Chapter 10 : Care of the Dying
Daniel Callahan: When Self Determination Runs Amok
Author: David Callahan
Title: "When Self Determination Runs Amok"
Publication Information: Hastings Center Report (March/April 1992, pp. 52-55).
In this article Callahan explores the concepts of euthanasia and physician-assisted suicide, however, for Callahan, these ideas are not simply an ethical debate, rather, they point to fundamental turning points in history. For Callahan, there are three fundamental turning points in relation to these issues: 1)The legitimate conditions under which a person can kill themselves. He claims the emergence of this issue is in stark contrast to many other efforts to curtail the reasons why one person can take another's life. 2)Meaning and limits of self determination. As for self determination, Callahan claims that such a notion simply leads to a "idiosyncratic view of the good life". 3)The claim such issues make upon the institution of medicine. For Callahan, forcing a physician to make his talents and skills available to achieve a patients private vision of the good life is simply wrong. Rather, he believes that a doctor should be availabe to, "promote and preserve human health" (p. 226) Callahan claims that people are confusing suffering, "which comes from life itself, not merely from a sick body" (p. 226). Once Callahan establishes these three concepts he moves on to explore the four ideas that have consistently been used in an attempt to support euthanasia and physician-assisted suicide.
The four ideas repeatedly used to support euthanasia and physician-assisted suicide are: 1)individual self-determination. 2)Moral irrelevance between killing and allowing to die. 3) The supposed paucity of evidence to show likely harmful consequences of legalized euthanasia. 4) The compatability of euthanasia and medical practice. (p.226). Callahan systematically picks apart the four argumants for euthanasia and physician-assisted suicide.
1)Self Determination- For Callahan, there is an important distinction between suicide and euthanasia. Intellectually, he states that individuals might have a self determining right to commit suicide, at least theoretically, however, suicide usually does not involve anyone else's help, euthanasia, clearly involves another person. " Euthanasia is thus no longer a matter of only self-determination, but of a mutual, social decision between two people, the one to be killed, and the one doing the killing" (p. 226). Callahan feels that it is not correct to put so much power into the hands of another human being with regards to your own life, he cites the example of slavery. This leads Callahan into a discussion of the definition of suffering and how difficult it can be to define such an abstract concept. Without a concrete definiton of suffering, Callahan finds it impossible to decide who qualifies for physician-assisted suicide. "Three people can have the same condition, only one will find the suffering unbearable" (p. 227).
2)The difference between killing and allowing to die- It is crucial to Callahan that people make this distinction. He feels that too many individuals think that there is no moral distinction. "It confuses reality and moral judgement to see an ommitted action as having the same casual status as one that directly kills" (p. 227). Callahan talks about removing an individual from life support as it is the underlying disease that kills the individual, not the doctor. For Callahan this is in stark contrast to a physician injecting an individual with a lethal dose of narcotic, even a healthy person would die from such an action. He feels this distinction needs to remain clear and if the distiction does not remian, doctors will always bear the moral burden of the death.
3)Calculating the consequeces of allowing euthanasia and physician assisted-suicide- There are three consequences for Callahan: 1) Ineviability of some abuse of the law. 2) Difficulty in writing and enforcing the law. 3) Slipperiness of the moral reasons for legalizing euthanasia. Callahan then discusses his observations of Holland where he feels doctors are using euthanasia somewhat freely.
4)Euthanasia and Medical Practice- In this section Callahan speaks to the true difficulty in deciphering true "organic" disease and its related suffering from the suffering people tend to feel in reaction to everyday life events. He has a hard time accepting that people should be allowed to take their lives in response to what we should assume to be universal suffering due to the human condition. Callahan states, "It is not medicine's place to lift the burden of that suffering which turns on the meaning we assign to the decay of the body and its eventual death" (p.229).
Callahan concludes that we cannot allow self-determination to run free, rather, doctors should focus on being comforting and palliative (ie reduce pain and anxiety) and that they should practice caring and compassion, instead of death.
Outline by Don Berkich, University of Texas, Corpus Christi (by permission)
Premise (2) is false, since
VAE and the Aims of Medicine
Premise (2) is false, since it implies that the aim of medicine is to promote the good life and make judgments about the value of a life whereas the true aim of medicine is simply to heal the sick or injured.
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