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View Poll Results: Do you believe you have the right to choose to die?
Yes 9 81.82%
No 2 18.18%
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Old 12th Jun 2006, 21:01   #1
kaninaki
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Default Notes on euthanasia ethics

This is basically in response to some points Rick brought up in the Animal Rights thread.

Two interesting points:
  1. That by supporting abortion and euthanasia one supports the idea that the value of human life is not absolute, and
  2. That Nazi ethics are similar to this ethical stance.
I spent some time trying to build up some background knowledge. Beware - this is Internet scholarship. Still, hopefully these notes may prompt some discussion, or not.

I don't have a response just yet. Need to process these notes, first.

Anyway - some notes.

Notes on euthanasia ethics



(Some of the issues raised here are relevant to the abortion argument?)



Nazi euthanasia

Basis: Three possible foundations. 1. Eugenics, 2. Pragmatic – solve problems of asylums, insufficient number of physicians, and 3. From Hitler’s “Mein Kampf”, that 'the right to live' should only be for the strong, esp. with war effort – a need for strongest.

Execution: Systematic elimination of 'unworthy life'

Reference: http://www.ethicsandmedicine.com/18/1/18-1-vermaat.htm Euthanasia in the Third Reich: Lessons for Today?
J A Emerson Vermaat



Singer’s euthanasia

Basis: Utilitarian. The maximization of good consequences for the majority of a population. E.g. Mill’s utilitarianism is “hedonistic” because it seeks to increase happiness. Singer’s utilitarianism is “preference utilitarianism” because it “defines the good to be maximized as the fulfilment of persons' preferences”

Execution: Voluntary. People exercise their choice.
Clarification after reading John's post below. I think this needs to be edited to Voluntary/Involuntary. Singer does not define babies, for example, as persons and hence (see definition below) are not "self-conscious, rational being" with rights that should be protected. Abortion law already provides for this - Singer is extending this to newborn babies. So euthanasia in the case of newborns, would be INVOLUNTARY. I guess?

Definitions: “VOLUNTARY euthanasia is understood to be active euthanasia following the consent of the person killed. A PERSON is a self-conscious, rational agent.” From: http://www.mnstate.edu/gracyk/course...Euthanasia.htm

References: Utilitarianism, Wikipedia http://en.wikipedia.org/wiki/Utilitarian



Dutch euthanasia

(Legal in The Netherlands)



Basis: Right-to-die

Execution: Voluntary, but reports that some citizens are euthanized involuntarily. E.g. disabled infants, terminally ill children and mental patients.



Some problems:
  • ‘Slippery slope’ – that begins slowly, that euthanasia exercised only in most extreme cases, but gradually becomes more and more acceptable and euthanasia is practiced more freely.
  • Culture of death – that doctors are more inclined to accept death as a possible outcome/treatment. E.g. Consider the case of Dr. Henk Prins, who killed--with her parents' consent--a three-day old girl with spina bifida and an open wound at the base of her spine. Dr. Prins never made any attempt to treat the wound, according to Wesley J. Smith, author of the book "Culture of Death." The treatment was death. http://opinionjournal.com/editorial/...ml?id=95000390
  • Difference between ‘letting die’ and ‘allowing to die’
  • Cost of healthcare for the elderly may lead to easy choice of euthanasia – Dutch example of elderly scared to go to hospital and holding Do Not Euthanize cards in their wallets to inform doctors. (Reference - http://opinionjournal.com/editorial/...ml?id=95000390)
  • Hippocratic Oath? It is clear about euthanasia, but equally clear about abortion. Yet, abortions happen more and more regularly and so most doctors no longer feel bound by that part of the oath. Same could happen with euthanasia - only needs a shift in attitude of doctors, as in case with Nazi and Dutch physicians.
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Last edited by kaninaki; 13th Jun 2006 at 12:42.
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Old 13th Jun 2006, 8:22   #2
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Default Re: Notes on euthanasia ethics

Quote:
Originally Posted by kaninaki
Same could happen with euthanasia - only needs a shift in attitude of doctors, as in case with Nazi and Dutch physicians.[/LIST]
I don't mean to compare Nazi and Dutch doctors. First of all, according to the article on the Opinion Journal, Dutch doctors never performed euthanasia during WWII. And attitudes towards euthanasia today come from a very different perspective - see "basis" in notes. The similarity is 'shift in attitude' that needs to occur in doctors. Once the mental shift happens, i.e., that euthanasia is a possible choice/treatment then euthanasia becomes an practical option.

For me, the main difference between Nazi euthanasia and Singer's euthanasia, to get back to Rick, is that the first is a product of a fascist government, executed during a time of war (or in preparation for war), and executed systematically. Singer's euthanasia ethics is based on a person's choice.

Of course, once the legislation is in place, things can get very blurry and I guess that's why old people in The Netherlands are scared. Singer's answer to that is that we must create the best possibly laws to protect us. But the elderly don't hold much power. In The Netherlands, a request for euthanasia must be "voluntary, persistent and well-considered." Requests go through a committee made up of a lawyer, doctor, ethicist/philosopher, before they are acted upon.

The biggest problem I see is with children and elderly, who are not often in positions to make decisions of their own.

Still thinking....
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Old 13th Jun 2006, 9:02   #3
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Default Re: Notes on euthanasia ethics

To legally allow euthanasia, I think, alters the whole culture's attitude to living and dying. You cannot go back to an unaltered perception of the sanctity of life after that, and I believe this would alter the baseline of thinking.
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Old 13th Jun 2006, 9:47   #4
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Default Re: Notes on euthanasia ethics

I can envisage a situation where I would want euthanasia to be available to me. I think most people can. And to put it in the medical canon, and making it an alternative "treatment" would, I think, render it a bit dangerous. But less dangerous, in my opinion, than many other factors in our society. I feel a person has a right to end their life. But I think ONLY the victim should have the choice. The last hard area is severely handicapped babies. I don't know what I feel about that. Many such people turn out to have satisfactory lives.
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Old 13th Jun 2006, 11:25   #5
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Default Re: Notes on euthanasia ethics

Well, Mr Potts and I have just redrafted our wills to include a living will in an effort to prevent our being kept alive by artificial means should we arrive at a point where there is little or no quality of life and no chance of recovery. Largely influenced by the fact that Mr Potts' mother died eventually of an Altzheimers-related illness but not before she spent over twenty years in an appalling state, much of it vegetative. Rather than put an end to her suffering, the doctors would only agree, in the end and after a bitter fight, to withdrawing all medication. This meant several months of frequent and increasingly violent epileptic fits and infection after infection, until at last, after two interminable weeks of gasping and fighting for every breath, she eventually died of pneumonia.
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Old 13th Jun 2006, 11:48   #6
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Default Re: Notes on euthanasia ethics

I think I am slightly confused. What I understand euthanasia to mean is not allowing people to choose when they themselves die, but killing incurably sick people for reasons of mercy. Most people can choose when they themselves die at any time: it's called suicide. Of course there are well known cases of people with motor neurone disease or the like, where they cannot kill themselves because they can't physically carry out the act. Then we're into the realms of what I would term assisted suicide, which has been much in the news recently.

Would I be right in thinking that, so far as concerns allowing people to choose when they themselves die, there is no controversy over the matter? That everyone believes this should be permitted? Of course the problems arise when people are in a persistent vegetative state, or unable to speak or express themselves (Edward St Aubyn's novel Mother's Milk is moving on this subject), but want to die or not be kept artificially alive. This leads to living wills, such as those Honey and Mr Potts have made. I've done a couple for clients, and although they currently have no legal effect, they can be influential, and it's likely that changes will come in to make them legally enforceable before long.

So my understanding of euthanasia is always third-person. Certainly my understanding of Singer's position - or the controversial element of it - is that it's to do with among other things the right (as he would have it) of parents to kill their child, including after birth, if it would make them happier not to continue to support it. The utility of what two people (the parents) want must, in Singer's philosophy, outweigh the utility of what one person (the child) wants.

Rick had suggested earlier that support for abortion and euthanasia might be inconsistent with belief in the absolute sanctity of life. It might well be. But was there anything inherently worthwhile, redeemable, valuable or sacred in the life of, say, Frederick West, who so far as we know spent his life inflicting misery, torture and death on people? How could his life have been sacred or worth preserving? If one such person existed then there can be no absolute sanctity of life. But I don't believe this leads to a slippery slope whereby disabled or 'undesirable' people are deemed 'life that is unworthy of life' - the measure is not what you are, but what you do.

In relation to abortion my view is that a foetus, while it cannot live independently of its mother, is not an individual life. This equates with the limited timescales for permitted abortion in the UK (up to 20, or 24, weeks?), on the basis that after these the foetus could in theory survive outside the mother albeit with a good deal of medical assistance.
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Old 13th Jun 2006, 12:05   #7
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Default Re: Notes on euthanasia ethics

This 'sanctity of life' above all is, for me, the sticking point. It's one of those principles that is far too dogmatic. As in my mother-in-law's case the 'sanctity of life' stance meant sustained cruelty. I'd be far happier with 'sanctity of compassion' as a governing principle.
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Old 13th Jun 2006, 12:18   #8
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Default Re: Notes on euthanasia ethics

Quote:
Originally Posted by John Self
Would I be right in thinking that, so far as concerns allowing people to choose when they themselves die, there is no controversy over the matter? That everyone believes this should be permitted? Of course the problems arise when people are in a persistent vegetative state, or unable to speak or express themselves ...
I would think there *is* controversy over the matter - I don't agree with it and neither do the folk at the House of Lords who rejected the Assisted Dying bill recently. That point (rather than the idea of 'euthanasing' someone else, not at their own request) was the point I was answering (albeit breifly).

Quote:
Originally Posted by John Self
But was there anything inherently worthwhile, redeemable, valuable or sacred in the life of, say, Frederick West, who so far as we know spent his life inflicting misery, torture and death on people? How could his life have been sacred or worth preserving? If one such person existed then there can be no absolute sanctity of life. But I don't believe this leads to a slippery slope whereby disabled or 'undesirable' people are deemed 'life that is unworthy of life' - the measure is not what you are, but what you do.
That is the slippery slope, in my opinion. We are what we are, not what we do - otherwise many people could be written off as being of little use to society, not contributing in any way another set of people judge to be useful. At what point can another human state 'this life is not worth it'? And the cut-off point of 'not worth redeeming' cannot be set - humanity cannot set its own standard of worthiness. None of us come up to the bar on that one. This ties in very well with some of the points in Lilith (who begs to die at one point in the story). Another question levelled in philosophy/theology circles is "Was Hitler beyond redemption?" and indeed the same question arises in the arguments for and against the death penalty.
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Old 13th Jun 2006, 12:24   #9
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Default Re: Notes on euthanasia ethics

Here are some definitions

Euthanasia Definitions

Euthanasia: the intentional killing by act or omission of a dependent human being for his or her alleged benefit. (The key word here is "intentional". If death is not intended, it is not an act of euthanasia)

Voluntary euthanasia: When the person who is killed has requested to be killed.

Non-voluntary: When the person who is killed made no request and gave no consent.

Involuntary euthanasia: When the person who is killed made an expressed wish to the contrary.

Assisted suicide: Someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. When it is a doctor who helps another person to kill themselves it is called "physician assisted suicide."

Euthanasia By Action: Intentionally causing a person's death by performing an action such as by giving a lethal injection.

Euthanasia By Omission: Intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water.

What Euthanasia is NOT: There is no euthanasia unless the death is intentionally caused by what was done or not done. Thus, some medical actions that are often labeled "passive euthanasia" are no form of euthanasia, since the intention to take life is lacking. These acts include not commencing treatment that would not provide a benefit to the patient, withdrawing treatment that has been shown to be ineffective, too burdensome or is unwanted, and the giving of high doses of pain-killers that may endanger life, when they have been shown to be necessary. All those are part of good medical practice, endorsed by law, when they are properly carried out.

Reference: http://www.euthanasia.com/definitions.html
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Old 13th Jun 2006, 12:36   #10
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Default Re: Notes on euthanasia ethics

Quote:
Originally Posted by Colyngbourne
To legally allow euthanasia, I think, alters the whole culture's attitude to living and dying. You cannot go back to an unaltered perception of the sanctity of life after that, and I believe this would alter the baseline of thinking.
Yes, absolutely. The closest thing we can compare it to (maybe) is abortion and medical/genetic testing of foetus early on in pregnancy to check for deformities, etc. Some/many parents chose to abort such foetuses. Singer actually uses this argument in support of his theory of killing defective newborns because they are not yet 'persons' with rights that need to be protected.

From that Guardian article that John linked us to in the Animal Rights thread:

For Singer, society is already practising a form of selective infanticide by promoting pre-natal screenings. The primary aim of amniocentesis is to detect abnormal foetuses, those with Down's Syndrome, and kill them. Few are morally outraged.

"There is a mistaken view that I think disabled people should be killed rather than I think their parents should have been given the choice. Maybe if their parents had the choice they would not be here. But they could also be standing outside pre-natal testing centres saying the same thing. Ninety per cent of women over 35 have pre-natal testing, and of those who are told their foetuses have Down's Syndrome or spina bifida, 95 per cent will terminate the pregnancy. There is a widely shared view that it's better not to have a child with those conditions," he says.
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