Chapter 10 : Care of the Dying


Dan W. Brock: Voluntary Active Euthanasia; a Utilitarian justification

Outline by  Don Berkich,  University of Texas, Corpus Christi (by permission)

Synopsis: Contrary to Callahan, Brock argues that the Utilitarian Argument is sound because it is indeed possible to construct rules in such a way as to maximize utility. Hence Brock's argument is a fairly trivial application of IRU. Our interest in Brock's argument is three-fold:
  1. Brock's argument constitutes a clear refutation of Callahan's criticisms of the Utilitarian Argument.
  2. Brock does a reasonably good job of exploring some of the policy pitfalls of VAE.
  3. Brock provides an example of the application of IRU.

The key to Brock's argument is the possibility of developing safeguards to insure that the practice of VAE is not abused. Brock presents at least a few safeguards, although there would, presumably, need to be many more.

Reasons for thinking that utility is maximized in the VAE world--i.e., good consequences of permitting VAE:

  1. Permitting VAE makes it possible to respect the Autonomy and thus the self-determination of competent agents.
  2. Permitting VAE would reassure people that they have control over their dying, even if they never exercise that control.
  3. Permitting VAE would help to relieve pain and suffering.
  4. Permitting VAE would enable the humane and peaceful end of life once death is seen as inevitable.


The No-VAE World

Most of Brock's efforts are put towards rejecting reasons for thinking that utility is maximized in the No-VAE world. What, then, are the reasons for thinking that utility is maximized in the No-VAE world--equivalently, what are the bad consequences of permitting VAE?

a. Permitting VAE would have bad consequences if physicians were responsible for performing euthanasia, since









1 VAE is incompatible with a physician's moral and professional commitment as a healer to care for patients and to protect life.












Response: Physician's first commitment should be to the patients' right of self-determination and the promotion of their well-being.










2 It would lead patients to fear that a medication was intended not to treat or care, but to kill, and so would cause patients to lose trust in their physicians.












Response: Restriction of VAE to cases where it is truly voluntary is assumed.







b. Permitting VAE would weaken society's commitment to provide optimal care for dying patients, since euthanasia would be seen as a cheaper alternative to care and treatment.









Response: No evidence shows that recognizing a patient's right to forgo life-sustaining treatment has caused an erosion in the quality of care for dying patients.



Response: VAE is used only 2% of the time in the Netherlands.







c. Permitting VAE would deny patients the alternative of staying alive by default and put them under a psychological burden to justify staying alive.









Response: Polls show most Americans would prefer having the choice.



Response: If the option of VAE makes people worse off, then we should take back the right to refuse life-saving treatment.







d. Permitting VAE would weaken the prohibition on homicide.









Response: In nearly all states suicide and attempted suicide are no longer considered a criminal offense, hence there has been an acceptance of individual self-determination. But this does not imply that homicide is suddenly as accepted.







e. Permitting VAE would lead, by a slippery slope argument, to the acceptance of non-voluntary active euthanasia.









Response: Abuses of laws permitting VAE would be mitigated by careful regulation. For example,









  1. Patients must be fully informed about prognosis, alternative treatments, etc.
  2. Patient's request for VAE must be stable and enduring.
  3. All reasonable alternatives to improve the patient's quality of life and to relieve suffering must be explored.
  4. The patient's request must not be the result of depression.
  5. Physicians should be involved in the development of procedural safeguards.
  6. The practice of VAE should be restricted to physicians--i.e., persons in authority--for reasons of accountability.




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Copyright Philip A. Pecorino 2002. All Rights reserved.

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