Euthanasia, Ethics, and Public Policy: An Argument against Legalisation

By John Keown | Go to book overview

FOREWORD

Forewords do not usually begin with a disclaimer, but there is a reason here, for Euthanasia, Ethics and Public Policy uncompromisingly addresses themes which colleagues of the present writer, and occasionally he himself, have tackled in the past, and may have to tackle together in the future. Comity and courtesy make it necessary to avoid the implication that the opinions expressed in this valuable work are necessarily shared in full. This being said, it is a pleasure to welcome a contribution to what is, at present, the most intellectually demanding, the most ethically challenging, and the most important for its contingent effects as well as for its immediate practical impact, of all the points on the line where law, medicine, belief and reason intersect.

The image of the slippery slope is often called up as a warning to those who take an easy step without looking to see where the next may lead, but it also reminds us that in this area the concepts themselves are slippery, escaping sideways from the effort to grasp them. The overlapping problems of accelerated death demand intellectual honesty rather than unfocussed right-thinking, and an emphasis on duties as well as individual rights.

The steepness of the slope, and its treacherous footing, are often concealed by an emollient vocabulary. Thus, the expression 'best interests' conveys an upbeat meaning, at odds with its more chilling implications. So also, the contemporary watchword 'personal autonomy' distracts attention from the duties of those implicated in the rights-based choice of the principal actor. Indeed, so deceptive is the terminology that these two antithetical concepts, authoritarian and libertarian, are quite frequently deployed at the same time: an important example of the need to know what words mean before employing them in debate. The present work uncompromisingly takes this stance, and is right to do so. Equally, it exposes the interchangeable usage of concepts which are not the same: intend/foresee,

-xiii-

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Euthanasia, Ethics, and Public Policy: An Argument against Legalisation
Table of contents

Table of contents

  • Title Page *
  • Contents vii
  • Preface xi
  • Foreword xiii
  • Acknowledgments xv
  • Table of Cases xvi
  • Abbreviations xviii
  • Introduction 1
  • Part I - Definitions 7
  • 1 - 'Voluntary Euthanasia' 9
  • 2 - Intended V. Foreseen Life-Shortening 18
  • 3 - 'Physician-Assisted Suicide' 31
  • Part II - The Ethical Debate: Human Life, Autonomy, Legal Hypocrisy, and the Slippery Slope 37
  • 4 - The Value of Human Life 39
  • 5 - The Value of Autonomy 52
  • 6 - Legal Hypocrisy? 58
  • 7 - The Slippery Slope Arguments 70
  • Part III - The Dutch Experience: Controlling Vae? Condoning Nvae? 81
  • 8 - The Guidelines 83
  • 9 - The First Survey: the Incidence of 'Euthanasia' 91
  • 10 - Breach of the Guidelines 103
  • 11 - The Slide Towards Nvae 115
  • 12 - The Second Survey 125
  • 13 - The Dutch in Denial? 136
  • Part IV - Australia and the United States 151
  • 14 - The Northern Territory: Rotti 153
  • 15 - Oregon: the Death with Dignity Act 167
  • Part V - Expert Opinion 181
  • 16 - Expert Committees 183
  • 17 - Supreme Courts 191
  • 18 - Medical Associations 208
  • Part VI - Passive Euthanasia: Withholding/withdrawing Treatment and Tube-Feeding with Intent to Kill 215
  • 19 - The Tony Bland Case 217
  • 20 - Beyond Bland: the Bma Guidance on Withholding/withdrawing Medical Treatment 239
  • 21 - The Winterton Bill 260
  • Conclusions 273
  • Afterword: the Diane Pretty Case 282
  • Bibliography 292
  • Index 303
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