A formal argument on Should physician-assisted suicide be legal? using 2 Ethical theories to take a stand.
Your task in this project is to articulate your position on a specific social justice question within the topics, and to defend your position by applying two of the ethical theories. Social Justice Question: Should physician- assisted suicide be legal? 1.) Virtue Ethics and 2.)Utilitarianism It should take the form of a formal argument in a 1700 - 2100 word essay. You must make use of at least 4 course resources and at least 4 scholarly sources outside of the course. (all will be listed below) This project is, in essence, a cumulative final exam, so make sure that it focuses primarily on the ethical theories you learn to apply in the course. Also be sure to make substantial use of course resources on your topic. Outside resources will also be needed to ensure that your reader thoroughly understands your topic question and your position. References: 1. https://nerdfighteria.info/v/-a739VjqdSI/ 2. https://plato.stanford.edu/entries/ethics-deontological/ 3. https://www.youtube.com/watch?v=PrvtOWEXDIQ 4. https://www.newworldencyclopedia.org/entry/Ethics_of_care Also, use attached articles NJMP31(2).book(NJMP_A_158849.fm) 121 Journal of Medicine and Philosophy, 31:121–137, 2006 Copyright © Taylor & Francis Group, LLC ISSN: 0360-5310 print/1744-5019 online DOI: 10.1080/03605310600588665 NJMP0360-53101744-5019Journal of Medicine and Philosophy, Vol. 31, No. 02, February 2006: pp. 0–0Journal of Medicine and Philosophy Voluntary Euthanasia, Physician-Assisted Suicide, and the Goals of Medicine Voluntary Euthanasia, Physician-Assisted SuicideJ. Varelius JUKKA VARELIUS University of Turku, Turku, Finland It is plausible that what possible courses of action patients may legitimately expect their physicians to take is ultimately deter- mined by what medicine as a profession is supposed to do and, consequently, that we can determine the moral acceptability of voluntary euthanasia and physician-assisted suicide on the basis of identifying the proper goals of medicine. This article examines the main ways of defining the proper goals of medicine found in the recent bioethics literature and argues that they cannot provide a clear answer to the question of whether or not voluntary eutha- nasia and physician-assisted suicide are morally acceptable. It is suggested that to find a plausible answer to this question and to complete the task of defining the proper goals of medicine, we must determine what is the best philosophical theory about the nature of prudential value. Keywords: goals of medicine, justification, objective, physician- assisted suicide, subjective, voluntary euthanasia I. INTRODUCTION It is plausible that what possible courses of action patients may legitimately expect their physicians to take is ultimately determined by what medicine as a profession is supposed to do and, consequently, that we can determine the moral acceptability of voluntary euthanasia and physician-assisted sui- cide on the basis of identifying the proper goals of medicine.1 Considering the recent bioethics literature, a distinction can be made between two main approaches to defining the proper ends of medicine. On the one hand, it is Address correspondence to: Jukka Varelius, Ph.D., Department of Philosophy, University of Turku, F1-20014 Turku, Finland. E-mail:
[email protected] 122 J. Varelius taken that the ends of medicine can be given an objective characterization in terms of such things as preservation of life, promotion of health, relief of pain and suffering, etc. On the other hand, philosophers stressing the value of individual autonomy in biomedical ethics would seem to be committed to accepting that the proper goals of medicine are ultimately determined by the autonomous decisions of patients. If the moral acceptability of what physicians may do is always dependent on the autonomous judgements of patients, the goals of medicine are in the end defined by the patients’ auton- omous decisions. In this article, I will examine the implications of these two ways of defining the ends of medicine to the question of whether or not voluntary euthanasia and physician-assisted suicide are morally acceptable. I will argue that, on the most plausible interpretation of them, neither of these two ways of defining the goals of medicine can present a clear answer to the problem of whether or not voluntary euthanasia and physician- assisted suicide are morally acceptable. I suggest that in order to solve this problem, and to complete the task of defining the goals of medicine, we should aim to identify the most plausible theory about the nature of pruden- tial value.2 II. DEFINING THE TERMS I will be talking about voluntary euthanasia, physician-assisted suicide, indi- vidual autonomy, subjective and objective theories of value, and subjectiv- ism and objectivism about the goals of medicine. By voluntary euthanasia I mean a doctor’s intentionally killing a patient at the patient’s autonomous request. By physician-assisted suicide I mean a doctor’s intentionally help- ing a patient to commit suicide by providing the patient with the means to end her life at the patient’s autonomous request.3 Although the notion of autonomy has been used in many distinct senses in different connections, it seems that in biomedical ethics there is a com- mon core understanding of the meaning of this notion (see, e.g., Beauchamp & Childress, 1994; Harris, 2003; and Mappes & Zembaty, 1991).4 According to this idea, autonomy means self-government. As an actual condition of an individual agent, autonomy means, roughly, that an agent uses her capacity to make her own decisions concerning her own life, and lives by these deci- sions. Of course, what exactly this means is controversial. I would however argue that all plausible theories of individual autonomy accept at least the following requirements of autonomy. If a person’s decisions, beliefs, desires, etc. are due to such external influences as unreflected socialization, manipulation, coercion, and brainwashing, they are not autonomous but heteronomous. And if a person’s beliefs concerning some matter are false, inconsistent with each other, or she is insufficiently informed about that matter without realizing it,5 then she is not autonomous with respect that Voluntary Euthanasia, Physician-Assisted Suicide 123 matter. Similarly, if a person’s behavior results from such things as compul- sion and weakness of will, then it is not autonomous but heteronomous. This conception of the nature of individual autonomy is rough, but suffi- cient for the purposes of this article. According to the commonly accepted understanding of what the distinc- tion between subjective and objective theories of value is about, subjective theories make value dependent on individuals’ attitudes of favor and disfa- vor. Objective theories of value deny this dependency (see, e.g., Arneson, 1999; Bernstein, 1998; Parfit, 1984; Sumner, 1996; and Thomson, 1987). Thus, when our task is to determine whether or not some particular thing, activity, or state of affairs is valuable, the subjective theories of value advise us to consult individual agents, to pay attention to their preferences and attitudes of favor and disfavor. Usually subjective theories require that the preferences that determine value must be informed or rational.6 Objective theories, in their pure forms, maintain that value is not determined by individuals’ own attitudes of favor and disfavor. Instead of these kinds of subjective states, objective theories usually make value dependent on such purportedly objec- tive issues as whether a thing or an activity satisfies human needs, realizes the human nature, etc. Above I distinguished between two different ways of defining the goals of medicine. The view that the ends of medicine can be given an objective characterization in terms of such things as prevention of disease, relief of pain and suffering, avoidance of premature death, etc., I will call objectiv- ism about the goals of medicine. The other stand mentioned above, namely that the ends of medicine are determined by the autonomous decisions of patients, I will call subjectivism about the goals of medicine. With this understanding of the notions of voluntary euthanasia, physician-assisted sui- cide, individual autonomy, subjective and objective theories of value, and subjectivism and objectivism about the goals of medicine, I turn to consider- ing the two ways of defining the goals of medicine and their implications to the issue of the moral justifiability of voluntary euthanasia and physician- assisted suicide. III. VOLUNTARY EUTHANASIA, PHYSICIAN-ASSISTED SUICIDE, AND SUBJECTIVISM ABOUT THE GOALS OF MEDICINE The case of subjectivism about the goals of medicine and the moral justifi- ability of voluntary euthanasia and physician-assisted suicide seems rela- tively straightforward. Subjectivism about the ends of medicine maintains that what possible courses of action physicians can legitimately take is ulti- mately determined by the autonomous decisions of their patients. Conse- quently, subjectivism about the goals of medicine would seem to be committed to holding that the moral acceptability of voluntary euthanasia 124 J. Varelius and physician-assisted suicide is also dependent on the patients’ autono- mous decisions. But before we draw the conclusion that subjectivism about the ends of medicine permits voluntary euthanasia and physician-assisted suicide under these circumstances, we should need a better understanding of this way of defining the proper goals of medicine and, hence, ask why individual autonomy is such a central value in subjectivism about the ends of medicine. Two main reasons for valuing individual autonomy have been presented in the bioethics literature. Firstly, it has been maintained that autonomy is valuable as an instrument of promoting the patient’s well- being. Secondly, it has been claimed that, in addition to whatever instru- mental value autonomy has in enhancing the patient’s well-being, auton- omy is also valuable for the patient independently of its role in promoting her good (see, e.g., Beauchamp & Childress, 1994; Buchanan & Brock, 1989; Crisp, 1990; Gillon, 2003; Harris, 2003; and Veatch, 2000). Let us briefly consider the latter view. If autonomy’s value for a patient is not exhausted by its role in promot- ing her well-being, then the patient’s autonomy should be respected even if the courses of action she is considering taking were harmful for her. But how should this be understood? Since it is commonly accepted that medi- cine should be looking at things from the point of view of the patients’ interests, it is plausible that the view that a patient’s autonomy should be respected even if the courses of action she is considering taking were harm- ful for her should be interpreted to be saying that we must allow a patient acting from self-interested reasons to harm herself. But whose conception of harm is at use here? It rationally cannot be that of the patient herself, since an autonomous person acting from self-interested reasons will not want to take courses of action that she herself considers as harmful for her and, con- sequently, there is no good reason to require that the patient should be allowed to act in such ways.7 So, it seems that the conception of what is harmful for the patient would have to be that of someone else. Since other persons’ subjective determinations of what is and what is not prudentially valuable might not apply to the patient’s case at all, the question here rationally must be about an objective conception of what harms persons. And it would