Euthanasia and Assisted Suicide
Good Care, Painful Choices, Richard Devine
Health Care Ethics: A Theological Analysis, Benedict Ashley & Kevin O’Rourke
Health Care Ethics: Theological Foundations, Contemporary Issues, Controversial Cases, Michael Panicola (et. al.)
Euthanasia
1. “Good death” … “happy death” … “mercy killing”
2. Performing with full knowledge & full consent (intent) an act that
will directly end own/another’s life
3. Occurs through commission or omission (Terry Schaivo)
4. Categories …
• Voluntary euthanasia => Person gives free and informed consent
• Nonvoluntary euthanasia => Person not capable of giving free and
informed consent (disabled infants in Netherlands)
• Involuntary euthanasia => Person refuses to give free and informed
consent (execution)
Assisted Suicide
1. “The act of making the means of suicide available to a patient …
who subsequently acts on his or her own.”
2. Differentiate Assisted Suicide from Euthanasia …
• Euthanasia


Doctor/HCP provides means of death
Doctor/HCP is principle cause of patient’s death
• Assisted Suicide

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Doctor/HCP provides means of death (instrumental cause)
Patient is principle cause of death
Arguments in Favor of Euthanasia & Assisted Suicide
Brittney Maynard video
Arguments in Favor of Euthanasia & Assisted Suicide
(including some Christian ethicists)
1. Rights … right to die in the manner of own choosing (Self-determination)
2. Autonomy … others must respect my free and rational decisions
3. Dignity … die in a dignified manner & avoid living in non-dignified way
4. Mercy … means to end pain and suffering
5. Quality of Life … “not worth living”
6. Burden … avoid becoming imposition on loved ones & society
7. Resources … prevent “wasting” scarce & expensive resources on terminally ill
8. HCPs must promote best interests of dying patients
- If cannot relieve suffering, duty to actively assist death
9. Euthanasia/Assisted Suicide is moral equivalent of “letting die”
10. [Suicide does not necessarily mean eternal damnation]
Oregon “Death With Dignity” Act (1998)
Assisted Suicide Criteria
• 18+ years old
• Possess decision-making capacity/exercise reason
• Diagnosed with terminal illness, less than 6 months
Oregon “Death With Dignity” Act (1998)
Process
1. Two oral requests to attending physician, separated by 15 days
2. Written request to attending physician, signed in presence of two
witnesses, at least one not related
3. Attending and consulting physician must confirm patient's
diagnosis & prognosis
4. Attending & consulting physician must determine if patient is
capable of making/communicating health care decisions (selfdetermination)
5. If either physician believes patient impaired (i.e., depression) =>
psychological evaluation
Oregon “Death With Dignity” Act (1998)
6. Attending physician must inform patient of feasible alternatives,
including comfort/hospice care and pain control
7. Attending physician must request, but not require, patient to
notify next-of-kin of prescription request …
• Patient can rescind a request at any time, in any manner
• Attending physician will offer patient opportunity to rescind request
at end of the 15-day waiting period following the initial request
(Source: http://egov.oregon.gov/DHS/ph/pas/faqs.shtml#whocan)
Oregon “Death With Dignity” Act (1998)
Physicians/HCPs and Pharmacists
1. Prescribing physician must inform patients of alternative options:
comfort/hospice care, and pain control
2. Prescribing physicians must request, but cannot require, that the
dying notify next-of-kin of request for PAS.
3. Prescribing physicians must report all prescriptions for lethal
medications to the Oregon Department of Human Services.
4. Pharmacists must be informed of the prescription’s intended use.
5. Physicians and pharmacists are under no obligation to participate
in a person’s request for lethal medication (conscience protection)
Arguments Against Euthanasia & Assisted Suicide
Video: “Ending Life” from 60 Minutes
Arguments Against … Theological
1. Rejects God’s gift of life
2. Undermines dignity/sanctity/infinite value of human life (phil & theo)
3. Humans determine when they die, not God
4. Abandon hope in God (no “good” from suffering) … life is “useless”
5. Violates 5th Commandment
Arguments Against … Philosophical
1. Effect on family & friends (response to rights & autonomy arguments)
• Euthanasia & AS affects more than me - spouse, children, extended
family (etc.) must live with my decision
• Abandonment of responsibilities to others & society
2. Fear “unbearable pain” – can be controlled (mercy & quality of life arguments)
• Many change mind when informed of palliative care
3. Depression
• Not in position to make life-death decision
• With treatment, many choose life
• Is assisted suicide truly voluntary?
Arguments Against … Philosophical
4. “Slippery slope”
• Why limit to only terminal patients?
• Results in …
a) Involuntary euthanasia (Groningen Protocol - Netherlands)
b) Killing of “undesirables”
c) Assisted deaths of those not terminal
Arguments Against … Philosophical
5. Contrary to principle of self-preservation
• General moral duty to preserve life
• Euthanasia /AS violates principle of self-preservation =>
contrary to human nature
6. Irrational?
• Humans  moral agents  rational & free decisions
• Euthanasia/AS valid use of reason & freedom when used to
destroy self?
Arguments Against … Philosophical
7. Euthanasia/Assisted Suicide and the HCP
• Violates Hippocratic Oath – “Do no harm”
• Introduces “new” & conflicting goal of medicine …
a) Saving & prolonging life
b) Comforting dying
c) Ending patients’ lives (new)
• Undermines HCP’s commitment to provide best EOL care =>
Lesser quality of (palliative) care for terminal patients (Oregon)
• Pressures vulnerable to end life prematurely, even non-terminal
(Kevorkian)
• Undermines trust between patient and HCP
• Government-forced HCP assistance in patients’ deaths, even
when contrary to conscience
Catholic Teaching on Euthanasia and Assisted Suicide
“Euthanasia is a grave violation of the law of God, since it is the
deliberate and morally unacceptable killing of a human person …
Euthanasia must be called a false mercy [because] true compassion
leads to sharing another's pain; it does not kill the person whose
suffering we cannot bear … [response to “mercy killing” argument]
Suicide (and assisted suicide) involves [a] the rejection of love of self
and [b] the renunciation of the obligation of justice and charity towards
one's neighbor, towards the communities to which one belongs, and
towards society as a whole [philosophical]. In its deepest reality, suicide
(& assisted suicide) represents [c] a rejection of God's absolute
sovereignty over life and death.” [theological]
John Paul II, Evangelium Vitae - “The Gospel of Life,” #65-66
Catholic Teaching on Euthanasia and Assisted Suicide
“Euthanasia is an action or omission that of itself or by intention
causes death in order to alleviate suffering. Catholic health care
institutions may never condone or participate in euthanasia or
assisted suicide in any way. Dying patients who request euthanasia
should receive (1) loving care, (2) psychological and spiritual
support, and (3) appropriate remedies for pain and other symptoms
so that they can live with dignity until the time of natural death.”
Ethical and Religious Directives, #60
“Whatever its motives and means, direct euthanasia consists [of]
putting an end to the lives of handicapped, sick, or dying persons. It
is morally unacceptable.”
Catechism of the Catholic Church, #2277
American Medical Association Code of Ethics
E-2.211 Physician-Assisted Suicide
“It is understandable, though tragic, that some patients in extreme
duress - such as those suffering from a terminal, painful,
debilitating illness - may come to decide that death is preferable to
life. However, allowing physicians to participate in assisted suicide
would cause more harm than good. Physician-assisted suicide is
fundamentally incompatible with the physician's role as healer,
would be difficult or impossible to control, and would pose serious
societal risks.”