Bioethics 3# test

While Rachels is correct that we will be inclined to judge Smith and Jones equally harshly, it is because they were both prepared to

kill for motives of personal gain. The same is true of Tooley's examples. -In their efforts to ensure that each person in their cases does not differ in any morally relevant way, they make the agents too similar: each agent is guilty of the same moral offense

The Concepts of Health and Disease- Since genetic therapy serves morally legitimate goals

it is morally acceptable; but since genetic enhancement serves morally questionable goals, it is not morally acceptable

Calling letting die (when it is in accordance with this ethics) 'killing' is to make a mistake- Killing' should be reserved for

lethal injections and stopping life support for patients who would otherwise recover

Euthanasia:

literally, from Greek meaning "good death"

Summary of Kuhse: Sanctity of life is the basis for

many laws -Murder is the intentional (including by omission) causing of death -Both killing and letting die are murder (Moral Difference Myth = a myth) -Sometimes, killing a severely disabled newborn is morally better than letting it die

Grisez and Boyle think every intentional killing is immoral because

it is at odds with the respect we owe to the life of such persons

"Listening and Helping to Die" Know the two case studies Admiraal discusses in his article

"As doctors we have two primary duties: to ensure the well-being of our patients, and to respect their autonomy. The first duty entails that we should seek to restore patients to health, and, if we can't, that we should try to reduce their suffering. The second duty entail that we listen closely to, and respect, the wishes of our patients." I have reached the conclusion that ther is, in the end, no morally relevant difference between these two forms of euthanasia (active and passive). In both cases, the doctor acts out of respect for the autonomy of the patient. In both cases, life is shortened. In both cases, the doctor has performed an act which has led to the patient's death, and in both cases, the doctor must take responsibility for that action." "Very often passive euthanasia is worse than active euthanasia.

Verdict on Sanctity of Life- Kuhse:

"Does human life, irrespective of its quality or kind, have 'sanctity',... or should life and death decisions in the practice of medicine at least sometimes be based on quality-of-life considerations?"

What is Kuhse's verdict on the sanctity of life?

"Does human life, irrespective of its quality or kind, have 'sanctity',... or should life and death decisions in the practice of medicine at least sometimes be based on quality-of-life considerations?"

(Helga Kuhse)- The Trial: Justice F

"However much the disadvantage of a mongol... no doctor has the right to kill it" -Sounds like the Sanctity of Life Ideal -But, Dr Arthur goes free! Why? Because (apparantly) he let John die (different to killing)

How does Admiraal respond to the "slippery slope" argument against allowing active euthanasia?

"I do not accept that there is a slippery slope. A clear moral and legal boundary can be drawn around the notion of consent....No patient-no matter how ill-will have his or her life cut short, unless there is an explicit request."

Pieter Admiraal Slippery Slope?

"I do not accept that there is a slippery slope. A clear moral and legal boundary can be drawn around the notion of consent....No patient-no matter how ill-will have his or her life cut short, unless there is an explicit request."

1) Self-Determination: How to get from our right of self-determination to waiving our right to life and giving a doctor the right to kill us?

"I have yet to hear a plausible argument why it should be permissible for us to put this kind of power in the hands of another"

Listenting and Helping to Die: The Dutch Way ( Pieter Admiraal): Euthanasia and Medical Practice quote

"I regard it as morally right, as not only compatible with the properly understood duties and responsibilities of a doctor, but as an act sometimes required by them. To fail to practice voluntary euthanasia under some circumstances is to fail the patient."

3) Over-extending medicine- Euthanasia's proponents' view:

"It should be prepared to make its skills available to individuals to help them achieve their private vision of the good life." -Asking for amputations and cat-face surgery

Is killing intrinsically worse than letting die? Or is it worse for agents motivated by personal gain to actively intervene against nature to gain his own ends, as opposed to an agent would just stand there and watch as nature does the work? Kuhse:

"Killing may be worse than letting die in those cases, and better than letting die in others." Example: A truck driver is stuck in a for-certain death, trapped in a blazing truck. He asks his co-driver to kill him, to put him out of his misery.

4) Euthanasia and Medical Practice: quotes

"The great temptation of modern medicine, not always resisted, is to move beyond the promotion and preservation of health into the boundless realm of general human happiness" "It would be terrible for physicians to [...] think that in a swift, lethal injection, medicine has found its own answer to the riddle of life."

Should euthanasia be restricted to those who are terminally ill, according to Admiraal? Why or why not?

"The notion of 'terminal illness' is slippery....This means that the notion of terminal illness cannot be employed, in a straightforward way, to justify medical end-of-life decisions." "The doctor might think that life with a certain condition is, or ought to be, bearable; but to the extent that the properly counselled and supported patient takes a different view, it is the patient's view, which must ultimately be the determinative one."

Slippery Slope

"They insult our sensitivity by the suggestion that a society of individuals of good will cannot recognize situations in which our fellows want and need help and cannot distinguish such situations from those in which the desire for death is rhetorical, misguided, temporary, or idiotic."

John Lachs, 'When Abstract Moralizing Runs Amok': quotes

"They must bear the pain of existence without the ability to perform the activities that give life meaning" And "few have a taste for blowing out their brains or jumping from high places" "That leaves drugs" but... the medical profession has "monopoly power over drugs"(which is why we turn to them) -And laws deter or prevent medical professionals from assisting these people

"The Note" Why does Hill decide life is no longer worth living for him? Despite the fact that he's worked hard to accept his new condition, he finds his efforts now to be "painful, frustrating, and completely unsatisfying." Some have told him he was fortunate because he can still work. But,

"[he] worked to live, not lived to work." He lost more than just his physical independence, but he also "lost [his] dignity and self-respect... would forever be a burden on those around [him] and [he] didn't want that no matter how willingly and unthinkingly family and friends assumed that burden.

'When Self-Determination Runs Amok' (Daniel Callahan on Euthanasia): "The euthanasia debate is not just a moral debate." It's

"emblematic of three important turning points in Western thought."

Why does Callahan argue that self-determination in cases of euthanasia is different from other cases of self-determination (in other words, what makes euthanasia more problematic than, say, physician-assisted suicide)?

"euthanasia and assisted suicide are perfectly compatible with the aims of medicine" Lots of people commit suicide because they find no meaning in life - a question of values Does anyone have the expertise to know if lives are worth living? Euthanasia is ... no longer a matter only of self-determination, but a mutual, social decision between two people, the one to be killed and the one to do the killing. Doctors are overburdened When patients die, doctors feel morally responsible Doctors will be encouraged to kill on grounds of "humanness and economics"

The status of self-determination is not absolute, but

"in the end, our lives belong to no one but ourselves" -Subject to normal liberal non-harming limits

Callahan's mischaracterization of people with terrible diseases

"looking for the meaning of existence and find it, absurdly, in a lethal injection" They are not looking for meaning, they want relief from their suffering!

The Difference Thesis Cont'd- Tooley concludes that if one wishes to appeal to intuitions,

"one must be careful to confine one's attention to pairs of cases that do not differ in these, or other significant respects."

1) Self-Determination: Suicide more personal than euthanasia

'Euthanasia is ... no longer a matter only of self-determination, but a mutual, social decision between two people, the one to be killed and the one to do the killing.'

2) The limits of self-determination

'The acceptance of euthanasia would sanction a view of autonomy holding that individuals may, in the name of their own private idiosyncratic view of the good life, call upon others, including such institutions as medicine, even at the risk of the common good.'

Calling letting die (when it is in accordance with this ethics) 'killing' is to make a mistake - 'you killed her' just means

'in my opinion you were involved in her death in a way that makes you blameworthy of her death'

The Death of John Pearson: 1980: Molly gives birth to John, healthy, but has Down's Syndrome (Helga Kuhse)

-"Parents do not wish baby to survive. Nursing care only" -Dr. Arthur prescribed a narcotic painkiller, water and no food - John died 3 days later; A hospital employee reported it

"A Modern Myth: That Letting Die is Not the Intentional Cause of Death" (Helga Kuhse) : Kuhse's Project

-'Busting the 'Moral Difference Myth' -Discrediting the Sanctity of Life Ideal -Opening the way for legalizing euthanasia -In cases where doctors would withhold care, they should consider killing

Can rights be transferred? Cont'd: The significance of context

-1st kidney is OK, but not the 2nd -Too much harm could be caused Extortion, misinformation etc.

What are the three almost certain consequences of permitting euthanasia according to Callahan?

-Abuses are inevitable -Not all will agree with law as written and bend it to their own ends -Some evidence of non-voluntary euthanasia in Holland -Police will have more important things to do than follow up on potential abuses -Hard to write law (what constitutes 'unbearable suffering'), so hard to enforce -Decisions within the context of private and confidential doctor patient relationship

"Persons soliciting help in dying must be ready to demonstrate that they are of sound mind and thus capable of making such choices, that their desire is enduring, and that both their subjective and their objective condition makes their wish sensible"

-And doctors must consider if they can and think they should perform such an act (in general and in this case) This includes proactive assessment of the patients claims -Privacy vs. abuse - permitting scrutiny is compatible with preserving the privacy to decision-making.

No antibiotics as the cause/difference:

-Babies normally survive pneumonia -Those not given antibiotics die -Not giving antibiotics was the cause of death

Jones manages to slip and fall and knock himself unconscious before he can drown the child, which he is attempting to do.

-By the time he regains consciousness, the child (unaware of Jones' intentions) manages to call his parents, and Jones' opportunity is gone. -Here, Jones neither kills his nephew nor lets him die, but "it would be agreed that given his preparedness to kill the child for personal gain, he is as reprehensible as Smith."

2) Killing vs. allowing to die: Causality vs. culpability

-Direct physical cause vs. attributing moral responsibility to human actions -Causality: direct physical cause of death -Culpability: Our attribution of moral responsibility to human actions

Two disturbing consequences of conflating killing and letting die:

-Doctors are overburdened -When patients die, doctors feel morally responsible -Doctors will be encouraged to kill on grounds of "humanness and economics" (even if patient not so keen?) Last 6 months costs the taxpayer a lot Last 6 months often involves objective suffering

Doctrine of Double Effect (DDE)

-It is sometimes permissible to cause a harm as a foreseen side-effect of one's intentional action, even though it would be impermissible to intentionally cause the same harm.

3) Calculating the consequences Cont'd: If self-determination allows euthanasia for the terminally ill, why not anyone who judges their life not worth living, including those with no medical problem?

-It would be unfair not to euthanize a demented person who is suffering -"If we really believe in self-determination, then any competent person should have the right to be killed by a doctor for any reason that suits him. If we believe in the relief of suffering, then it seems cruel and capricious to deny it to the incompetent." -There is no logical stopping point once the door is open

Can rights be transferred? Cont'd: It's not a 'fundamental moral wrong' to give away my second kidney

-It's just not a good idea to allow it when all things are considered -The same goes for euthanasia

Tooley's Smith and Jones - Case 1: Jones wants Smith dead, and shoots him. Case 2: Jones is about to shoot Smith, when he sees that Smith will be killed by a bomb unless Jones warns him, as he easily can.

-Jones does not warn Smith, and the bomb explodes, killing Smith.

Why does Nesbitt say that the behavior of Smith and Jones (the "nasty uncles") is equally reprehensible?

-Jones neither kills his nephew nor lets him die, but "it would be agreed that given his preparedness to kill the child for personal gain, he is as reprehensible as Smith." -We judge Jones to be just as reprehensible as if he had killed Smith, but since he was fully prepared to kill him had he not been saved the trouble by the bomb, we should make the same judgment even if he had neither killed Smith nor let him die -overlook that what determines whether or not someone is reprehensible is not simply what he does, but what he is prepared to do.

4) Euthanasia and Medical Practice :Some think: "euthanasia and assisted suicide are perfectly compatible with the aims of medicine" Do doctors have the relevant expertise?

-Lots of people commit suicide because they find no meaning in life - a question of values -Does anyone have the expertise to know if lives are worth living?

Which are Conditions and which is the Cause? - Why did the plants die?

-No rain -No visitors watered them -The gardener didn't water them

Which are Conditions and which is the Cause? - Why is the house on fire?

-Oxygen present -House made of wood -Curtains made of flammable cloth -Alight kerosene lamp knocked over

3) Calculating the consequences: Abuses are inevitable -Not all will agree with law as written and bend it to their own ends -Some evidence of non-voluntary euthanasia in Holland

-Police will have more important things to do than follow up on potential abuses -Hard to write law (what constitutes 'unbearable suffering'), so hard to enforce -Decisions within the context of private and confidential doctor patient relationship

Pneumonia as the cause/difference:

-Rejected handicapped babies normally die -Some die from pneumonia, others from other illnesses -Pneumonia was the cause of death

The Abnormal Child vs the Child Next in Queue- The dilemma is this: Andrew (the child next in queue) will only be born if the first (abnormal) child is not born (or if the abnormal child does not survive after birth)

-So it is in Andrew's interest for the first child not to be born -Hare envisions a prenatal conversation between Andrew and his possible sibling, trying to agree on a proposal that gives the best possible chance of a healthy baby for the parents

Argument: Active Euthanasia is often more humane than passive Case 1.2: A Down's Syndrome infant suffers a malady (ex: intestinal blockage) that requires a simple operation in order to live.

-Suppose his parents and the doctor decide not to operate, to let the baby die. -The baby would suffer dehydration and infection before dying. -It would be cruel if the baby were not given a lethal injection (since its terminal fate is death anyway).

What is the proposal the abnormal fetus suggests?

-The abnormal fetus argues for this proposal: "We'll make a bargain. We will say that I am to be born and operated on, in the hope of restoring me to normality. If the operation is successful, well and good. If it isn't, then I agree that I should be scrapped and make way for Andrew." -This compromise gives the best possible chance of having a healthy baby and at the same time gives the fetus all the chance it ever had of itself being that baby

2. Argument: The doctrine leads to decisions concerning life and death on irrelevant grounds- Case 2.1: A Down's Syndrome infant needs a medically-doable operation (intestinal operation) unrelated to the Syndrome in order to live.

-The operation is not done because the child has Down's Syndrome, and thus it is better for the child to die. -It is Down's Syndrome that is the defining grounds for death, not the operation. -The presence of the intestinal blockage merely serves as the "excuse" for letting die. Since, if that's not the case, "nothing can be done, for one must not 'kill' it"

Most rights can be transferred,Of course there are limits:

-Usually involving making money from things (e.g. selling your kids) -I can work minimum wage flipping burgers 10 hours a day, but I can't permanently sell myself as a slave

Two basic approaches to the definition of health

-Value-neutral (descriptive) approach -Value-laden (prescriptive) approach

4 types of genetic interventions:

1) Somatic genetic therapy (SGT) 2) Germline genetic therapy (GLGT) 3) Somatic genetic enhancement (SGE) 4) Germline genetic enhancement (GLGE)

Rachel's "Nasty Uncles"- We should judge Jones just as harshly as Smith, given what he was

prepared to do, even if he had not let his nephew die

Rachel's "Nasty Uncles"- Rachels argues that

-if letting die were in itself less bad than killing, Jones' defense that "I didn't kill him; I only let him die" would carry some weight. -So we conclude that Jones is just as reprehensible as Smith.

Why do many people believe that gene therapy is permissible while genetic enhancement is not?

-risk to future generations -parent used as a means to achieve eugenic effect in offspring -Therapy relieve human suffering

Most rights can be transferred:

-teeth cleaning, (sweetheart, dental hygienist) -home ownership, kidneys, -deciding when to rise, sleep (by joining the army).

Causality and Culpability: Stopping treatment is not the cause of death- The cause of death is

-the disease. Turning off the life-support machine does not kill a healthy person -Although not a cause, we might find stopping treatment culpable (blameworthy) -Stopping treatment out of malice or mistake

Justice F: In medicine, murder and the mere setting of conditions in which death might occur are very different; This may seem unusual But Justice F explains 4 examples

1) A baby with Down's and an intestinal blockage (=setting of conditions) 2) A healthy, but severely handicapped child. Doctor prescribes lethal dosage of pain-killer (=murder) 3) Terminal cancer patient. Doctor prescribes lethal dosage of pain-killer but only for pain relief (=setting of conditions) 4) A rejected severely handicapped child gets pneumonia. The doctor withholds antibiotics (=setting of conditions)

Killing vs. Letting Die- Two ways of fleshing out the killing/letting die distinction

1) Act/Omission distinction: 2) Sometimes we do things, other times we refrain from doing things.

Argument: Active Euthanasia is often more humane than passive- Case 1.1: Patient is dying of incurable cancer, in terrible unalleviable pain, subject to irrefutable imminent death. (first and second)

1) Because of the last clause, the patient and his immediate family has decided to end the patient's life 2) If the doctor withholds treatment (a la the AMA doctrine) he would justify the action by noting that the patient would die anyway, and it is wrong to prolong suffering needlessly.

The three turning points:

1) Legitimating another way to kill 2) The limits of self-determination 3) Over-extending medicine

Proponents of euthanasia have The Four Arguments:

1) Self-determination 2) Killing and allowing to die 3) Calculating the consequences 4) Euthanasia and medical practice

When Self-Determination Runs Amok" What are the 4 categories of euthanasia arguments?

1) Self-determination 2) Killing and allowing to die 3) Calculating the consequences 4) Euthanasia and medical practice

Conclusion- Currently the distinction between active and passive euthanasia is generally accepted by physicians 2. Problems:

1) The distinction is not morally relevant - physician is no less responsible for death in the case of passive euthanasia 2) Active euthanasia seems morally preferable in some cases 2) Passive euthanasia often makes our action depend on arbitrary factors

What are the different interests involved in the sort of cases considered?

1) the interest of the (abnormal) child 2) the interest of the mother 3) the interests of the other family members 4) the interests of the medical professionals AND 5) the interests of the child next in queue!

Whose interests are to be considered?

1) the interest of the (abnormal) child 2) the interest of the mother 3) the interests of the other family members 4) the interests of the medical professionals AND 5) the interests of the child next in queue!

Triage: process of determining the priority of patients' treatments based on the severity of their condition. Traditionally, patients were divided into three groups:

1) who are likely to live, regardless of what care they receive; 2) Those who are likely to die, regardless of what care they receive; 3) Those for whom immediate care might make a positive difference in outcome -Only the third group would receive treatment

3 Methods of Changing Genetics of Future Generations

1)Environmental changes 2) Use of eugenic policies aimed at altering breeding patterns (ex. Genetic counseling or even various kinds of compulsion 3) Genetic engineering using enzymes to add to or subtract from DNA

Rachels' Arguments: first two arguments

1. Active euthanasia is often more humane than passive. 2. The conventional doctrine leads to decisions concerning life and death on irrelevant grounds. (The "excuse" to kill babies with Down Syndrome)

The Concepts of Health and Disease BUT this argument is based on two questionable assumptions:

1. That we have a clear and uncontroversial account of health and disease 2. That the goal of treating diseases is morally legitimate, while other goals are not

What treatment was prescribed for John Pearson by Dr. Arthur?

1980: Molly gives birth to John John is healthy, but has Down's Syndrome "Parents do not wish baby to survive. Nursing care only" Dr. Arthur prescribed a narcotic painkiller, water and no food John died 3 days later A hospital employee reported it

1. Argument: Active Euthanasia is often more humane than passive (3 & 4)

3) But, if one simply withholds treatment, the patient may take longer to die, would thus suffer more, relative to the case of active euthanasia, i.e., lethal injection. 4) Thus: once the decision to not prolong agony is made, active euthanasia is preferable to passive. (Otherwise, the patient would suffer more, which is contrary to the "humanitarian impulse" that prompts the decision to end the suffering in the first place.)

What are the 4 examples Judge F discusses? 1) A baby with Down's and an intestinal blockage (=setting of conditions) 2) A healthy, but severely handicapped child. Doctor prescribes lethal dosage of pain-killer (=murder)

3) Terminal cancer patient. Doctor prescribes lethal dosage of pain-killer but only for pain relief (=setting of conditions) 4) A rejected severely handicapped child gets pneumonia. The doctor withholds antibiotics (=setting of conditions)

Rachels' Arguments: last two arguments

3. The conventional doctrine rests on a distinction between killing and letting die that itself has no moral importance. 4. The most common argument in favor of the conventional doctrine is invalid

physician-assisted suicide

A form of active euthanasia in which a doctor provides the means for someone to end his or her own life process in which physicians provide dying patients with a fatal dose of medication that the patient self-administers

passive euthanasia

A situation in which a seriously ill person is allowed to die naturally, through the cessation of medical intervention; Not taking steps to prevent a dying person's death

active euthanasia

A situation in which someone takes action to bring about another person's death, with the intention of ending that person's suffering.

What example does Kuhse give to show a case where killing is better than letting die?

A truck driver is stuck in a for-certain death, trapped in a blazing truck. He asks his co-driver to kill him, to put him out of his misery.

Argument: The Most Common Arguments for the Doctrine are Invalid 3. Death is regarded as a great evil, thus it is bad to be a causer of death.

Active -- directly causes death Passive -- does "nothing." Patient dies from illness ("letting nature take its course") BUT: if a doctor lets a patient with a curable illness die, he would be the cause of death. And: If euthanasia is decided upon for a case, "it has already been decided that in this instance death is no greater evil than the patient's continued existence."

How is the difference between active and passive euthanasia usually framed?

Active -- directly causes death Passive -- does "nothing." Patient dies from illness ("letting nature take its course") The distinction between active vs. passive euthanasia is essentially "to kill or to let die."

The Sanctity of Life (Helga Kuhse)

An Ideal that underpins many of our laws -Human life has some very special value, so it's always prima facie wrong to kill -All forms and qualities of human life are equally valuable and, therefore, equally inviolable -Therefore, killing innocent humans is wrong

What is the Sanctity of Life principle?

An Ideal that underpins many of our laws Human life has some very special value, so it's always prima facie wrong to kill All forms and qualities of human life are equally valuable and, therefore, equally inviolable Therefore, killing innocent humans is wrong

What is the dilemma regarding the abnormal child and the child next in queue ("Andrew")

Andrew (the child next in queue) will only be born if the first (abnormal) child is not born (or if the abnormal child does not survive after birth) So it is in Andrew's interest for the first child not to be born

The Goals of Medicine

Another argument claims that genetic therapy is on solid moral ground because it promotes the goals of medicine, while genetic enhancement promotes other, morally questionable goals BUT: what exactly are the goals of medicine

Value-laden ,prescriptive, approach

Argues that our concepts of health and disease are based on social, moral, and cultural norms. A healthy person is someone who falls within those norms. Example: although schizophrenia has biological basis, some cultures view schizophrenics as "gifted" or "sacred"

The Difference Thesis Cont'd- Tooley:

Besides motives, there are other morally relevant differences between typical acts of killing and typical acts of failing to save which make us judge such cases differently.

When Abstract Moralizing Runs Amok" How does Lachs answer Callahan?

Callahan has missed the personal side of this problem by focusing on abstract theories "Moral reasoning is more objectionable when it is abstract than when it is merely wrong Callahan's mischaracterization of people with terrible diseases "looking for the meaning of existence and find it, absurdly, in a lethal injection" [386] They are not looking for meaning, they want relief from their suffering" "They must bear the pain of existence without the ability to perform the activities that give life meaning"

What example does Rachels give to illustrate that the doctrine against active euthanasia lead to decisions concerning life and death on irrelevant grounds?

Case 2.1: A Down's Syndrome infant needs a medically-doable operation (intestinal operation) unrelated to the Syndrome in order to live. The operation is not done because the child has Down's Syndrome, and thus it is better for the child to die. The presence of the intestinal blockage merely serves as the "excuse" for letting die. Since, if that's not the case, "nothing can be done, for one must not 'kill' it"

What is the "nasty uncle" scenario that Rachels gives and how does it illustrate his argument that killing is no worse than letting die?

Case 3.1: The perpetrator Smith purposefully drowns his cousin. Case 3.2: The perpetrator Jones plans to drown his cousin, but his cousin dies in an accident (which he did not cause), which Jones witnesses in full sight. Jones has the power to save his cousin, but he merely stands by and does nothing! Jones argues, "I didn't kill him; I only let him die." -If letting die is intrinsically less bad than killing, this "defense" is actually somewhat valid -- however, such a "defense" can only be regarded as a grotesque perversion of moral reasoning. Thus, it is no defense at all.

3. Argument: Is Killing Morally Worse Than Letting Die? Example: "The Nasty Uncles": In both cases, the perpetrator stands to gain, perhaps through a large inheritance, if his 6-year old cousin were to die. Case 3.1: The perpetrator Smith purposefully drowns his cousin.

Case 3.2: The perpetrator Jones plans to drown his cousin, but his cousin dies in an accident (which he did not cause), which Jones witnesses in full sight. Jones has the power to save his cousin, but he merely stands by and does nothing!

What does Callahan mean by the difference between causality and culpability?

Causality vs. culpability Direct physical cause vs. attributing moral responsibility to human actions Causality: direct physical cause of death Culpability: Our attribution of moral responsibility to human actions

Solution: A Mixed System?

Combination of parental initiative and central veto (the power of group of decision-makers is restricted to one of veto)

To decide if a life is worth living (etc), doctors will have to treat patients' values - but how can they make this judgment?

Doctors say that there is no objective measure of whether a life is worth living

What does the doctrine/law of double effect have to do with this argument?

Doctrine of Double Effect: an act which is otherwise morally unacceptable may be permissible if it is the inevitable and unavoidable result of carrying out primarily morally desirable interventions. Recipients of such treatment ought not to reproduce "until we had a chance to vouchsafe the genetic integrity of their reproductive cells"

voluntary euthanasia

Ending life painlessly when someone in great pain asks for death; suffering person makes decision to die

involuntary euthanasia

Euthanasia performed without a person's consent The act of ending a terminal patient's life by medical means without his or her permission

The positive-negative distinction is sometimes blurry (raising someone's IQ score from 80 to 100 points could be considered therapeutic, but raising someone's IQ score from 100 to 120 might be considered enhancement)

Even though the distinction is blurry, most people have stronger reaction to positive engineering

What is their stance on martyrs, i.e., is giving one's life ,or someone else or for some higher purpose, intentional killing?Grisez and Boyle claim that martyrs don't intend their own deaths. They intend some other action, recognizing that their death is likely to follow as a side-effect.

Ex: the soldier who jumps on the grenade to save his fellows realizes that his actions will result in his own death. But he doesn't intend to kill himself. He intends to smother the grenade, recognizing that his death will be a side-effect of the only way to do this, given the circumstances

Martyrs

Example: the soldier who jumps on the grenade to save his fellows realizes that his actions will result in his own death. But he doesn't intend to kill himself. He intends to smother the grenade, recognizing that his death will be a side-effect of the only way to do this, given the circumstances

What about Values?

Fact is that we are swayed by fashion and we do not know the limitations of our own outlook so it is conceivable that if decisions are left to parents, all parents choose to have blond and blue eyed offspring. BUT: his again supports a principle of caution instead of complete ban!

DDE is a focus of the

G&B distinction between killing in the strict sense (which they take to always be impermissible) and certain cases of letting die (which are sometimes permissible).

The Problem of Eugenics- Claim:

Genetic enhancement is morally wrong because is just another form of eugenics

What about admirable self-sacrificers (martyrs)?

Grisez and Boyle claim that martyrs don't intend their own deaths. They intend some other action, recognizing that their death is likely to follow as a side-effect.

What thought experiment does Hare envision?

Hare envisions a prenatal conversation between Andrew and his possible sibling, trying to agree on a proposal that gives the best possible chance of a healthy baby for the parents

Was Dr. Arthur found guilty of murdering John Pearson?

However much the disadvantage of a mongol... no doctor has the right to kill it"- Justice F Sounds like the Sanctity of Life Ideal But, Dr Arthur goes free! Why? Because (apparantly) he let John die (different to killing)

Killing vs. Letting Die Example

I may drown you or I may let you drown. - Some philosophers think that there need not be a moral difference between some killings and their counterpart letting-die cases

"The Nasty Uncles" cont'd- Jones argues, "I didn't kill him; I only let him die."

If letting die is intrinsically less bad than killing, this "defense" is actually somewhat valid -- however, such a "defense" can only be regarded as a grotesque perversion of moral reasoning. Thus, it is no defense at all. Therefore: the bare difference between killing and letting die does not, in itself, make a moral difference

(Helga Kuhse) Law: "everyone must be taken to intend that which is the natural consequence of his action"

If you could have refrained from acting, but did it anyway, then all of the foreseeable consequences of that action should count as intended under the law (even merely foreseen consequences)

Verdict on 'The Moral Difference Myth'- Is it a myth that 'letting die' is always more moral than 'killing'? Kuhse:

In some cases, killing is better for the patient than letting die

What is Kuhse's conclusion when it comes to the Moral Difference Myth?

Is it a myth that 'letting die' is always more moral than 'killing'? Kuhse: In some cases, killing is better for the patient than letting die.

How does Kuhse argue that killing may be worse than letting die in some cases, and better than letting die in others?

Is killing intrinsically worse than letting die? Or is it worse for agents motivated by personal gain to actively intervene against nature to gain his own ends, as opposed to an agent would just stand there and watch as nature does the work? Nesbitt claims to have shown that killing someone is, other things being equal, always worse than allowing someone to die. But this conclusion is illegitimate. While Nesbitt is correct when he suggests that killing is sometimes worse than letting die, this is not always the case

Overall Improvement is Unlikely or Impossible Cont'd

It is important to acknowledge that different characteristics may turn out to be linked in ways we do not yet realize; however, we do not have to assume that there MUST be a compensating loss with every gain we make.

1) Self-Determination: The value of self-determination

It's good to be able to build our lives as we see fit, but what should the limits be?

What case study does Kuhse use in her article?

John Pearson case

Was Dr. Arthur the Cause? Details of the death of John

John died of pneumonia "Nursing care only" = no antibiotics Dr. Arthur could have arranged for life-saving care, but refrained

Rachel's "Nasty Uncles"- Recall: Both Smith and Jones stand to gain if their respective six-year-old cousins die. Smith sneaks in while his cousin is bathing, and drowns him in the tub.

Jones is planning to do the same, but sneaks in to find his cousin drowning all on his own. He stands ready to drown the child if need be, but the child drowns without Jones having to lift a finger

2) Killing vs. allowing to die: Killing is not the same as allowing to die

Lethal injection vs. turning off life-support Commission vs. omission is not the same -death from disease has been abolished, leaving only the actions of physicians as the cause of death.' Do we really want to say that nature/biology is not the cause?

3) Over-extending medicine- The traditional view:

Medicine should limit its domain to promoting and preserving human health."

Conventional doctrine Example: AMA Doctrine:

Mercy killing ("the intentional termination of life of one human being by another") is wrong. -The patient and immediate family decide on withholding treatment if and only if there is "irrefutable evidence" of imminent death

What is Kuhse's definition of murder?

Murder = the intentional causation of death Kuhse: includes direct and indirect killings

Conclusion- Rachels:

Nasty uncles demonstrate that there is no intrinsic moral difference between killing and letting die.

Conclusion- Nesbitt:

Nasty uncles fail to show that the difference thesis is false.

What does Resnik mean by positive and negative eugenics?

Negative eugenics: attempts to reduce the number or harmful or undesirable genes Positive eugenics: attempts to increase the number of favorable or desirable genes in human gene pool

How does the motive of the moral agent influence whether killing is worse or better than letting die?

Nesbitt agrees that Rachels' examples support the common intuition that Jones and Smith are equally reprehensible because both were prepared to kill for the sake of personal gain. Both cases contain the same moral clincher: the agent was prepared to kill. Is killing intrinsically worse than letting die? Or is it worse for agents motivated by personal gain to actively intervene against nature to gain his own ends, as opposed to an agent would just stand there and watch as nature does the work?

Is death always the greatest evil that can befall a person?

Nesbitt assumes death is always and everywhere an evil. However, this view is already challenged by patients and doctors who practice passive euthanasia by, perhaps, stopping treatment in cases of terminal illness

Why Killing is Not Always Worse -- and Sometimes Better -- Than Letting die: Main Argument (Helga Kuhse)

Nesbitt claims to have shown that killing someone is, other things being equal, always worse than allowing someone to die. But this conclusion is illegitimate. While Nesbitt is correct when he suggests that killing is sometimes worse than letting die, this is not always the case

Then What About Euthanasia?

Nesbitt does not reconnect the killing/letting die distinction back to Rachels' central topic of interest: euthanasia.

Conclusion- Kuhse:

Nesbitt fails to establish the truth of the difference thesis.

Definition of Intentional Killing (killing in the strict sense)

One intends to bring about a person's death, thereby undertaking a commitment to bring this result about

How do Grisez and Boyle define intentional killing?

One intends to bring about a person's death, thereby undertaking a commitment to bring this result about

What does Glover mean by the "genetic supermarket"?

One solution to the problem of having one group of people impose their views on the world is to have parents choose their children's characteristics

Second Argument Againts Positive Genetic Engineering- The Family and Our Descendants: Relationship problems might ensue

One threat posed by positive genetic engineering might be that fact that usually parents like to identify with their children and once children are genetically altered, parents might have problems identifying

1) Self-Determination & doctor's independent grounds to kill: These decisions don't rest on objective physiological facts

Pain is felt differently Physical disabilities cause varying psychological problems

Passive Euthanasia (can be voluntary but is often involuntary)

Passive euthanasia is an alternative name for withdrawal of treatment - the doctor withholds life-sustaining treatment. Passive euthanasia occurs when the patient dies because the medical professionals either don't do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive. The doctor may switch off life-support machines, disconnect a feeding tube, not carry out a life-extending operation, or don't give life-extending drugs "letting nature take its course"

Indirect Euthanasia

Providing treatment (usually to reduce pain) that has the foreseeable side effect of causing the patient to die sooner. The patient dies sooner as a side effect of giving a medical treatment given to relieve pain or improve end-of-life symptoms. (often appeals to the Doctrine of Double Effect)

One Argument against Positive Genetic Engineering: Overall Improvement is Unlikely or Impossible

Some people believe there are no gains without compensating losses (for instance, if we bring about a genetically based improvement such as higher intelligence, we will have to pay a price for it, perhaps higher susceptibility to disease) BUT: this is a naïve view of evolutionary theory, because in evolutionary theory, some mutations turn out to be advantageous and if natural mutations can be beneficial without compensating loss, why should artificially induced ones not be so too?

Foreseen But Unintended Causing of Death

Sometimes a doctor may aim at bringing about some result (that isn't itself a bad or impermissible result to aim at) and she may foresee that taking the means to this result will have the effect of ending her patient's life. In these cases, the killing may be permissible.

Physician-Assisted Suicide

Somewhat of a hybrid between passive and active euthanasia is physician-assisted suicide (PAS), also known as voluntary passive euthanasia. In this situation, a physician supplies information and/or the means of committing suicide (e.g., a prescription for lethal dose of sleeping pills, or a supply of carbon monoxide gas) to a person, so that that individual can successfully terminate his or her own life.

Terminology

Special words and expressions used in certain subjects

What does he mean by state-sponsored and parental eugenics? Are all forms of eugenics immoral according to Resnik?

State-sponsored eugenics: the government attempts to control the human gene pool Parental eugenics: parents exert control over the gene pool through their reproductive choices -doesn't seem as troubling; in fact, parents practice this kind of eugenics every time they select a mate, or a sperm or egg donor

What is their stance on suicide, i.e., is suicide a case of intentional killing?

Suicide is one such intentional killing—the suicidal person intends to bring about his or her own death. So suicide is always wrong in virtue of its incompatibility with respect for the good of life. And assisting suicide will be assisting someone's perpetration of a wrongful killing. So voluntary euthanasia is wrong as well, as it's the assistance of a killing

Doctrine of Double Effect Cont'd- Ex: Terror bomber vs strategic bomber:

Terror bomber intends to destroy the school and the munitions factory. Strategic bomber intends to destroy the munitions factory, seeing that destroying the school is a side-effect of hitting the factory.

What is the "Moral Difference Myth"?

That Letting Die is Not the Intentional Cause of Death" In medicine, murder and the mere setting of conditions in which death might occur are very different eliberate examples of letting die in the practice of medicine are, morally and legally, different from killings. Another way of stating this myth is to say that to deliberately allow someone to die is not to intentionally cause that persons death

euthanasia

The act of painlessly killing a suffering person or animal; mercy killing

Foreseen But Unintended Causing of Death Cont'd- Failure to provide burdensome life extending treatment from an intention not to burden.

The latter is not a morally problematic form of self-killing nor is assisting it as a doctor an objectionable form of assistance

Involuntary/ Non-Voluntary Euthanasia:

The person cannot make a decision or cannot make their wishes known. This includes cases where the person is in a coma, the person is too young (e.g. a very young baby), the person is senile, the person is mentally retarded to a very severe extent, the person is severely brain damaged, the person is mentally disturbed in such a way that they should be protected from themselves.

Why are Smith-like persons more dangerous than Jones-like persons, according to Nesbitt?

The reason we have morality is to make it possible for people to live together in reasonable peace and security It is clearly preferable to have (modified) Jones-like people around than Smith-like people: we are threatened by the latter, but not by the former. This is why killing is, indeed, morally worse than letting die.

Is Killing no Worse than letting die?" What is the difference thesis?

There is a moral difference between killing and letting die: it is morally worse to kill someone than to let them die. -It seems that common moral intuitions favor the Difference Thesis

The Difference Thesis

There is a moral difference between killing and letting die: it is morally worse to kill someone than to let them die. -It seems that common moral intuitions favor the Difference Thesis.

The abnormal fetus argues for this proposal: "We'll make a bargain. We will say that I am to be born and operated on, in the hope of restoring me to normality. If the operation is successful, well and good. If it isn't, then I agree that I should be scrapped and make way for Andrew."

This compromise gives the best possible chance of having a healthy baby and at the same time gives the fetus all the chance it ever had of itself being that baby!

Foreseen But Unintended Causing of Death Cont'd -Emergency triage foreseeably leading to the deaths of the untreated.

This may not be a morally problematic form of killing when the doctor is intending to save certain patients with a foreseen consequence of harming others (again: DDE)

Voluntary Active Euthanasia:

Those instances of euthanasia in which a clearly competent person makes a voluntary and enduring request to be helped to die -causing the death of a person through a direct action, in response to a request from that person

1) Self-Determination & doctor's independent grounds to kill

To be responsible moral agents, doctors' would also need "independent moral grounds" to kill . No objective grounds to decide whether: -Suffering is unbearable or -A life is worth living or -How much value a life can provide

Dr. A: I prescribed DF118 because I intended to "reduce any suffering on the part of the infant" Kuhse: response?

True, but there would have been no suffering had Dr. A not also prescribed "nursing care only"

"The Abnormal Child" What is the fundamental ethical principle Hare discusses?

When faced with a decision which affects the interests of different people, we should treat the interests of all these people (including ourselves if we are affected) as of equal weight, and do the best we can for them

You should know the main points Resnik discusses in his article (e.g., the concepts of health and disease, changing the human form etc.). For instance, what is the value-laden approach to the definition of health versus the value-neutral approach? Are the goals of medicine clearly defined?

Value-neutral (descriptive) approach: claims that health and disease are descriptive concepts that have an empirical, factual basis in human biology. Example: a diseased organism lacks the functional abilities of a normal (typical) member of its species Value-laden (prescriptive) approach: argues that our concepts of health and disease are based on social, moral, and cultural norms. A healthy person is someone who falls within those norms. Example: although schizophrenia has biological basis, some cultures view schizophrenics as "gifted" or "sacred" Another argument claims that genetic therapy is on solid moral ground because it promotes the goals of medicine, while genetic enhancement promotes other, morally questionable goals; No

1) Legitimizing another way to kill

We have been trying to reduce the ways we can (legitimately or otherwise) kill each other. Euthanasia would add a whole new category to killing to a society that already has too many excuses to indulge itself in that way.' -Guns, war, murder etc

Causality and culpability cont'd: Now that we have some control, we have decided what actions are culpable around life and death

We have constructed an ethics of life and death for medicine

The Difference Thesis Cont'd -Rachels & Tooley:

When we compare a case of killing with one which differs from it only in being a case of letting die, we will agree that either agent is as culpable as the other.

What modifications do Rachels' and Tooley's cases require if they are to be used to legitimately gauge our attitudes towards killing and letting die?

With Rachels' case of Smith & Jones, we must remove Jones' being prepared to kill the child: it must be the case that, though Jones was prepared to let his nephew die, he was not prepared to kill the child.

Rachel's "Nasty Uncles"- Note that Jones was perfectly prepared to kill his nephew, and would have done so had it proved necessary.

[S]omeone who is fully prepared to perform a reprehensible action, in the expectation of certain circumstances, but does not do so because the expected circumstances do not eventuate, is just as reprehensible as someone who actually performs that action in those circumstances."

John Lachs, 'When Abstract Moralizing Runs Amok'- Callahan has missed the personal side of this problem by focusing on

abstract theories. "Moral reasoning is more objectionable when it is abstract than when it is merely wrong"

It's absurd to say (as Callahan does) that doctors must either

accept or reject all of patients views about their life and wellbeing or risk treating values instead of biological facts

Regarding the issue of causation, does Kuhse think that causation can occur through omission or only through action?

action or omission, a fairly direct causal connection must be made between murderer and victim Causation by omission is established when the omitted act is normally expected (e.g. giving antibiotics in cases of pneumonia?) I.e. the omitted act must not be a background condition (conditions that remain the same)

Conventional doctrine

active euthanasia is always forbidden.

Why do some people argue that it is morally significant whether germ lines are directly affected (in germ line therapy) or only indirectly affected (in somatic gene therapy)?

aimed at changing the genotype of future generations is impermissible. therapeutic are permissible somatic-do not affect the intergenration Germ-line therapy: directed at the reproductive cells, and so passed on to future generations Somatic gene therapy: intended to affect the somatic or body cells of individuals BUT can indirectly affect germ cells as well è permissible via the law of double effect! therapy-enhancement distinction as our moral compass in human genetics! Instead, we should look at whether the intervention poses significant risks, offers significant benefits, violates or promotes human dignity etc

Typically, saving someone requires more effort than refraining from killing someone. An act of killing necessarily results in someone's death, but

an act of failing to save does not (someone else may come to the rescue).

Definitions of Health cont'd -It is highly questionable that we have a clear

and uncontroversial account of health and disease

The Difference Thesis Cont'd - Consider two cases:

ase 1: I push someone who I know cannot swim into the river, thereby killing her. Case 2: I come across someone who is drowning, and who I could easily rescue, yet fail to do so, thereby letting her die. It seems that my behavior is morally worse in the first case than the second. We assume some malicious motive in the first case, but perhaps only fear or indifference in the second.

Positive eugenics:

attempts to increase the number of favorable or desirable genes in human gene pool

Negative eugenics

attempts to reduce the number or harmful or undesirable genes

Callahan: "[if euthanasia is legalised, then] any competent person should have a right to

be killed by a doctor for any reason that suits him" -Lachs: no, we have to balance the costs in each case -Terminally ill and suffering person with no f&f vs. young father at dentist who says he wants to die

Summary of Kuhse: Intentional causing of death to severely disabled newborns needs to be

be re-evaluated -Re-evaluation shows that it should be allowed by law in certain circumstances

Pieter Admiraal Limit Active Euthanasia to Terminal Illness? "The doctor might think that life with a certain condition is, or ought to be,

bearable; but to the extent that the properly counselled and supported patient takes a different view, it is the patient's view, which must ultimately be the determinative one."

Nesbitt agrees that Rachels' examples support the common intuition that Jones and Smith are equally reprehensible because

because both were prepared to kill for the sake of personal gain Both cases contain the same moral clincher: the agent was prepared to kill. There is a moral significance between killing and letting die if "the raison d'etre of morality is to make it possible for people to live together in reasonable peace and security."

Nesbitt claims that both Rachels and Tooley overlook that what determines whether or not someone is reprehensible is not simply what he does,

but what he is prepared to do.

Value-neutral (descriptive) approach

claims that health and disease are descriptive concepts that have an empirical, factual basis in human biology. Example: a diseased organism lacks the functional abilities of a normal (typical) member of its species

DDE is extremely controversial in

contemporary moral philosophy.

Nesbitt accepts common intuitions as decision-

decision-bases of public policy, since we cannot wait for a demonstration of the correct moral theory before making decisions However, survey results in the USA, Australia and the UK show that people's common intuition allows for active euthanasia

Germ-line therapy

directed at the reproductive cells, and so passed on to future generations

The Concepts of Health and Disease: It is frequently thought that aim of genetic therapy is to treat

diseases while the aim of genetic enhancement is to perform other kinds of interventions

Callahan on Euthanasia Proponents of euthanasia have four general arguments -

each of which is bad

Positive eugenics

encouraging propagation of good allele; encourage people who have intelligence to marry each other have produce offspring. will end up with super race of British people who are white and rich and titled. (galton)

Positive gene therapy

enhancement; adding desirable traits, improvements

Are euthanasia and medical practice compatible according to Callahan?

euthanasia and assisted suicide are perfectly compatible with the aims of medicine" Do doctors have the relevant expertise? Lots of people commit suicide because they find no meaning in life - a question of values

Nesbitt's Project- Nesbitt argues that the examples employed by Rachels (and Michael Tooley) to show that killing is no worse than letting die are

faulty, and that, in fact, killing is worse than letting die

Argument: The Most Common Arguments for the Doctrine Are Invalid -AMA identifies "intentional termination of life of one human being by another - mercy killing" to be

forbidden, but it does not deny the cessation of treatment (is that not the intentional termination of life as well?)

most eugenic policies are open to straightforward moral objections, as they usually override people's autonomy BUT:

genetic engineering need not involve overriding anyone's autonomy

Does Resnik believe that genetic enhancement is inherently immoral?

genetic enhancement is not inherently immoral

Possible Solution? The Genetic Supermarket One solution to the problem of having one group of people impose their views on the world is to

have parents choose their children's characteristics BUT the genetic supermarket might still lead to problems, such as imbalance of the sexes, so some central regulation might be necessary

What modifications do Rachels' and Tooley's cases require if they are to be used to legitimately gauge our attitudes towards killing and letting die? t further cannot be the case that he is not prepared to kill the child because

he fears punishment, or that he is too lazy, or that the idea simply hadn't occurred to him. Rather, he must be reprehensible enough to let the child die for his gain, but not enough to kill the child. With these modifications, Smith's behavior is, indeed, morally worse than Jones

Suicide is - such intentional killing were she or

he suicidal person intends to bring about his or her own death.

Doctrine of double effect

if doing something morally good has a morally bad side-effect, if it is right to do it providing the bad side-effect is not intended; Doing something morally good which has morally bad consequences is ethically ok as long as you can show you intended the good consquences

Doctrine of Double Effect Cont'd- Ex: Terror bomber vs strategic bomber: Both

inflict the same harm. -But DDE at least allows that the latter may be permissible even if the former isn't.

Who are they to judge? Callahan: Patients views about their life and wellbeing are

inherently subjective Lachs: True, but so are their views about their health and illness symptoms, and doctors still rely on these to make important medical decisions

Somatic gene therapy

intended to affect the somatic or body cells of individuals BUT can indirectly affect germ cells as well -permissible via the law of double effect!

Is intentional killing ever morally permissible according to them?

is immoral because it is at odds with the respect we owe to the life of such persons; is always impermissible

Change of the Human Form: Yet another argument might claim that genetic enhancement is morally wrong because

it changes the human form BUT: most moral theories imply that there is nothing inherently wrong with changing the human form

Sometimes Killing Is Better Than Letting Die- We should not be comforted by the presence of the difference thesis believer who would not have killed even in an act of

mercy. Nesbitt assumes death is always and everywhere an evil. However, this view is already challenged by patients and doctors who practice passive euthanasia by, perhaps, stopping treatment in cases of terminal illness.

The Difference Thesis Cont'd- James Rachels and Michael Tooley argue that we favor the Difference Thesis because

most cases are not adequately set up.

Glover focuses on genetic engineering instead of eugenics because

most eugenic policies are open to straightforward moral objections, as they usually override people's autonomy

Causation: By action or omission, a fairly direct causal connection must be made between

murderer and victim

Glover avoids the

nature-nurture debate because of its presumed irrelevance

Definitions of Health cont'd- The prescriptive account of health and disease can be used to show that therapy is good BUT

neither of the two main approaches to health and disease provides us with solid moral boundaries between therapy and enhancement

Sometimes Killing Is Better Than Letting Die- If patients can be benefitted by being let die, because death is good, they can be benefitted by being killed. There are patients for which death would be a good... Doctors who do

not make die would, in effect, be acting like rocks or trees. If the raison d'etre of morality is to allow people to live together in relative peace and security, we would like doctors to be motivated to primarily seek our good, to let die or make die, when either action serves us best

Difference Thesis Revisited: Rachels vs. Nesbitt- By the usage of the Jones and Smith example, Rachels argues that the difference between killing and letting die is

not morally relevant in itself. Thus, Rachels claims, the difference thesis is false

Doctors are good on turning patient's subjective views into

objective judgments

The Abnormal Child (R.M. Hare)- The Fundamental Principle: When faced with a decision which affects the interests of different people, we should treat the interests of all these people (including ourselves if we are affected) as

of equal weight, and do the best we can for them

Callahan on Euthanasia - "There are already too many chances to kill one another, so lets not harm society and burden doctors with euthanasia because

of our overblown sense of self-determination"

Conclusion- The AMA should not give the distinction of active versus passive euthanasia any added authority and weight by writing it into

official statements of medical ethics.

How does Rachels argue that active euthanasia is sometimes preferable to passive euthanasia?

once the decision to not prolong agony is made, active euthanasia is preferable to passive. (Otherwise, the patient would suffer more, which is contrary to the "humanitarian impulse" that prompts the decision to end the suffering in the first place.)

The Difference Thesis Cont'd- We tend to think killing is worse than letting die because we tend to think of cases that differ in

other morally relevant respects.

Some philosophers think that there need not be a moral difference between some killings and their counterpart letting-die cases but

others might think the distinction is inherently morally significant

Glover, "Questions about Some Uses of Genetic Engineering": Main argument

our resistance to genetic improvement of the human race is based on a complex of different values and reasons, none of which is sufficient to rule out in principle the positive use of genetic engineering

Uses of Genetic Engineering "What is the main argument of the article?

our resistance to genetic improvement of the human race is based on a complex of different values and reasons, none of which is sufficient to rule out in principle the positive use of genetic engineering

Parental eugenics:

parents exert control over the gene pool through their reproductive choices -doesn't seem as troubling; in fact, parents practice this kind of eugenics every time they select a mate, or a sperm or egg donor

Pieter Admiraal "Very often ______ euthanasia is worse than _____ euthanasia.

passive......active

The Social Argument: The reason we have morality is to make it possible for

people to live together in reasonable peace and security. It is clearly preferable to have (modified) Jones-like people around than Smith-like people: we are threatened by the latter, but not by the former.This is why killing is, indeed, morally worse than letting die.

4. Argument: The Most Common Arguments for the Doctrine Are Invalid- People find killing worse than letting die because the media often portrays killing as terrible, essentially, the acts of murderous criminals with petty motives, while "letting die" is a role

played by doctors for humanitarian reasons. BUT: Both acts involve killing, thus: Killing, itself, is not what makes it worse than letting die, but the motives of the killer versus the "let-dier."

Triage

process of determining the priority of patients' treatments based on the severity of their condition.

By allowing people's common intuition to come into play, Nesbitt thus betrays support for

public policies that allow active euthanasia.

So suicide is always wrong in virtue of its incompatibility with

respect for the good of life.

Rachel's "Nasty Uncles"- but does not do so because the expected circumstances do not eventuate, is just as reprehensible as someone who actually performs that action in those circumstances." To think otherwise would

seem to place some moral value on one person having opportunity or luck and the other not.

Definitions of Health cont'd- The prescriptive account of health and disease can be used to

show that therapy is "good" (because it moves from disease to health) but does it therefore imply that enhancement is bad?

Conclusion- We should not use the therapy-enhancement distinction as our moral compass in human genetics! Instead, we should look at whether the intervention poses

significant risks, offers significant benefits, violates or promotes human dignity etc.

Kuhse shows that killing is

sometimes better than letting die.

Nesbitt shows that killing is

sometimes worse than letting die.

Eugenics

study of factors that influence the hereditary qualities of the human race and ways to improve those qualities; science dealing with improving hereditary qualities

The Rights of the Unborn- Argument against enhancement claims

that it violates the rights of the unborn BUT: rests on morally controversial claim that unborn children have rights!

Does Rachels agree that killing is always worse than letting die?

the bare difference between killing and letting die does not, in itself, make a moral difference

Killing vs. Letting die The distinction between active vs. passive euthanasia is essentially "to kill or to let die." example:

the direct action to kill a terminally ill patient as a form of 'mercy killing' or to merely withhold treatment

State-sponsored eugenics:

the government attempts to control the human gene pool

(Helga Kuhse) Murder

the intentional causation of death -Kuhse: includes direct and indirect killings -NSW: murder includes "the things by him omitted to be done, causing the death charged"

What is the raison d'etre of morality?

the most important reason or purpose for someone or something's existence / reason or justification for being or existence

Pieter Admiraal Limit Active Euthanasia to Terminal Illness? "The notion of 'terminal illness' is slippery....This means that

the notion of terminal illness cannot be employed, in a straightforward way, to justify medical end-of-life decisions."

Causation by omission is established when

the omitted act is normally expected (e.g. giving antibiotics in cases of pneumonia?) -I.e. the omitted act must not be a background condition (conditions that remain the same)

Fourth Argument Against Positive Genetic Engineering- Not Playing God: By employing positive genetic engineering we are playing god BUT

the prohibition against playing God is obscure because if it tells us not to interfere with natural selection at all, this rules out all medicine

Germ-line therapy definition

the repair or replacement of a defective gene within the gamete-forming tissues, which produces an inheritable change in an organism's genetic constitution _______________________________________ is when DNA is transferred into the cells that produce reproductive cells, eggs or sperm, in the body. This type of therapy allows for the correction of disease-causing gene variants that are certain to be passed down from generation to generation.

Tooley's Smith and Jones - We judge Jones to be just as reprehensible as if he had killed Smith, but since he was fully prepared to kill him had he not been saved the trouble by the bomb, we should make

the same judgment even if he had neither killed Smith nor let him die (say, if both the bomb and the bullet were duds).

Does Resnik believe that the therapy-enhancement distinction is morally significant? Why or why not?

the therapy-enhancement distinction does not mark a firm boundary between moral and immoral genetic interventions, and genetic enhancement is not inherently immoral

The Moral Significance of the Therapy-Enhancement Distinction in Human Genetics : Main Argument

the therapy-enhancement distinction does not mark a firm boundary between moral and immoral genetic interventions, and genetic enhancement is not inherently immoral

Negative gene therapy

therapy; getting rid of genetic diseases, elimination of defects

Difference thesis

there are morally relevant differences between homosexual and heterosexual; male and females reason and behave differently due to social or biological differences

Pieter Admiraal "I have reached the conclusion that their is, in the end, no morally relevant difference between

these two forms of euthanasia (active and passive). In both cases, the doctor acts out of respect for the autonomy of the patient. In both cases, life is shortened. In both cases, the doctor has performed an act which has led to the patient's death, and in both cases, the doctor must take responsibility for that action."

Third Argument Against Positive Genetic Engineering: Risks and Mistakes- Positive genetic engineering is inherently risky; we may produce unintended results BUT

this does not mean that we should outright prohibit all positive genetic engineering; instead, it asks to employ the Principle of Caution

Pieter Admiraal "As doctors we have two primary duties:

to ensure the well-being of our patients, and to respect their autonomy. The first duty entails that we should seek to restore patients to health, and, if we can't, that we should try to reduce their suffering. The second duty entail that we listen closely to, and respect, the wishes of our patients."

4) Euthanasia and Medical Practice: Doctors should only provide therapy for biological concerns related to

to illness and aging

somatic gene therapy

transfer of a section of DNA to any cell of the body that doesn't produce sperm or eggs. Effects of gene therapy will not be passed onto the patient's children. ______________________________________ Is the transfer of genes into the somatic cells of the patient, such as cells of the bone marrow, and hence the new DNA does not enter the eggs or sperm. The genes transferred are usually normal alleles that could 'correct' the mutant or disease alleles of the recipient

Callahan: the right to kill yourself cannot be

transferred. "a fundamental moral wrong" to give your "life and fate to another"

Usually, therapeutic genetic engineering is regarded as morally

unproblematic whereas enhancement is regarded as problematic

Definitions of Health cont'd- The descriptive account of health and disease by itself does not provide us with

way of drawing a solid moral line between therapy and enhancement because it lacks an account of why therapy is right and enhancement is wrong

Second Argument Againts Positive Genetic Engineering- The Family and Our Descendants: Relationship problems might ensue BUT

we bring about environmental changes in children (like literacy) and it is not clear that genetically induced changes are any more objectionable

Principle of Caution

we should alter genes only where we have strong reasons for thinking the risk of disaster is very small, and where the benefit is great enough to justify the risk

What is the principle of caution?

we should alter genes only where we have strong reasons for thinking the risk of disaster is very small, and where the benefit is great enough to justify the risk

"The Note" What is Hill's medical condition? What is the note about?

wheelchair- paralyze waist down It is a suicide note for the family exampling why he wants to die.

Rachel's "Nasty Uncles" - Rachels assumes that we will agree that Smith, who kills his nephew, is no worse, morally speaking, than Jones, who

who merely lets his nephew die.

2. Argument cont'd -Rachels writes: "I can understand why some people are opposed to all euthanasia and insist that such infants must be allowed to live. I think I can also understand why other people favor destroying these babies quickly and painlessly. But ....

why should anyone favor letting "dehydration and infection wither a tiny being over hours and days"? The doctrine that says that a baby may be allowed to dehydrate and wither, but may not be given lethal injection that would end his life without suffering, seems so patently cruel as to require no further refutation." (Rachels)

Fourth Argument Against Positive Genetic Engineering: Not Playing God- This objection has more weight when considering who

would be in control of positive engineering policy -The group in control would probably impose their own limited view of what human beings should be like on everybody else.

And assisting suicide will be assisting someone's perpetration of a wrongful killing. So voluntary euthanasia is

wrong as well, as it's the assistance of a killing