Medical Ethics
Michael Green
Manuel Vargas
phone, office information

24 April. Passive and active euthanasia
27 April. Intended vs. extraordinary means
29 April. Are intentions relevant to the moral assessment of actions?
4 May. Can it be worse to have more choices?

Medical Ethics: 6 May. Would it be unfair if the poor used PAS more?

A note on what a right to physician-assisted suicide (PAS) would be

Velleman is treating a right to PAS as meaning that doctors would be obligated to help a patient who requested help in committing suicide.

Dworkin, et. al. are assuming that a right to PAS would mean that a patient could legally receive help in committing suicide from a doctor. But if a doctor didn't want to provide this service for a patient, she wouldn't have to.

I don't think this makes a lot of difference to the arguments.

Two ways of putting that point about fairness

This sounds like a perverse argument: poor patients can't afford palliative care, so they should be allowed to choose PAS because that would offer them a way of escaping a painful death.

Many people think that this gets it wrong: we should improve palliative care for the poor, not give them the option of death (Jesús and Lorie were the most prominent advocates of this position in class).

There are two ways of expressing this point.

1. The consequentialist way: allowing the poor to die quickly would take away the pressure to improve palliative care for the poor.

This argument appeals to the good consequences of, gulp, allowing some poor people to die in pain: if we do that, we'll make it more likely that the medical system will be reformed such that fewer poor people die in pain in the long run.

The argument will work only if there is a real prospect of reform that legalizing PAS would block.

2. The deontological way: it's wrong of us to allow poor patients to choose between death and pain when we could easily prevent the pain by providing palliative care.

This argument appeals to the intrinsic wrongness of deciding for this reason. It does not assert that things will be better in the long run if we do not legalize PAS (hence "deontological;" the argument doesn't appeal to consequences of actions, policies, or decisions). It simply states that when we make our policy in this area we should not consider these as the only two options: death and (preventable) pain.

The main objection to this argument is that it does nothing for the people who despearately want PAS because they do not have good palliative care and are dying in terrible pain.

Perhaps that's not so important. Perhaps the upshot of this argument is that we should only consider their cases in debating whether to improve the provision of palliative care for the poor. However, when we're considering PAS, one might think, this kind of consideration is improper.

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