Physician-Assisted Suicide: What are the Issues?

237 Pages·2002·4 MB·English

by  Loretta M. Kopelman, Kenneth A. De Ville (auth.), Kenneth A. De Ville (eds.)

PHYSICIAN-ASSISTED SUICIDE:
WHAT ARE THE ISSUES?
Philosophy and Medicine
VOLUME 67
Founding Co-Editor
Stuart F. Spicker
Editor
H. Tristram Engelhardt, Jr., Department of Philosophy, Rice University, and
Baylor College of Medicine, Houston, Texas
Associate Editor
Kevin Wm. Wildes, SJ., Department of Philosophy and Kennedy Institute of
Ethics, Georgetown University, Washington, D.C.
Editorial Board
George J. Agich, Department of Bioethics, The Cleveland Clinic Foundation,
Cleveland, Ohio
Nicholas Capaldi, Department of Philosophy, University of Tulsa, Tulsa,
Oklahoma
Edmund Erde, University of Medicine and Dentistry of New Jersey, Stratford,
New Jersey
Eric T. Juengst, Center for Biomedical Ethics, Case Western Reserve
University, Cleveland, Ohio
Christopher Tollefsen, Department of Philosophy, University of South
Carolina, Columbia, South Carolina
Becky White, Department of Philosophy, California State University, Chico,
California
The titles published in this series are listed at the end of this volume.
PHYSICIAN -ASSISTED
SUICIDE:
WHAT ARE THE ISSUES?
Edited by
LORETTA M. KOPELMAN
KENNETH A. DE VILLE
Department of Medical Humanities
The Brody School of Medicine at East Carolina University
Greenville. North Carolina
USA
....
KLUWER ACAD"EMIC PUBLISHERS
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Library of Congress Cataloging-in-Publication Data is available.
ISBN-13: 978-1-4020-0365-3 e-ISBN-13: 978-94-010-9631-7
DOl: 10.1007/978-94-010-9631-7
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TABLE OF CONTENTS
ACKNOWLEDGMENTS vii
LORETTA M. KOPELMAN AND KENNETH A. DE VILLE I
The Contemporary Debate Over Physician-Assisted Suicide 1
PART I: ON THE PERMISSIBILITY OF
PHYSICIAN-ASSISTED SUICIDE
H. TRISTRAM ENGELHARDT, JR. I Physician-Assisted Suicide and
Euthanasia: Another Battle in the Culture Wars 29
R. G. FREY I RefusalsIWithdrawals and Physician-Assisted Suicide 43
DAN W. BROCK I Physician-Assisted Suicide - The Worry
About Abuse 59
PART II: CHALLENGING THE CASE FOR
PHYSICIAN-ASSISTED SUICIDE
ROBERT L. HOLMES I Is There a Slippery Slope From Suicide,
to Assisted Suicide, to Consensual Euthanasia? 77
LORETTA M. KOPELMAN I Does Physician-Assisted Suicide Promote
Liberty and Compassion? 87
LAURIE ZOLOTH I Job Openings for Moral Philosophers in Oregon:
Physician-Assisted Suicide and the Culture of Romantic Rescue 103
PART III: PHYSICIAN-ASSISTED SUICIDE:
VIEWS FROM THE CLINIC
GAILJ. POVARI Physician-Assisted Suicide - A Clinician's
Perspective 119
DAVID B. RESNIK I Physician-Assisted Suicide: The Culture of
Medicine and the Undertreatment of Pain 127
STEVEN H. MILES I Managed Health Care at the End of Life 149
VI TABLE OF CONTENTS
PART IV: VISIONS OF THE FUTURE FOR
PHYSICIAN -ASSISTED SUICIDE
KENNETH A. DE VILLE / Physician-Assisted Suicide and the States:
Short, Medium, and Long Term 171
MARGARET P. BATTIN / Safe, Legal, Rare? Physician-Assisted
Suicide and Cultural Change in the Future 187
WILLEM A. LANDMAN / A Proposal for Legalizing Assisted Suicide
and Euthanasia in South Africa 203
NOTES ON CONTRIBUTORS 227
INDEX 231
ACKNOWLEDGMENTS
It may seem surprising, even morbid, that the Department of Medical
Humanities in the Brody School of Medicine at East Carolina University
celebrated its twentieth anniversary with a conference on Physician-
Assisted Suicide. Yet in many ways this topic represents the central goals
of the department. It is an important topic that demands critical
examination of moral, social and professional values and presuppositions
about duty, relief of suffering, the limits of autonomy, compassion,
nonmalificence, and fidelity. This subject, moreover, raises enduring
problems about how to choose between such momentous values as
preserving life and alleviating suffering when they conflict. Finally, this
subject is timely since several important court cases were decided shortly
before this conference was held on March 13-14, 1998 in Greenville,
North Carolina, where most of the papers appearing herein were
presented.
Only part of the conference was devoted to debates over physician-
assisted suicide, the rest of the conference entitled, "Controversies in
Bioethics," included papers on a variety of other topics. As the spring
meeting of the Society of Health and Human Values (SHHV), it
constituted very nearly its last event before it went out of existence. Later
that year, SHHV along with two other organizations, the American
Association of Bioethics and the Society for Bioethics Consultations,
combined to form the American Society of Bioethics and Humanities
(ASBH) in 1998. As the last president of the SHHV and the founding
president of ASBH, the conference had special meaning for me (LMK).
The conference was sponsored by the Department of Medical
Humanities, the Bioethics Center, and the office of CME at the Brody
School of Medicine.
It is our pleasure to acknowledge the contributions of several people
who played key roles in the development of the Department of Medical
Humanities and in enhancing the intellectual climate of the institution.
We wish to thank the former Deans and Vice Chancellors for Health
Sciences at the Brody School Medicine, William Laupus and James A.
Hallock, for their support of the Department of Medicial Humanities. Dr.
Laupus hired Loretta Kopelman in 1978 during the first year of the
viii ACKNOWLEDGMENTS
school's existence as a four-year medical school, enabling the program to
grow with the school. He secured support for two more positions in the
next six years and John Moskop and Todd Savitt joined the program.
Reidar Lie was hired in 1987 and remained until he returned to Norway to
head the medical humanities program at the University of Oslo. Jeff Kahn
was appointed in 1989 and now directs the Center for Bioethics at the
University of Minnesota. Kenneth De Ville was hired in 1992. In 1995,
with the support of Dr. Hallock, the Pitt County Memorial Hospital
funded the Bioethics Center in the Department of Medical Humanities at
which time John Moskop became its director. Willem Landman was
appointed that year, but returned to South Africa in 2000 as CEO of the
Ethics Institute of South Africa. In 1998, David Resnik was hired. Our
most recently hired faculty member in the Department is John Davis.
We wish to thank Lisa Boward Bagnell, administrator of the
Department of Medical Humanities, for working so hard to collect the
various draft essays from the authors and overseeing and attending to the
many details of editing, proofreading, and formatting papers. Shirley Nett
also helped with these tasks, as did our student assistant, Kristy L. Aro, a
senior from East Carolina University's Department of English, who
proofread the entire manuscript for us.
Most important, we would like to thank the contributors to this volume
for their willingness to highlight the important issues that shape the
debate over physician-assisted suicide.
Loretta M. Kopelman
Kenneth A. De Ville
July, 2001
Greenville, North Carolina
LORETTA M. KOPELMAN
KENNETH A. DE VILLE
THE CONTEMPORARY DEBATE OVER
PHYSICIAN-ASSISTED SUICIDE
The debate over physician-assisted suicide is momentous, complex, and
contentious. Since ancient times reasonable and informed people of good
will have disagreed about the permissibility of suicide, assisted suicide,
and physician-assisted suicide and discussed the proper legal, ethical or
professional response to people prepared to assist others with suicide or
euthanasia. Some Hippocratic writings instructed early physicians about
how to help patients who might wish to commit suicide or relieve their
suffering through euthanasia. Yet the influential Hippocratic Oath from
the same period forbids doctors from participating in such activities.
Some philosophers, including Plato and Aristotle, offered principled
objections to suicide or killing even for merciful reasons, while other
early philosophers, most notably the Stoics, defended the rationality of
such policies in some cases.
Contemporary societies are also strongly divided about the
permissibility of suicide, assisted suicide, and physician-assisted suicide.
Currently, few jurisdictions permit assisting suicides even where there are
no criminal sanctions for attempting to commit suicide, and there is an
almost universal prohibition against clinicians participating in euthanasia
or assisting suicide. Yet recently The Netherlands and the state of Oregon
began to allow physicians to assist suicides under some conditions, and
The Netherlands and Japan have begun to permit euthanasia under certain
circumstances. Some observers see this as a growing trend to develop
more options for competent people who wish to end their lives.
After introducing recent court rulings that have had an impact on the
contemporary U.S. debate over physician-assisted suicide, we consider
the meaning of key terms in the discussion: assisted suicide, physician-
assisted suicide, and euthanasia. In the final sections of this introduction,
we offer a map of the main arguments for and against physician-assisted
suicide and euthanasia.
Loretta M. Kopelman and Kenneth A. De Ville (eds.), Physician-Assisted Suicide, 1-25.
© 2001 Kluwer Academic Publishers.
2 LORETTA M. KOPELMAN AND KENNETH A. DE VILLE
1. TWO U.S. SUPREME COURT DECISIONS
Two rulings by the U.S. Supreme Court have altered the contemporary
debate on physician-assisted suicide, Washington v. Glucksberg (1997)
and Vacco v. Quill (1997). In these cases, decided together in June 1997,
the Supreme Court unanimously reversed two circuit court decisions and
upheld the constitutionality of state laws that prohibit assisted suicide,
and therefore physician-assisted suicide. These much-anticipated rulings
were, as many commentators realized, both an end and a beginning. In
some ways, they mark the apex of over two decades of unprecedented
litigation regarding end-of-life care. At the same time, however,
Glucksberg and Vacco probably also signal the beginning of a new
clinical, ethical, and legal debate over the extent of an individual's right
to control the timing, manner and means of his or her death. After
Glucksberg and Vacco, however, this debate will be more frequently
relegated to state legislatures, rather than to the courts (Emanuel, 1998).
Although the issue of physician-aided death clearly has deep historic
roots (Emanuel, 1994), the public and legal discussion of patients' rights
in regard to end-of-life care exploded onto the scene primarily in the last
two decades of the twentieth century. In re Quinlan (1976) and Cruzan v.
Director, Missouri Dept. of Health (1990) captured the attention of the
nation as well as the medical and bioethics communities. Since Quinlan,
scores of state and federal appellate courts (and perhaps many more trial
courts) have rendered judgments on the legal aspects of end-of-life
decision making, most but not all relating to the appropriateness of the
removal or refusal of life-sustaining medical treatment (National Center
for State Courts, 1993). But public and professional discussion and
interest did not remain limited to the removal or withholding of unwanted
medical care. Increasingly, discussions of the defensibility of actively
shortening lives no longer considered worth living crept into the public
eye. For example, the activities of organizations such as the Hemlock
society, as well as the popularity of its founder Derek Humphrey's book
Final Exit, illustrate the way in which end-of-life discussions evolved and
became central concerns of public debate and policy reform (Humphrey,
1991). Medical literature, too, gradually addressed with more regularity
not only withdrawing care from patients who wished it, but also the more
controversial questions of euthanasia and physician-assisted suicide, in
articles such as the anonymous "It's Over Debbie," and Timothy Quill's
narrative on death with dignity (Anonymous, 1988; Quill, 1991). Perhaps