Download Oregon`s “Death with Dignity” Act

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Euthanasia
III
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Some Background:
Oregon’s “Death with Dignity” Act
• It is possible in Oregon for a terminally-ill patient to get a
prescription to kill him or herself (beginning 1997).
• Patient must be:
- 18 years of age or older;
- a resident of Oregon;
- capable of making and communicating health care
decisions for him/herself; and
- diagnosed with a terminal illness that will lead to death
within six (6) months.
• (Note: Oregon law doesn’t require that the patient be suffering).
• As of 2006, 292 total deaths have resulted from this act
(including 3 between 18 and 34). Many more recipients of the
medication to end lives than recipients who took the
medication.
www.oregon.gov/DHS/ph/pas/
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Some Background:
Oregon’s “Death with Dignity” Act (cont’d)
• Most prominent reasons patients cited for wanting to end
their lives include:
- Loss of autonomy (87%)
- Loss of ability to engage in enjoyable activities (87%)
- Loss of dignity (80%)
- Loss of control of bodily functions (57%)
- Burden on family/friends/caregivers (38%)
- Inadequate pain control or concern about it (26%)
- Financial implications of treatment (2%)
• The average time between digestion of life-ending
medication and unconsciousness was 5 minutes.
• The average time between digestion of life-ending
medication and death was 25 minutes.
www.oregon.gov/DHS/ph/pas/
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Some Background:
The Hemlock Society
• Founded in 1980, making it the oldest organization of its kind
in North America.
• 45,000 members.
• Advocates legal change and distributes how to die
information.
• Publishes “how-to” suicide guides, including founder Derek
Humphry’s best-seller Final Exit, with sales exceeding
1,000,000 copies.
www.compassionandchoices.org/hemlock/
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Richard Doerflinger: “Assisted Suicide: ProChoice or Anti-Life?”
Doerflinger’s Project
• Doerflinger objects to the permissibility of assisted suicide
(including active euthanasia) on two bases:
1) The standard pro-choice appeal to autonomy is at odds
with itself.
2) Pro-choice advocates fail to appreciate the risks of a
slippery slope towards allowing wrongful practices of
killing.
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Assisted Suicide vs. Respect for Life
Claim from assisted-suicide advocates:
• A life of suffering “racked with pain” is “not the kind of life we
cherish.” (256)
• Doerflinger notes (and such advocates would agree) that this
proposal is incompatible with the conviction that human life is
of intrinsic worth.
Problem: “If society is to help terminally ill patients to commit
suicide because it agrees that death is objectively preferable to a
life of hardship, it will be difficult to draw the line at the seriously ill
or even at circumstances where the victim requests death.” (256-7)
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Assisted Suicide vs. Respect for Life (cont’d)
Autonomy Argument
Some assisted-suicide advocates claim that we should respect the
wishes of such patients because humanity or personhood has a
dignity that demands respect for individual freedom.
• They claim that suicide is the “ultimate” exercise of selfdetermination, and thus deserves not only respect, but the
assistance of others.
• On this principle, the Hemlock Society and others advocate a
constitutional “right to die.”
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Life vs. Freedom
The autonomy-based approach departs from American traditions
on liberty in one fundamental respect:
• The inalienable human rights described in the Declaration of
Independence are: “life, liberty, and the pursuit of happiness.”
• These seem to be in order of priority:
- Liberty allows for the pursuit of happiness.
- Life allows for liberty.
• “Safeguards against the deliberate destruction of life are thus
seen as necessary to protect freedom and all other rights.” (257)
• On this view, suicide is not the ultimate exercise of freedom, but
its self-contradiction.
- By destroying life, one destroys all future freedoms.
- “If life is more basic than freedom, society best serves
freedom by discouraging rather than assisting selfdestruction.” (257)
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Life vs. Freedom (cont’d)
Objection #1: The person who ends his life has not truly suffered
loss of freedom. Unlike a slave, he doesn’t have to live with his
loss of freedom.
• To say that a slave is worse off than a corpse is to say limited
freedom is worse than no freedom, which seems inconsistent
with the “pro-choice” position.
Objection #2: Assisted suicide is only being offered to those who
can no longer meaningfully exercise other freedoms.
• Even the painfully bedridden have some freedom.
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Life vs. Freedom (cont’d)
Advocates of assisted suicide tend to prioritize the avoidance of
suffering over and above freedom.
• Freedom (and life itself) is viewed as instrumental to the value
of happiness (the avoidance of suffering).
• On this system, someone who is suffering and yet chooses to
live will be seen as irrational.
Under the Oregon Act, one can be given a lethal prescription if
they have only six months to live, but not if they have seven
months to live.
• If suffering avoidance is our primary interest, wouldn’t it be
better to allow this practice earlier rather than later?
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Slippery Slopes, Loose Cannons
“Contingent factors in the contemporary situation may make it
virtually inevitable in practice […] that removal of the taboo against
assisted suicide will lead to the destructive expansions of the right
to kill the innocent.” (258)
• Elderly and disabled patients are often invited to see
themselves as useless burdens on younger generations.
• Society seems to say, ‘You can continue to live if you want, but
the rest of us have no real interest in your survival.’
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Slippery Slopes, Loose Cannons (cont’d)
Health Care Crisis
• With assisted suicide seen as a viable option for those requiring
expensive health care, health care providers will have an
incentive to make this option more attractive.
- Life-extending care of the terminally-ill will be increasingly
seen as elective, and society may become less willing to
provide funds for such care.
- Pressure to accept death will grow accordingly.
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Slippery Slopes, Loose Cannons (cont’d)
Legal Doctrines
• Where courts have recognized a right to refuse treatment, they
have concluded it is unjust to deny this right to the mentally
incompetent.
- In such cases, such a right may be exercised by a legal
guardian.
- Once assisted suicide is established as a right, courts will
almost certainly pass the right to the guardians of the
mentally incompetent.
- This would almost certainly lead to legalized cases of
nonvoluntary (if not involuntary), active euthanasia.
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Slippery Slopes, Loose Cannons (cont’d)
Definitions of “Terminal Illness”
• The Hemlock Society wishes to offer assisted suicide only to
those suffering from terminal illness.
• But what qualifies as a “terminal illness”?
- Derek Humphry says “two and a half million people alone
are dying of Alzheimer’s disease.”
- Dutch courts found the paralysis of a quadriplegic woman
qualified as a terminal illness as paralyzed patients “have
difficulty swallowing and could die from aspirating their
food at any time.”
- Diabetics risk death without the life-preserving treatment
of insulin.
- Some courts already see comatose and vegetative states
as terminal because patients in such states cannot feed
themselves.
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Slippery Slopes, Loose Cannons (cont’d)
Disabilities
• Definitions of terminal illness could foreseeably come to
encompass severe physical or mental disabilities.
• While we don’t want to say people with such disabilities have
“lives not worth living,” our prejudices against people with such
disabilities may lead such people to believe their lives are
meaningless.
Character of the Medical Profession
• Physicians resist giving lethal injections because of legal and
societal sanctions.
• “To allow killing by physicians in certain circumstances may
create a new lobby of physicians in favor of expanding medical
killing.” (260)
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Slippery Slopes, Loose Cannons (cont’d)
Human Will to Power
• Human beings are tempted to enjoy exercising power over
others.
- Ending another person’s life is the ultimate exercise of
that power.
- Once the taboo against killing is lifted, it becomes
progressively easier to channel one’s aggressive instincts
into the destruction of life in other contexts.
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Discussion
 At the end of the article, Doerflinger notes his “loose
cannon” arguments are not conclusive. How convincing
are they? Is the burden of proof on him or on his
opponents?
 How should we define “terminal illness”? Does it have
something to do with our old issue of “extraordinary
means”?