Physician-assisted suicide: utility, virtue, and the definition of good

Summary and Critique In Vaughn’s (2012) chapter entitled “Euthanasia and Physician-Assisted Suicide,” the author identifies the crux of the ethical issues of euthanasia by stating: “the bioethical heart of the matter is the moral rightness of killing or letting die for the good of the patient” (p. 625). Vaughn (2012) goes on to note that nearly 70% of all physicians surveyed oppose physician-assisted suicide and that 42% of them oppose it on religious and non-religious grounds. However, on the matter of terminal sedation, far fewer had any problem with it and even fewer—only 5%—saw the withdrawal of life support as a moral problem. Vaughn looks at the major theories that could be used to explain these differences, such as utilitarianism (Mill), deontology (Kant), natural law (Roman Catholicism), and then provides a case study and various readings for further assistance in developing the nature of the issue.

Physician-Assisted Suicide: A Critical Philosophical Essay As with any discussion of ethics and philosophy, one cannot make any assumption about what constitutes the good. One of the problems of utilitarianism is that its moral principle is based upon the idea that what is best for the common good is what is moral—but it does not adequately define the “good” that should be viewed as common, at least not to the extent that Socrates sought to define it in Plato’s Dialogues. Plato pointed to Ideal Forms. The Transcendentals—the One, the Good, the Beautiful—these were guides that classical philosophers used to get to the heart of what is meant by the good. When referring to the good of the patient, one has to start somewhere in order to judge this good. Is it a personal or private good? Is it universal in character? What are its parameters? What defines what is good for the patient? Is it wholly subjective? Or is there an objective good that should be considered? If so, what is it and how is one to know it?
For instance, a Catholic might argue that the good in the case of a dying patient is not necessarily the “ease” with which he passes but rather the spiritual readiness the patient possesses as he prepares to come before God. Instead of being drugged into a state of insensibility or having the dying process instigated by a doctor so as to avoid pain, the Catholic might argue that those final moments or days or weeks or months of one’s life are the most important, for those are the moments God gives to a person to reflect on his life, take accounting, confess sins, and right himself with God before going to face judgment. For a Catholic, that is how the good might be defined. In this argument, one can see the tenets of virtue ethics that reach all the way back to Aristotle and Greeks.
For an irreligious man, the good might be defined wholly differently. Rather than preparing for judgment, he might assert that the time is his to do with it as he pleases. If he would rather end the suffering, or even end his life before the suffering begins, he should be free to do so. His life is his own and no one has a right to tell him how to live it or how to die. In this argument, one can see the philosophy of Egoism—the idea that what is moral is that which allows one to achieve one’s desired end. If a person’s desire is to avoid suffering, it is his choice to request euthanasia
As Vaughn (2012) notes, “moral reasoning and conceptual clarity [are] needed” and he points to the case of Terri Schiavo in 2005 as a case in point (p. 625). Schiavo was euthanized by having her feeding tube removed: it was her husband’s belief that Terri would not have wanted to live in her state; her parents objected. A court battle ensued and the judge ruled that the husband had the right to make that determination. The feeding tube was removed and over the course of two weeks, Terri starved to death. To some, it was murder. To others, it was simply the passive act of letting one who could not take care of herself die. To still others, the distinction is irrelevant: whether the doctor is actively causing death or allowing it through inattention is immaterial—the whole point of the physician is to preserve and facilitate life. Vaughn (2012) focuses on the voluntary and non-voluntary aspects of euthanasia as well as on the concepts of autonomy, mercy, and harm and how they might apply to this discussion while using other examples to show how these concepts might be considered. For example, Vaughn uses the story of a person in a car wreck who is trapped and is going to be burned alive. Rather than be killed in such a painful way, the person begs the onlooker to break the window and smash his head with a rock and kill him instantly. Vaughn asks, “Should the onlooker oblige him?” (p. 631). Because personal pain is such a subjective phenomenon, Vaughn notes that bioethicists are in disagreement about what the right answer should be. They focus, of course, on the pain aspect of life and death. By focusing on this subjective threshold, however, they wave off all claims to any objective standard by which one might rationally judge.
Vaughn applies a number of theories to help bring clarity to the issue, such as utilitarianism. However, Vaughn simplistically states that in utilitarianism the good is defined as “happiness,” which is somewhat of a misreading of Mill’s philosophy. Moreover, Vaughn does not define what is meant by “happiness,” and so the discussion is superficial at best. The classical philosophers would devote pages and pages of content to this question of what is meant by happiness. Indeed, Aristotle did exactly that. What does it mean to be happy? What is happiness? These are the questions that have to be considered at a fundamental level before an issue like euthanasia can be adequately addressed. In Vaughn’s chapter, however, the author is content to move quickly and superficially through the application of a number of different philosophies, the way one moves through lenses or filters on a camera when taking a picture in an attempt to find one that puts the image in the best light. The overall process is rushed and not given the care and consideration it deserves.
Granted, Vaughn does discuss the various utilitarian perspectives—rule-utilitarian vs. preference-utilitarian vs. classic utilitarianism; but the overall effect is still the same. The author wants to cover sufficient ground without lingering too long in any one place, which is understandable—but it does not help to adequately answer or address the issue. It is the philosophical equivalent of a daytime talk show attempting to address important social issues. There are no commercial breaks but the method does not facilitate the exploration of important details and tangents that one might get to explore more closely when reading Plato or Aristotle or Augustine or Aquinas.
Vaughn concludes his analysis of the issue by commenting that most arguments against euthanasia are based on the slippery slope argument—i.e., that “allowing these practices would inevitably lead to abuses, most notably unjustified killing” (p. 637). However, this is not a convincing argument, as the theories discussed prior indicate that the main moral problem with euthanasia has to do not with potential abuses but rather with whether the act of killing (mercy killing) is moral or whether the act of passively allowing someone to die is moral. Here Vaughn associates the slippery slope argument against euthanasia with the data obtained from regions where legalization of euthanasia in some parts of the world has occurred.
The slippery slope argument, though, does not appear to be an effective way to have the last word on this issue, as it is not the main ethical problem. No one is arguing that euthanasia is immoral because everyone might start seeking physician-assisted suicide and that that would be bad. Rather, the ethical argument for it or against it is simply based on the concept of the good, as Vaughn points out in the beginning of the chapter. The good, however, is never defined adequately in the chapter and thus the issue is never resolved. Vaughn takes no point on the matter but rather relates in a superficial manner some of the approaches one might take when establishing a position.
For a more effective take on the issue of euthanasia, Vaughn could have established a fuller position and then justified it. Considering that this is a textbook only and not a treatise or article in which a claim is might, it makes sense why Vaughn attempts to remain objective and distanced from coming down on one side or another. But the fact that he concludes his discussion with the slippery slope argument as though this were the main reason people might oppose it suggests that there are no good ethical reasons for opposing euthanasia other than that people fear what the outcome might be. This is a disingenuous conclusion for a chapter that purportedly set out to examine the ideas on both sides of the argument. Instead, it is a superficial conclusion that falls in line with the superficial overview of the discussion at the heart of the euthanasia issue: “the moral rightness of killing or letting die for the good of the patient” (Vaughn, 2012, p. 625). Vaughn (2012) never gives an answer one way or another. My View My view on this matter is that the most appropriate ethical approach to physician-assisted suicide can be found in natural law as described in Roman Catholicism. In this view, as Vaughn (2012) points out, natural law would forbid “active and passive euthanasia, though the condemnation comes with qualifications” (p. 635). The nuance of this approach can be found in the intention of the care provider: it is permissible, for example, for morphine to be given a patient in the final stages of life to ease the patient’s suffering even though doing so will also speed up the dying process as the body will begin to shut down. But if the care provider’s intention is only to ease the pain of the person and not to bring about the patient’s death, it is permissible.
This qualification may be confusing to some who are for euthanasia because they might say that their intention is merely to ease the pain of the person, too—but the difference is in the respect for life. In physician-assisted suicide, the intention is to end the life of a patient, for example, who may have terminal cancer—and the death is brought about with a strong dose of pharmaceutical intervention that will overwhelm the body in a few moments. This is not the same as giving low doses of morphine when an elderly patient has stopped eating and is obviously in the final stages of death and the morphine is given to ease the pain even though it will also hasten the death of the individual.
It is also different from the removal of Terri Schiavo’s feeding tube. The feeding tube could not be considered an extraordinary means of prolonging a person’s life but rather a natural means of doing so. Schiavo was aware and even communicative according to her parents, though her husband argued this was not the case. By denying her basic necessities of food and water, Schiavo was starved to death. This was a case of passive euthanasia and natural law would not permit it. In my view, Schiavo was murdered by the hospital, the court, and her husband. It was a violation of ethics of the most basic fundamental aspect—that life is good and should be preserved insofar as is naturally possible.
This definition of good is what should guide the ethical approach to this question. Classical philosophy shows that everything has a purpose or a natural end and when human actions are in conformity with that end they can be called moral. Understanding this end can help people to see where they are acting morally in their own lives and where they are acting immorally.
A physician’s duty is to protect and preserve life. The problem in the U.S. is that life has been politicized. Life in the womb is seen not as life in the womb but rather as a political issue impacting women’s rights. People want to talk about rights when what they should be talking about is duty. The deontological ethics of Kant apply here: one’s actions are moral insofar as they align with one’s duty. What is the duty of a father once a child is born? To provide for it, shelter it, and help it to grow. What is the duty of a mother when a child is conceived in the womb? The exact same. However, because of the politicization of the issue, it is not viewed the same. This is now happening, too, with individuals who suffer and want to die. Suicide—the voluntary taking of one’s life—has generally been viewed throughout history as a violation of charity and hope, same as with euthanasia.
Since morality, however, inevitably brings up the God question, in my view terminating a life to end one’s suffering is a sin against faith, hope, and charity. As all things come from God, one should hope to accept them with love and courage and prepare oneself for the next world. But that, of course, now takes this philosophical discussion into the realm of theology, which is another discussion altogether.

References
Vaughn, L. (2012). Bioethics: Principles, issues, and cases. Oxford University Press.