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

By John Keown | Go to book overview

PREFACE

There are few more momentous and controversial questions facing contemporary society than the legalisation of voluntary, active euthanasia (VAE) and active physician-assisted suicide (PAS). The campaign for their legalisation shows little sign of abating. In January 1997, campaigners for PAS argued their case before the United States Supreme Court. They had persuaded two Federal Appeal Courts that the US Constitution recognised a right of mentally competent, terminally ill patients to PAS. Unanimously, the Supreme Court reversed both decisions.1

As the Supreme Court's decisions illustrate, despite the popular support the campaign for legalisation seems to enjoy and the considerable media attention it has generated, the campaign has as yet enjoyed surprisingly little success in changing laws around the world. This is largely because opposition to change remains strong. That opposition is partly based on the view that it is always morally wrong for one person, doctor or not, intentionally to kill another innocent person, even at their request. But it is also rooted in the concern that if VAE/PAS2 were permitted they would not remain voluntary for long, and that patients who did not really want to die, or who were not suffering severely, or whose suffering could be alleviated by palliative medicine, would nevertheless have their lives terminated. Indeed, fear of this 'slippery slope' is proving to be the major obstacle to reform. But is this fear justified or illusory? This is the question which has taken centre-stage in the current political debate, and it is the question which forms the centre-piece of this book.

Many people favour the legalisation of VAE. Their reasons are typically twofold: compassion and autonomy. They think VAE is right because it

____________________
1
Washington v.Glucksberg 138 L Ed 2d 772 (1997);Vacco, Attorney-General of New Yorket al. v.Quill et al., 138 L Ed 2d 834 (1997).
2
Hence forth, to avoid repetition, 'VAE'will be used to in clude PAS, unless the contrary is apparent from the context.

-xi-

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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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