Euthanasia

Basic issues
Video- active euthanasia
  http://www.youtube.com/watch?v=Rk3ri1ADIsI
 Euthanasia and the adult
 Definition: killing of someone for the sake of
mercy to relive great suffering
 Illegal in every state except Oregon,
Washington
 Open and practiced in Netherlands for 20+
years
 Doctors must be convinced the request is
voluntary, well considered and the patient has
unremitting pain
 5000 cases a year internationally
Reasons for request
  For those sound of mind: loss of autonomy,
  decreasing ability to participate in enjoyable
activates,
  and loss of dignity were cited by 76-96% of
patients
Some schools of thought
 1. active and passive euthanasia are
not morally significant
 2. active is wrong, passive OK
 3. both active and passive euthanasia
are different than the cessation of
extraordinary means of treatment to
prolong life
 4. doctors cannot be an agent of harm
 5. some people have a duty to die
Some definitions
  Passive euthanasia is simply allowing the person to
die, either by withholding treatment or by
discontinuing such treatment, once begun.
  Active euthanasia, on the other hand, is taking
some positive step to terminate life, such as the
administration of a toxic substance or the injection
of an air bubble into the blood stream.
  Euthanasia may also be classified as either
voluntary, where the subject himself expresses his
desire for his life to end,
  or involuntary, in cases where he has not indicated
such a choice.
Philosophical issues
  The AMA [American Medical Association] says
euthanasia is contrary to medical professional
standards
  Legalization would cause loss of hope, fear of
medical institutions, and involuntary
euthanasia
  Women will request it more [female ethics]
 Other considerations
  Intentions and euthanasia - as long as the intended
act is good [relieving pain], any unforeseeable bad
act is negated [death from overdose] – “the double
effect”
  Parent/ child care vs. partners: there is a different
relationship between each
  Subjective quality of life: an NBA star might have a
different standard than an academic
Two situations
  There are at least two situations where
cessation is not the same as passive
euthanasia :
  the right to refuse treatment
  and when continued treatment brings more
discomfort and has little chance of survival
Patient’s right
  In general, a competent adult has the right
to refuse treatment, even when the
treatment is necessary to prolong life
  It may be overridden [if you have a
dependent child]
  No one can make you undergo treatment
which you have not consented to [or is
justified by necessity created by the
circumstances of the moment]
Continued treatment and pain
  When continued treatment has little chance of
improving the patients condition, and brings
greater comfort than relief termination of
treatment does not “bring about the death of a
patient”
  To continue would be “extraordinary”
  The term means different things in different
situation
Children, minors and euthanasia
Advocacy for legitimating physician-assisted
suicide and euthanasia in the US has largely
ignored children and adolescents.
Support for assisted suicide and euthanasia thus
rests on the assertion of competent patients’
rights and physicians’ duties of beneficence.
 Reasons
 Relegating pediatric assisted suicide and
euthanasia to the margins is reassuring. The
intentional killing of children and adolescents,
or assistance in their suicides, is surely more
disquieting than the same practices among
competent adult patients.
Two situations where it might be
moral
  A child is suffering terribly from incurable
cancer, and both he and his parents request a
lethal injection of drugs to put an end to his
pain.
  A newborn with defects that cause severe,
chronic pain is asked to be given an overdose
of pain medication.
The Law
  As of 2002 euthanasia for children aged 12 to 16 is
legal in the Netherlands when the child's parents agree
to his or her request.
  Minors aged 16 or 17 can legally request and receive
euthanasia based on their decision alone, although the
child's parents must be informed of that decision.
  Euthanasia and doctor-assisted suicide for children
under 12 remains illegal in the Netherlands.
  Euthanasia or physician-assisted suicide of all minors
is illegal throughout the United States.
Update on Netherlands
  As of 2004 Dutch authorities drew up
protocols to allow doctors to euthanasia
children under 12.
  This extends options to even younger
children, including newborns, if they have an
incurable illness or unbearable suffering.
 Doctors
 All are are
the patients given these
suffering senarios:
from painful,
terminal cancers.
 1. both the patient -- aged 15 or under – and
parents, agreed that lethal drugs were
required to help end life and suffering.
 2. parents disagreed with their child's wish for
euthanasia or assisted suicide.
  3. parents made the request for lethal drugs
on behalf of an unconscious child unable to
make the decision for themselves.
What the doctors would
permit:
  When pediatricians in the Netherlands were
surveyed 48 -60 % in #1, said yes with
acceptance rising along with the age of the
patient, the researchers report.
  13-28% said yes, based on the patient's age
in #2
  37- 42 % agreed in #3
Some ethical concerns
  end-of-life decisions made by children may be
too easily colored by the concerns of those
around them.
  Hypothetical situations do not determine real-
life actions
  Neurological or psychological issues mean
children cannot be expected to make these
decisions for themselves
 Denying euthanasia for
minors..
  ignores reported cases of pediatric euthanasia in
the US.
  ignores the Dutch pediatric and medical
associations who advocate pediatric euthanasia
and assisted suicide, and courts that are
excusing it.
  ignores the difficulty of confining any right to
these practices to adults, as rights to termination
of life-sustaining treatment and abortion - the
roots, many argue, of rights to assisted suicide
and euthanasia - have already been extended
to minors
 Yet is should be remembered
that:
 minors may be more vulnerable to euthanasia
and more apt to request assisted suicide
because of inferior pain relief,
 the large numbers who are poor,
  the substantial number who are uninsured,
 the complex dynamics of parental decision
making for ill or disabled minors,
 and psychological differences between adults
and those who are younger.
Video- hospice

 http://www.youtube.com/watch?
v=vHBni1BUJz0
Other last resort options
  Pain and symptom management
  Right to forgo lifesaving treatment
  Voluntarily stopping eating and drinking
[VSED]
  Sedation to unconsciousness
Pain and symptom management

  Pain medicine is increased so the person

sleeps a lot and eats little
  Informed consent is involved
  Death may be hastened this way
  But the obligation to relieve pain must be met
too
Right to forgo lifesaving treatment

  Includes ventilators, intubation, ANH, advanced

chemo, etc.
  May change mind after these have been started
  Must be in stable state of mind of have Advance
directive
  Can also be sedated, if removal of ventilator is
required
Voluntarily stopping eating and drinking [VSED]

  Some controversy
  Different than natural disinterest in food/drink at end
of life
  Involves considerable resolve
  Must be physician supported
  Sometimes eating/ drinking difficult anyway
  Will be put on hospice care
Sedation to unconsciousness

  Not proportionate to relief of suffering

  Intention to escape pain and end life by
simultaneously ending other treatments
  Most acceptable when death is inevitable
  Death comes quick w/o food and water
Question
  Howwould you respond if your best friend
was in a terminal coma and you have to
make an end-of-life decision for her?
Euthanasia
Judaism
Presuppositions
  The doctrine of life's essential holiness
means that we must stand in reverence
before the very fact of life, the gift of God
that renders us human.
  This reverence does not diminish as
human strength declines, for the dying
person still possesses life, a life stamped
indelibly with the image of God until the
moment of death.
Against Active
  In the past Reform rabbis have directed attention
to euthanasia as a pressing moral issue.
  In a seminal report of the Responsa Committee of
the Central Conference of American rabbis held
in 1948, this issue was discussed in detail.
  In the Committee's report, which was passed by
the majority of the Conference, it was argued that
it is contrary to the spirit of Judaism to allow
voluntary active euthanasia
  or involuntary active euthanasia
Against involuntary
  In subsequent responsa a similar view was
expressed, though it was noted that
traditional Judaism does allow patients to die
if they are being kept alive by artificial means
(such as a life support system).
  In making these judgments, Reform rabbis
have appealed to the halakhic tradition as a
basis for their recommendations despite the
recognition, as expounded by the 1948
Committee's report, that liberal rabbis
Rational
  The Bible states that a person must
accept his lot; therefore he should not
tamper with life.
  In the rabbinic period, this same attitude
prevailed, as is illustrated by Hananiah
ben Teradion who in his martyrdom
proclaimed: 'it I best that He who hath
given the Soul should also take it away; let
no man hasten his own death.'
Rational
  Thelaw is based on the conviction that life is
a sacred gift from God. Created in God's
image, man is 'endowed with unique and
hidden worth and must be treated with
reverence.’
  Such a position is codified in the legal system.
Thus in the case of one who is dying, the law
prohibits anyone from employing any positive
and direct means to hasten his own death, no
matter what protracted an ailment he may
suffer (Yoreh De'ah 339).
In sum…
  The Jewish ideal of the sanctity of human
life and the supreme value of the
individual soul would suffer incalculable
harm if, contrary to the moral law, men
were at liberty to determine the
conditions under which they might put an
end to their own lives and the lives of
other men
  i.e. any active euthanasia is wrong, but
passive can be accepted
Doctor’s responsibility
  There is no duty incumbent upon the
physician to force a terminal patient to
live a little longer,' he wrote. But he may
do nothing positive to hasten death
  if the patient is a hopelessly dying patient,
the physician has no duty to keep him
alive a little longer. He is entitled to die. If
the physician attempts actively to hasten
the death, that is against the ethics of
Jewish law
Pain killers
  We have every right to administer
treatment to relieve pain.
  We may recommend pain-killing drugs
which would ease the remaining days of
a patient's life.
  We are under no obligation to take every
conceivable measure to prolong a life a
suffering.
  it remains a fact, however, that pain and
suffering are part and parcel of the
human condition.
Life and death
  The choice we face when we are ill is
essentially the same choice we confront
at every other moment of our lives:
  These include determining, as human
beings in covenant with God, what to do
with the time and the strength available
to us on this earth..
  Judaism bids us to respond to the
challenges of life by choosing life, to
praise God whether that life brings us joy
or sorrow.
Slippery slope
  Thereis a concern that euthanasia will
lead to value judgments about other’s lives
  This could end in “mercy killings” or such
events such as the Holocaust.
  Once we have adopted the 'quality of life' as
our standard, we have no principled reason
to oppose the suicide of any person.
  If we permit the talking of human life by a
patient's consent, this will be the thin edge of
the wedge leading to euthanasia without
consent, infanticide, etc.
  it could be abused by doctors, members of
the family and other interested parties who
might put pressure on the patient to terminate
his life
Other objections
  doctors occasionally misjudge illness.
  It could happen that a diagnosis is
wrong, or a new treatment might be on
the way for a particular disease
  active euthanasia interferes with God's
sovereignty over human life, yet a similar
objection could be made to any medical
remedy which prolongs human life.
Alternate view
  However, some say our concern is more
with people than with the legal system.
  Traditional law should be abandoned if it
is not in accord with our sense of humane
concern.
  in a discussion of the criteria for a modern
halakhah the central role is humanitarian
concern
  the virtues of humane concern,
compassion and loving kindness are
overriding features.
  Given such an emphasis on human
For active
  Unlike involuntary euthanasia where the
patient has no role in the decision made
concerning his life, voluntary euthanasia
only concerns cases where a request is
made by the person who wishes to die.
  In this light it seems callous not to allow a
person to elect his or her own death.
  It is arguable that since the sufferer's
choice to bring on death does not harm
others, it is a permissible exercise of
individual liberty and ought not to be a
subject to the compulsion of law.
rational
  some kinds of suffering are so intense and
so prolonged as to be unendurable for
both patients and families.
  Sometimes those who are dying see
themselves gradually stripped of their
former character and of the activities
they once enjoyed.
  Such individuals are not only subjected to
intense pain; they are also aware of their
own deterioration and the fact that they
have become a burden to others.
Moving forward
  Reform responsa, following the halakhic
tradition, allows for passive euthanasia.
  On humanitarian grounds there are
compelling reasons for Reform Judaism to
widen its approach by allowing active
voluntary euthanasia as well.
  Though voluntary active euthanasia has
so far been rejected by Reform Judaism,
there are important reasons to go beyond
the halakhic tradition in advocating its
legalization on the grounds of humane
concern and compassion.
Question
 Beyond a theological perspective,
is there any benefit to suffering?
Video-Death without god
  http://www.youtube.com/watch?
v=dTuhSdvlX-A
Euthanasia
Christian
Methodology
  Christians must carefully, prayerfully, and
thoroughly think through their position on
this matter.
  There is always a danger that the Church
will formulate rather early a stance on an
ethical issue and then allow that stance
to become an unexamined tradition.
Agreement
  A large number of Christians have no
ethical objections to passive euthanasia,
at least in principle.
  Likewise, involuntary active euthanasia is
usually condemned on the basic premise
that a person's life is his most intimate
possession.
Middle issue
  Active,voluntary euthanasia is then a
point of disagreement
Against
  #1 It is a violation of the Sixth Commandment:
"Thou shalt not kill [murder].”
  Such consent does not relieve the killer of
guilt for the sin of murder.
  #2 it is suicide.
  If suicide were in all circumstances morally
wrong, then in no circumstances would
voluntary euthanasia be morally permissible
#1 The Bible and “murder”
  The law distinguished among several
different varieties of homicide.
  Willful and especially premeditated killing
or murder was always subject to capital
punishment (Lev. 24:17; Num. 35:16-21).
  Contrasted with this were cases of
accidental manslaughter, in which the
manslayer was clearly immune from the
punishment imposed for willful killing.
#1 Elements in the Biblical
concept of murder
  It is intentional.
  It is premeditated.
  It is malicious.
  It is contrary to the desire or intention of
the victim.
  It is against someone who has done
nothing deserving of capital punishment.
#1 Killing and scripture
  Killing
in capital punishment was obviously
not regarded as wrong when due care
had been exercised to ascertain the guilt
of the murderer.
  While the taking of life per se was bad (cf.
Gen. 9:6), there was condemnable killing
(murder), excusable killing, and even
mandatory killing.
#1 Check?
  Voluntary active euthanasia seems to fulfill
criteria 1, 2, and 5.
  It certainly does not involve 4, and
presumably would not be characterized
by 3 either.
#2 suicide and euthanasia
  To establish the wrongness of voluntary
active euthanasia would require two
steps:
  (1) to prove that such euthanasia is
actually an instance of suicide;
  (2) to demonstrate the wrongness of
suicide.
#2 suicide and the Bible
  1. Abimelech asked his armor-bearer to kill him
with his sword so that no one could say, "A woman
killed him.,, This the armor-bearer did (Jg. 9:50-57).
  2. Saul asked his armor-bearer to "thrust him
through." When the latter refused to do so, Saul
took his own sword and fell on it, and the armor-
bearer did likewise (1 Sam. 31)
  3. Samson, at the end of his life, pulled a building
down on himself (Jg. 16:28-31).
  4. Judas Iscariot, following his betrayal of Jesus,
committed suicide (Matt. 27:5; cf. Acts 1:18).
#2 distinguishing voluntary
death
  Where there is a reasonable expectation of
continued life, and because of some personal
distress the life is terminated, significantly
altering the time when death occurs =suicide.
  Where imminent death is certain and there is
great suffering = euthanasia.
  Where death could be avoided but is chosen
for the sake of another. This, if out of loyalty to
God =martyrdom; if it is for the sake of
another being = self-sacrifice.
Suicide and theology
  sanctity of life, which affirms that life is an
inherent and absolute good. It is therefore
never to be taken.
  the principle of the sovereignty of God.
This reminds us that God is the Creator, the
giver of life, and deduces that only he has
a right to bring life to an end.
Salvation and euthanasia
  The Christian who is still able to engage in
prayer, or to be an encouragement or
example to others even if he cannot
involve himself in more active service, can
still be very useful in ways not ordinarily
recognized by secular or humanist
thinkers.
  Euthanasia also cuts short the opportunity
for a non-Christian to accept the Lord's
offer of salvation
Theodicy and death
  The Bible identifies suffering as an evil, but not
an unqualified evil.
  At times it seems to have a purifying or
strengthening effect, i.e. Job, as well as of
Paul (cf. 2 Cor. 4:17; 12:10).
  Peter's reference to the outcome of suffering
trials (1 Pet. 1:6-9) and James' statement
about the product of the testing of faith may
include allusions to physical suffering.
Questions
  Isit ever right, and therefore permissible,
to terminate the life of a person for whom
there is no reasonable hope of recovery,
who is undergoing severe pain, and who
has requested that action be taken to
hasten his death?
 Video- against active euthanasia
  http://www.youtube.com/watch?
v=5Qr9_hzVfYI&feature=related
Euthanasia Bibliography

   General
  Adapted from “Contemporary Approaches to Bioethics”,
EXP 0027. Taught at Tufts University, Spring 2012.
  Millard J. Erickson and Ines E. Bowers, “EuthanASIA AND
CHRISTIAN ETHICS” JOURNAL OF THE EVANGELICAL
THEOLOGICAL SOCIETY 15-24: 15
  Christian Euthanasia
  Millard J. Erickson and Ines E. Bowers, “EuthanASIA AND
CHRISTIAN ETHICS” JOURNAL OF THE EVANGELICAL
THEOLOGICAL SOCIETY 15-24: 15-19, 22.
  Jewish Euthanasia
  Dan Cohn-Sherbok, “Judaism and Euthanasia” Judaism
and Euthanasia 27- 33: 27-32.