PH258 – Medical EthicsPH258 – Medical Ethics

AgendaAgenda

CLASSIC CASES, Chapter 1 – Requests to Die: Elizabeth Bouvia and Larry McAfee

CLASSIC CASES, Chapter 2 – Comas: Karen Quinlan, Nancy Cruzan, and Terri Schiavo

Requests to Die: Elizabeth Bouvia and Requests to Die: Elizabeth Bouvia and Larry McAfeeLarry McAfee

Elizabeth Bouvia – totally paralyzed from cerebral palsy; no use of legs; partial use of one arm; mentally competent

Requested to die in hospital Initially denied – Chicken Little

argument

Chicken Little Defense

If Elizabeth Bouvia is given right to terminate her life, then other disabled people might also ask for this option

Later given the right to terminate her life

Changed her mind

Five years before the Nancy Cruzan US Supreme Court decision, Bouvia won right to terminate her life.

Elizabeth Bouvia case – show effects of long-standing abuse of people with disabilities

Larry Mcafee – paralyzed from a motorcycle accident

Requested to dieIn 1989, he won the right to

terminationYet he decided to live.Bouvia and Mcaffee given three

options:Become a burden to one’s

family

Exist in a large public health

care facility

Kill oneself

Dax Cowart – burns over 2/3 of his body

Requested to terminateInitially refused.Later given right to terminationYet he decided to live.

Adaption effect (p. 16)

Historical Views of SuicideHistorical Views of Suicide

Ancient Greek Plato Aristotle

Stoic View Seneca Marcus

Aurelius

Judaic and Christian Views of Suicide

Old Testament – suicide of Saul – 1st king of Israel by prophet Samuel – routed Philistines and others – later usurped Samuel – accused of stealing war booty and not killing a captured king of the Amalekites – was later routed by Philistine forces – 3 sons killed in battle – committed suicide – body was recovered through daring raid from his soldiers – buried with honor

New Testament – suicide of Judas Iscariot

Conflicting accountsGospel of Matthew – betrays Jesus – later

returned the 30 silver coins – hanged himself

Acts of the Apostles – keeps the money – buys a farm – falls down in the field – disemboweled

Gospel of Judas – not part of Bible – Jesus asks Judas to hand him over

St. Augustine - against suicide

St. Thomas Aquinas – suicide – a sin

No chance for repentance Life is gift from God Robs children of their parents Unnatural

Private

killings

Killings endorsed

by God

Not OK OK

Michel de Montaine - “If we have learned how to live properly and calmly, we will know how to die in the same manner.”

Baruch Spinoza – “A free man, that is to say, a man who lives according the dictates of reason alone, is not led by the fear of death.”

John Donne – “When the [terminal] disease would not reduces us, [God] sent a second and worse affliction, ignorant and torturing physicians.”

David Hume – favors suicide– if someone’s health is failing, letting

it happen is following causal lawsAudacious to think our life – or death –

influences the vast universeTo kill oneself is only to stop doing

good

Immanuel Kant - against suicideSuicide cannot be universalized – ‘Act

so that your action becomes a universal law.’ (categorical imperative)

Suicide does not treat another (in this case, oneself) as an end – ‘Treat each person as an end in himself, never merely as a means.’

Immanual Kant (continued)Suicide is a form of disrespect to

oneself. This could lead to disrespect others.

Humans as ‘sentinels on earth’ – we are God’s property

John Stuart Mill“Over himself, over his own body and

mind, the individual is sovereign.”

Self-regarding actions Other-regarding actions

Total freedom Limited freedom

Autonomy Vs. Government-Paternalism

What qualifies as a suicide?

People with a terminal illness

People fully competent and without a terminal illness

Forgoing treatment Kill themselves

Not suicide Suicide

Elizabeth Bouvia, Larry McAfee, Dax Cowart:

Assisted suicide

Autonomy Paternalism

Empowerment Prejudice

Rule of Rescue operative

http://www.npr.org/2011/06/16/137217016/the-nation-keeping-the-right-to-die-alive