What are the five best arguments against euthanasia?

h/t Bioedge

As medical societies around the world consider changes to their position on euthanasia, several influential doctors and ethicists have co-published a commentary in the Journal of Palliative Care opposing any policy change.

Among the authors of the article, entitled “Physician-Assisted Suicide and Euthanasia: Emerging Issues From a Global Perspective”, are Georgetown University’s Daniel Sulmasy, who served on President Obama’s Commission for the Study of Bioethical Issues, Margaret Somerville, a legal scholar and one of the most vocal opponents of the legalisation of euthanasia in Canada, and influential palliative care specialist Lukas Radbruch.

The authors summarise what they take to be the five strongest reasons to oppose euthanasia. They include:

1) “slippery slopes”: The authors assert that “despite safeguards for euthanasia in the Netherlands and Belgium, there are data that safeguards are ineffective and violated...Allowing voluntary euthanasia has led to nonvoluntary euthanasia”.

2) “lack of self-determination”: The authors note that many expressions of a desire for death do not mean that a patient wants to euthanasia or assisted suicide; “As individual requests for PAS-E are often labile, complex in origin, and subject to the individual’s changing priorities, such requests require careful and repetitive attention”.

3) “inadequate palliative care”: “Holistic knowledge of palliative care”, they state, “is the most urgent ethical obligation of jurisdictions worldwide rather than legalizing PAS-E

4) “medical professionalism”: doctors assisting in PAS-E, the authors argue, threaten the moral integrity of the medical profession.

5) “difference between means and ends”: the push for PAS-E confuses the problem of suffering with the life of the person: “we must kill the pain and suffering, not the person with the pain and suffering”.

Coincidentally, a completely different vision of euthanasia emerges from a recent article in the Belgian Tijdschrift voor Geneeskunde (Journal of Medicine). J.L. Bernheim, a researcher at the End-of-life Care Research Group, 
flatly denies that critics of Belgian euthanasia know what they are talking about. He divides criticisms into pragmatic (factual) and essentialist (moral and legal).

On the first score, Bernheim denies that there was or is a “slippery slope” or that vulnerable patients are not protected adequately. On the second, he argues that euthanasia is a genuinely compassionate supplement to end-of-life care. It’s an interesting to see how different euthanasia looks inside the borders of Belgium. Unfortunately, the article is available only in Dutch at the moment.

Daniel Callahan backs ‘slippery slope’ on assisted suicide

by Michael Cook | 25 Mar 2018 |

The idea of a slippery slope for euthanasia is mocked by supporters.  But in a recent opinion piece in the Bioethics Forum of The Hastings Center, one of America’s most respected bioethicists endorses it. In a brief opinion piece, Daniel Callahan, the co-founder of The Hastings Center, the world's first bioethics research institute, and the author or editor of 47 books, writes:

I have been opposed to physician-assisted death for well over 30 years. ....

I came into the debate with wariness and curiosity. On the one hand, my work on end-of-life care and the emergent hospice movement made clear that many deaths could be painful, psychologically traumatizing, and messy. I could well understand interest in that problem, but I wondered why the growing hospice program was not enough. What was to be made of the zealotry of proponents for euthanasia or physician aid in dying? I was especially curious about their long-term aspirations.

I also became interested in the pressures that medical progress was putting on care of the dying. Most notably, it has been increasing the possibility of medical efforts to incrementally find ever more ways to keep the sick and dying alive. The logic of medical progress has an unpleasant feature. It is the gradual movement from short lives and quick death to longer lives and extended dying. The quick deaths from heart attacks in my parents’ generation have given way to longer lives and Alzheimer’s disease. Is that progress?

Interest in assisted death comes, in part, from a culture of medical progress that does not know how to stop extending our lives. Medicine is particularly good in extending our dying—and much of that extension is in old age. I believe that the care of the elderly is rapidly coming to be a crisis for many countries, rich and poor. Inevitably, this crisis has also meant a growing attraction to assisted death. Some studies show that suicide rates are especially high in countries with low birthrates, rapidly aging populations, and significant health care and caretaker costs. The U.S. may not be spared.

My introduction to the Dutch scene in the late 1980s was to see a slippery slope in the making, first in the Netherlands and then in other countries. In Belgium, for example, euthanasia is now legal for terminally ill children, as well as for adults who have mental illness and dementia, and who are “tired of living.” The loosening of restrictions on who qualifies for euthanasia is evidence of the high value placed on individual autonomy in determining the time and means of death. It is a concept with no inherent limits.

A self-driving car killed a pedestrian. What now?

by Xavier Symons | 25 Mar 2018 |

A self-driving Uber vehicle has hit and killed a pedestrian in United States, raising concerns about the regulation of new autonomous vehicle (AV) technology.
Elaine Hertzberg was struck down late on Sunday night in Tempe, Arizona, after accidently stepping in front of an AV vehicle -- an Audi SUV -- travelling at approximately 60 kph.
The vehicle’s front sensor failed to detect the woman, while a safety driver present in the car was not watching the road.
Uber has announced an immediate halt on its AV trials across North America after the incident, and police are investigating. Legislation currently being discussed in Washington will look to introduce federal safety standards for the use of AV technology.
Some analysts suggest that regulations of self-driving vehicles need to be stronger. “Moving too quickly could put lives at risk and set back a technology that could ultimately help reduce the number of people killed and injured on the roads each year”, wrote Will Knight of the MIT Technology Review.
Others suggested that fatalities are inevitable -- albeit far less likely -- with self-driving vehicles. The Economist argued that, while self-driving vehicles will reduce the number of fatalities, “the sad truth is that there are bound to be fatal accidents on the road to a driverless world”.
These robot vehicles have a link to bioethics, especially to the well-known utilitarian trolley problem. After all, someone has to program them to make “decisions” about what to do when faced with conflicting choices.
Last year the German Federal cabinet adopted 20 recommendations by the Ethics Commission on Automated Driving, as a basis for the local car industry to advance its driverless technology. But it noted that “at the level of what is technologically possible today […] it will not be possible to prevent accidents completely. This makes it essential that decisions be taken when programming the software of conditionally and highly automated driving systems.”

What does it mean to be a genetic parent?

by Xavier Symons | 10 Mar 2018 |

In a world where assisted reproduction is becoming increasingly common, bioethicists are beginning to ask the question: “what counts as genetic parenthood?”.

It is tempting to think that genetic parenthood is about sharing half of one’s genes with another person. But this alone is not enough. Imagine a situation in which you had an identical twin, and your twin had a child. The child of your identical twin would share half of your genes. But would this make you their parent as well? Our intuitions tell us “no”.

In a new article in The Philosophical Quarterly, State University of New York philosopher Monika Pitrowska attempts to offer an account genetic parenthood that deals some of the complexities of the parent-offspring relationship. According to Pitrowska, there are three criteria that must be met for something to count as genetic parenthood: overlap, development, and persistence.

Readers may consult the article for a full development of the argument. Yet to provide a basic summary, Pitrowska argues that mere genetic similarity, or causal relationships between parents and children, are insufficient as a definition of parenthood. An vital feature of genetic parenthood is the passage of genetic material from one generation down through several successive generations. Pitrowska develops an definition that tracks this specific feature of parenthood.

As Pitrowska observes, the question of genetic parenthood is more than an esoteric, philosophical matter. While assisted reproduction has transformed society’s understanding of the family unit, our concern to know our genealogy remains. Furthermore, in a world where we are questioning whether mitochondrial replacement therapy creates three parent babies, or whether surrogates have a genetic link to the children they bear, it is important to achieve conceptual clarity.

Netherlands euthanasia case under renewed scrutiny

by Xavier Symons | 10 Mar 2018 |

In a new article in the Journal of Medical Ethics, researchers from the National Institutes of Health offer an insightful analysis of one of the most controversial cases of euthanasia to have occured in the Netherlands.

Bioethicists David Gibbs Miller, Rebecca Dresser and Scott Kim analyse the official medical records of a severely demented woman who was euthanized in Holland in 2016. The woman, who was in her 70s, had her life ended by a geriatrician in aged care facility after having written an advance directive indicating her wishes for receiving euthanasia.

The advance care directive was written several years before her death, and there has been much discussion about whether it remained binding.

The most controversial feature of the case, however, was the manner in which the woman was euthanised. The supervising doctor mixed sedatives into the coffee of the woman without her knowledge. When the sedatives did not work, the doctor administered a stronger drug subcutaneously.  

While the doctor was administering the lethal dose, the patient tried to get up and had to be restrained by family members.

The authors observe that there is insufficient scrutiny of the process by which Advance Care Directives are prepared:

...physicians and the RTE [Dutch regional euthanasia review committees] accept a low threshold of decisional capacity for preparing AEDs. The RTE’s Code of Practice states that in early dementia, "the patient generally…is decisionally competent in relation to his request for euthanasia". This apparent presumption of capacity in early AD (and in the case [of this patient], a much more advanced state) is incompatible with existing data on Alzheimer’s disease and decisional capacity.

The authors also question whether an Advance Care Directive should override the contemporaneous wishes of a severely demented patient:

The failure to provide adequate protection to a vulnerable patient was exacerbated by the failure to respect her contemporaneous interests and statements. By privileging the AED as the expression of Mrs A’s ‘real self ’—a judgement that itself was dubious in light of her questionable capacity and understanding when she made the AED—physicians failed to protect her … when they disregarded her contemporaneous statements and actions.

Till death do us part: Couple die together in Oregon

by Xavier Symons | 10 Mar 2018 |

A controversial new documentary has been released in the US telling the story of an Oregon couple who took their own lives via lethal medication in April 2017.

The documentary recounts the story of Charlie and Francie Emerick, 88 and 87 respectively, who last year applied to the Oregon Health Authority for a lethal prescription after being diagnosed with terminal illnesses. Charlie was suffering from advanced Parkinson's Disease, and Francie had battled for several years with lymphoma.

The Emericks died at home in April 2017, surrounded by family. They had been married for 66 years.

“They were each other‘s best friend,” Jerilyn Marler, their eldest of the couple’s three children, told reporters. “In their last years, Dad was Mom’s eyes and Mom was Dad’s ears. It was natural for them to want to die together”.

The documentary presents the couple’s decision in a very favourable light, though some close friends and relatives disagreed. Bioethicist Thaddeus Mason Pope speculated that they may have been the “first couple” to take their lives together under Oregon’s Death with Dignity law. Nearly 1,300 people have died in Oregon via lethal prescription since the enactment of the law in 1997.