The Death of Socrates, by Jacques-Louis David (1787)

Technology prolongs and sustains life artificially. Parallel to the question of when becomes a person in the abortion debate, a central question in the euthanasia debate is when does one cease to be a person? If one is deemed no longer to be a person, then the question of their rights is less important.

What is death? Until recently the cessation of breathing and heartbeat defined death. Now machines maintain respiration and heartbeat even when there is no brain functioning. So increasingly brain death is the preferred definition.

Also relevant to discussion of death are: 1) philosophical concerns about what is a person; 2) physiological concerns about what criteria define death; and 3) methods used to determine physiological states. Moreover the various definitions have a huge impact on moral decisions (if one is already dead, the moral situation is different from if one is not.)

Another important distinction is between ordinary treatment that offer a hope of benefit without undue cost vs. extraordinary treatment that offer no hope of benefit at great cost. The most obvious difficulty here is that the definitions keep changing, as what was once extraordinary—say heart surgery—becomes ordinary.

Also to be differentiated is killing vs allowing to die. The former refers to an act of commission (causing harm) that brings about death; the latter to an act of omission (permitting harm) that brings on death. Defenders of the importance of the distinction argue that if we kill, we are the cause of death; whereas if we allow someone to die, the disease is the cause of death. Opponents argue the distinction is not relevant.

A narrow definition of euthanasia (E) includes only killing as E; allowing to die is not E. Proponents typically view E as wrong; but allowing to die as not wrong.

A broad definition of E includes both killing (active E) and allowing to die (passive E). Proponents typically argue that both killing and letting die can be moral.

Another distinction is between voluntary E—where the patient consents to treatment or non-treatment—and non-voluntary E—where someone other than the patient gives consent.  In addition, sometimes the category of involuntary E is introduced, cases where one doesn’t consent but had not made their wishes known beforehand.

Another important category is assisted suicide, typically by a physician (PAS). This is similar to voluntary active E except that in PAS the physician does not kill the patient but enables it.

In addition, the right to refuse treatment has been recognized in America since 1990. In addition, the use of living wills, durable power of attorney, advanced directives, and similar documents are now allowed.

Other problematic cases include the issue of defective newborns (DN). Here positions range from: 1) allowing to die in most circumstances; 2) allowing to die only when DN won’t have meaningful lives; 3) never allow to die. (At the other extreme would be killing in most circumstances.)

In the next few posts, we will outline some views on the issue.

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