Lecture 7 Notes Feb 25 PDF

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Download Lecture 7 Notes Feb 25 PDF

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Writing Titles: Puns are hilarious, make it snappy Quotations: make sure your quotes make sense, when in doubt paraphrase to demonstrate understanding of the material Depth: go all in on one idea, stick to the main line WHO definition of health: lack of this unachievable status doesn’t equal unhealthy

Medical Assistance in Dying Definitions Physician assisted death: catch all term, not specific Active/Passive distinction: physician directly causes the death v.s. allows the death Voluntary/Involuntary distinction: with consent v.s. without consent or lacking capacity Euthanasia: usually means ‘active’ euthanasia, ‘good death’, term is often avoided due to polarizing views Assisted suicide: patient self-administers medicine to cause death, brings about their demise themselves, ‘suicide’ as a term has stigma associated with it

Arguments for Euthanasia Suffering: obligation to relieve suffering, suffering is intrinsically bad Autonomy: can’t override autonomy w/o a good reason, adults can make their own decisions, don’t have a good enough reason to ban someone from making a choice about their own death Dignity: people have right to dignity, preventing MAiD prevents a dignified death James Rachels’s Argument ● Argument from consistency ● Demand that the reader accepts another viewpoint, so accept this additional thing ● Withholding treatment that results in a hastening death is legally and ethically permissible ● No ethical/legal

Smith & Jones example - drown cousin to get inheritance money, active drowning v.s. passively allowing them to drown, intention matters to people ● Ethical difference b/w doing and allowing something (important to deontologists but not consequentialists) ● Many people think they are equally bad, therefore euthanasia is justified b/c doing and allowing death are seen similarly ● Intention justifies the permissibility, not the doing and allowing distinction ● Not only is MAiD permitted, but it may be preferable in certain situations Down Syndrome example - assess the best interests of the baby, poorly aged part of the article

Arguments against Euthanasia Innocent Killing: always wrong to kill an innocent person Killing v.s. Letting Die: killing is never permissible but letting someone die can be, active euthanasia is wrong but removing treatment isn’t necessarily Intending v.s Foreseeing: bad outcome isn’t permissible if the intention is a bad outcome but a foreseen bad outcome could be permissible Playing God: actions we shouldn’t perform because we can’t predict their effects Right to Life: inalienable, violated if we are killed Callahan’s Argument Self-determination = autonomy Doctors need ‘independent moral grounds to kill’ Killing involves ‘treating the patient’s values’ Doctor would have to share those values to be responsible Unfair to doctors to assess people’s values Inappropriate to burden doctors with these decisions Lots of cases where doctors are treating values so the logic doesn’t always follow Doctors don’t need to have moral grounds for every situation They do lots of things they may not personally agree with Act v.s omission - doing v.s. allowing Causality v.s. Culpability - blame is involved in culpability, involves knowledge of what they’re doing ● Omission death = disease, Act death = physician ● ● ● ● ● ● ● ● ● ● ●

● Usually euthanasia favour is based on self-determination and s uffering, combo to make it permissible Why must the competent person be suffering? ● Just tired of life? ● Are the incompetent less deserving of relief from suffering? Goals of medicine: Should doctors be making these judgements about the kinds of lives worth living? ● Not up to the physician since the patient is competent and can make their decision ● Similar things happen with treatment

Oregon Model ● ● ● ● ● ● ●

Terminally ill (within 6 months) Be an adult Self-administer Assisted suicide rather than physician assisted State resident Given to about 1500 from 1998-2018 Solid record keeping

End of Life Concerns (in order of weight): loss of autonomy, loss of ability to engage in activities that are enjoyable, loss of dignity, becoming a burden, loss of bodily functions, inadequate pain control, financial concerns ● Some are concerned it will replace palliative care due to concern about pain control ● Now implemented in more US states Concerns about Vulnerable Populations ● ● ● ● ●

Equal gender distribution Higher educated and SES Not institutionalized Not affecting the poor as much as originally thought Predominantly Caucasian

Carter v. Canada Background: 1993 case of Rodriguez v. BC, was justification for MAiD in liberty and suffering, but insufficient evidence to implement it and protect vulnerable people Gloria Taylor & Lee Carter (mother was sick): ALS & spinal disease, both progressive, Carter went to other countries to seek assistance in dying, BCCLU file on behalf of Taylor to end her life before she became paralyzed ● ● ● ●

Ban on assistance in dying is struck down Previous concern about protecting vulnerable people Evidence showed legislation could exist to allow both MAiD and protect people Law can infringe on rights only if there’s a ‘pressing and substantial object and the means chosen are proportional to that object’

Charter of Rights and Freedoms: Section 7 (right to life and liberty) & Section 15 (anti discrimination) The Very Clever Argument: Previous law violated Right to Life because it forced people to die earlier than they otherwise had to (eg. Carter had to travel while still healthy enough rather than dying later in her own country) *various quotes in the article* ● Right to Life can be waived, otherwise it would become a ‘Duty to Live’ which is onerous, withdrawing life support would be illegal ● Previous law did achieve protection but was overboard C-14 ● Either the physician or patient can administer (almost no one has chosen the latter) ● Allow physician option because it violates Section 15, people with mobility restrictions wouldn’t be able to do it Conditions: be an adult, no ‘suicide tourism’, have to be legal resident, capacity to make decisions, griveous and irremediable medical condition, make voluntary request, give informed consent after being informed about palliative care and other options Death has to be ‘reasonably foreseeable’ - Supreme Court got rid of specific timeline for death

● What does foreseeable mean? Like a year? A month? (Now getting changed in the legislature) ‘Grievous and irremediable’ ● Serious or incurable illness, disease or disability ● In advanced state of irreversible decline ● Enduring physical or psychological suffering that is intolerable to them and can’t be relieved under conditions that they consider acceptable ● Suffering and pain is subjective, difficult for physicians to decide that, everything is up to the patient ● Distinguish b/w mental and other physical illness Other points: ● 10 day waiting period (which can be waived due to immediate loss of capacity or severe pain which would be unjust to extend) ● 2 separate independent doctors ● About 13,000 since legalization ● Most people have cancer who request it

C-7 10 day waiting period is gone if death is reasonably foreseeable If it’s not foreseeable, you can qualify but with a 90 day waiting period Advance consent is allowed if the person is at risk of losing capacity later on “If the person doesn’t demonstrate by words, sounds, or gestures, refusal to have the substance administered or resistance to its administration” ● Explicitly rules out mental illness as sole diagnosis (discrimination??) ● ● ● ●...