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the intentional killing by act or omission of a dependent human being for his/her alleged benefit
Different types of Euthanasia
- Voluntary = you ask for it by requesting to die (direct consent or legal advance directive)
- Non-voluntary = you’re unable to determine the patient’s wishes (unconscious, no advance directive)
- Un/Involuntary = person has made an expressed wish not to die (verbal or advance directive)
Active vs. Passive Euthanasia
- Active = death is directly induced (e.g. morphine overdose)
- Passive = treatment is withheld or terminated after it has begun. The disease, injury, or trauma is what actually kills the patient
PAS is different from euthanasia because
In PAS, the patient administers the means of death (Doc prescribes it, patient ingests it)
AMA's stance on euthanasia:
- It would cause more harm than good.
- It's fundamentally incompatible with the physician’s role as healer
- It would be difficult or impossible to control
- It would pose serious societal risks.
Life support is defined as:
- Feeding tube
In "PAS: A Tragic View" Arras' conclusion on PAS is:
- Don't do it YET - too many problems to pass it at the moment.
- "Extend prohibition into the near future, but remains open to the possibility"
Arras' "tragic choice" theory of PAS states:
- Whether we legalize it or not, there will be victims.
- Prohibition: those suffering in pain
- Legalization: Depressed elderly, person on cheap HMO (can't treat pain). Slippery slope all the way down to the uncommunicative victim, uninsured & poor who can't afford alternative treatment
Problems Arras' addresses:
- Docs aren't trained enough to recognize depression
- Slippery slope to include non-terminally ill, active euthanasia
- Likelihood of abuse
Arras' proposed solution to PAS:
- Postpone legalization
- Drastic changes to healthcare (access to palliative care, wait for a more equitable/compassionate system)
- Realize there's a small percentage we can't help. For them, we could induce perm veg stage, sedation by doc + removal of life support, simply ask doc
According to Hardwig, do we have a duty to die?
Sometimes. "There are circumstances when we have a duty to die."
Hardwig's individualistic fantasy states:
- Lives are separate and unconnected, or that they could be if we so chose.
- FALSE: The patient isn't the only one affected by the medical decisions made about his/her treatment.
Burdens of caring for the terminally ill include:
- Exhaustion of the caregivers
- Emotional devastation
- Diminished social life
- Decreased friendships
- Financial devastation
Circumstances when we DO have a duty to die (according to Hardwig)
- 1. Continuing life places substantial burdens on loved ones
- 2. As age increases, duty increases because you have less time left
- 3. Already lived a full & rich life
- 4. Loved ones are impoverished, or only had a small share of good things of life
- 5. Loved ones have already made great contributions/sacrifices to make your life good
- 6. Loss of identity (the part of you that people love)
- 7. When you've already spent your own money on a lavish lifestyle
Do the incompetent have a duty to die?
Only if they were formerly capable of making moral decisions
Reforms to social policy regarding the duty to die.
If we had a long-term care facility, we would have the duty to forgo personal care by a family member who knows them and really cares for them, but these sacrifices don't include the sacrifice of life
Marquis believes that abortion is ____________.
- Consider the human timeline - we were all fetuses once.
The Pro-life/Anti-abortionist stance states that it is always wrong to _________________.
end human life
The Pro-choice stance states that it is morally wrong to _____________.
kill PERSONS (i.e. those with personhood)
Human Being vs. Person:
- Human being = biological category, member of Homo sapiens
- Person = moral category, the necessary & suff category for human rights
- People with rationality and consciousness.
- They have a stake in their own future
- NOTE: Marquis doesn't like this, because then vegetative coma patients wouldn't have rights.
Definition of FLO:
- Future Like Ours, that is, a "future of positive experiences"
- A characteristic it has RIGHT NOW.
- Does NOT rely on personhood
Benefits to Marquis' theory involving FLO:
- Overcomes the problem of speciesism
- Makes room for the possibility that active euthanasia is morally permissible
- Can account for why it is morally wrong to kill infants and very young children
- Also, it explains why...
- killing is one of the worst crimes
- sometimes death is valued
The problem with the discontinuation account is...
- It inherently relies on one having experiences in the past and that shouldn't be necessary.
- SIDE NOTE: it does NOT provide a better pro-life argument.
Objection to Marquis' FLO account:
- It fails because valuable future experiences require a valuer (fetuses can't value).
- Resp: a future can be valuable even if the beholder can't see it (e.g. a suicidal teen will come to value a future)
Steinbock believes that MOST abortions are not wrong based on:
- the moral status of the fetus
- the burdens imposed on women by pregnancy & childbirth
Biological life vs. Biographical life
- Biological life = you have life (e.g. cells)
- Biographical life = you have a conception of self over time; you have existence
Steinbock's interest view states that...
- Once you can suffer, you have an interest not to suffer.
- Since a fetus lacks sentience / consciousness, it has no moral status.
Rejections to the potentiality argument:
- Potentiality <> Actuality
- Leads to the absurd conclusion that sperm & eggs must be protected
In response to Marquis' FLO argument, Steinbock asserts:
- Past experiences do matter.
- Boonin: Psychological continuity = without a past, there is no one with a personal future (your past is who you are).
- An unconscious individual has a biographical life, fetus has only biological.
Steinbock's argument of self-determination:
- echoes Judith Thompson: "Right to life <> Right to life support"
- Women are not obligated to sustain the lives of pre-sentient fetuses
According to Steinbock, actions are morally wrong if they
- harm others
- it reflects poorly on the moral character of the agent
According to Steinbock, sex selection and fetal reduction are morally ____________.
According to Steinbock, it is morally wrong to have abortions for _________ reasons.
Trivial (e.g. bikini season) or vengeful (e.g. as revenge to an unfaithful husband)
Robertson affirms that procreative liberty is a ___________ right.
Procreative liberty is the freedom to ____________________________, which doesn't include __________.
- either have children or avoid having them
The theoretical justification for respecting procreative liberty:
- Whether or not one reproduces is central to identity, dignity, and the meaning of one's life.
- NOTE: Practical avoids intrusive government
Objections / Specific concerns regarding noncoital reproduction:
- Reduction in demand for hard-to-adopt children
- Coercive/exploitative bargains offered to poor women
- Commodification of children and reproductive collaborators
- Objectification of women as reproductive vessels
- Undermining of the nuclear family
In limiting procreative rights, Robertson offers a two-part analysis. Part 1 looks at...
- Whether a distinctly procreative interest is involved
- Those who understand the reprecussions and possess the requisite mental capacities for grounding an interest in procreative liberty can do so
- OK: HIV, unmarried, homosexual, disabled, imprisoned
- Not OK: Severely mentally challenged
In limiting procreative rights, Robertson offers a two-part analysis. Part 2 looks at...
- Whether the harm threatened by reproduction satisfies the strict standard for overriding this liberty interest (that others are substantively harmed)
- General (COITAL) concerns include:
- unfitness of parents
- harm to offspring
- costs to the state & others
Regarding procreative liberty, Murray states that we need a ______________________ approach to the question of procreative technology.
A flourishing-centered approach reflects on
- the most important values central to the family (at the heart of that relationship)
- moral significance of the relationship between parents and children
- the ways people flourish
Characteristics of a flourishing-centered approach to procreative technology:
- Broadens the lens of consideration to address both men's and women's flourishing
- Takes into account the flourishing of the family and all its members
- It acknowledges that institutions and practices shape the possibilities for flourishing
Murray's problems with the FRAMING of the standard account of procreative liberty:
it frames the issues WRT autonomy and choice - i.e. would the child have been better off not being born?
Three problems with the standard account:
- Confusion about the purpose (laws & policies over tech?)
- Confusion regarding framing as the flip-side of abortion
- Doesn't take into account family values
Nash family case:
- Daughter would die unless she got an injection of immuno-compatible blood
- So, the family had another daughter for a supply
- Also, they made sure that the new daughter didn't have this defect
Standard account on Nash case:
- Did the parents make an informed choice? Yes.
- Would the child have been better off never being born? No.
- Conclusion: family made an ethically defensible action
Flourishing approach to Nash case:
- Does preimplantation testing/selection in this instance support or undermind the values central to parents & children?
- Will it strengthen that family's prospects for flourishing?
- What effect will this case have on practices & policies in pre-implantation genetic testing?
- Can't answer, but the Nash probably made the right call.
- Child was born in compassion for the suffering of one child, and not an effort to exert excessive control over the traits of another
Sandel's view on Stem Cell research:
It's good. The government SHOULD fund THERAPEUTIC SC research.
Sandel's response to the argument over the destruction of human embryos (long ago we were all once embryos:
- Persons are different than embryos
- Acorn analogy: although every oak tree was once an acorn, it does not follow that acorns ARE oak trees, or that we mourn the loss of acorns the same as an oak tree falling from a storm.
- Embryos lack sentience
- NOTE: we can't treat embryos however we want!
Sandel states that if we REALLY thought embryos were persons...
we would ban SC research entirely instead of simply arguing over funding
Insisting that embryos are persons leads to
- the ridiculous conclusion that we should outlaw discarding (including freezing) extra embryos developed by IVF
- we are morally obligated to prevent natural failed fertilizations and miscarriages
Sandel's response to the slippery slope argument (i.e. SC research would lead to embryo farms, fetus spare parts, commodification of humans)
- Don't ban it, REGULATION IS KEY!
- Ban human reproductive cloning (e.g. Multiplicity)
- Follow the UK's guidelines:
- Don't develop embryos beyond 14 days
- Restrict commodification of embryos of gametes
- Establish a SC bacnk to prevent proprietary interests from monopolizing access
George & Lee's conclusion on stem cells:
- human embryos (regardless of origin) should be accorded the same rights & respects as human beings in later stages of development
- They only support SCs harvested harmlessly from non-embryonic sources.
George & Lee dislike how the SC debate is framed because...
it focuses on embryonic SC research and not on the permissibility of killing members of a certain class of human beings
Paul McHugh believes that
- it is morally permissible to destroy clonotes before the 14th day of development for the purpose of creating a sc line
- Clonotes ARE different than embryos
- NOTE: Sandel doesn't draw any distinctions; kill all embryos
George/Lee response to McHugh's assertion that clonotes are different than embryos:
It's still an embryo, and human embryos ARE human beings (just at an earlier stage of development, as we all once were)
McHugh's second argument (reductio ad absurdum)
- IF we rely on the notion that SCNT clonotes must be protected because with manipulation they may become a living clone
- THEN we must protect all somatic cells since they have that same potential
George/Lee response to McHugh's second argument:
- Somatic cells aren't members of Homo sapiens
- Embryos are self-directed and can draw a timeline
- Also, if clonotes aren't a species, then the adult isn't that species either
George/Lee issue with Sandel's acorn analogy
- Embryos are NOT different in kind
- We value oak trees based on their accidental properties
George/Lee issue with Sandel's argument that embryos are not persons:
- Personhood is not something one acquires at some point & may lose
- Rather, we come into being with a rational nature
Savulescu believes that genetic enhancement is...
not only morally permissible, but obligatory!
Savulescu argues that there's already interest for enhancement based on
- beauty industry
- cosmetic surgery
- teeth whitening
- muscle products
- body art (tattoos, piercings)
- performance enhancing drugs (of ALL kinds: sex, sports, intellect)
- mood enhancing drugs
Neglectful Parents vs. Lazy Parents:
- Neglectful: super smart kid needs a supplement to maintain intelligence, they don't do it
- Lazy: child with normal intellect, needs a supplement to bring up to super smart status, but they can't be bothered
- Conclusion = they're both equally bad
Argument #2: genetic enhancement is different because it's permanent, but supplements aren't
- Response: many environmental factors do leave permanent changes
- Also, "you're only a novice once..."
Modern vs. Nazi eugenics:
- Modern = voluntary, aimed & directed at the well-being of the child, still room for freedom
- Nazi = mandatory, standard set
Savulescu advocates only enhancing "non-positional qualities," which are
- "All purpose goods"
- sense of humour
- sunny temperment
Limits to procreative liberty:
- harm to others
- distributive justice
- *what constitutes a better life for the child (well-being)
- parents' choices are limited to foster the child's autonomy
- * = most important
- intervention cannot be delayed until the child can make its own decision
- intervention is plausibly inthe child's best interest
- intervention is compatible with the development of autonomy
Sandel believes that we should __________ biotech enhancements because _______________.
- NOT allow
- it erodes key features of our moral landscape: humility, responsibility, and solidarity
- ...but therapeutic enhancement is OK.
Sandel's response to GE being an unfair advantage:
It's no different than natural endowments
Sandel's response to GE forming two classes of people (those who can afford it and those who can't)
It's not a question of access; bigger problem
Sandel's response to GE used for sex discrimination/selection
Microsort already does this to BALANCE families
Sandel's response to GE threatening agency:
- It doesn't erode agency - it causes hyperagency.
- We're not taking away effort, we're giving control to parents and they're running amuck.
Which is affected more, effort or morality?
Sandel's opinion of eugenics and biomedical enhancement:
BOTH are wrong since they turn children into products of deliberate design
Sandel's non-sectarian response to deliberately designed children:
- Degrades humility: kids are no longer a crapshoot
- Degrades responsibility: parents would be held responsible for NOT improving their children
- Degrades solidarity: parents get together and complain / men & women reflect on the contingency of their talents and fortunes