Voluntarily Assisted Suicide
and Euthanasia
Soazig Le Bihan - University of
Montana
1
Introduction
Why should we care?
Our death
Aging Society
Discussion
When to stop?
Definitions
Doctors
Decisions
What this class is about
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Outline
Introduction
Important Distinctions
The argument from autonomy and its critics
The utilitarian argument and its refinement
A controversial distinction: Active vs. Passive Euthanasia
Slippery Slopes and the Pandora Box: Fears vs. Reality
Conclusion
3
Outline
Introduction
Important Distinctions
The argument from autonomy and its critics
The utilitarian argument and its refinement
A controversial distinction: Active vs. Passive Euthanasia
Slippery Slopes and the Pandora Box: Fears vs. Reality
Conclusion
4
Important Distinctions
Assisted Suicide /Euthanasia
Assisted Suicide: the person kills herself with a medication
prescribed by a doctor
Euthanasia: the doctor administrates herself the medication
Voluntary / Non-voluntary / Involuntary
Involuntary: against the patient’s will – nobody defends it!
Non-voluntary: the current desire of the patient is unknown
because she is physically or mentally unable to
express it
Voluntary: in agreement with the patient’s will
 We will focus on the morality of Voluntary Assisted
Suicide (VAS) and Voluntary Euthanasia.
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Outline
Introduction
Important Distinctions
The argument from autonomy and its critics
The utilitarian argument and its refinement
A controversial distinction: Active vs. Passive Euthanasia
Slippery Slopes and the Pandora Box: Fears vs. Reality
Conclusion
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The argument from autonomy
The argument from autonomy:
P1: Each individual’s autonomy ought to be respected
P2: Denying someone the right to assisted suicide amounts to
disrespect her autonomy
CC: Nobody should be denied the right to assisted suicide
 Is this a tenable argument?
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The argument from autonomy
Problems
Doerflinger:
The argument is self-contradictory because life is a necessary
condition for the exercise of one’s autonomy.
“Suicide is not the ultimate exercise of freedom but its
ultimate self-contradiction”
Voluntary vs Non Voluntary
The argument from autonomy only works for voluntary
assisted suicide and euthanasia
 The argument from autonomy is not the best
argument!
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The Argument from Autonomy
Conclusion
1. The argument from autonomy
2. Problems:
(a) Suicide in the name of autonomy is self-contradictory
(b) Could only work for voluntary cases
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Outline
Introduction
Important Distinctions
The argument from autonomy and its critics
The utilitarian argument and its refinement
A controversial distinction: Active vs. Passive Euthanasia
Slippery Slopes and the Pandora Box: Fears vs. Reality
Conclusion
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The Utilitarian Argument
The utilitarian argument:
P1: A given action is right if and only if it serves to increase
the amount of happiness/ decrease the amount of misery
P2: Euthanasia for suffering patients with terminal illnesses
decreases the amount of misery
CC: Euthanasia for suffering patients with terminal illnesses
is right
Advantage: the argument applies to Voluntary assisted
suicide, voluntary and non-voluntary euthanasia.
 Is this a tenable argument?
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The Utilitarian Argument
Problems
General Problem for Utilitarianism:
Utility vs. Rights
The Problem applied to Euthanasia:
It seems that the utilitarian argument could be used to
justify involuntary euthanasia – against the will
Which is of course unacceptable !
 The Utilitarian Argument is not acceptable as it is.
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The Utilitarian Argument
Refined by Rachels
The utilitarian argument: Refine
P1: A given action is right if andd:only if it serves to increase
the amount of happiness/ decrease the amount of misery
and violates no one’s
rights patients with terminal illnesses
P2: Euthanasia for suffering
decreases the amount of misery
and in many cases violates no one’s
rightsfor suffering patients with terminal illnesses
CC: Euthanasia
is right
 The utilitarian argument as refined by Rachels is
tenable!
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The Utilitarian Argument
Conclusion
1. The argument from mercy: applies to VAS and
euthanasia
2. Problem: Conflict with Rights
3. Solution: Refined argument from mercy
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Outline
Introduction
Important Distinctions
The argument from autonomy and its critics
The utilitarian argument and its refinement
A controversial distinction: Active vs. Passive Euthanasia
Slippery Slopes and the Pandora Box: Fears vs. Reality
Conclusion
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Active vs. Passive Euthanasia
The distinction: Killing vs. Letting die
Accepted in the US: AMA 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.”
 Does this make moral sense?
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Active vs. Passive Euthanasia
Pb 1: Is the distinction morally relevant?
Moral Responsibility: Is “passive” euthanasia really passive?
- Rachels’ example: Jones and Smith and their cousin in the
bathtub – Is Jones’ any less responsible than Smith is of
his cousin’s death?
- Withhold food and fluids? grand ma, infant
- Withhold medication? diabetic
 The Distinction is not morally relevant: passive and
active euthanasia involve the same moral
responsibility
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Active vs. Passive Euthanasia
Pb 2: Which is morally preferable?
Example from Rachels: infants with Down Syndrome
“I can understand why some people are opposed to all
euthanasia and insist that such infants must be allowed
to live. I think I can also understand why other people
favor destroying these babies quickly and painlessly.
But why should anyone favor letting “dehydration and
infection wither a tiny being over hours and days”? The
doctrine that says that a baby may be allowed to
dehydrate and wither, but may not be given lethal
injection that would end his life without suffering, seems
so patently cruel as to require no further refutation.”
(Rachels)
 In some cases, active euthanasia seems morally
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preferable
Active vs. Passive Euthanasia
Pb 3: Arbitrariness
The problem: passive euthanasia:
(a) One agrees that it would be better that the unnecessary
suffering ends
(b) But one waits until a separate health problem “allows” for
a quicker death – a chancy event
Rachels’ argument:
- Either (a) is true, and then our moral action should not
depend on irrelevant circumstances
- Or (a) is false, and then, not to treat the patient in (b) is
wrong
 Passive Euthanasia makes our action depend on
arbitrary factors
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Active vs. Passive Euthanasia
Conclusion
1. A distinction generally accepted by physicians
2. Problems:
(a) The distinction is not morally relevant – no less
responsible in the case of passive euthanasia
(b) Active euthanasia seems morally preferable in some
cases
(c) Passive euthanasia makes our action depend on
arbitrary factors
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Outline
Introduction
Important Distinctions
A controversial distinction: Active vs. Passive Euthanasia
The argument from autonomy and its critics
The utilitarian argument and its refinement
Slippery Slopes and the Pandora Box
Conclusion
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Slippery Slopes
Fears and Reality
Slippery Slopes: Beware!
Doerflinger’s slippery slopes:
Subtle coercion, economic incentives, substituted judgment,
prejudice against people with disabilities etc.
The Facts: Oregon’s Death with Dignity Act
Conditions to be eligible
Conditions to receive the prescription
Results?
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Number of qualifying people: ~ 80,000!
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Outline
Introduction
Important Distinctions
A controversial distinction: Active vs. Passive Euthanasia
The argument from autonomy and its critics
The utilitarian argument and its refinement
Slippery Slopes and the Pandora Box: Fears vs. Reality
Conclusion
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Conclusion
Argument from autonomy: limited and arguably selfcontradictory
Utilitarian Argument: refinement protecting rights
Passive vs Active Euthanasia: distinction not morally
acceptable
Slippery Slopes: not supported by available evidence
 Fundamental divide: absolute rules vs about serving
everyone’s best interest
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