PHL 223 Week 3 READING
PHL 223 Week 3 READING PHL 223
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This 4 page Class Notes was uploaded by Paola Araque on Sunday February 14, 2016. The Class Notes belongs to PHL 223 at University of Alabama - Tuscaloosa taught by Stuart Rachels in Summer 2015. Since its upload, it has received 55 views. For similar materials see Medical Ethics in PHIL-Philosophy at University of Alabama - Tuscaloosa.
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Date Created: 02/14/16
Medical Ethics Notes: Week 3 Lecture ● Brain Death: ○ Harvard criteria: loss of nearly all brain activity and there are 2 flat EEGs. ● The Uniform Brain Death Act (1978) ○ irreversible loss of all brain function. (law in all 50 states) ● The Irreversibility Standard ○ when unconsciousness is irreversible (NOT a law) ● The Cognitive Criterion ○ Loss of core mental properties such as reason, memory, and self awareness. ○ “Biographical life” is what matters, not “Biological life” ● James Rachels ○ “Active and Passive Euthanasia” ■ The legal distinction between active and passive euthanasia is unjustified ■ Why is active euthanasia murder? Why is passive euthanasia morally permissible? ■ Active euthanasia is often more humane than passive euthanasia. ■ Suppose someone… ● has throat cancer and is in great pain. ● he/she must die within 48 hours, and begs the doctor to kill him/her. ● it would be humane to kill him. ● Compassion, Well Being, Mercy ● The value of autonomy can also favor active euthanasia ● If a competent adult wants to die, this is a reason (small or big) to kill him. ● But isn’t killing worse, in itself, than letting die? ● Rachels: Consider two cases that are just the same,except that one is a case of killing, the other of letting die. ○ same motive: both want to kill for personal gain ○ same result: the child dies by drowning ○ the only difference is that Smith kills, while Jones lets die. ○ Rachels: what Smith and Jones do is equally bad. ● So active and passive euthanasia, in themselves are on a moral par. ● Rachel’s main argument ○ passive euthanasia and active euthanasia are, in themselves, ethically equivalent.(justified by Smith/Jones) ○ passive euthanasia is often less human than active euthanasia (justified by throat cancer patient) ○ conclusion: if passive euthanasia is okay (morally and legally) then active euthanasia should be okay too. ● Why do people think killing is so much worse than letting di ? ○ society and its upbringing ○ they have never faced the challenge of being in that situation. ● Rachels: because they have in mind the paradigm (standard, typical) cases ● Paradigm case of killing: ○ cold blooded murder ● Paradigm case of letting die: ○ a merciful act involving someone who is dying and suffering ○ this case of killing is worse than this case of letting die ● But it’s killing healthy person vs. letting someone die who is dying and suffering. ● GayWilliams’ Objections: ○ euthanasia goes against our natural instincts. ■ but often we should go against nature...poisons are natural ■ it is so important to thinatura as not just a moral term ○ the possibility of being cured (often a naive hope) ● How to deal with the dying: ○ do not deny the fact that they are going to die. ○ be as optimistic as you can be, without losing the touch of reality. ● The Slippery Slope ○ scare tactic? you can always create a doomsday scenario when someone is dying, and it scares people ○ there are no known abuses of active euthanasia in the Netherlands or of PAS (physician assisted suicide) in Oregon ■ The Netherlands have been practicing active euthanasia the longest and are the most open about it. Readings ● Vacco vs. Quill ○ Background: Whether or not ban on assisted suicide in NY is constitutional. Specifically, whether or not it violates the Equal Protection Clause of the 14th Amendment. The Supreme Court said it did not violate the Equal Protection Clause, and left it up to the state to establish its own policy on the issue. ○ In NY it is a crime to aid someone in committing or attempting suicide. ○ Patients are allowed to refuse lifesaving medical treatment. ○ Quill’s “standards of medical practice” would be to prescribe lethal medication to “mentally competent, terminally ill patients” who are in great pain and want a doctor’s help in committing suicide. ○ However, NY’s law keeps them from doing that. ○ Patients that are now dead, sued the State Attorney General in the U.S. District Court saying that refusing life sustaining treatments is the “same thing” as physician assisted suicide, violating the Equal Protection Clause. ○ Court of Appeals: patients who are in the final stages of terminal illness, who are on life support systems are allowed to hasten their deaths by directly removing themselves from life support systems. Those who are in the final stages of terminal illness and are not on life support systems, are not allowed to hasten their deaths by selfadministering prescribed drugs. ○ Everyone is entitled, if competent, to refuse unwanted lifesaving medical treatment; no one is permitted to assisting a suicide. ○ When a patient refuses lifesustaining medical treatment, he dies from the fatal disease. ○ If a patient ingests lethal medication prescribed by a physician, he is killed by the medication. ○ Majority of states disapprove of suicide and assisted suicide either in statutes dealing with durable powers of attorney in healthcare situation, or in ‘living will” statutes” Even though the States move to protect and promote patient’s dignity at the end of life, they remain opposed to physicianassisted suicide. ○ Employing a rationality test to examine the guarantees of the Equal Protection Clause, the Court held that New York's ban was rationally related to the state's legitimate interest in protecting medical ethics, preventing euthanasia, shielding the disabled and terminally ill from prejudice which might encourage them to end their lives, and, above all, the preservation of human life. ● Death and Dignity Timothy Quill ○ Dr. Quill is tells the story of one of his patients (Diane) with terminal cancer, who wanted to face death on her own terms. ○ Diane was diagnosed with acute leukemia, and did not want to go through with chemotherapy treatments due to the effects of treatment and only a 25% chance of survival. ○ Diane wanted to maintain control of herself and her dignity. When she was no longer able to do this, she wanted to die. ○ Quill prescribed Diane barbiturates for sleep, knowing that she wanted to eventually commit suicide, and that it was an essential ingredient in a Hemlock Society suicide. ○ Quill made sure to inform Diane about how much she needed to take in order to help her with her sleeping problems, and let her know that taking too much would kill her. ○ Eventually, Diane committed suicide with the barbiturates that Quill prescribed her. ○ Quill did not directly assist Diane in committing suicide, but he helped make it possible. ● Baby M James Rachels ○ 1985 Elizabeth and William Stern could not have children ○ Contracted Marybeth Whitehead to be their surrogate and paid her $10,000 ○ Elizabeth stern would be the adoptive mother and Marybeth would never see the child again ○ Child was born on March 27th, 1987 and Whitehead changed her mind and wanted to keep the baby ○ Mr. Stern was given temporary custody. ○ When the police went to the Whitehead household to retrieve the baby Mr and Mrs Whitehead kidnapped the baby and fled to FL. ○ Eventually the Whiteheads were brought back to NJ and a judge gave the Sterns temporary custody of the baby. ○ People felt that Mrs. Whitehead should be able to keep her baby until the public started finding out about her past (teen mom, no education, had two children before the age of 19, stripper, low income, etc) ○ Mrs. Whitehead threatened to kill the baby. ○ The Sterns got to keep the baby, and Mrs. Whitehead was stripped of all parental rights.