Assisted death in the terminally ill

jdsk2006

Have any of you seen last nights programme on sky 'how to die in oregan'? I watched it and was utterly compelled at cody curtis' s bravery and dignity. She and her family were very selfless to allow cameras follow such a truly heartbreaking time in their lives.
I must admit i was very upset watching it and it weighs heavily on my mind today :-( but has me thinking a lot about the issue......

Dr.David

There IS help to prevent suffering in a desperate medical condition, when a patient is clearly terminal, and with great suffering. The procedure is usually a body of physicians of few specialties, consulting first. When/if they come to an agreement that this is the appropriate step in this case, they prescribe the right medication. High dose pain suppression, in IV form, is administered, with automatic syringe for continuous flow. It keeps the patient either very heavily sedated, or unconscious.Eventually, it will suppress automatic functions, such as breathing, and the patient dies peacefully. It is a humane way to deal with it, very hard on physicians, but the best under the circumstances.

Pat Mustard

So, in Ireland we allow high-dose pain suppression which is ultimately fatal, over a relatively short period of time. I think that it must be difficult to argue that this is not euthanasia, Irish style.

Would it be fair to say that for practical purposes, a form of euthanasia is in place in this country, for certain terminally ill patients?

Dr.David

Indeed. Called by different names, it is that, we all know that high dose opiates would suppress vitals, and hasten patients demise. If the system wanted to prevent physicians from this practice,they would find a legal way. But they know there is a real need for this service, which we all hope to never be involved with. Actually, I have treated a very late stage 4 cancer patient lately, who was given huge dose of opiates, which she hated with passion. She wanted me to help her live with less pain, but no drugs. I used long treatments of short wave, and other frequency devices, so she lived another two months with little pain, and with full mental capability, which allowed her to take care of her business deals, to instruct lawyers and accountants, and close things before her death. This is a rare occurrence, unfortunately. There are options, but because of lack of knowledge among physicians, lack of financial interest, and suppression of therapies by pharmaceutical corporations, we miss on.

MrPudding

Another example of the doctrine of 'double effect.'

MrP

Peregrinus

Well, it's an example of a ethical problem to which the principal of the double effect offers a possible approach.

In this situation, application of the double effect principle involves reasonings as following:

(a) Killing someone is generally wrong, but

(b) if an act has the effect of killing somebody and another effect, and my intention is to bring about the other effect, and the other effect is so good that it justifies accepting the unintended effect of killing someone, then I can do that act.

Life-shortening pain relief is one practical application of the doctrine. Another more unusual one would be, say, bringing down an airliner which a hijacker is about to fly into a skyscraper full of people.

You may not like the principle. Consequentialist moral reasoners generally don't, since they consider that the moral quality of an act is determined by its consequences, not by the intentions or motivations of the actor.

But if you reject the principle, you have a problem. Either you can then never do any act which hastens death, or you must find some other principle to justify such an act (or you can reject the premise that causing death is generally wrong, but I assume we can leave that possiblity to one side). You can't, I think, deny that intention of relieving pain justifies life-shortening pain relief, and at the same time argue that the same intention justifies the coup de grace. So if you reject the double effect principle, then you have to find some other principle which justifies whatever it is you think you should do to respond to the dilemma you face.

MrPudding

Peregrinus wrote: »

Well, it's an example of a ethical problem to which the principal of the double effect offers a possible approach.

In this situation, application of the double effect principle involves reasonings as following:

(a) Killing someone is generally wrong, but

(b) if an act has the effect of killing somebody and another effect, and my intention is to bring about the other effect, and the other effect is so good that it justifies accepting the unintended effect of killing someone, then I can do that act.

Life-shortening pain relief is one practical application of the doctrine. Another more unusual one would be, say, bringing down an airliner which a hijacker is about to fly into a skyscraper full of people.

You may not like the principle. Consequentialist moral reasoners generally don't, since they consider that the moral quality of an act is determined by its consequences, not by the intentions or motivations of the actor.

But if you reject the principle, you have a problem. Either you can then never do any act which hastens death, or you must find some other principle to justify such an act (or you can reject the premise that causing death is generally wrong, but I assume we can leave that possiblity to one side). You can't, I think, deny that intention of relieving pain justifies life-shortening pain relief, and at the same time argue that the same intention justifies the coup de grace. So if you reject the double effect principle, then you have to find some other principle which justifies whatever it is you think you should do to respond to the dilemma you face.

I simply think the doctrine of double effect is intellectually, morally, politically and legally lazy.

MrP

Peregrinus

Well, possibly. But do you have an alternative which is not open to the same criticism? Or would you just not permit any kind of either euthanasia or life-shortening pain relief?

MrPudding

Peregrinus wrote: »

Well, possibly. But do you have an alternative which is not open to the same criticism? Or would you just not permit any kind of either euthanasia or life-shortening pain relief?

The alternative is to talk about and legislate for it. I fully support doctor assisted euthanasia and I also see the need for life shortening pain relief. I object to the manner in which it is delivered, behind a dishonest cloak designed to protect the morals of those too delicate to see it for what it is, or who refuse to accept that in some cases death is the right move.

MrP

Peregrinus

MrPudding wrote: »

The alternative is to talk about and legislate for it.

That's not really an alternative, though, since we could talk about it and then adopt or approve legislation which give effect to the principle of the double effect, or some other principle. What I'm inviting you to do is to articulate that other principle, one which will give effect to the outcome you want.

MrPudding wrote: »

I fully support doctor assisted euthanasia and I also see the need for life shortening pain relief. I object to the manner in which it is delivered, behind a dishonest cloak designed to protect the morals of those too delicate to see it for what it is, or who refuse to accept that in some cases death is the right move.

Look, in terms of winning people over to your viewpoint, you're probably playing a sticky wicket when your principal tactic is to demonise those who hold different viewpoints. I can't but note that most of your contribution to this thread consists of excoriating those who hold a viewpoint that you don't hold, rather than offering a coherent account of your own viewpoint, and reasons why others should agree with you. This might be an effective tactic for gratifying people who already agree with you, but it won't do much to win over those who don't.

The principle that human life is valuable and killing people is generally problematic is not an unreasonable one. The principle that suffering is bad and pain should be relieve is also not unreasonable. There are obviously circumstances in which those principles collide, and reconciling them in a satisfactory way is difficult. The principle of the double effect is an attempt to negotiate this. You denounce it as "dishonest", but don't say why. You suggest that it is "designed to protect the morals of those too delicate to see it for what it is" without saying what you think it is, and in terms which suggest that you think people who are trying to be true to their moral values are doing something bad.

Fine. You don't like the principle of the double effect. We're still not clear about i]why[/i] you don't like it, but we do sense the depth of your dislike. But can we move on? Can you tell us what you do like, and offer reasons why you like it, and why we should too? Can you talk about this in a positive way, without making any reference at all to the principle of the double effect and your opinions about those who profess it?

How do you think the principles of respect for human life and empathy for suffering should be reconciled? Or do you think, in fact, that only one of those principles has any moral value?

MrPudding

Peregrinus wrote: »

That's not really an alternative, though, since we could talk about it and then adopt or approve legislation which give effect to the principle of the double effect, or some other principle. What I'm inviting you to do is to articulate that other principle, one which will give effect to the outcome you want.

Well it kind of is an alternative... I don't object to the result of double effect, I merely object to it replacing a proper system. I will try to explain further below.

Peregrinus wrote: »

Look, in terms of winning people over to your viewpoint, you're probably playing a sticky wicket when your principal tactic is to demonise those who hold different viewpoints. I can't but note that most of your contribution to this thread consists of excoriating those who hold a viewpoint that you don't hold, rather than offering a coherent account of your own viewpoint, and reasons why others should agree with you. This might be an effective tactic for gratifying people who already agree with you, but it won't do much to win over those who don't.

I think that is slightly unfair, and not really representative of what I have posted. Are you saying that the doctrine of double effect is not a work around to make a certain section of the population more comfortable with something they may otherwise be uncomfortable with?

Peregrinus wrote: »

The principle that human life is valuable and killing people is generally problematic is not an unreasonable one. The principle that suffering is bad and pain should be relieve is also not unreasonable.

I don't disagree with you here. I strongly believe that life is valuable and I also strongly believe that, outside of certain circumstances, killing people is also wrong. Most people, even those that object to euthanasia or abortion (not starting an abortion debate, merely mentioning it because it is relevant to this particular point and because it is also an area where double effect rears its ugly head), do accept that in certain circumstances killing is justified.

Peregrinus wrote: »

There are obviously circumstances in which those principles collide, and reconciling them in a satisfactory way is difficult. The principle of the double effect is an attempt to negotiate this. You denounce it as "dishonest", but don't say why. You suggest that it is "designed to protect the morals of those too delicate to see it for what it is" without saying what you think it is, and in terms which suggest that you think people who are trying to be true to their moral values are doing something bad.

To be honest I didn't provide any further explanation as I thought it was fairly self evident. I will try and provide a little more reasoning behind my view.

First, why I think it is dishonest. Everyone knows what is going on. When the life shortening dose of pain relief is given no one is in any doubt what is going to happen. Ending someone's life is a fairly serious thing, cloaking it in dishonesty is not a sensible thing to do. Saying 'well I didn't really intend to kill him, I was just giving him a dose of morphine of such a size that I know he won't survive, but that is not my intention. Yes, it was you intention. Stop being dishonest.

Protect the morals of those too delicate. This is an easy one. Double effect allows people, or organisations, that would typically be against a particular act to condone that act and pretend it is something else. So the relative that disapproves strongly of euthanasia, but is happy for his or her old mum to be given a lethal dose of morphine, or perhaps agrees to have support and nutrition withdrawn (I know this is not double effect, but the principle for the purposes of this is close enough), can happily say 'we were just trying to ease her pain' or 'we didn't actually kill her, we just let nature take its course.' In both cases they did kill them. One by direct action and other other by simply letting them die. It really winds me up that people think it is ok to remove nutrition and fluids form a person, and let them die from malnutrition but mention giving them an injection to kill them mercifully and you are a monster.

Peregrinus wrote: »

Fine. You don't like the principle of the double effect. We're still not clear about i]why[/i] you don't like it, but we do sense the depth of your dislike. But can we move on? Can you tell us what you do like, and offer reasons why you like it, and why we should too? Can you talk about this in a positive way, without making any reference at all to the principle of the double effect and your opinions about those who profess it?

How do you think the principles of respect for human life and empathy for suffering should be reconciled? Or do you think, in fact, that only one of those principles has any moral value?

I would like there to be a system in place where rather than the 'nudge nudge, wink wink' system we have there is a properly legislated for and properly regulated system whereby doctors can assist people, in certain circumstances to end their lives.

Do I want a free for all where we have bands of homicidal doctors roaming the streets euthanising those they deem unfit? No. I want a system, with checks and balances (which the current 'system' does not have) where people can get the help they want and need, but not be pressured into taking their own lives early, or having the decision taken away form them.

This does not need to be a slippery slope. The system in Oregon is working very well, though I personally think it is too restrictive, though as a starting point it is very good indeed.

MrP