Hardwig: Dying at the Right Time: Reflections on (Un) Assisted Suicide

Question 1

The timing of death

Answer 1

it doesn’t always come at the right time. death can come too soon but it can also come too late

Question 2

the social context of dying

Answer 2

1. the individualistic fantasy is a flawed way of thinking about ourselves
2. Falsely assumes that our lives are separate
3. Death is usually “death in the family.”
4. Need to consider that relational context. Often medical ethics discussions about death does not do so

Question 3

when would someone be better off dead?

Answer 3

point 1: pain not the only reason

point 2: sometimes can be better off dead even if you don’t have a terminal illness

Question 4

reasons to be better off dead

Answer 4

1. severe and unrelieved pain
2. permanent unconsciousness
3. severe dementia
4. physical disability
5. progressive/continuous deterioration
6. lose of independence/dehumanization
7. notice that these are not all of these involve standard physical pain

Question 5

dying as a relief

Answer 5

1. terminal illness is not the only situation in which one is better off dead
2. it might be worse to not have a terminal illness. consider case of progressive dementia
3. refusing medical treatment does not always create a reasonably good death

Question 6

religion and ending life

Answer 6

1. it is wrong to end life before God chooses to end it
2. assumption: life is God’s gift to give/take away
3. all suicide (even mercy killing) ends a life before God chooses it
4. Therefore, all suicide is wrong

Question 7

objection 1

Answer 7

should work both ways

Question 8

objection 1: should work both ways

Answer 8

1. If it is possible to die sooner than God wants, it should be possible to die later than God wants
2. If the reply is “everyone dies at the right time ordained by God,” then a suicide would be the right time

Question 9

Objection 2

Answer 9

God’s “Right Time” might involve suicide

Question 10

objection 2: god’s “right time” might involve suicide

Answer 10

“ . . . .we have no right to assume that God will ‘take my life’ when it is the right time for me to die. There could be a religious test—God may want me to take my own life and question whether I will meet this final challenge” (p. 684).

Question 11

main argument about WHO has a duty to die

Answer 11

1. i have special obligations to loved ones (especially family)
   - these special obligations may require me to sacrifice my own interests in ways other obligations don’t
2. i shouldn’t impose severe burdens on my loved ones
3. if prolonging my life does impose severe burdens, then i ought (have a duty to) not prolong my life (i should die)
   - the duty to die is prima-facie
   - the conclusion is influenced by a number of conditions which strengthen or weaken the duty (the WHEN question)

Question 12

WHEN is the duty to die stronger?

Answer 12

1. The greater the burdens you impose.
2. Your loved ones are having a hard life.
3. Loved ones have sacrificed for YOU.
4. You have already lived a good, full life.
5. You are older and have less life to live.
6. You cannot adjust to your illness or handicap.
7. The part of you that is loved will soon be gone.

Question 13

Who should kill me?

Answer 13

myself, my family, doctors

Question 14

unassisted suicide: i should kill myself

Answer 14

1. I am responsible for my own life, especially the most important matters like whether to continue to live or die.
2. It is unreasonable for me to ask others to perform actions that I am most responsible for.
3. It is unreasonable to impose the burden of killing me on others.
4. Therefore, I should kill myself.

Question 15

5 reasons why killing myself is not optimal

Answer 15

1. many people, especially the very sick, are physically unable
2. not always so easy to “pull the trigger”
3. risk of failed suicide attempt resulting in permanent damage
4. might take life earlier than necessary
5. isolated approach to suicide that does not include family

Question 16

Family-Assisted Suicide

Answer 16

1. It is important that the duty to die involve family members in order to affirm the relational context of the decision.
2. Family members could provide the needed assistance to overcome the difficulties raised against self suicide.
3. Therefore, it should be a family member that kills the person with a duty to die.

Question 17

major objections

Answer 17

1. It will likely cause much pain and suffering to the family member killing the person who has a duty to die (especially if that duty is for their sake!).
2. Family member is very vulnerable to legal punishment.
3. Family member may easily bungle the job and not be able to go through with it.

Question 18

My doctor should kill me

Answer 18

1. Physicians have extensive knowledge about disease and dying.
2. Physicians have knowledge of drugs and methods to make sure the suicide works.
3. Not as much social stigma surrounding doctors performing mercy killing on behalf of patients/families.
4. Doctors SHOULD be with their patients at the moment of death in order to give them the maximal care they deserve.

Question 19

Concluding points

Answer 19

medicine and justice

Question 20

Concluding points: medicine and justice

Answer 20

1. other societies have taken the duty to be central (Eskimos)
2. medicine increases the numbers of situations in which people’s lives are prolonged with great suffering
3. U.S. political system shifts care and cost of medicine onto families so the duty to die is only more pressing (discuss this one)
4. the strong focus on patient autonomy increases the chances that death will come to late. Need to reorient to the relational context of a patient’s decisions