PHLB09H3 Chap.7 Physician-Assisted Death
Physician-Assisted Death
The readings and the exam question
Week eight pairs James Rachels on active and passive euthanasia with a chapter from John Keown on the value of autonomy.
The oral exam question asks how Rachels defends active euthanasia, how he compares it with passive euthanasia, which objections Keown raises against voluntary active euthanasia, whether Rachels relies on autonomy, and how Rachels might answer Keown.
Keown on autonomy
Keown sets out the autonomy argument for euthanasia, including Ronald Dworkin's claim that forcing an unwanted death on someone is tyranny.
He replies that autonomy is valuable as a means to flourishing, so a choice deserves respect only within a sound moral framework. A choice to kill an innocent person, oneself included, does not qualify.
He adds that our choices affect others, that death ends autonomy itself, and that many requests are distorted by pain, depression or feeling a burden.
Where Keown accepts autonomy
Keown agrees that patients may refuse futile or overly burdensome treatment and that their view of burden is central.
His line is drawn at intentional killing, which makes the active and passive comparison the natural pressure point for discussion.
What this chapter covers
- 01
Active and Passive Euthanasia
- 02
Voluntary Active Euthanasia
- 03
Autonomy Within a Moral Framework
- 04
Inviolability of Life
- 05
How Autonomous Are Requests
- 06
Refusing Burdensome Treatment
Worked example · free
Map Keown's objections onto the autonomy argument
- 2State the autonomy argument and its key premise.
- 2Present three of Keown's objections, each aimed at a different premise.
- 2Assess which objection is strongest and why.
Key terms
- Active Euthanasia
- Active euthanasia is a deliberate act by which a physician ends a patient's life.
- Passive Euthanasia
- Passive euthanasia is withholding or withdrawing treatment so that a patient dies of their condition.
- Inviolability of Life
- The inviolability of life is the principle that it is always seriously wrong to intentionally kill an innocent human being.
- Philosophers' Brief
- The Philosophers' Brief is a 1997 submission to the United States Supreme Court arguing that decisions about one's own death belong to the individual.
Physician-Assisted Death FAQ
What does Keown mean by saying autonomy needs a moral framework?
He argues that autonomy is valuable because, through our choices, we promote our own and others' flourishing. A choice therefore earns respect only when it is consistent with that flourishing and with human dignity. A choice to murder is autonomous but deserves no respect, and he holds that a choice to kill oneself, or to have oneself killed, is similar.
Does Keown give patients any say at the end of life?
Yes. He accepts that patients may refuse treatment that is futile or overly burdensome, and that the patient's own view is central to judging burden because people tolerate pain differently. He says the law should presume such refusals deserve respect. His objection is to intentional killing, not to declining treatment.
Why does Keown doubt that euthanasia requests are autonomous?
He points out that requests often come from patients whose judgement is impaired by pain, medication side effects or depression, who may be poorly informed about their prognosis or palliative care, or who feel abandoned or a burden. He cites research linking requests to depression and undertreated symptoms, concluding that many requests would not be truly autonomous.
What is the difference between voluntary active euthanasia and refusing treatment?
In voluntary active euthanasia a physician deliberately ends a patient's life at the patient's request. In refusing treatment, a patient declines an intervention and may die of the underlying condition. Keown accepts refusals of futile or overly burdensome treatment and rejects euthanasia because it involves an intention to kill, which is exactly the kind of line Rachels's comparison puts under pressure.
Exam move
List Keown's objections from memory and sort them into four groups: the value of autonomy, the value of life, the reality of requests and the distraction from intentional killing. Write Rachels's comparison of active and passive euthanasia in your own words from the reading, with one sentence on each similarity and difference he draws. Then mark which of Rachels's premises depend on the patient's request.
Rehearse a one-minute opening and three follow-up answers aloud, timing yourself.
