Forced abandonment and euthanasia: a question from Katrina

Social Research, Spring, 2007 by Kenneth Kipnis

The Objections

Objections to the argument from intractable suffering focus on the proviso that there be "no sound and proportional countervailing reasons." Here it is useful to distinguish between "yellow light" objections, urging caution, and "red light" objections, admonishing one to stop. While the former express concerns about the possibility of adverse consequences, the latter hold that euthanasia is impermissible on its face.

Many are the yellow-light objections. There is the alleged slippery slope down which we can slide to holocaust. Further, compassionate homicide might erode the professional commitments of physicians as well as our trust in doctors. (That might be a reason for barring the involvement of physicians.) There are the fears that patients will be depressed or pressured at the time of decision, that they may have been misdiagnosed, that haste in ending patients' lives can prevent possible recoveries, that relatives and health care providers will conspire to end the lives of the ill, and that protective measures will be unequal to the task of preventing carelessness and misconduct. These objections can be definitively assessed only when we have determined what protective measures we are talking about and how these have worked in practice. Here we can usefully study the Oregon record, as it becomes available, and the experience of the Dutch, the Belgians, and the Swiss. Unlike the Nazis, we can require our protocols to be implemented in the light of day. And even if some adverse consequences should occur following legalization, these would have to be measured carefully against the adverse consequences of prohibition.

Prematurity is a concern that permeates many of the yellow light objections: worries that life-ending decisions will be unnecessarily rushed. If only there were enough time to reconfirm the diagnosis, to labor with patients about their decisions, to try out other strategies for alleviating discomfort or for stopping the progress of the disease, to await new treatments that might suddenly become available, to rule out depression or undue pressures on the part of friends and relatives. ... If only there were enough time, then many (most? all?) patients who now seem only too ready to let go of their lives might decide to hold on instead. Physicians have weighty duties to prevent the deaths of their patients or, failing that, to see them through the burdens of the dying process. When the death of another is a foreseen consequence, one wants to be sure there are no better options. Perhaps no one can ever be sure enough. There is here a venerable ideal of a certain type of therapeutic partnership between the vulnerable patient and the steadfast clinician. Even if a dying person is pleading for the relief that only death can promise, a clinician who kills a patient arguably betrays his or her commitment to that alliance.

Many of the red light objections emerge from within discrete religious traditions. These sectarian counterarguments often proceed from a premise that human life is, in some way, sacred, not to be discarded or taken; that euthanasia is, at bottom, a mortal sin. But in a pluralist society, the considerations that settle public issues ought to be ones that can, at least in principle, persuade any reasonable person: not just those who have embraced some preferred sectarian view. (5) So if, for example, the closely related idea of human dignity can be given a secular interpretation--one that is both broadly persuasive and sufficiently weighty--and if the favored understanding of that idea mandates the continuation of medical care while precluding euthanasia, then it may be reasonable to keep the law of homicide as it is (Sulmasy, 1994). Such arguments would have to be examined in detail (Dworkin, 1994: 68101,179-217).