[6.3.5.5.] Assisted Suicide: A Conceptual Slippery Slope.

 

Doerflinger uses the following conceptual slippery slope argument[1]: a law that allows doctors to help a patient to die if he has been diagnosed as having only six months to live, but which holds the same action to be homicide if the patient has eight months to live (for example), is completely arbitrary.

 

Expressed more formally, the argument is something like this:

 

1.      If we permit PAS for six-month patients, there will be no good reason not to permit PAS for eight-month patients.

2.      We should not permit PAS for eight-month patients.

3.      Therefore, we should not permit PAS for six-month patients.

 

 

[6.3.5.6.] Assisted Suicide: Several Practical Slippery Slopes.

 

Doerflinger also considers seven different practical slippery slope arguments (he calls them loose cannon arguments) against PAS (RTD 315-19). He says that there are seven factors already existing in society which, if combined with legalized PAS, would have bad consequences:

 

1.      “The psychological vulnerability of elderly and dying patients.” Such patients will feel a burden of proof regarding the continuation of their own lives, i.e., they will feel like the choice not to request PAS is something that they will have to justify. The choice to stay alive will begin to look “eccentric or even selfish.”

 

2.      “The crisis in health care costs.” Once PAS becomes an acceptable option, society will become less willing to help pay for life-sustaining treatments that cost more than PAS.

 

3.      “Legal doctrines on ‘substituted judgment.’” The right to refuse life-sustaining treatment has already been extended by the courts to incompetent patients (e.g., people in permanent comas or persistent vegetative states), and other, competent parties have been allowed to exercise that right on such patients’ behalf; that is, they have been allowed to substitute their own judgment for that of the incompetent patient. [This is what happened in the case of Terri Schiavo, who was taken off of life-support and allowed to die in 2005.] Similarly, legalized PAS will result in the legal right to active euthanasia being extended to such patients. So competent third parties will have the ability to choose active euthanasia for the incompetent patient.

 

4.      “Expanded definitions of terminal illness.” Doerflinger cites a definition of terminal illness suggested in the 1980s according to which a terminal illness is “one that would cause the patient’s death in a relatively short time if life-preserving treatment is not provided.” (RTD 317) Taken literally, this definition implies that people who cannot breathe on their own, and even people with diabetes, are terminally ill. Such definitions will result in an improper expansion of the group of patients who are eligible for PAS such that people with diabetes (for example) become eligible, even when PAS is legally restricted to the “terminally ill.”

 

5.      “Prejudice against citizens with disabilities.” If the definition of terminal illness is broadened, then more and more people who are not in danger of imminent death (e.g., the disabled) will be considered terminally ill. The existing prejudice against the disabled will exert pressure on disabled people to choose PAS.

 

6.      “Character of the medical profession.” “Once physicians abandon the traditional medical self-image, which rejects direct killing of patients in all circumstances, their new substitute self-image may require ever more aggressive efforts to make this killing more widely practiced and favorably received.” (RTD 318-19)

 

7.      “The human will to power.” “Once the taboo against killing has been set aside, it becomes progressively easier to channel one’s aggressive instincts into the destruction of life in other contexts. … the skill and the instinct to kill are more easily turned to other lethal tasks once they have an opportunity to exercise themselves.” (RTD 319)

 

 

When Doerflinger wrote this article (1989), assisted suicide (physician-assisted dying and physician-assisted suicide in the strict sense) was legal nowhere in the United States.

 

Physician-assisted dying went into practice in Oregon in 1998, and then in Washington in 2009 (it is also legal in Montana, but no cases of PAD have actually occurred there yet).

 

In September 2007, a study in the Journal of Medical Ethics reported that predictions of legalized PAD and AE (in Oregon and the Netherlands) would lead to vulnerable people being pressured into using them had not come to pass.[2] The study found:

·         the average age of patients choosing PAD or AE is 70, and most are suffering from cancer;

·         in Oregon, patients without health insurance, who are more likely to be a financial burden on their families, are no more likely to request PAD than are those with health insurance;

·         there is no evidence of people with mental illness or other chronic, non-fatal diseases being pressured to use either method.

It concluded: “Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations.”

 

 

[6.4.] Classical Utilitarianism.

 

Utilitarianism was given its classical statement in the 19^th century by two English philosophers:

·         Jeremy Bentham (1748-1832)

·         John Stuart Mill (1806-1873), the author of Utilitarianism

The lives of both are discussed by Rachels in his introduction to RTD ch.3 (pp.29-30).

 

Every form of utilitarianism must identify something that has intrinsic value—

 

·         intrinsic value (df.): something has intrinsic value when it is valuable for its own sake rather than because it can help you attain something else of value. The opposite is extrinsic value...

·         extrinsic value (df.):  something has extrinsic value when it is valuable as a means to an end, rather than as an end in itself.

 

So, in other words, every form of utilitarianism must identify something worth having for its own sake, something that is intrinsically good.

 

Utilitarians use the word “utility” to refer to whatever it is that is worth having for its own sake.

 

They will then explain what a morally right action is by saying that it is an action that increases the overall amount of utility. According to utilitarianism, the moral status of an action will depend upon whether it increases the amount of that intrinsically valuable thing.

 

For Mill’s version of utilitarianism, that something is happiness.

 

But Mill has a relatively complicated understanding of what happiness is... (to be continued).

 

 

Stopping point for Friday October 9. For next time finish reading EMP ch.8 (pp.111-116) and study today’s notes (as always, a pop quiz on either is possible).