Dr. Jacquelyn A.K. KegleyCalifornia State University

U.S.A.

Some Basic RightsSome Basic RightsThe right to life- The right to life- a natural/human a natural/human

right; a claim right? Is it absolute? right; a claim right? Is it absolute? Definition of “life”- quality, quantityDefinition of “life”- quality, quantityRight to free choice- Right to free choice- informed informed

consent, intentionality, proxy.- who consent, intentionality, proxy.- who can make decisions for others?can make decisions for others?

Beneficence- in the “best interests” Beneficence- in the “best interests” of another- who can make this of another- who can make this choice?choice?

Euthanasia- the ConceptPhysician acts on behalf of the Physician acts on behalf of the

patient either in accordance with patient either in accordance with patient’s wishes or patient’s wishes or paternalistically.paternalistically.

Death- intended.Death- intended.““Passive”- letting die; nature takes Passive”- letting die; nature takes

course; omission.course; omission.““Active”- using some means to Active”- using some means to

hasten or cause death.hasten or cause death.

Physician-Assisted SuicidePhysician-Assisted SuicideThe act is chosen and The act is chosen and performed by the performed by the person, assisted by the person, assisted by the physician.physician.

Provides a Provides a prescription.prescription.

Physician-Assisted SuicideOregon Law- 1997- six month prognosis verified by 2nd opinion; request in writing; repeat 15 days; “rational”; not depressed; can ingest medicine.

The Legal ArgumentsThe Legal ArgumentsArguments were presented by various groups to the Supreme Court when the issue was presented to them.

Philosophers’ Amicus BriefPhilosophers’ Amicus BriefEvery competent person has right to Every competent person has right to

make “momentous” personal make “momentous” personal decisions which invoke fundamental decisions which invoke fundamental religious/philosophical convictions religious/philosophical convictions about life and its value for self.”about life and its value for self.”

State State CANCAN protect against protect against impulsive, uninformed decisions impulsive, uninformed decisions through reasonable demonstration.through reasonable demonstration.

COALITION OF HOSPICE PROFESSIONALS COALITION OF HOSPICE PROFESSIONALS BRIEFBRIEFRemoving ban on PAS will enhance Removing ban on PAS will enhance

the opportunity for advanced the opportunity for advanced hospice care for all hospice care for all becausebecause regulations of PAS would mandate regulations of PAS would mandate that all palliative measures be that all palliative measures be exhausted as a condition precedent exhausted as a condition precedent to assisted suicide.to assisted suicide.

““Terminal sedation”- no evidence Terminal sedation”- no evidence not painful.not painful.

Legal PrecedentsLegal PrecedentsLiberty Right- DecisionsLiberty Right- DecisionsCasey v U.S.- “the heart of liberty is the Casey v U.S.- “the heart of liberty is the

right to define one’s own concept of right to define one’s own concept of existence, of the meaning of the universe existence, of the meaning of the universe and of the mystery of human life.”and of the mystery of human life.”

W.Va. v Bd. Ed.- fixed constitutional W.Va. v Bd. Ed.- fixed constitutional constellation- state cannot prescribe constellation- state cannot prescribe what shall be orthodox- what shall be orthodox-

RIGHT TO WITHDRAW TREATMENTRIGHT TO WITHDRAW TREATMENTKaren Quinlan (1976)-”right of Karen Quinlan (1976)-”right of

terminally ill (or surrogates) to refuse terminally ill (or surrogates) to refuse particularly “burdensome” treatment.particularly “burdensome” treatment.

Cruzan v. Dept. Missouri Health Cruzan v. Dept. Missouri Health (1990)- implied that state must allow (1990)- implied that state must allow individuals to make these decisions individuals to make these decisions through advance directives or proxy.through advance directives or proxy.

Cruzan- can withdraw artificial Cruzan- can withdraw artificial nutrition and hydration.nutrition and hydration.

Right to Refuse TreatmentRight to Refuse TreatmentMcKay v. Bergstredt (Nev. 1990)- McKay v. Bergstredt (Nev. 1990)-

young severe, spinal cord injury; young severe, spinal cord injury; quadriplegic, ventilator dependent. quadriplegic, ventilator dependent. “Competent patient refusing/with-“Competent patient refusing/with-drawing- drawing- mustmust be examined by two be examined by two non-attending physicians to non-attending physicians to determine mental competence; if determine mental competence; if understands prognosis & treatment understands prognosis & treatment options; free of coercion or pressure options; free of coercion or pressure in making decision.in making decision.

Arguments for PASBasic liberty right of persons- Casey v. U.S.- right to define one’s own concept of existence; meaning.

Momentous personal decision.

Utilitarian- Suffering The KeyUtilitarian- Suffering The KeyEmphasis is on relief of suffering and the Emphasis is on relief of suffering and the

principle of utility- to increase the amount of principle of utility- to increase the amount of happiness or to decrease the amount of happiness or to decrease the amount of misery.misery.

The policy of killing, at their own request, The policy of killing, at their own request, hopelessly ill patients who are suffering great hopelessly ill patients who are suffering great pain would decrease the amount of misery in pain would decrease the amount of misery in the world.the world.

Therefore such a social policy is morally right.Therefore such a social policy is morally right.It is also correct if it promotes the best It is also correct if it promotes the best

interests of everyone.interests of everyone.

Arguments Against PASAnnihilates basis for autonomy-kills SUBJECT.

Autonomy as only good- trumps all others.

Assistance violates physician’s intrinsic duty to promote health.

Slippery Slope ArgumentSlippery Slope ArgumentImpossible to limit a right to Impossible to limit a right to assisted suicide in an acceptable assisted suicide in an acceptable way, once the right is recognized.way, once the right is recognized.

Contra- State can override a right Contra- State can override a right to protect person from irrevocable to protect person from irrevocable mistake; procedures already mistake; procedures already established in McKay v Berstedtestablished in McKay v Berstedt

New Framework WouldFocus on virtues of compassion & respectfulness.

Person not just as rational.Physician to assist –health and life “for something.”

Suffering as broader concept.

False Cartesian Medicine“Lived body” not “machine.”

Suffering via body, via relations with others and via powers of the self.

Frustration of self’s goals, plans and will.

Fours Levels-Self/SufferingEmbodied action- access, movement, action in world.

Intersubjective life- roles and responsibilities, relations.

Will- lifestyle, plan, goals.Universal- meaning of life.

Pain- Reduction of SelfMore attention to pain and to palliative measures.

Must see pain in relation to the total personality of the individual in question to really address the problem.

Reductionistic EthicsExclusive focus on rational agent; autonomy; negative rights such as informed consent and right to refuse treatment.

Compassion not in picture.

Problems with AutonomyIgnores persons as social beings whose actions take place in a complex physical, social environment.

Ignores power relations and vulnerability and dependence.

Autonomy-Obey DoctorConflict with what “medicine deems correct.”-negative right.

Dax Case- though deemed competent and rational- challenged-ignored full range of his suffering.

Human self-as relationalSelf-consciousness dependent on social contrast; others.

Knowledge of external dependent on others.

Importance of ethnic, cultural, gender perspectives on health.

Self- temporal & historicalPerson as future-oriented; growth, change, history.

Self as “narrative.”-Process of self interpretation; other-interpretation.

As “text” there is no closure.

Objective & Technological Conflict- autonomy suggests that you are a “director of your own death” and yet “death” is viewed by medicine as that to be fought with every tool.

Person gets lost in this battle.

Move to New ViewpointPhysician as nature’s assistant; medicine as “art.”

Virtue-based ethics .Humility- recognize limits.Prudence- practical wisdom.

Compassion as a virtueCompassion includes rational.

Three beliefs: (1) possibilities of self similar to those of the sufferer; (2)suffering is serious;(3) suffering not caused by the sufferer’s own actions.

Respect as a Key VirtueRespect is based on a common human vulnerability and dependency.

“All of us, as humans, have the capacity to suffer and in this sense gain our equality.”