Notwithstanding this response, as was seen earlier, at least some proponents of voluntary medically assisted dying wish to question why medical assistance with dying should be restricted to those covered by, in particular, the first three conditions set out above in Section 2. Why, for example, should those suffering from depression, or forms of dementia, not be eligible for medically assisted dying?
Most proponents of voluntary medically assisted dying hold that there are at least two reasons for restricting access to it to those who satisfy the conditions set out earlier or, a modified set that takes account of the concerns canvassed in the discussion of those proposed conditions. First, they contend that there are political grounds for doing so, namely, that because legalizing medically assisted dying for competent individuals is politically contested, the best hope for its legalization lies in focusing on those forms of suffering most likely to effect law reform.
Second, and relatedly, most proponents of the legalization of medical assistance with dying have been cautious about supporting medically assisted death for those suffering from, for example, depression and dementia, because not only are they not terminally ill, but their competence to request assistance with dying is apt to be called into question, particularly in instances where they have given no prior indication of their preference for such assistance.
Restricting access to medical assistance with dying to those whose suffering is less likely to be disputed avoids becoming embroiled in controversy. Some critics of the restrictive approach e. Only in a few jurisdictions, viz.
In short, these latter hold that making an autonomous request for assistance with dying is necessary, but should not be sufficient, for triggering such assistance. There is one final matter of relevance to the moral case for voluntary medically assisted death on which comment must be made.
The comment concerns a point foreshadowed in a previous paragraph, but it is also linked with the remark just made about the insufficiency of an autonomous request for assistance with dying to trigger that assistance. The value or, as some would prefer, the right of self-determination does not entitle a patient to try to compel medical professionals to act contrary to their own moral or professional values. Hence, if voluntary euthanasia is to be legally permitted, it must be against a backdrop of respect for professional autonomy.
Given that, to date, those who contend that no scope should be permitted for conscientious objection within medical practice have garnered very little support for that view, making use of referrals and transfers remains the most effective means of resolving such disagreements. Opponents of voluntary euthanasia have endeavored in a variety of ways to counter the very straightforward moral case that has been laid out above for its legalization see, for example, Keown ; Foley, et al.
Some of the counter-arguments are concerned only with whether the moral case warrants making the practice of voluntary euthanasia legal, whereas others are concerned with trying to undermine the moral case itself. In what follows, consideration will be given to the five most important counter-arguments. For more comprehensive discussions of the morality and legality of medically assisted death see Keown ; Biggar ; Gorsuch ; Young ; Sumner It is sometimes said e. Some have urged, in consequence, that voluntary euthanasia is unnecessary. There are several flaws in this contention.
First, while both good palliative care and hospice care make important contributions to the care of the dying, neither is a panacea. To get the best palliative care for an individual involves trial and error, with some consequent suffering in the process; moreover, even the best care fails to relieve all pain and suffering. Perhaps even more importantly, high quality palliative care commonly exacts a price in the form of side-effects such as nausea, incontinence, loss of awareness because of semi-permanent drowsiness, and so on.
A rosy picture is often painted as to how palliative care can transform the plight of the dying.
Such a picture is misleading according to those who have closely observed the effect of extended courses of treatment with drugs like morphine. For these reasons many skilled palliative care specialists acknowledge that palliative care does not enable an easeful death for every patient. Second, even though the sort of care provided through hospices is to be applauded, it is care that is available to only a small proportion of the terminally ill and then usually only in the very last stages of the illness typically a matter of a few weeks.
Notwithstanding that only relatively few of the dying have access to hospice care it is worth drawing attention to the fact that in, Oregon, to cite one example, a high proportion of those who have sought physician-assisted suicide were in hospice care. Third, and of greatest significance for present purposes, not everyone wishes to avail themselves of palliative or hospice care.
For those who prefer to die on their own terms and in their own time, neither option may be attractive. As previously mentioned, a major source of distress for many dying patients is the frustration that comes with being unable to satisfy their autonomous wishes. Fourth, as also indicated earlier, the suffering that occasions a desire to end life is not always traceable to pain caused by illness. For some, what is intolerable is their forced dependence on others or on life-supporting machinery; for these patients, the availability of effective pain control is not the primary concern.
In relation to the preceding matters see Rietjens, et al. It is certainly true that a request to die may not reflect an enduring desire to die just as some attempts to commit suicide may reflect only temporary despair. That is why advocates of the legalization of voluntary euthanasia have argued that a cooling off period should normally be required before euthanasia is permitted to ensure that the request is enduring. If a competent person discusses the issue with others on different occasions over time, and remains steady in her resolve, or privately reflects on the issue for an extended period and does not waver in her conviction, her wish to die surely must be counted as enduring.
But, it might be asked, what if a person is racked with pain, or mentally confused because of the measures taken to relieve her pain, and is, in consequence, unable to think clearly and rationally about the alternatives? It has to be agreed that a person in those circumstances who wants to die should not be assumed to have a truly voluntary and enduring desire to die. However, there are at least two important points to make about those in such circumstances. First, they do not account for all of the terminally ill, so even if it is acknowledged that such people are incapable of agreeing to voluntary euthanasia that does not show that no one can ever voluntarily request help to die.
View Voluntary Euthanasia Research Papers on ookafgaylad.tk for free. View Euthanasia Research Papers on ookafgaylad.tk for free. Dying Without a Script: Some Theological Reflections on Voluntary Assisted Dying.
Second, it is possible in at least some jurisdictions for a person to indicate, in advance of losing the capacity to give competent consent, how she would wish to be treated should she become terminally ill and suffer either intolerable pain or an unacceptable loss of control over her life cf. As long as they are easily revocable in the event of a change of mind just as civil wills are , they should be respected as evidence of a well thought-out conviction.
For more detailed consideration of these instruments see the entry on advance directives. Perhaps, though, what is really at issue in this objection is whether anyone can ever form a competent, enduring and voluntary judgement about being better off dead, rather than continuing to suffer from an illness, prior to suffering such an illness cf. If this is what underlies the objection it is surely too paternalistic to be acceptable. Why is it not possible for a person to have sufficient inductive evidence e.
This is not the appropriate forum for a full consideration of the doctrine, for which see the entry on the doctrine of double effect. However, there is one very important criticism to be made of the application of the doctrine that has direct relevance to the issue of voluntary euthanasia.
At other times, it is understood, more strictly, as damage that has been wrongfully inflicted. On either understanding of harm, there can be instances in which death for a person does not constitute a harm for her because it will either render her better off, or, as some would insist, no worse off, when compared with remaining alive.
Accordingly, in those instances, the doctrine of double effect can have no relevance to the debate about the permissibility of voluntary euthanasia. For extended discussions of the doctrine of double effect and its bearing on the moral permissibility of voluntary euthanasia see, e. The reason why passive voluntary euthanasia is said to be morally permissible is that the patient is simply allowed to die because steps are not taken to preserve or prolong life.
This happens, for example, when a dying patient requests the withdrawal or the withholding of measures whose administration would be medically futile, or unacceptably burdensome.
Despite its popularity and widespread use, the distinction between passive and active euthanasia is neither particularly clear nor morally helpful. For a fuller discussion, see McMahan Whether behavior is described in terms of acts or omissions a distinction which underpins the alleged difference between active and passive voluntary euthanasia and that between killing a person and letting her die , is often a matter of pragmatics rather than anything of deeper moral importance.
Are these acts or omissions? If the answers turn on merely pragmatic considerations the supposed distinction between passive euthanasia and active euthanasia will be hard to sustain.
Even supposing that the distinction between acts and omissions, and the associated distinction between killing and letting die, can be satisfactorily clarified on which see the entry doing v. Consider a case of a patient suffering from motor neurone disease who is completely respirator dependent, finds her condition intolerable, and competently and persistently requests to be removed from the respirator so that she may die. Even the Catholic Church in recent times has been prepared to agree that it is permissible, in a case like this, to turn off the respirator.
No doubt this has been because the Catholic Church considers such a patient is only being allowed to die. Even were it to be agreed, for the sake of argument, that such a death should be regarded as an instance of letting die, this concession would not show that it would have been morally worse had the patient been killed at her request active voluntary euthanasia rather than being allowed to die passive voluntary euthanasia.
Indeed, supporters of voluntary medically assisted death maintain that since death is beneficial in such an instance or, at the very least, leaves the dying person no worse off , actively bringing about the death is morally to be preferred to just allowing it to happen because the desired benefit is achieved sooner. But it will often be implausible. Suppose as sometimes happens that this is then followed by withholding artificially supplied nutrition.
Winkler Nor is it appropriate to claim that what kills the patient is the underlying disease. What kills the patient is the act of depriving her of nutrition i.
The point can be generalized to cover many more instances involving either the withdrawal or the withholding of life-sustaining medical treatment. In short, there is no good reason to think that whereas so-called passive voluntary euthanasia is morally acceptable active voluntary euthanasia never can be. But we can go further.
Giving titrated doses of morphine that reach levels beyond those needed to control pain, or removing a respirator from a sufferer from motor neurone disease, seem to many of us to amount to intentionally bringing about the death of the person being cared for. To be sure, as was acknowledged above, there are circumstances in which doctors can truthfully say that the actions they perform, or omissions they make, will bring about the deaths of their patients even though it was not their intention that those patients would die.
Nevertheless, as we have seen, there are other circumstances in which it is highly stilted to claim, as some doctors continue to do, that they had no intention of bringing about death. These considerations should settle matters but do not do so for those who maintain that killing, in medical contexts, is always morally unjustified — a premise that underwrites much of the debate surrounding this fourth objection. But this underlying assumption is open to challenge and has been challenged by, for instance, Rachels and McMahan One of the reasons the challengers have given is that there are cases in which killing a competent dying person when she requests assistance with dying, is morally preferable to allowing her to die, namely, when taking the latter option would serve only to prolong her suffering against her wishes.
Further, despite the longstanding legal doctrine that no one can justifiably consent to be killed on which more later , it surely is relevant to the justification of an act of killing that the person killed has autonomously decided that she would be better off dead and so asks to be helped to die.
It is sometimes said that if society allows voluntary euthanasia to be legalized, we will then have set foot on a slippery slope that will lead us eventually to support other forms of euthanasia, including, in particular, non-voluntary euthanasia.
Slippery slope arguments come in various versions. One but not the only way of classifying them has been to refer to logical, psychological and arbitrary line versions. For further discussion see, e. We need first to consider whether, at the theoretical level, any of these forms of argument is powerful enough to refute the case for the legalization of voluntary euthanasia.
To begin with, there is nothing logically inconsistent in supporting voluntary euthanasia while maintaining the moral inappropriateness of non-voluntary euthanasia. Undoubtedly, some advocates of voluntary euthanasia wish also to lend their support to some acts of non-voluntary euthanasia, for example, for those in persistent vegetative states who have never indicated their wishes about being helped to die, or for certain severely disabled infants for whom the outlook is hopeless.