Bioethics Luiss PPE Program Class 14 April 10 2015
Topics for today’s Class Suicide Assisted Suicide and Voluntary Euthanasia Active and Passive Euthansia Slippery Slope Argument
Suicide and the Classics Diogenes Laertius: “The sage leads himself rationally ( eulogos ) out of life, namely on behalf of fatherland or friends, also when he suffers from pain which is too fierce, mutilations or incurable diseases” Is there any significant moral difference between these two sets of voluntary deaths? We can easily recognize some voluntary deaths as morally excellent, because prudent and courageous, it is likely that in other cases morality counsels its own silence.
Hobbes on suicide There is no plausible secular argument to show that suicide is a subset of murder. There cannot be, since there is convincing argument to suggest that “self-murder” is an oxymoron: injustice to oneself is an incoherent idea, as Hobbes, who explained murder as a species of injustice, demonstrated: Whatever is done to man, conformable to his own Will signified to the doer, is no Injury to him. For if he that doeth it, hath not passed away his original right to do what he pleases, by some Antecedent Covenant, there is not breach of Covenant; and therefore no injury done him. (1845: 137)
Hume on Suicide That Suicide may often be consistent with interest and with our duty to ourselves , no one can question, who allows, that age, sickness, or misfortune may render life a burthen, and make it worse even than annihilation. If Suicide be supposed a crime, it is only cowardice can impel us to it. If it be no crime, both prudence and courage should engage us to rid ourselves at once of existence, when it becomes a burthen. It is the only way, that we can then be useful to society, by setting an example, which, if imitated, would preserve to every one his chance for happiness in life, and would effectually free him from all danger of misery.
Kant on Suicide To annihilate the subject of morality in one's person is to root out the existence of morality itself from the world as far as one can, even though morality is an end in itself. Consequently, disposing of oneself as a mere means to some discretionary end is debasing humanity in one's person… (Kant 423) For Kant, our rational wills are the source of our moral duty, and it is therefore a kind of practical contradiction to suppose that the same will can permissibly destroy the very body that carries out its volitions and choices. Given the distinctive worth of an autonomous rational will, suicide is an attack on the very source of moral authority. (Cholbi, Suicide, Stanford Encyclopedia)
Confusions and Prejudice about suicide Suicide is the key concept in any broadly philosophical discussion of voluntary death Suicide still carries a strongly negative subtext, and on the whole, we exhibit a greater willingness to categorize self-killings intended to avoid one's just deserts as suicides than self-killings intended to benefit others (Beauchamp & Childress 1983, 93–94). Conceptual confusion surrounding the morality of voluntary death, derived in the main from traditional religious attitudes, thwarts mature evaluation of suicide, assisted suicide, and euthanasia.
Causing one’s death Is causing oneself to die sufficient to say that a person is suicidal? Conversely, can a person can be suicidal when she only sets the circumstances that would lead to her death?
A definition of Suicide A person S 's behavior B is suicidal iff 1. S believed that B , or some causal consequence of B , would make her death at least highly likely, and 2. S intended to die by engaging in B . This account renders the notion of suicide as self-inflicted attempted death more precise, but it is not unproblematic.
Is Suicide a form of Self-murder? Pro Argument: Suicide needs special justification simply because it is a form of killing, all killing being wrong. Contra Argument: Suicide is not among the cases of killings that count as murders and are wrong. Suicide lacks the essential element which allows us to include it among the subset of killings that are wrong.
Two cases Eluana Englaro and Terry Schiavo
Eluana Englaro Eluana Englaro (25 November 1970 – 9 February 2009): entered a persistent vegetative state on 18 January 1992, following a car accident. Shortly after her accident, medical staff began feeding Englaro with a feeding tube, but her father "fought to have her feeding tube removed, saying it would be a dignified end to his daughter's life. He said that before the crash his daughter visited a friend who was in a coma and told him she didn't want the same thing to happen to her if she were ever in the same state." The authorities refused his request, but the decision was finally reversed in 2009, after she had spent seventeen years in the coma.
Therri Schiavo Terri Schiavo collapsed in her St. Petersburg, Florida, home in full cardiac arrest on February 25, 1990. She suffered massive brain damage due tolack of oxygen and, after two and a half months in a coma, her diagnosis was changed to vegetative state. For the next two years doctors attempted speech and physical therapy and other experimental therapy, hoping to return her to a state of awareness. In 1998 Schiavo's husband, Michael, petitioned the Sixth Circuit Court of Florida (Pinellas County), to remove her feeding tube pursuant to Florida Statutes Section 765.401(3). [3] He was opposed by Terri's parents, Robert and Mary Schindler, who argued that she was conscious. The court determined that she would not wish to continue life-prolonging measures, [4] and on April 24, 2001, her feeding tube was removed for the first time, only to be reinserted several days later. On February 25, 2005, a Pinellas County judge ordered the removal of Terri Schiavo's feeding tube. Several appeals and federal government intervention followed, which included U.S. President George W. Bush returning to Washington D.C. to sign legislation designed to keep her alive. After all attempts at appeals through the federal court system upheld the original decision to remove the feeding tube, staff at the Pinellas Park hospice facility where Terri was being cared for disconnected the feeding tube on March 18, 2005. Terri died on March 31, 2005.
Assisted Suicide and Euthanasia Both these modes of voluntary death are morally derivative from suicide, because if there is compelling reason to provide aid in dying, either indirectly or directly, it stems from the sovereign role of the dying patient in determining that their life project is to be completed. The strength of the person’s reasons for terminating life through suicide provides whatever reasons there are for helping. Respect for the patient’s authentic desires and compassion for their suffering provide the moral case for assisted suicide and euthanasia: they establish a claim – usually stated as a moral right – to aid-in-dying, and provide the basis for a charge that any legal structure which impedes access to aid is cruel because it perpetuates pointless unwanted suffering.
Argument from Equal Liberty If it is unjust to discriminate against those who are terminally ill but not machine-dependent, then it is equally unjust to discriminate against a subset of them, namely those who are disabled to a point where suicide is not a realizable option but who nonetheless strongly desire a swift death.
Two rulings On March 6, 1996, the Ninth Circuit Court of Appeals, sitting in San Francisco, found that liberty interests based on the 14th Amendment made American law forbidding physician-assisted suicide unconstitutional. Of the 11 judges, 8 concurred in the judgment that there is a constitutionally protected liberty in determining the time and manner of one’s death. On April 2, 1996, the Second Circuit Court of Appeals, sitting in New York, came to the same conclusion for slightly different reasons. Relying on the equal protection clause of the 14th Amendment, the court argued that there was no difference between withdrawal of life-support systems and the prescription of drugs to cause death.
Argument from Reasonableness The terminally ill who see suicide as a means of exercising sovereign control over the timing of their death may do so for different reasons. Access to those reasons could only come through a deeper knowledge of their life project and how it was conscientiously shaped. There is no guarantee that their aspirations are easily accessed by those who see them professionally, and it is not uncommon for members of the same family to be in dispute about choices near death.
Rachels on Active and Passive Euthanasia The distinction between active and passive euthanasia is thought to be crucial for medical ethics. The idea is that it is permissible, at least in some cases, to withhold treatment and allow a patient to die, but it is never permissible to take any direct action designed to kill the patient. American Medical Association 1973: “The intentional termination of the life of one human being by another -mercy killing - is contrary to that for which the medical profession stands and is contrary to the policy of the American Medical Association. The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family. The advice and judgment of the physician should be freely available to the patient and/or his immediate family.”
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