Physician-Assisted Death

Preface 1 How Should We Think about Death and Dying? How do we tell when death has occurred? What do we mean by death? Why is it (usually) a bad thing to die? How might death sometimes be a good thing? How and where do we typically die? 2 What is End-of-life Care? What is the end of life? What end-of-life treatment options are currently available to patients? Do patients have the right to refuse treatment? Do patients have the right to refuse life-sustaining treatment? What is pain management? What is terminal sedation? What is physician-assisted death? 3 What is the Ethical Case in Favor of Physician-Assisted Death? What is the argument from well-being? What is the argument from autonomy? When is PAD justified? Is there an ethical difference between the two forms of PAD? 4 What is the Ethical Case Against? What is the right to life? What is the sanctity of life? What is the doctrine of double effect? What is the doctrine of doing and allowing? Is there an ethical difference between PAD and other end-of-life treatment options? What role can be played in this issue by religious arguments? 5 What is the History of Legal Physician-Assisted Death? Is it legal to refuse life-sustaining treatment? Is it legal to administer pain medication that may hasten death? Is terminal sedation legal? Where did any form of PAD first become legal? Where has PAE become legal? What has been happening in the United States? 6 What are the Options for a Legal Regime? Must the illness be terminal? What kinds of suffering should be recognized? What kinds of illnesses should be included? What about people who are just "tired of life"? How do we determine decisional capacity? Adults only? PAS , PAE, or both? What procedures should be required? What system of review and oversight would be appropriate? What should be done about conscientious objection? 7 What is the Case in Favor of Legalization? What is the relationship between ethics and law? What is the argument from compassion? What is the argument from respect? What is the argument from freedom of conscience? What is the argument from parity? What is the argument from democracy? 8 What is the Case Against? What is the slippery slope argument? What is the abuse argument? Is helping patients to die contrary to a doctor's professional duty? Would helping patients to die undermine the physician-patient relationship? Are doctors willing to assist the deaths of their patients? Is helping patients to die consistent with the goals of palliative care? Would legalizing PAD erode the delivery of other forms of palliative care? Shouldn't we wait to legalize PAD until we can guarantee every dying patient high-quality palliative care? Why do patients need doctors to help them die? Can't they just do it themselves? Why do patients need PAD, when they can die by refusing food and water? 9. What Might Lie Farther Down the Road? What is nonvoluntary PAD? Is it legal to withhold life-sustaining treatment from permanently unconscious patients? What role should be played by advance directives? Is there a case for euthanasia for permanently unconscious patients? What about patients suffering from dementia? What about infants? 10 How might legalization be achieved? What kind of legal regime should advocates aim for? What role might be played by legislatures? What role might be played by courts? What role might by played by prosecutors? What role might be played by referenda? Appendix Oregon Death with Dignity Act Notes Bibliography Index