Definitions, One More Time
The Law Today
- The Netherlands has the most permissive society in the world with regard to euthansia. The law there allows euthanasia when all of the following have been met:
- the patient has asked repeatedly
- the patient’s suffering is unbearable with no prospect of improvement
- the doctor has prior to the act consulted a colleague.
- the patient has to be at least 12 years old; patients between 12 and 16 years of age require consent of their parents
- In 2003, there were 1626 cases of euthanasia where a physician was involved
- Oregon and Washington are the only US states that have legalized physician assisted suicide.
- The Oregon law only allows the doctor to prescribe a treatment.
- Since 1998, 171 people in Oregon have used the law (Oregon Death with Dignity Act).
- The law requires that the patient
- must be terminally ill
- must have 6 months or less to live
- must make two oral requests for assistance in dying
- must make one written request for assistance
- must convince two physicians that she/he is sincere, is not acting on a whim, and that the decision is voluntary
- must not have been influenced by depression
- must be informed of “the feasible alternatives, including, but not limited to, comfort care, hospice care and pain control.”
- must wait for 15 days
- The law requires that the patient
Three Philosophical Arguments for Euthanasia
Four Philosophical Arguments Against Euthanasia
Respect for Human Life
Negative Consequences of Utilitarian Thinking/Slippery Slope
- Allowing utilitarian thinking to influence life and death decisions can be dangerous. Would utilitarian calculations allow killing the indigent, the very elderly, the very young?
- Some philosophers have argued that these groupd could be easily vicitimized by hospitals, families and governments with financial motivation to end their lives.
- Some utilitarian thinkers have increased these fears, notably Peter Singer, who wrote, “”Killing a defective infant is not morally equivalent to killing a person. Sometimes it is not wrong at all.”
- In 1989, the U.S. Civil Rights Commission issued a 153-page report entitled “Medical Discrimination Against Children with Disabilities.” Among the events considered by the Commission was an experiment conducted from 1977 to 1982 at the Children’s Hospital of Oklahoma. Doctors there developed a “quality of life” formula for babies with spina bifida, taking into account the socioeconomic status of the baby’s family to determine what to advise families about a simple but life-and-death procedure. Better-off families were provided a realistic and optimistic picture of their child’s potential. Poor families were provided a pessimistic picture. All of the families who were given an optimistic picture asked for medical care for their children. Conversely, four out of five poor families agreed not to treat their children, and twenty-four babies died. The U.S. Civil Rights Commission concluded:
- To accept a projected negative quality of life . . . based on the difficulties society will cause . . . , rather than tackling the difficulties themselves, is unacceptable. The Commission rejects the view that an acceptable answer to discrimination and prejudice is to assure the “right to die” to those against whom the discrimination and prejudice exists.1
- The doctors conducting the study developed a “formula” which they published as part of their write-up in “Pediatrics”, the most famous and influential medical journal devoted to the care of children.
- This is their “formula”: Quality of Life is Natural Endowment by the contribution of the Home plus the contribution of Society. In a more mathematical style it reads: QL equals NE * (H + S). The doctors measured the “H” – the contribution of the home – primarily in financial terms: family income, family debt, employment and employability of the parents, etc. The parents’ “intellectual resources,” defined in terms of their educational level, were also included in the calculation of “H,” which had the effect of crowding the pessimistic outcome group with parents less likely to challenge the doctors’ “facts”.
- This argument also maintains that once euthanasia is permitted, we will be on the ol’ slippery slope. Many who argue against euthanasia fear that once it becomes legally permissiable, euthansia will spread beyond narrowly defined allowances. Soon, any number of patients could be a risk.
- Jonathan Pincus, M.D., from Yale, writes: “I have yet to hear of a set of guidelines for euthanasia which would not lead to terrible abuses even in the opinion of those physicians who are sometimes willing to practice it. Inevitably, this form of ‘therapy’ would spread to situations in which at present it would be unthinkable.”
- Such arguments often rely on the example of the Nazis, who were said to begin with the seriously disabled.
- Recent evidence, however, suggests that the danger of the slippery slope is overstated:
The panel examined reports from each of these jurisdictions, with the exception of Montana (where legalization of assistance in dying occurred only in 2009, and reliable data are not yet available). In The Netherlands, voluntary euthanasia accounted for 1.7% of all deaths in 2005 – exactly the same level as in 1990. Moreover, the frequency of ending a patient’s life without an explicit request from the patient fell by half during the same period, from 0.8% to 0.4%.
Indeed, several surveys suggest that ending a patient’s life without an explicit request is much more common in other countries, where patients cannot lawfully ask a doctor to end their lives. In Belgium, although voluntary euthanasia rose from 1.1% of all deaths in 1998 to 1.9% in 2007, the frequency of ending a patient’s life without an explicit request fell from 3.2% to 1.8%. In Oregon, where the Death with Dignity Act has been in effect for 13 years, the annual number of physician-assisted deaths has yet to reach 100 per year, and the annual total in Washington is even lower.
The Canadian panel therefore concluded that there is strong evidence to rebut one of the greatest fears that opponents of voluntary euthanasia or physician-assisted dying often voice – that it is the first step down a slippery slope towards more widespread medical killing. The panel also found inadequate several other objections to legalization, and recommended that the law in Canada be changed to permit both physician-assisted suicide and voluntary euthanasia.