not mean a decision to neglect , and it may be possible to make the remaining months of a defective child ‘s life comfortable, pleasant and filled with love…this alternative is surely more decent and humane than killing the child.”

25. Tooley’s argument • “If a person is suffering due to an incurable illness, then sometimes it is in that person’s best interest to die. If their committing suicide wrongs no one, and does not make the world a worse place, then it is not morally wrong…The view that a just and merciful God would condemn them to eternal hell is not persuasive.”

26. Callahan’s argument • “Euthanasia is part of the drift toward a view of life that regards the loss of control as the greatest of human indignities…I wonder if the voters of Oregon mean to empower unto death that small subclass of patients uncommonly bent on the control of their lives. It is bad public policy.”