The topic of death and dying, in the bioethics context, is massive and fascinating. There are many subtopics that we could take weeks exploring. However, since we have only a couple of classes to cover the whole topic, I have had to pick and choose.
In wrapping up our discussion of the physician-patient encounter, we will continue with the theme of a physician paternalistic concern vs. patient autonomy. And in this context, what is at stake is not living a good life, by either the physician’s or patient’s lights, but rather having a good death. For a nice introduction to our topic, watch Dr. Maggie Little’s brief discussion below.
On the first day, we will discuss some of the famous cases that have paved the way for our current understanding of issues in death and dying, focusing on questions of when exactly a patient is dead, and what the physician’s role is in prolonging life in various, difficult cases. Although some of these issues are still hotly debated — such as what the correct view of death is — others have begun to enjoy some consensus, such as a patient’s right to refuse treatment. This first issue, however, then naturally leads to another, which is perhaps even more vexed — namely, the issue of whether a doctor can assist a patient in dying, or ‘euthanasia’.
This is a big day, so strap in to do some bioethics! First, Dr. Bob Veatch, one of the foremost experts on issues of death and dying, provides an overview of some of the issues here:
For a more philosophical look at the problem of defining death, read the Stanford Encyclopedia of Philosophy article by David Degrazia on the definition and standard of death. Hopefully that will help set the stage for Dr. Veatch’s brief look at definitions here.
Turning from the conceptual issue concerning when death occurs, we can start to ask about moral issues concerning what role physicians are allowed, or obligated, to take regarding patient’s death. The first of these questions concerns what physician’s are allowed or obligated to do in order to keep the patient alive. For a seminal case in determining a patient’s right to refuse treatment, read Dax’s Story.
Finally, then, check out one more short video by Dr. Veatch on the case of Karen Quinlan and the consensus concerning continuing treatment:
Although the issues addressed during the previous day are quite complicated enough, they only form half of the story concerning the physician’s interacting with a dying patient. Whereas the first question concerned what the physician is allowed or required to do in order to keep a patient alive, a perhaps even more difficult question is what the physician is allowed or required to do in order to help the patient die.
To help us get started, watch the brief introductory video below by Dr. John Keown, in which he lays out the conceptual landscape concerning physician-hastened death. This will help us to understand what it is that both Dr. Keown, and we, are interested in — the particular question of voluntary active euthanasia.
One of the first questions that we turn to in thinking about euthanasia is a question of the value of life. Discovering what kind of value one thinks that human life has often helps us to understand why she thinks as she does concerning euthanasia. Dr. Keown’s first video concerns this issue. In the next three, then, he lays out common arguments on both sides of the debate. Watch each of these videos.
In the final video, Dr. Keown discusses a difficult, and fascinating, philosophical distinction: that between intending, and merely foreseeing a person’s death. The principle that this distinction matters morally — and that it is intentional killing, and not merely foreseeing death that is morally prohibited — is the famous and slippery Doctrine of Double Effect (DDE). This principle can be formulated in a variety of ways, and is hotly contested. It is a pillar of Catholic ethics and just war theory, but many philosophers question if it is defensible to rest any moral weight on the distinction.
Given the principle’s importance, let’s linger a bit on the topic. Philosopher Warren Quinn provides a rather nuanced look at the defensibility in this paper. If pressed for time, focus more on his analysis of the principle and its problems than on Quinn’s particular, ‘Kantian’ solution.