Euthanasia & Physician-Assisted Suicide (625-637)
*Active voluntary (illegal)= mercy killing; direct with consent
*Active nonvoluntary (illegal)= mercy killing; direct without consent
*Passive voluntary (legal)= withholding care with consent
*Passive nonvoluntary (legal)= withholding care without consent
*Physician-Assisted Suicide: prescribing lethal dose of medicine for patient to take himself; only legal in Oregon, Washington, Montana, Vermont, & California *Whole Brain View: determines brain death (Higher brain view might be more accurate scientifically)
*Difference between intending death and not intending but forseeing it (ex. high dose of morphine prescribed intended to stop pain but could possibly result in death)
*Nancy Cruzan Case: back & forth about feeding tube; eventually removed
Active & Passive Euthanasia by James Rachels (678-681)
*Morally: killing is not any worse than letting die
*Active euthanasia = Passive euthanasia (morally)
*Doctors should be concerned only for legal not for moral reasons
The Wrongfulness of Euthanasia by J. Gay-Williams (Blackboard) We also discuss several other topics like What is psychological reasoning?
*Killing: always deliberate and intentional
*Passive euthanasia: NOT actually euthanasia at all
*Human nature: will to survive
*Might incline people to give up too easily
*Slippery slope: voluntary >> deputizing a representative >> involuntary euthansia as social policy
*Suffering: natural part of life
Paternalism & Patient Autonomy (pg. 81-93) If you want to learn more check out What is social perception?
*Paternalism: overriding a person's actions or decision-making for his own good *Early medicine: strongly paternalistic
*Autonomy: person's rational capacity for self-governance or self-determination *Weak paternalism: over diminished capacity people only
*Strong paternalism: over autonomous people as well
*Patients have right to refuse treatment (does NOT apply to parents using religious refusal for minors)
*Futile treatment: physicians not obligated to comply with futile requests *Elizabeth Bouvia: quadriplegic/arthritis pain; hospital force-fed her when she refused to eat; ultimately won right to die voluntarily We also discuss several other topics like Differentiate evolution from ecology.
Vacco v. Quill (pg. 707-709)
*Supreme Court determines whether or not a New York state ban on assisted suicide is constitutional.
*SC decides that the ban does NOT violate constitution-- no constitutional right to physician's assistance in dying. Don't forget about the age old question of What is neoliberal institutionalism?
Don't forget about the age old question of What is qualitative data?
*However, SC will allow each state to establish its own rules about the issue.
Death and Dignity by Timothy Quill (pg. 642-645) Don't forget about the age old question of What is a pyramidal neuron?
*Dr. Quill explains why he personally made the choice to assist with his longtime patient Diane's suicide.
*He helped Diane die with dignity rather than being forced to be in pain and dependent on others for everything.
*He felt that he was doing the right thing morally even if the law did not agree.
Baby M by James Rachels (Blackboard)
*very dramatic, highly publicized surrogacy case
*Through an infertility clinic in New York, Mary Beth Whitehead (already a mother of 2) agreed to be a surrogate for the Sterns.
*Whitehead was artificially inseminated with Mr. Stern's sperm & was intended to gestate the baby and then give it to the sterns upon birth.
*When baby was born, Whitehead suddenly wanted to keep the baby. *Mr. Stern got a court order for temporary custody, but Whitehead ran off with the baby.
*Once she was tracked down, a huge court battle ensued.
*Ultimately, judge's ruling was a total victory for the Sterns. The child was officially now theirs, and Whitehead was stripped of all her parental rights.
Reproductive Technology (pg. 409-428)
*Infertility: inability to get pregnant after one year of unprotected sex *In vitro fertilization steps: ovarian stimulation; egg retrieval; insemination/fertilization; embryo culture; embryo transfer
*IVF risks for mother and child such as side effects of surgery, fertility drugs, higher risk of multiple pregnancies which raise risk of gestational diabetes, uterine rupture; for child, may be birth defects, low birth weight, possible link to cancer
*Surrogacy: a woman goes through the pregnancy and gestates that fetus for another woman or couple. Compensation sometimes allowed, and most contracts strip surrogate of future parental rights.
*Cloning: asexual production of a genetically identical entity from one already in existence (for reproductive cloning, a somatic cell's nucleus is inserted into an egg) *Many frozen embryos from IVF cycles currently exist with much indecisiveness about what to do with them (ex. destroy them or use them for research)
IVF: The Simply Case by Peter Singer (pg. 429-432)
*simple case: egg taken from woman and sperm taken from husband are merged into fertilized embryo outside body and then inserted into female for gestation *objections: unnatural, risky, expensive, not as good as adoption, overpopulation threat, negative impact on women as a gender
Stem Cells (pg. 552-560)
*embryonic stem cells: can deferentiate into any type of cell and can reproduce indefinitely and create a huge supply
*adult stem cells: can replace old cells and grow new bone, cartilage, etc. but are much less effective from embryonic stem cells
*stem cell research has faced major legal opposition
*embryos themselves are destroyed in process of obtaining the stem cells
Human Cloning and the Challenge of Regulation by Robertson (Blackboard) *cloning reproduces something that actually does occur in nature-- twins *cloning not overly likely to be abused; more likely to be used by infertile couple looking to legitimately have a biological child
*concern over welfare of the clone-- how will having same DNA as another person impact him/her
*concern that children could just become a commodity
*goal: instead of prohibiting cloning, focus on making sure that the process is done well and carefully controlled and surveilled
Key Points from Lectures to Review:
1. Euthanasia: active vs. passive; legal vs. moral issues
2. Important court cases: Karen Quinlan, Nancy Cruzan, Elizabeth Bouvia, Quill vs. Vacco
3. How death is defined and why that is important to specify (PVS low survival rates; defining brain death)
4. James Rachels essay arguing that active and passive euthanasia are morally equivalent
5. J. Gay-Williams objection to euthanasia, implying potential for abuse and slippery slope effect
6. Physician-Assisted suicide: experience in the Netherlands where it’s legal; Dr. Jack Kevorkian and Dr. Timothy Quill; Oregon’s Death with Dignity Act
7. Suicide: impulsive nature; impact of guns on suicide rates 8. Assisted reproduction: in vitro fertilization (IVF) and somatic cell genetic transfer (cloning); possible motives for cloning as well as possible objections to cloning