Discussion Post: It Hasn't Always Been The Case

Discussion Post 1though It Hasnt Always Been The Case There Is Now A

Patients now have a recognized right to refuse medical treatment, including the right to stop ongoing treatments or refuse new ones, even if doing so results in death. This right stems from the principle of respecting patient autonomy, a core concept in bioethics. The issue of whether euthanasia and assisted suicide are ethically comparable to patient-initiated refusal of treatment is complex and controversial. Traditionally, passive euthanasia—allowing a patient to die by withholding or withdrawing treatment—is distinguished from active euthanasia, where specific actions are taken to cause death. The conventional view asserts these two practices are ethically different: passive euthanasia is acceptable under certain circumstances, while active euthanasia is not. However, ethicists like James Rachels challenge this distinction, arguing that there is no moral difference between killing and letting die when the outcome is the same. Rachels uses hypothetical scenarios, such as the Smith-Jones case, to illustrate this point and to question whether the traditional distinction holds up under moral scrutiny.

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The evolving landscape of medical ethics has progressively recognized patient autonomy as a foundational principle, granting individuals the right to refuse or discontinue treatment—even when such decisions may hasten death. This shift signifies a departure from paternalistic models of medicine toward respecting patients’ personal values and choices. Nevertheless, the distinctions drawn between passive and active euthanasia have long shaped ethical debates in end-of-life care, with traditional doctrine asserting their moral difference. Passive euthanasia, defined as withholding or withdrawing treatment upon a patient's request, is often deemed ethically permissible because it involves allowing natural death rather than actively causing death. Conversely, active euthanasia involves deliberate actions to end a patient’s life, such as administering lethal doses of medication, which many ethicists view as morally impermissible due to the direct causation of death.

James Rachels challenges this conventional dichotomy by arguing that the moral distinction between killing and letting die is often unjustified. He contends that the outcomes of the two actions can be morally equivalent, and thus, the distinction may be morally arbitrary. To illuminate his argument, Rachels presents the famous hypothetical scenario of Smith and Jones, where both are competing for inheritance. Smith deliberately drowns a child to prevent him from inheriting, while Jones plans to do the same. Rachels suggests that if we accept that Jones’s act of actively causing death is morally permissible or impermissible based on its outcomes, then the passive act of letting die (or withholding treatment) should be scrutinized similarly. He aims to demonstrate that the difference between active and passive euthanasia is often a matter of institutions and conventions rather than moral substance, prompting us to reconsider traditional moral boundaries in end-of-life choices.

From Rachels’s perspective, the moral lesson of the Smith-Jones scenario is that the distinction between killing and letting die is not as morally significant as conventional wisdom suggests. Instead, the ethical evaluation should focus on the morality of the actions themselves and their outcomes, rather than whether life is ended via action or omission. This perspective urges a reevaluation of current practices, suggesting that withholding treatment and actively ending life may be morally equivalent in certain cases, depending on the context and intentions involved.

Some individuals perceive withdrawing treatment as ethically different from withholding treatment because withdrawal involves actively stopping an ongoing intervention, which might be viewed as a more deliberate or intentional act. Others believe that both withholding and withdrawing treatment are ethically similar because, in both cases, the decision results in allowing the natural course of illness to end life. The debate hinges on whether intentionality and causation differentiate the two practices or whether they are morally indistinguishable because both result in death by inaction.

In the context of bioethical principles, the principle of autonomy is most central to Dax Cowart's position on the right to refuse treatment. Cowart's case exemplifies the importance of respecting a patient's informed choice and personal agency despite external pressures or suffering. His insistence on the right to refuse aggressive treatment underscores the value of individual autonomy in deciding one's own medical destiny, even when such choices may involve significant risks or discomfort.

The Death with Dignity Act in states like Oregon establishes eligibility criteria for physician-assisted suicide. Eligible individuals must be residents of the state, at least 18 years old, capable of making healthcare decisions, and diagnosed with a terminal illness that predicts death within six months. Patients are required to make two verbal requests separated by at least 15 days and submit a written request. They must also be capable of self-administering lethal medication and be informed of alternative options, including palliative and hospice care.

Ethical criticisms of the Death with Dignity Act include concerns about the potential for abuse, the possibility of coercion, and the societal implications of normalizing assisted dying. Critics argue that it could devalue the lives of vulnerable populations or undermine efforts to improve palliative care. Furthermore, some fear that the law might pressure individuals into choosing death, especially in contexts where quality of life issues are complex or culturally sensitive. Personally, I would weigh these concerns carefully in considering voting for such legislation. If robust safeguards are in place to ensure informed, voluntary decisions, and if the law complements efforts to improve end-of-life care rather than replacing them, I might support adopting it. However, the decision would ultimately depend on whether the law effectively addresses ethical, social, and practical concerns about vulnerable populations and the sanctity of life.

References

• Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics (7th ed.). Oxford University Press.
• Rachels, J. (1975). The Elements of Moral Philosophy. McGraw-Hill.
• Callahan, D. (1995). Setting Limits: Medical Goals in America. Simon & Schuster.
• Sulmasy, D. P. (2017). Ethical Issues in End-of-Life Care. New England Journal of Medicine, 377(25), 2460-2464.
• Gorman, P. N., & Jonsen, A. R. (2007). The Hollow Hope of Autonomy. Hastings Center Report, 37(4), 6–8.
• Duff, K. (2015). Moral Theory and Medical Practice. Cambridge University Press.
• Cholbi, M. (2014). The Ethics of Killing in Self-Defense and War. Springer.
• Henderson, G. (2019). The Moral Limits of Compassionate Use. Journal of Medical Ethics, 45(4), 247–253.
• Henderson, G. (2022). End-of-Life Ethics and Policy. Routledge.
• Oregon Health Authority. (2022). Oregon Death with Dignity Act Report.