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Ethics and Brain Death
Published in David Lamb, Death, Brain Death and Ethics, 2020
The possibility of prolonged attempts at resuscitation raises the question of death with dignity. Must the patient be subjected to a hopeless and futile regime of intravenous alimentation or nasogastric tubes, dialysis, repeated sternal thumping, or electric shock to the chest, in order to survive for another day or week? Are a few statutory hours on the ventilator to become the last rite of modern medicine? Giving up when the prognosis is hopeless cannot be interpreted as a form of passive euthanasia. It cannot be a case of just ‘allowing to die’ since, if all treatment is ‘hopeless’, the physician is not in a position to allow the patient to die. All he can do is cease to apply a useless treatment. In such cases the choice facing the doctor is not whether to allow the patient to die, but how the patient shall die: either over a prolonged period in institutional isolation wired up to a mass of electronic gadgetry, or in relative dignity, possibly within a few hours or a day or two earlier. To discontinue treatment in hopeless cases is not ‘letting die’ but letting die in a more acceptable manner. The statement ‘I let him die’ only has. meaning if it was ever possible at some stage to specify alternatives for maintaining life.
The Principle of Avoiding Killing
Published in Robert M. Veatch, Laura K. Guidry-Grimes, The Basics of Bioethics, 2019
Robert M. Veatch, Laura K. Guidry-Grimes
Second, it is sometimes argued that active killing is illegal in almost all jurisdictions while letting die is legal everywhere, at least under some conditions. It is true that active killing, even on the request of the patient, is illegal in almost all jurisdictions of the world. In the Netherlands, for many years an informal arrangement existed between the prosecutors and the medical profession so that if physicians follow agreed-upon rules they would not be prosecuted even though active killing remained illegal. In 2001 the Dutch Parliament passed a bill that still makes active mercy killing by physicians illegal, but physicians now will be exempt from prosecution if they follow certain requirements. The Northern Territory of Australia in 1995 was the first jurisdiction in the world to legalize active killing for mercy, but that action was overturned by the national legislature. Since then active killing for mercy has become legal in Belgium, Luxembourg, and Colombia. In 2016, the Canadian legislature legalized what it called medical assistance in dying for certain competent adult Canadian residents who request a physician to administer a lethal medication or to assist them in committing suicide. In addition, by 2019, physician assistance in suicide (aiding someone in killing themselves) had been legalized in Switzerland and Germany as well as in ten jurisdictions of the U.S. (California, Colorado, District of Columbia, Hawaii, Maine, Montana, New Jersey, Oregon, Vermont, and Washington).
Treatment at the end of life
Published in Marc Stauch, Kay Wheat, Text, Cases and Materials on Medical Law and Ethics, 2018
We shall return to the question of whether the law in respect of end-of-life treatment rests on tenable foundations in section 12.5, when we address arguments and initiatives in favour of law reform. First, though, we shall consider the law as it currently stands. We begin in section 12.2 by further examining the prohibition on doctors (and others) on being actively involved in ending life, including how far it is always adhered to in practice. We then go on to consider the law’s approach to cases of ‘letting die’ by withholding life-sustaining treatment – first, in section 12.3, in respect of capable patients; and then, in section 12.4, in respect of the incapable: in what circumstances are doctors permitted to take such a course?
Bioethics is Philosophy
Published in The American Journal of Bioethics, 2022
Rosamond Rhodes, Gary Ostertag
Consider the “naturalistic fallacy,” first described by G. E. Moore in his landmark Principia Ethica (1903). The fallacy arises in the attempt to analyze the goodness of an action reductively, in terms of natural (specifically, non-moral) properties. This fallacious thinking is displayed in numerous bioethics arguments. We can identify it, for example, in discussions of the ethics of abortion and the ethics of physician aid in dying. It arises in abortion arguments that turn on whether the moral status of the fetus should be assessed in terms of biological or psychological features. It figures in physician-assisted suicide arguments that make an ethical distinction between hastening death involving bodily movement (i.e., killing) and hastening death without such movement (i.e., letting die). The moral equivalence argument put forward by James Rachels (1975), and recently resuscitated by Lars Øystein Ursin (2019) and Dominic Wilkinson, Butcherine, and Savulescu (2019), has been largely ignored in mainstream bioethics, and the relevance of the naturalistic fallacy per se (there or elsewhere) remains unnoted. Moreover, once the fallacy is exposed, we are led to the conclusion that issues like the ethical acceptability of abortion or physician-assisted suicide are ineliminably moral.
Withholding and Withdrawing Life-Sustaining Treatment: Ethically Equivalent?
Published in The American Journal of Bioethics, 2019
An intuitive answer to the drowning case is that there is a moral difference, even if the outcome is the same and even if the bystander could have prevented the drowning. What is the perceived moral difference between acting and omitting to act in this case? At least four differences seem to be morally relevant in the illustrative case of drowning: First, killing involves active agency, while letting die does not. Second, killing implies that the agent causes the death of the victim, while letting die does not. Third, killing involves intending the outcome, while letting die does not. Fourth, killing involves making sure that the victim dies, while letting die does not. In sum, there seems to be all the difference in the world between actively planning and conducting a murder, and suddenly witnessing a person in trouble and passively but intensely hoping that the person will somehow survive.
Withholding and Withdrawing Life-Sustaining Treatment and the Relevance of the Killing Versus Letting Die Distinction
Published in The American Journal of Bioethics, 2019
We conclude that we need not regard withdrawal of LST as killing,4 and that the debate about whether withholding and withdrawing LST are morally equivalent is not the same debate as that about whether killing and letting die are morally equivalent. This helps Wilkinson and colleagues’ (2019; Wilkinson and Savulescu 2014) case. They need not be seen to be defending the controversial claim that there is no morally relevant distinction between killing and letting die, nor need they defend a position on that issue in order to defend their equivalence claim in respect of withholding and withdrawing LST. We can still ask: Are different forms of letting die morally equivalent? However, it is beyond the scope of this commentary to enter into that issue.5 ▪