Reflections on euthanasia, pain and suffering (original) (raw)
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The rationing of health care: A doctor's dilemma
Journal of Religion & Health, 1993
Physicians are currently presented with very difficult ethical issues regarding who receives what level of medical care and for how long. A meaningful response to these perplexing issues necessitates a collaboration of doctors with others steeped in religious and ethical traditions. This paper addresses the complicated issue of the rationing of health care, and this issue is then addressed by responses from representatives of the religious community. This symposium took place at the New York Hospital--Cornell Medical Center in March 1991.
Physician-assisted suicide (PAS) presents one of the greatest contemporary challenges to the medical profession's ethical responsibilities. Professor Baroness Llandaff commented UK law on physician assisted suicide possesses “stern face and a kind heart” , regrettably however, it still retains an “irrational mind and an unpredictable will.” This essay is not a debate on whether PAS is ‘right or wrong,’ but whether the consequences of a reform in the law, would be better or worse than the status quo. It will focus on four main issues. The ambiguity and inadequacy of current UK law with regards to PAS. Whether the law as it stands results in unnecessary suffering. Examination and rebuttal of the main arguments against a reform in the law. Finally if a reform is needed, what form would it take?
On the Ethics of Medical Care under Resource Constraints
Spontaneous Generations: A Journal for the History and Philosophy of Science, 2007
The aim of this discussion is practical; otherwise it largely repeats some very general observations, chiefly historical and philosophical. I boast no expertise in anything specifically medical, to do with either medical care or medical administration. My concern is with the system of medicine and with the ethical and social issues that it involves. 1 Applied philosophy is a still uncharted territory. Philosophers traditionally focus more on justifying accepted solutions than on seeking new solutions to urgent or interesting problems: their staple problems are those of justification. Thus, they spend less time discussing scientific problems and difficulties, and more time discussing the justification of the claims that we know. They habitually choose the simplest and most unproblematic claims for knowledge, and then try to substantiate them. As the famous writer William Somerset-Maugham has observed, from reading philosophy one might get the impression that there is no pain more important than my toothache. Possibly this makes sense: philosophers discuss the justification of the claims that are most accessible, since if they cannot justify them they cannot justify anything. This is indeed the case: even to justify that I have toothache or that I see a desk before me is impossible. Philosophers often find this tormenting. And perhaps it is. Yet
The Problem of Inadequately Relieved Suffering
Journal of Social Issues, 1996
A request for euthanasia or assistance in suicide usually derives from severe patient distress and indicates signijkant suffering. Although the Hippocratic purview of medicine requires that suffering be acknowledged, its causes be identified, and that steps be taken to provide adequate relief, an appreciation of the diversity of factors that may contribute to sufering underscores the need for methodical assessment and familiarity with a range of therapeutic strategies. It may be argued that when other options to effectively relieve suffering are available, euthanasia and assisted suicide fall outside of the purview of Hippocratic medicine. Given the existence of other options, the capacity for human maleficence, and the lack of resources currently allocated to the relief of suffering, this paper presents a number of reservations regarding the legalization of euthanasia and assisted suicide. In addition, it is suggested that the current community focus on the issue of inadequately relieved suffering should be harnessed to work toward the provision of care that would diminish the impression that elective death is necessary to ensure adequate relief. For a patient with incurable illnesses such as cancer, the goals of care may be stated as the alleviation of suffering, the optimization of quality of life until death ensues, and the provision of comfort in death (Wanzer et al., 1989). Persistent suffering that is inadequately relieved (or the anticipation of this situation) undermines the value of life for the sufferer. Without hope that this situation will be relieved, patients, their families, and professional health care providers may see euthanasia or assisted suicide as their only alternatives. The truth of the perception that patients need to be killed, or assisted to kill themselves, to be adequately relieved of suffering depends upon the adequacy of the available
An Argument for Physician-Assisted Suicide and Against Euthanasia
The article opens with the hypothesis that the default position that should guide healthcare providers when treating patients at the end of life is that patients opt for life. In the absence of an explicit request to die, we may assume that patients wish to continue living. Thus the role of the medical profession is to provide patients with the best possible conditions for continued living. The article makes a case for physician-assisted suicide legislation. It examines the ‘quality of life’ argument, and the issue of the patient’s autonomy and competence. It is argued that (1) quality of life is a subjective concept. Only the patient can conclude for herself that her quality of life is so low to warrant ending it, and that (2) only competent patients may request ending their lives. Patients’ lives should not be actively terminated by the medical team without the explicit consent of patients. The article then probes the role of physicians at the end of life, arguing that medicine should strive to cater to the wishes of all patients, not only the majority of them. Physicians should not turn their backs to justified requests by their patients. Physicians are best equipped to come to the help of patients at all stages of their illness, including their end-of-life. At the same time, in ending life, the final control mechanism should be with the patient. Thus physician-assisted suicide is preferred to euthanasia in order to lower the possibility of abuse and of ending the lives of patients without their consent and against their wishes. As matters of life and death are grave, they should be taken with utmost seriousness, requiring the instalment of ample checks against abuse and facilitating mechanisms designed to serve the patient’s best interests. The article concludes with nineteen careful and detailed guidelines for physician-assisted suicide. These are necessary measures designed to ensure that the best interests of the patients are served as they wished.
Yale journal of health policy, law, and ethics, 2002
I will argue that limited solidarity and limited community (the "caring" part of the 'Just Caring" problem) can be adequately protected under a liberal conception of health care justice, and such a limited notion is sufficient to protect these values as much as they ought to be protected. Going beyond these limits will threaten both the liberality and the justness of our society as far as health care is concerned. I will also argue that the first virtue of our health care system, and of managed care plans within that health care system, must be the virtue of justice. My intent is to reject the views of both libertarians, who would assign value preeminence to unequal liberty, and communitarians, such as Michael Sandel, 4 who would relegate justice to the status of a minor remedial virtue of social institutions. Finally, I will argue that the best approach to resolving fairly the last chance therapy problem will be through a form of rational democratic deliberation, which I describe below. Such an approach will yield rationing decisions when life itself is at stake that are 'just enough," that protect 'just liberty" adequately enough, and that sufficiendy maintain the bonds of a liberal pluralistic community. The practical implication of the philosophic claims I advance above is that we want our managed care plans to be Rawlsian-like liberal political communities on a small scale. 5 This would mean that members of these plans would not necessarily share with one another any comprehensive vision of the good (or even a vision of the good as it related to health care). Instead, they would share a commitment to a certain set of liberal virtues and liberal social practices, the most important of which would be a commitment to rational democratic deliberation as the primary method through which social conflict within the plan would be addressed (i.e., problems such as the last chance therapy rationing problem). Health care rationing decisions need to be made communally, if they are to be made fairly. There is no practical way for individuals as individuals to make rationing decisions for themselves of the range and complexities required by our current health care system and still preserve overall fairness. But we also readily recognize that rationing decisions need to be made freely and autonomously if they are to have moral and political legitimacy. After all, rationing (as used in this Article) is about denying individuals what all would agree is beneficial health care-albeit what is judged from some larger social point of view to be marginally beneficial, non-costworthy health care. 6 Still, it will sometimes be the case, as with last chance therapies, that marginally beneficial care is what might make the difference between life and death for a given individual (if only for a relatively brief period of time). Given the significance of an outcome like this, in a liberal society such a decision should be endorsed at some level