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

By John Keown | Go to book overview

Conclusions

Given that each chapter in the book has its own conclusions, this concluding chapter will be brief, and confine itself to drawing together some of the main threads of the argument the book has advanced against legalising VAEor PAS.

Part VI highlighted a corner of the euthanasia debate which is too often overlooked – passive euthanasia – and argued that it deserves greater consideration, not least in view of cases such as Bland and the guidance produced by the BMA. If it is wrong intentionally to kill patients by an act, why should doctors be allowed intentionally to kill patients by withholding or withdrawing treatment or tube-feeding? Is it not gravely inconsistent for the law to prohibit doctors from administering a lethal injection to a patient at the patient's request, but to allow doctors intentionally to starve a patient to death without request? Although the bulk of this book has been concerned with VAE rather than PE, intellectually consistent opposition to the former requires opposition to the latter.

The Introduction noted that many people support the legalisation of VAE and/or PAS. Those people, many of whom have seen their loved ones die in distress, campaign for the law to be relaxed to allow doctors actively and intentionally to hasten the deaths of competent patients who freely request death as a last resort to avoid unbearable suffering. The book began in Part I by stressing the importance of clarity in definition, and of distinguishing (as do the Dutch) intentional (purposeful) from merely foreseen life-shortening. Part II outlined the central moral arguments advanced to support V A E in principle, and concluded that those arguments are unpersuasive. It went on to argue that, even if VAE or PAS were morally acceptable in certain, rare 'hard cases', it would be bad public policy to relax the law in order to accommodate those cases. The lawyer's adage 'hard cases make bad law' is particularly apt in response to the campaign for VAE.

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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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