Should Doctors Practice Euthanasia?

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...and yet I think of the gentleman I admitted to my service 3 days ago who'd lost 50 lbs in 1 month from his hepatocellular carcinoma, widely metastatic, who was told point blank he wasn't a candidate for treatment. And yet, no one recommended hospice, which I am somewhat angry about, until he was sent to the hospital for a paracentesis, and the EM doc is the one who intervened. Thank you, random colleague. He hadn't been able to swallow his pain medicines in weeks.

Did I euthanize him? Nope. His cancer killed him. I didn't even really have time to get his pain under control, but he was finally a bit more comfortable. And his family knew he was dying and just wanted his pain controlled.

Lots of cancer patients are told they aren't candidates for treatment because they are too sick. Or more often, their oncologists dance around saying "you have to get stronger before we can start chemo." And of course they don't.
 
I think there is another avenue of argument - different from the sanctity of life. The sanctity of life argument would say that NOBODY should perform euthanasia, so of course doctors shouldn't either. If you reject the sanctity of life argument (I don't find it very compelling myself) then you could still make (at least) 2 other arguments against euthanasia:

1 - You think some people can choose death for themselves (suicide), but the act of killing another remains prohibited. So, no euthanasia.
2 - You think euthanasia can be appropriate, but you think that DOCTORS should not perform euthanasia as it undermines the fundamentals of what it means to be a physician.

The first line can be based on either rule based ethics (killing another is always wrong) or virtue based ethics (if I kill someone, it will establish patterns in me that I do not want established).
The second is definitional, and sits on your definition of a physician.

I find #1 with a virtue based ethics rationale to be the most compelling reason to not perform euthanasia. I recognize this is a personal choice.
 
WilcoWorld said:
I think there is another avenue of argument - different from the sanctity of life. The sanctity of life argument would say that NOBODY should perform euthanasia, so of course doctors shouldn't either. If you reject the sanctity of life argument (I don't find it very compelling myself) then you could still make (at least) 2 other arguments against euthanasia:

1 - You think some people can choose death for themselves (suicide), but the act of killing another remains prohibited. So, no euthanasia.
2 - You think euthanasia can be appropriate, but you think that DOCTORS should not perform euthanasia as it undermines the fundamentals of what it means to be a physician.

The first line can be based on either rule based ethics (killing another is always wrong) or virtue based ethics (if I kill someone, it will establish patterns in me that I do not want established).
The second is definitional, and sits on your definition of a physician.

I find #1 with a virtue based ethics rationale to be the most compelling reason to not perform euthanasia. I recognize this is a personal choice.
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The problem with this line of thinking is that it begs the question: If we already acknowledge that a patient can rightfully take her own life, then it only makes sense that a physician could/should facilitate it in the least painful way possible, just as a physician oversees the death penalty.

Also, would you say that someone has the right to kill themselves but cannot get any help from anyone else in doing it? So they have to figure out how to off themselves purely by themselves? Or can the suicide industry only be staffed by non-physicians in your view?

This is to say nothing of the fact that we would then be downgrading the protections we have placed on human life -- upon which all of human rights is based -- to a mere quibble about the role a physician is known for in society.
 
AlmostAnMD said:
But you're nothing, Angry Birds. You're just a collection of fused atoms exploded from other stars. Inside your mind is a network of cells that follow a determined pathway that react to excitation or inhibition. You have no "purpose," you have no "meaning," you aren't even yourself because the electrons you were born with have long since traded into other forms.

You are not better than a dog.
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Ok, thought experiment time.

There is a ship with a man (NOT Angry Birds), a woman, a baby, and a three year old dog in it. It's sinking and there is a life boat that can only fit 3 of the 4 on it. Who gets left out here in your opinion?

I'd be interested in the answer of our vet friends here too.
 
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Angry Birds said:
Ok, thought experiment time.

There is a ship with a man (NOT Angry Birds), a woman, a baby, and a three year old dog in it. It's sinking and there is a life boat that can only fit 3 of the 4 on it. Who gets left out here in your opinion?

I'd be interested in the answer of our vet friends here too.
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Well I’m already in the life boat, so I’m taking the baby and the dog and we’re going on an adventure! Hijinks ensue, hit sitcom to follow.
 
A simple argument could be a line of thought that we have in vet med: don't perform the euthanasia if you're uncomfortable. The personal feelings of the clinician are maintained; those who feel that euthanasia is acceptable are then also not prevented from offering the service.
 
Angry Birds said:
Ok, thought experiment time.

There is a ship with a man (NOT Angry Birds), a woman, a baby, and a three year old dog in it. It's sinking and there is a life boat that can only fit 3 of the 4 on it. Who gets left out here in your opinion?

I'd be interested in the answer of our vet friends here too.
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The ones most likely to survive the journey home. And, not for nothing, the dog could be food if necessary.

I feel like a better, more realistic thought experiment is: a child and their dog run out into the road; which do you hit with your car? In that case, I hit the dog.
 
battie said:
The ones most likely to survive the journey home. And, not for nothing, the dog could be food if necessary.

I feel like a better, more realistic thought experiment is: a child and their dog run out into the road; which do you hit with your car? In that case, I hit the dog.
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This is a thought experiment. So, we could stipulate that they all have an equal chance of surviving the journey home.
But, the fact that you say the dog can be food (not the baby?) -- and that you would hit the dog instead of the child -- means that you affirm human exceptionality, right? On what basis do you justify this exceptionality?
 
And since I’m obligated to post my opinion on the topic, I am pro-palliation, pro-physician-assisted-suicide… though fully agree there are massively problematic grey areas and possible abuses, and I’m not necessarily interested in being the doctor of record in those cases (maybe in another career-life).

I’m allow to give vaguely effective oral morphine drops to a dying patient for 72hr while they descend into delirium, coma, death… but not a large dose of oral morphine (or IV fentanyl) at the 24hr mark when death is assured but distant. To me, this is a distinction with less of a difference than what many of my co-posters on this forum feel. I certainly get your point of view, but my personal morality isn’t bothered by this act of mercy (assuming this is something we KNOW the patient wants… everything is about the patient).

I was just reading some history books last night… sailors attacked by aircraft in the middle of the ocean, bombed, explosions on their ship… some suffered 85-90% TBSA burns. Clearly they will die…there is no hospital for 1000 miles, their ship is afloat but in a bad way. Its the 1940s, we aren’t saving them even in an ICU if they were teleported to one. They are awake, and suffering horribly. Screaming, moaning, begging their companions to hasten death. Is it OK to give them a likely-lethal dose of morphine? Should their fellows sailors, when out of morphine, consider literally mercy-killing them with a gun? Should they be told suffering is part of their religious tradition, and allowed to wallow on deck until they die some hours or days later?

Clearly a rather specific example, but I think it pins one edge of our slippery slope, the other edge would be an 18yo kid with transient SI who uses a suicide-pod owned by a for-profit-healthcare-corporation that will euthanize the patient for the low fee of $99.99 and a single swipe of a credit card! No in person visit needed! A five-minute tele-consult will be performed prior to your death!

Perhaps both ends are ridiculous comparisons to typical modern American life, but I think there is space on one end of this slope where physician-involved care that hastens death may be quite reasonable (and I would argue our current hospice practice already allows for physician-hastened-death, but with soft gloves and verbiage that the POINT is to reduce suffering NOT to speed death…)
 
Angry Birds said:
human exceptionality
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I don't think the child is more exceptional than the dog on a personal level. But the parents certainly do. Which scenario leads to the least overall suffering? Hitting the dog. Especially if the dog is beyond saving, it can be euthanized. If the child is beyond saving, they sit in a coma for however long (and cannot be euthanized).

As far as baby vs dog for food, I feel like the average dog would have more edible parts compared to the baby. But that then gets into nitty gritty details of Maltese and 10 month old baby or a Bassett Hound vs a 2 month old baby.
 
Angry Birds said:
This is a thought experiment. So, we could stipulate that they all have an equal chance of surviving the journey home.
But, the fact that you say the dog can be food (not the baby?) -- and that you would hit the dog instead of the child -- means that you affirm human exceptionality, right? On what basis do you justify this exceptionality?
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Why do you continue to use this word? I think you use it because there isn't another that can exceed something that is "unusually good", "extraordinary", "deviating widely from a norm" (those are all general definitions of "exceptional")

I don't think humans are exceptional. Certainly not all. There are some downright awful human beings that should have never been born.

I don't think the human condition is exceptional either. In fact...if lions or iguanas could rise up and rule the world the way we did...they would.

I feel like you believe all humans, every single one, are exceptional.
 
Angry Birds said:
The reason we jump to euthanasia so quickly for pets is precisely because their lives are not considered equally sacrosanct-- rather, they are expendable.
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Perhaps another reason, at least mine, is that as much as we may love our pets we have not real way to communicate with them as we do with other humans and it's impossible to know the extent of their consciousness and mental life. We do know when they are hungry or experiencing pain and I think I know when they are feeling happy. Whether or not they have immortal souls I do not know. And when they are suffering from something I cannot fix I will bring them to the vet to end their pain and life and not feel that doing so is a sin. Not so for another human being. The Hippocratic Oath admonishes giving deadly drugs, even if asked, to end another's life. We are allowed to give drugs to alleviate pain. Only one is allowed to administer death, and we are not. Just my opinion, I know others feel differently.
 
Janders said:
I was just reading some history books last night… sailors attacked by aircraft in the middle of the ocean, bombed, explosions on their ship… some suffered 85-90% TBSA burns. Clearly they will die…there is no hospital for 1000 miles, their ship is afloat but in a bad way. Its the 1940s, we aren’t saving them even in an ICU if they were teleported to one. They are awake, and suffering horribly. Screaming, moaning, begging their companions to hasten death. Is it OK to give them a likely-lethal dose of morphine? Should their fellows sailors, when out of morphine, consider literally mercy-killing them with a gun? Should they be told suffering is part of their religious tradition, and allowed to wallow on deck until they die some hours or days later?
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Your story reminds me of a scene in the Netflix show Vikings: Valhalla. After pillaging a village, one of the Christian Vikings goes around driving a spear into the hearts of the severely decapitated dying soldiers. His pagan fellow soldier asks him, aren't Christians supposed to be merciful? He responded that giving these soldiers a quick death was in fact an act of mercy.

In modern times, if he did that, he'd be court-martialed and tried for war crimes. It seems right and wrong is arbitrary and changes with the times.
 
battie said:
I don't think the child is more exceptional than the dog on a personal level. But the parents certainly do. Which scenario leads to the least overall suffering? Hitting the dog. Especially if the dog is beyond saving, it can be euthanized. If the child is beyond saving, they sit in a coma for however long (and cannot be euthanized).

As far as baby vs dog for food, I feel like the average dog would have more edible parts compared to the baby. But that then gets into nitty gritty details of Maltese and 10 month old baby or a Bassett Hound vs a 2 month old baby.
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This is all over the place.
In a philosophical thought experiment all you need to do is remove variables to tighten the question. You can say the parents are dead and the human baby has no family or loved ones. In this case, would you save the human baby or the dog? We can up the ante by saying the dog actually belongs to someone, unlike the baby. Now, which are you saving?

As for your discussion of Maltese and Basset Hound... wow, just wow.

thegenius said:
Why do you continue to use this word? I think you use it because there isn't another that can exceed something that is "unusually good", "extraordinary", "deviating widely from a norm" (those are all general definitions of "exceptional")

I don't think humans are exceptional. Certainly not all. There are some downright awful human beings that should have never been born.

I don't think the human condition is exceptional either. In fact...if lions or iguanas could rise up and rule the world the way we did...they would.

I feel like you believe all humans, every single one, are exceptional.
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My choice of verbiage is not arbitrary. It is a philosophical position:

"...human exceptionalism (HE), which is the idea that humans are unique, distinctive beings that ought to be assigned a fundamental moral value in accordance with that distinctiveness"
www.psychologytoday.com

On Human Exceptionalism

Are people unique beings that warrant special moral privileges? Or are we just another species of animal, and our claims to superiority are a function of self-serving biases?
www.psychologytoday.com www.psychologytoday.com
 
But humans aren't exceptional. I actually think we are kind of lousy animals. We could do so much more with our intelligence, strength, ingenuity, creativity, and compassion and yet all we seem to do is quickly destroy this planet and most of the plant and animal species on it.

I guess we will disagree on the point of human exceptionalism. Which makes discussions about euthanasia hard to have.

Kind of reminds me about talking to people about their religious views, or topics that have a strong religious backdrop. Once they say "It's because God says so" or "it's in the bible" or "it's because of divinity...." those comments more or less end the discussion.


I don't have much more to offer on the topic of euthanasia anyway. This thread...like most on here, took a left turn many posts back and has kind of meandered off on an oblique topic.
 
thegenius said:
But humans aren't exceptional. I actually think we are kind of lousy animals. We could do so much more with our intelligence, strength, ingenuity, creativity, and compassion and yet all we seem to do is quickly destroy this planet and most of the plant and animal species on it.

I guess we will disagree on the point of human exceptionalism. Which makes discussions about euthanasia hard to have.

Kind of reminds me about talking to people about their religious views, or topics that have a strong religious backdrop. Once they say "It's because God says so" or "it's in the bible" or "it's because of divinity...." those comments more or less end the discussion.


I don't have much more to offer on the topic of euthanasia anyway. This thread...like most on here, took a left turn many posts back and has kind of meandered off on an oblique topic.
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Exceptional is not being used here in the (lay) way that you are using it, but rather, in a strict technical sense, i.e. forming an exception. It has, in other words, nothing to do with whether we are great or lousy... Rather, it has to do with moral status.

As for this thread going in a certain direction, I understand that people would think this, but in reality, this debate lies at the heart of the issue... good medical ethics means going deep into the philosophical underpinning of the various views.

Anyways, I have tried to be civil and cordially stand my ground on what seems to be an unpopular view on this forum. I can stop if it's getting annoying though.
 
Angry Birds said:
Anyways, I have tried to be civil and cordially stand my ground on what seems to be an unpopular view on this forum. I can stop if it's getting annoying though.
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You have, and you are an exceptional member of this forum! No pun intended!
 
Angry Birds said:
In a philosophical thought experiment all you need to do is remove variables to tighten the question. You can say the parents are dead and the human baby has no family or loved ones. In this case, would you save the human baby or the dog? We can up the ante by saying the dog actually belongs to someone, unlike the baby. Now, which are you saving?
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Id still pick the dog because that is still the lowest level of suffering. If either is going to experience the worst case scenario of traumatic injuries, at least the dog can be euthanized, whereas the baby could not.
Angry Birds said:
As for your discussion of Maltese and Basset Hound... wow, just wow.
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You brought up that I specified the dog as food over the baby in the stranded in the middle of the ocean scenario. Just explaining why eating the dog makes more sense than eating the baby in a pure thought experiment.
Angry Birds said:
Exceptional is not being used here in the (lay) way that you are using it, but rather, in a strict technical sense, i.e. forming an exception. It has, in other words, nothing to do with whether we are great or lousy... Rather, it has to do with moral status.
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If humans are the exceptional species elevated above all others, then why deny individual humans the option to end their lives humanely? In my field, prolonging suffering for the sake of quantity over quality of life is considered unethical. Why not in human medicine?
 
battie said:
In my field, prolonging suffering for the sake of quantity over quality of life is considered unethical. Why not in human medicine?
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That's the million-dollar question of this topic, one likely not to be answered. As previously touched on, personal views on life gray what otherwise should be a clear answer to your question.

I can only parrot you as a response, we in human medicine value quantity of life over quality. That would be very, very hard for anyone in this topic to argue otherwise. Look at the pointless, constant suffering of chronic illness that is our ICUs as evidence.
 
battie said:
Id still pick the dog because that is still the lowest level of suffering. If either is going to experience the worst case scenario of traumatic injuries, at least the dog can be euthanized, whereas the baby could not.
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Let me lay it out again in an even more simplified way: You are the conductor of a trolley and can either divert the trolley to kill a baby or in another direction to kill an adult dog. We can stipulate that whoever you don't hit goes on to live a long, healthy, and happy life. What do you do?

Again. Please keep in mind that this is a thought experiment where the point is to isolate variables.
 
AlmostAnMD said:
That's the million-dollar question of this topic, one likely not to be answered. As previously touched on, personal views on life gray what otherwise should be a clear answer to your question.

I can only parrot you as a response, we in human medicine value quantity of life over quality. That would be very, very hard for anyone in this topic to argue otherwise. Look at the pointless, constant suffering of chronic illness that is our ICUs as evidence.
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Please don't include me in this bucket. I spend a lot of time talking to my patients about quality of life and helping them to navigate choices that prioritize quality over quantity.
 
Angry Birds said:
Let me lay it out again in an even more simplified way: You are the conductor of a trolley and can either divert the trolley to kill a baby or in another direction to kill an adult dog. We can stipulate that whoever you don't hit goes on to live a long, healthy, and happy life. What do you do?

Again. Please keep in mind that this is a thought experiment where the point is to isolate variables.
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While I enjoy thought experiments, I think they rarely resolve ethical questions. They can be quite good at exposing the intuitions that have previously gone unstated, and that is useful. However we don't actually encounter such situations in nature and that makes our answers of limited generalizability. In reality, I need a lot more information to answer the question.

For instance, if the baby above was an infant Stalin, and the adult dog was Lassie - I'd choose to kill the baby.

I guess what I'm trying to say is that I don't see trolley problems as answering the question of euthanasia for me.

The more I think about ethics, the less I'm convinced that such questions have single, universal answers. In my opinion, ethical discussions go best when we try to understand each others' reasons for their choices, rather than trying to force our answers upon others.
 
WilcoWorld said:
While I enjoy thought experiments, I think they rarely resolve ethical questions. They can be quite good at exposing the intuitions that have previously gone unstated, and that is useful. However we don't actually encounter such situations in nature and that makes our answers of limited generalizability. In reality, I need a lot more information to answer the question.

For instance, if the baby above was an infant Stalin, and the adult dog was Lassie - I'd choose to kill the baby.

I guess what I'm trying to say is that I don't see trolley problems as answering the question of euthanasia for me.

The more I think about ethics, the less I'm convinced that such questions have single, universal answers. In my opinion, ethical discussions go best when we try to understand each others' reasons for their choices, rather than trying to force our answers upon others.
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Thanks for this. I understand where you are coming from but I (naturally) disagree. Thought experiments are essential to do good philosophy and in order to have clear thinking. On the flip side, one needs to understand that actual applications are indeed often messy and context dependent. But this is all the more reason to first abstract out and have clear commitments before taking a look at particular situations.

In this case, your baby Stalin example is a bad one. Not only can we not see into the future but what you are talking about leads to a bunch of other moral problems, such as holding people to account for what they will do in the future, etc. We would also need to then go even deeper into consequentialism, etc., which would be a useful exercise but also then speak to the need to abstract out in this way.

Furthermore, one can simply stipulate that the baby and dog would be equally neutral in their future lives. Again, the entire advantage of such thought experiments is to eliminate all variables and lead to clearer thinking.
 
Angry Birds said:
Thanks for this. I understand where you are coming from but I (naturally) disagree. Thought experiments are essential to do good philosophy and in order to have clear thinking. On the flip side, one needs to understand that actual applications are indeed often messy and context dependent. But this is all the more reason to first abstract out and have clear commitments before taking a look at particular situations.

In this case, your baby Stalin example is a bad one. Not only can we not see into the future but what you are talking about leads to a bunch of other moral problems, such as holding people to account for what they will do in the future, etc. We would also need to then go even deeper into consequentialism, etc., which would be a useful exercise but also then speak to the need to abstract out in this way.

Furthermore, one can simply stipulate that the baby and dog would be equally neutral in their future lives. Again, the entire advantage of such thought experiments is to eliminate all variables and lead to clearer thinking.
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I appreciate the discussion.

You say it's a bad example, because I can't know the baby's future at that moment. I say the thought experiment is lacking in persuasive power, because it doesn't give me enough information (context) to give a good answer to the question. To me, that sounds like we have some common ground.

I do think thought experiments can be quite useful in some circumstances. Einstein famously developed Relativity through thought experiments. But I think scientific theory is quite different than ethics, for science strives to find generalizable truths whereas (I think) ethics strives to answer the question of "how do I live a good life?", which (again, I think) is a very personalized question. For this reason I think thought experiments are much better suited to theory than to praxis.
 
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I'll speak broadly and ignore details that while are important bog down the underlying conversation. Fundamentally, I'm supportive of the notion that some individuals can make the informed decision that life is no longer worth living, and I would feel it could be ethical practice as a physician in some situations either prescribing for physician assisted suicide or actively euthanizing. I've heard the argument of what's the need if you're able to alleviate suffering through other means, but I don't think that necessarily holds water. Pragmatically, I worry more about the pressures of corporate medicine on physicians, societal / familial pressures on patients (perceived or actual), and how the physician-patient-family dynamic might be altered if the physician had that ability. Personally, I don't think I would feel comfortable assisting without some sort of enduring long term relationship with the patient. And the unspoken details from earlier matter quite a bit in actual practice. I don't know where I ultimately sit on the legality of either, most likely in favor of physician assisted suicide and against active euthanasia, but suffice to say I wouldn't practice contradictory to active law.
 
dchristismi said:
...and yet I think of the gentleman I admitted to my service 3 days ago who'd lost 50 lbs in 1 month from his hepatocellular carcinoma, widely metastatic, who was told point blank he wasn't a candidate for treatment. And yet, no one recommended hospice, which I am somewhat angry about, until he was sent to the hospital for a paracentesis, and the EM doc is the one who intervened. Thank you, random colleague. He hadn't been able to swallow his pain medicines in weeks.

Did I euthanize him? Nope. His cancer killed him. I didn't even really have time to get his pain under control, but he was finally a bit more comfortable. And his family knew he was dying and just wanted his pain controlled.

Lots of cancer patients are told they aren't candidates for treatment because they are too sick. Or more often, their oncologists dance around saying "you have to get stronger before we can start chemo." And of course they don't.
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I have met the kind of oncologists who just would not consider hospice, but there is also a good chance hospice was talked about and even advocated for but the patient/family was in denial and wouldn't go for it and now forget it was discussed (or perhaps blocked it from their mind). When calling their oncologists or diving through the chart (because as a surgeon I often get called at the end for these kinds of patients and prefer not giving them a long painful drawn out post surgical death if I can help it) I find the latter is much more common than the former.
 
Southpaw said:
I agree it's wonderful to care for an elderly parent, IF they are of sound mind and body and can still enjoy life. To make it personal, I have no interest in being a burden to my children. I want them to live happy lives and my spouse and I want to be part of those lives. However, if and when I get to the point where I can no longer enjoy life, and I require the help of others for the basic functions of life, and there is no hope of that ever reversing course, then please respect MY WISHES and let me die.
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LET is the crucial word, and I completely agree with your statement above. I would totally disagree if you had said "please respect my wishes and kill me."
 
neurodoc said:
LET is the crucial word, and I completely agree with your statement above. I would totally disagree if you had said "please respect my wishes and kill me."
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Yes!

I suppose it could be fair to claim the burden of proof lays upon those of us who want to make this distinction to argue how and why withdrawing artificial life support is different from adding an intervention that will hasten death since the patient is expected to end up dead either way. I'll think about coming back to make that argument, but now it's a nice day so I'm going to go play catch with my kids.
 
Kryptocoin said:
Alternate question: Can someone be pro-death penalty and anti-euthanasia?
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I don't subscribe to that belief, but I don't see why it would be challenging to adopt that perspective. If you view death as a universal negative / punishment, it's pretty easy to see how someone could be pro death-penalty and anti-euthanasia.
 
BoardingDoc said:
I don't subscribe to that belief, but I don't see why it would be challenging to adopt that perspective. If you view death as a universal negative / punishment, it's pretty easy to see how someone could be pro death-penalty and anti-euthanasia.
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So death is a universal negative. That's why we give violent prisoners a quick and humane death while we prolong the suffering and pain of our patients until the ravages of their disease eats them alive.

They both die in the end, except one took a much torturous path to get there.
 
Kryptocoin said:
So death is a universal negative. That's why we give violent prisoners a quick and humane death while we prolong the suffering and pain of our patients until the ravages of their disease eats them alive.

They both die in the end, except one took a much torturous path to get there.
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This framing of the issue takes the agency away from the patient "we prolong the suffering and pain". I think patients should be able to choose whether or not to endure life prolonging care. However forcing a patient to endure life-prolonging care is not the only alternative to euthanasia. Palliative care strives to preserve patient autonomy while offering relief from suffering.
 
WilcoWorld said:
Yes!

I suppose it could be fair to claim the burden of proof lays upon those of us who want to make this distinction to argue how and why withdrawing artificial life support is different from adding an intervention that will hasten death since the patient is expected to end up dead either way. I'll think about coming back to make that argument, but now it's a nice day so I'm going to go play catch with my kids.
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Ok, I'm going to take a crack at this.

There is a real and significant difference between providing comfort while allowing a disease process to take a patient's life versus taking an action to bring about that death. This can be difficult to wrap our heads around because the difference is not felt by that particular patient - in both cases the patient ends up (ideally) dying a comfortable death - the difference is felt by the physician and their future patients.

First, I'll claim that "passive euthanasia" is a contradiction in terms: it is my position that euthanasia is active. Euthanasia is taking an action with the intention of bringing about death. Therefore it can not be passive. Now, some will say "you ARE taking an action when you remove an endotracheal tube, thus it is not passive." I would counter that the intention of removing the endotracheal tube is not to cause death - it is to stop causing suffering. Importantly, removal of the endotracheal tube does not reliably cause death. Many (in my practice, most) patients survive compassionate extubation and go on to die from a process other than apnea. In cases of euthanasia the intent of the action is to cause death, and the actions taken more reliably cause death. If one wants to argue that it is only the consequences and not the intent of an action that determine its morality, then one opens oneself up to A LOT of responsibility. If you chose to fund your retirement account instead of donating to charity, then in this consequentialist framework you are causing the death of impoverished children by funding your retirement. I reject this.

Second, who is harmed by euthanasia? I argue it's the physician and their future patients. The physician is harmed, because in providing euthanasia they have begun to establish a pattern in their behavior. Causing death is something that they have now willingly done. This may make them more willing to cause death in the future. Their patients are harmed because they now know it's possible that their doctor's intention may be to cause their death. What was previously a possibility that they didn't have to consider is now a legitimate worry, "could my doctor be trying to kill me?"

In summary - withdrawal of artificial life support is different from euthanasia because only the latter requires the intention of causing the patient's death. I chose to not practice euthanasia, while being comfortable providing comfort care at the end of life, because I worry that providing euthanasia could establish patterns of thought and behavior in myself that I do not want established. I also want my patients to be secure in the knowledge that they can trust I am not trying to kill them.
 
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Kryptocoin said:
So death is a universal negative. That's why we give violent prisoners a quick and humane death while we prolong the suffering and pain of our patients until the ravages of their disease eats them alive.

They both die in the end, except one took a much torturous path to get there.
Click to expand...
1: I'm going to reiterate that I don't personally share the view that I described, but was rather simply answering your question.

2: Your response in absolutely no way refutes this theoretical viewpoint. Just because you're executing someone as a form of punishment does not mean that you need to torture them while doing so. Moreover, there is no logical connection between meting out capital punishment to those who (presumably) don't want it but have been sentenced to it, and whether or not that same action should be provided to non-criminals who willingly seek it.

This side discussion bears little relevance to the topic at hand.
 
WilcoWorld said:
Second, who is harmed by euthanasia? I argue it's the physician and their future patients. The physician is harmed, because in providing euthanasia they have begun to establish a pattern in their behavior. Causing death is something that they have now willingly done. This may make them more willing to cause death in the future. Their patients are harmed because they now know it's possible that their doctor's intention may be to cause their death. What was previously a possibility that they didn't have to consider is now a legitimate worry, "could my doctor be trying to kill me?"
Click to expand...
Dutch physicians would probably disagreed with you. Euthanasia has been legal in the Netherlands for over 20 yrs, and the rate of PAS has remained the same. Nor has the societal status of physicians diminished in the eyes of the public.
 
Kryptocoin said:
Dutch physicians would probably disagreed with you. Euthanasia has been legal in the Netherlands for over 20 yrs, and the rate of PAS has remained the same. Nor has the societal status of physicians diminished in the eyes of the public.
Click to expand...
I'm confident that many will disagree with me.

I do think there's a difference between physician assisted suicide and euthanasia, however.
 
WilcoWorld said:
I do think there's a difference between physician assisted suicide and euthanasia, however.
Click to expand...

Yes...both are legal. But yes, I meant PAE*, not PAS. Rate of PAE in Netherlands have been pretty consistent.
 
Last edited:
Kryptocoin said:
Yes...both are legal. But yes, I meant PAE*, not PAS. Rate of PAE in Netherlands have been pretty consistent.
Click to expand...
I'm curious about your sources. I just did a few searches on the subject and the articles I'm finding report that the rates of these practices have measurably increased in the last 20 years.
 
BoardingDoc said:
1: I'm going to reiterate that I don't personally share the view that I described, but was rather simply answering your question.

2: Your response in absolutely no way refutes this theoretical viewpoint. Just because you're executing someone as a form of punishment does not mean that you need to torture them while doing so. Moreover, there is no logical connection between meting out capital punishment to those who (presumably) don't want it but have been sentenced to it, and whether or not that same action should be provided to non-criminals who willingly seek it.

This side discussion bears little relevance to the topic at hand.
Click to expand...

I understand it's not your position. It's just an academic debate.

I'm afraid I have to disagree with your second point. But that is a much bigger topic for another thread.
 
Kryptocoin said:
"Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey".


www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61034-4/fulltext
Click to expand...
Thanks. Seems like, unsurprisingly, the results are effected by how you measure and what time periods you compare:


"The annual incidence of euthanasia in the Netherlands as a percentage of all deaths rose from 1.9% in 1990 to 4.4% in 2017"
 
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