Arras: Physician-Assisted Suicide: A Tragic View

Question 1

2 Judicial Decisions Striking Down Anti-PAS Laws

Answer 1

1. Reinhardt (9th Circuit): right to privacy that applied to abortion applies to choice to die
2. Miner (2nd circuit): due process clause of Constitution protects PAS
3. Supreme Court says that PAS permissible

Question 2

Arguments for PAS

Answer 2

1. Autonomy: right to self-determination, especially about matters of life, death, and meaning
   - tyranny to violate that right. don’t impose values on patients
2. Mercy: duty to relieve suffering (connected to beneficence)
3. Motives: fear of loss of control, depression

Question 3

Objections to PAS/Euthanasia

Answer 3

1. Religious (we live in a pluralistic society, so how strong?)
2. Physician Role
3. Even if morally defensible in individual cases, the consequences of a legal policy are too dangerous (this is Arras preferred line of attack).

Question 4

Slippery Slope 1

Answer 4

• Logical: once you allow PAS on grounds of mercy and autonomy, why would you (logically) stop there?
• Why not move towards “substitute judgment” for incompetent patients?
• Why not extend this to patients whose impairments do not permit self-administered suicide? Not fair to deny it to them!

Question 5

Slippery slope 2

Answer 5

1. the likelihood of abuse
2. defenders would require 3 checks:
   - - voluntary requests
   - - alternatives to PAS fully explored
   - - need a system of reporting

Question 6

Worry about voluntariness

Answer 6

how can we be sure that depression is not unduly influencing the decision

Question 7

worry about exploring alternatives

Answer 7

• won’t the disadvantaged be encouraged to die? poor, minorities, elderly, etc.
• given the lack of access to basic healthcare in the U.S., won’t there be pressure to take this option?

Question 8

Problems with judicial approach

Answer 8

1. totally focuses on individual rights and ignores social consequences
2. equal protection approach likely to undermine the very policy constraints needed to prevent abuse. if PAS is just like allowing to die, then the latter’s standards should apply to it
3. conflating killing and allowing to die not good: forcing someone to receive treatment is major imposition different than failure of mercy killing
4. slippage into all kinds of objectionable mercy killing, especially those who are not terminally ill
   discrimination against the mentally ill, for example

Question 9

state laboratories

Answer 9

1. Arras hopes states would be in a better position to appropriately regulate PAS, perhaps even excluding it.
2. States would serve as a moral buffer from impositions at federal level.

Question 10

Legal Restraint and Aggressive Medical Intervention

Answer 10

1. Current situation enables tragic victims to be visible.

2. Legalization would tend to keep the victims hidden.

Question 11

Arras adopts a tragic choice approach: there will always be some victims

Answer 11

1. Number of cases that could justify PAS are small. So focus on good care.
2. Risks of legalization are high.
3. Let’s focus energy not developing structure for legal PAS, but rather palliative care, education, and healthcare access.
4. Let’s concede that there will be cases in which docs dose patients to death for compassionate and good reasons. That’s okay in private