Euthanasia: Is lethal injection worse than pulling the plug?

[Intro + Jingle] Is it ever okay for a doctor to intentionally kill their patient? In this Wi-Phi video, we’ll ask what steps a healthcare provider should be allowed to take to help a suffering patient with a terminal condition who wants to die. Medical science has made amazing advances, enabling people to live longer, better quality lives than ever before. Yet even current medicine has its limits. Sometimes, while trying to treat a particularly devastating injury or aggressive disease, the patient’s medical team realizes there’s no stopping further deterioration of the patient’s condition whatever they do, the patient will, to the best of our medical knowledge, surely die soon. When a patient's condition becomes terminal, healthcare providers shift from curative care where they’re trying to cure or promote recovery from the underlying problem – to palliative care, where the aim is to keep the patient comfortable for whatever time they have left. This is partially what it means to enter Hospice, for example. Sometimes, though, despite our best efforts to reduce their pain, the patient continues to suffer And sometimes their quality of life is bad enough that they ask their doctor to help them die more quickly and painlessly: in other words, they ask their doctor to facilitate their voluntary euthanasia. Now, while certain aspects of voluntary euthanasia provoke intense debate, there is in fact widespread agreement. At least regarding terminal patients suffering a miserable quality of life. at there are some steps a doctor should be allowed to take, at their patient’s request, to limit how much longer the patient has to live in suffering. For example, there’s a virtual consensus on allowing or even requiring providers to follow a patient’s explicit instructions not to try to resuscitate them if they go into cardiopulmonary arrest. Most people also agree that if a patient hooked up to a life support machine directs their doctor to withdraw this life-sustaining care so they can die more quickly, their doctor is allowed to do so. Where many people draw the line, though, is when a patient asks their doctor to medically expedite their death, by providing them with a lethal dose of pills to kill themselves or by directly administering a lethal injection. Taking these steps, they say, would violate the healthcare professional’s oath to “do no harm.” Others disagree, arguing that the oath isn’t literally about doing no harm – or else surgery would also be a violation. Rather, it’s about balancing harms and benefits to serve the best interests of the patient. If voluntary euthanasia is in the patient’s best interest, it shouldn’t matter whether this is done by non-rescusitation or by lethal injection. Yet many insist that there is a crucial difference here. After all, when a provider refrains from resuscitating a patient, she’s simply allowing the natural course of events to proceed without her intervention: she is simply letting him die an act of passive euthansia. On the other hand, if the provider injects her patient with a lethal drug, she is intervening to help him die. This is active euthanasia, in that she is actively killing him. And there’s a clear ethical distinction between killing someone and simply letting them die. Intentionally killing someone who isn’t threatening you and doesn’t otherwise deserve to die is absolutely wrong, no exceptions. The ethics of letting someone die, though, is less straightforward. After all, people die all the time, and we can’t try to save everyone. Sometimes, then, it is permissible to let someone die: like in the voluntary passive euthanasia of a terminal patient facing unendurable suffering. Now, there’s certainly something intuitively plausible about this distinction. When we compare cases of killing with cases of letting die, it does feel like killing is worse. But is it actually worse? Or are our intuitions just getting distracted by other differences between the cases? Some think we’re just getting distracted that cases of killing feel worse only because the person in these cases has worse intentions or more control over what happens than the person in the letting die cases. Take away these differences, and the apparent ethical distinction between killing and letting die also disappears. To illustrate this point, philosopher James Rachels asks us to imagine two characters, Smith and Jones. Smith and Jones both stand to gain a generous inheritance if their young nephews were to die – and both really want that inheritance. One night, while Smith’s nephew is having a bath, Smith sneaks up and drowns the boy. Jones also plans to drown his nephew during bathtime, but as he sneaks up, he sees the boy slip and fall unconscious into the water. Jones monitors the situation, ready to push the boy’s head back underwater if necessary – but, as it turns out, the boy drowns all on his own. So both Smith and Jones intend to murder their nephews with the goal of getting the inheritance. And each has enough control over what happens to ensure that his nephew will end up dead. The only difference is that Smith kills his nephew while Jones doesn’t have to do the “wet” work (as it were) – he just lets his nephew die. And this difference in how they carry out their plans doesn’t seem to make a real ethical difference: they’re both guilty of murder! Likewise, Rachels would say, as long as a doctor’s intention is to mercifully fulfill her patient’s wish to die as soon as possible, it shouldn’t matter whether she carries this out by passive non-resuscitation or by active lethal injection. In fact, if lethal injection accomplishes this goal more quickly and painlessly, it might even be the more ethical way to go! And where exactly is the line between killing and letting die, anyway? When a doctor turns off the life support machine keeping her patient alive, is she passively letting him die, or actively killing him? What if she significantly increases his morphine dosage, intending to effectively manage his intense pain, but also knowing that it’s likely to halt his breathing? If this action does lead to death, it would seem to be an act of killing rather than an act of letting die. Yet most opponents of voluntary active euthanasia are willing to allow it. So does the doctor’s obligation to do no harm really justify a prohibition on voluntary active euthanasia even as it allows voluntary passive euthansia? Or is the intuitive difference between killing and letting die actually just based on a gut feeling, with no ethical significance? What do you think? [Outro+Jingle]