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CHAPTER 10 - ALLOWING SOMEONE TO DIE, MERCY DEATH, AND MERCY
KILLING
General Overview
In this chapter the issue of euthanasia is examined. The author uses slightly different terminology. The standard
terminology isn't settled but instructors will have to make up their own minds whether the terms used here offer
any advantages. In the US the development of hospice appears to have changed the nature of the debate. In any
case, this is a complex and fascinating topic and goes right to the heart of the difficult philosophical question
regarding the meaning of life and death.
Class Suggestions
Many students will distance themselves from this topic and will not understand why someone may want to
choose to die or why someone might ask for help in dying. This is because of a combination of factors including
youth and lack of experience. Usually only those who have had some experience, most often in their own
families, will be engaged by the topic. The challenge for the instructor then is to get a class of mainly 18 to 19
year olds thinking hard about this issue. One suggestion to make this relevant and closer to home would be to
explain how developing technologies will almost certainly make this an issue for everyone in the class since
someone in their family, perhaps the student themselves, will be faced with decisions like this. Showing a good
video can bring the issue closer as can cases, preferable real ones (like the cases discussed in the chapter).
Looking at the case of Jack Kevorkian could be an interesting project, as could a research report on the
legalization of euthanasia in the Netherlands.
Chapter Summary
Definition of Terms
Euthanasia – "good death." Author replaces euthanasia with allowing someone to die, mercy death, and mercy
killing.
Allowing Someone to Die
Allow patient to die natural death.
Mercy Death
Direct action to terminate patient's life upon request - assisted suicide.
Mercy Killing
Direct action to terminate a patient's life without the patient requesting it.
Current Legal Status of Mercy Death and Mercy Killing
Thirty-nine states specifically prohibit mercy death (assisted suicide), and it is generally illegal under homicide
statues. Mercy killing is outlawed in all states with the exception of Montana, Oregon, Vermont and
Washington, and most countries.
Brain Death
Medically death now defined as "brain death." Heart and lungs may still function but little or no brain activity.
Persistent Vegetative State (PVS) or Irreversible Coma
Distinct from brain death. PVS results from cerebral, cortex, neocortex or "front brain" death. This controls
cognitive functioning. More basic heart and lung systems still function unaided since controlled by the other
parts of the brain. May be awake but no conscious interaction with environment.
Allowing Someone to Die
Die a natural death without interference from medical science. However, many are now aided by new
technologies that raise issues of quality of life and end of life care, prompting claims that we need new ways of
"allowing someone to die."
Arguments Against Allowing Someone to Die
1. Abandonment of patients
2. Possibility of finding cures
3. Impossibility of options for death
4. Interference with God's divine plan
Arguments for Allowing Someone to Die
1. Individual rights over bodies and lives
2. Shortening of period of suffering
3. The right to die with dignity
Ordinary and Extraordinary Means
Extraordinary, or Heroic, Means:
Starting or discontinuing rare, unusual, risky, or expensive treatment. To what lengths should doctors go to save
lives? In certain situations doctors are justified in using extraordinary means to save a patient's life though they
are not obligated to use such means indefinitely.
Ordinary Means:
Controlling pain and other symptoms, but rare cases are unclear.
Appropriate or Inappropriate Care:
Defined by reference to patient rather than - as with ordinary and extraordinary - by reference to patients
generally.
Patient Self-Determination Act (PSDA)
Act of Congress (1990) stipulating rights of patients, especially the right to "formulate advance directives."
Advance Directives
Allow patients to state the kind of care they wish to receive if they become too ill to communicate their wishes
to others.
The Hospice Approach to Care for the Dying
Hospice is the most prevalent approach to "terminally ill" in the U.S. It involves seven elements:
1. Comforting and caring for patients
2. A team approach
3. Pain and symptom control
4. Outpatient and home care
5. Humanized inpatient care
6. Freedom from financial worry
7. Bereavement counseling and assistance
Mercy Death
Assisted suicide: Direct action taken to terminate life at patients' request.
Arguments Against Mercy Death
1. The irrationality of mercy death
2. The religious argument
3. The Domino argument
4. The justice argument
5. The possibility of finding cures
6. The Hospice alternative
Arguments for Mercy Death
1. Individual freedom and rights
2. Human rights versus animal rights
Changes in Attitudes Toward Mercy Death
Hemlock society and Dr. Jack Kevorkian have both continually advocated for mercy death.
"Death with Dignity" act passed in Oregon, 1994.
Lack of autonomy of patients in medical care because physicians and pharmacists have control over drugs and
technologies.
Health Care Personnel have Practical Forms of Assisted Suicide:
Many doctors and nurses are already assisting in patient suicides.
Strong Desire for Greater Autonomy and Control over Life and Death
Patients who have terminal conditions often want autonomy to decide their own death, including physician
assistance.
Suggested Safeguards for Mercy Death
1. Permissive rather than compulsory or mandatory
2. A written request
3. A waiting period
4. Counseling
5. More than one doctor
6. Abuse of safeguards punishable
7. Assisted suicide should be painless
Other safeguards:
1. Judge approval
2. Bioethics committee
Although these two are restrictive, would make questionable mercy death very difficult.
Mercy Killing
Direct action but not at patient's request.
Arguments Against Mercy Killing
1. Direct violation of the Value of Life principle
2. The Domino argument
3. The possibility of finding cures
Arguments for Mercy Killing
1. Mercy for the "living dead"
2. Financial and emotional burdens
3. The patient's desire to die
The Possibility of Establishing Legal Safeguards:
If mercy death and killing were sanctioned they would be abused. Can establish safeguards against some but
perhaps not all-possible abuse.
KEY TERMS AND CONCEPTS
Euthanasia
Allowing Someone to Die
Mercy Death
Mercy Killing
Assisted Suicide
Passive Euthanasia
Active Euthanasia
Brain Death
Persistent Vegetative State (PVS)
Irreversible Coma
Right to Die
Ordinary Care
Extraordinary Care
Appropriate Care
Inappropriate Care
Advance Directive
Hospice
ESSAY QUESTIONS
1. How does mercy death differ from mercy killing? Is one more morally acceptable than another? Why or
why not?
2. What are the arguments for and against mercy death? Is it morally justifiable in some situations?
3. Carefully examine the reasons for and against mercy killing. State and defend your position.
4. Do we have a "right to die"? Explain why or why not.
5. "Slippery slope" or "domino" type arguments are often used to oppose euthanasia. Critically evaluate this
type of argument looking at the evidence for and against.
TRUE/FALSE
1. Euthanasia comes from the Greek and means "a bad death."
2. Mercy death is defined by the author as direct action to terminate a patient's life without the patient's
permission.
3. Thirty-nine states specifically prohibit mercy death.
4. The state of California has included brain death in its legal definition of death.
5. Mercy killing is legally acceptable in some states in the US.
6. There is no law prohibiting euthanasia in the US.
7. Hospice care is available only to those with "advanced directives."
8. "Inappropriate care," according to the author, is care that does not suit the situation of the patient.
9. A recent study of 850 nurses revealed that 141 had received requests from patients for assisted suicide.
10. The main arguments against mercy death is the possibility of finding cures.
MULTIPLE CHOICE
11. Direct action to terminate a patient's life requested by the patient is called by the author
a) allowing someone to die.
b) mercy death.
c) mercy killing.
d) suicide.
12. Technology has created problems with the medical definition of death. This is known as
a) brain death.
b) persistent vegetative state.
c) irreversible coma.
d) the zombie problem.
13. Most arguments for allowing someone to die are based on the principle of
a) justice.
b) goodness.
c) individual freedom.
d) life.
14. Which US state has a law allowing "assisted suicide"?
a) California
b) Michigan
c) Florida
d) Oregon
15. Dr. Jack Kevorkian is infamous because he
a) murdered many people.
b) performed mercy killings.
c) performed mercy death.
d) allowed his patients or die.
16. If you have an "Advance Directive" it means that
a) your medical condition has advanced to a serious or life threatening stage.
b) you already know what God wants for you.
c) you have a legal document which states how you wish to be treated if you are seriously ill.
d) you have a legal document which allows mercy death and mercy killing.
17. According to the author one of the strongest arguments against mercy death is
a) abuse.
b) God's will.
c) selfishness.
d) economic.
18. A strong argument against mercy killing is based on the principle of
a) justice.
b) freedom.
c) goodness.
d) life.
19. The "domino" argument against mercy killing says that, if sanctioned, mercy killing would
a) set a dangerous precedent.
b) prevent finding cures.
c) make doctors and nurse uncaring.
d) violate life.
20. The approach to dying that emphasizes "comfort and care" is known as
a) mercy death.
b) mercy killing.
c) the "Kevorkian" approach.
d) hospice.
Answer Key to Chapter 10 Test Questions
True or False:
Multiple Choice:
