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Euthanasia. Decisions at the end of life. What is Euthanasia?. Euthanasia means “a good death,” or “dying well.” What is a good death? Peaceful Painless Lucid With loved ones gathered around. Some Initial Distinctions. Active vs. Passive Euthanasia

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Decisions at the end of life

what is euthanasia
What is Euthanasia?

Euthanasia means “a good death,”

or “dying well.”

  • What is a good death?
    • Peaceful
    • Painless
    • Lucid
    • With loved ones gathered around
some initial distinctions
Some Initial Distinctions
  • Active vs. Passive Euthanasia
  • Voluntary, Non-voluntary, and Involuntary Euthanasia
  • Assisted vs. Unassisted Euthanasia
active vs passive euthanasia
Active vs. Passive Euthanasia
  • Active euthanasiaoccurs in those instances in which someone takes active means, such as a lethal injection, to bring about someone’s death;
  • Passive euthanasiaoccurs in those instances in which someone simply refuses to intervene in order to prevent someone’s death.
criticisms of the active passive distinction in euthanasia
Criticisms of the Active/Passive Distinction in Euthanasia
  • Vague dividing line between active and passive, depending on notion of “normal care”
  • Principle of double effect
  • Does passive euthanasia sometimes cause more suffering?
compassion for suffering
Compassion for Suffering
  • The most important question when lives are ending is: how do we respond to suffering?
    • Hospice and palliative care
    • Aggressive pain-killing medications
    • Sitting with the dying
    • Euthanasia
the sanctity of life
The Sanctity of Life
  • Life is a gift from God
  • Respect for life is paramount
  • Importance of personhood
  • The approach of Natural Law
  • Importance of ministering to the sick and dying
  • See life as “priceless” (Kant)
  • Respect for life once the dying process has begun
the quality of life
The Quality of Life
  • Peter Singer – low quality of life justifies ending a life
  • BUT what is quality of life – is it more than can be judged medically?
  • Would extraordinary means improve the quality of life of a patient?
  • Refusal of medical treatment
the right to die
The Right to Die
  • Do we have a right to die?
  • Negative right (others may not interfere)
  • Positive right (others must help)
  • Do we own our own bodies and our lives? If we do own our own bodies, does that give us the right to do whatever we want with them?
  • Isn’t it cruel to let people suffer pointlessly?
two ethical approaches
Two ethical approaches
  • A Utilitarian approach, which emphasises consequences
  • A Kantian approach, which emphasises autonomy, rights, and respect
the utilitarian approach
The Utilitarian approach
  • Goes back at least to Jeremy Bentham (1748 – 1832) and John Stuart Mill (1806-73)
  • The greatest good for the greatest number
main tenets
Main Tenets
  • Morality is a matter of consequences
  • We must count the consequences for everyone
  • Everyone’s suffering counts equally
  • We must always act in a way that produces the greatest overall good consequences and least overall bad consequences.
the calculus
The Calculus
  • Morality becomes a matter of mathematics, calculating and weighing consequences
  • Key insight: consequences matter
  • The dream: bring certainty to ethics
what is a good death
What is a good death?
  • Jeremy BenthamHedonistic utilitarians:

a good death is a

painless death.

  • John Stuart Mill

Eudaimonistic utilitarians:

a good death is a happy


euthanasia and personal autonomy
Euthanasia and personal autonomy
  • John Stuart Mill – in matters which do not concern others, individuals should have full autonomy
  • Should a competent adult be allowed to decide the time and circumstances of their death?
the kantian model
The Kantian Model
  • Central insight: people cannot be treated like mere things.
    • Key notions:
      • Autonomy & Dignity
      • Respect
      • Rights
autonomy respect
Autonomy & Respect
  • Kant felt that human beings were distinctive: they have the ability to reason and the ability to decide on the basis of that reasoning.
  • Autonomy = freedom + reason
  • Autonomy for Kant is the ability to impose reason freely on oneself.
protecting autonomy
Protecting Autonomy
  • Advanced Directives are designed to protect the autonomy of patients
  • They derive directly from a Kantian view of what is morally important.
autonomy who decides
Autonomy: Who Decides?
  • Kantians emphasize the importance of a patient’s right to decide
  • Utilitarians look only at consequences – but it can justify too much, as there is no protection for the minority or safeguarding of the individual’s rights
  • Many of the ethical disagreements about end-of-life decisions can be seen as resulting from differing ethical frameworks, especially Kantian vs. Utilitarian.
  • or Quality of Life vs. Sanctity of Life