Concerned With Voluntary Euthanasia

J. David Velleman and Dan W. Brock are both concerned with voluntary euthanasia; a competent patient making a voluntary request to have his or her life ended. The arguments laid out in Velleman’s, “Against the Right to Die”, and Brock’s, “Voluntary Active Euthanasia” deal with active and passive voluntary euthanasia. Active being that the patient actively takes the last step in their death, while passive is usually defined as withdrawing medical treatment with intent to cause death. They do not consider cases involving involuntary euthanasia, when the patient is competent and refuses treatment. Nor do they consider non voluntary euthanasia, when the patient isn’t competent at all. Many people believe that giving legality to voluntary active euthanasia (VAE) will in turn lead to involuntary and nonvoluntary euthanasia, the slippery slope fallacy, but for the purposes of this paper I’m only concerned with VAE. Both authors agree that anyone could possibly be morally entitled to be allowed or helped to die. However, Velleman argues against an institutional right to die. He believes that making the choice of voluntary active euthanasia available to the people can make them worse off even if they choose the option that is best for them. The ability to make a choice makes one worse off than going with the default option. In this paper, I’m going to analyze Velleman’s arguments while explaining how Brock responded to Velleman’s arguments. To keep the integrity of each authors’ thoughts, I am going to use similar word phases which will be identified in quotes and later labeled with the paper number of reference.

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Velleman agrees that we have an obligation to assist some deaths, however he disagrees with those who use Kantian terms to justify such an obligation. He explains that voluntary active euthanasia deals with two major rights a person has, according to Kantian moral theory. They have the right to dignity and their autonomy. A multitude of life-preserving treatments are said to, “violate a person’s dignity or to detain him in an undignified state” (Velleman, pg 2). A patient has the right of autonomy, or self-determinism, which is that we respect his/her competent wishes even if it’s a wish to die. Velleman goes on to explain how these rights become confusing when dealing with Kantian language in the terms of medical ethics. He has reservations about the loose definitions which don’t match up with the extreme states of patients who are in question while dealing with euthanasia. Because of these qualms, Velleman disregards these Kantian-based arguments and moves on.

Aside from problems in definition, VAE is dealing with other peoples autonomy. If laws are to be made which prohibit this autonomy, than these laws should make people better off. Velleman feels he has an answer to this dilemma which leads to his second argument against the option of euthanasia being given to patients, but unlike the first, this reason is consequentialist.

When Velleman speaks of his consequentialist reasoning, he isn’t referring to the consequences of mistakingly choosing to die, but instead, the consequences of placing such an option in the hands of the patient. He believes that giving patients this option will actually make them worse off. I’m going to explain how Velleman attempts to prove this and then give the objections laid out by Brock.

Contrary to natural thought, if we are given a second option besides the default, it will make us worse off than before no matter which option is chosen. Velleman explains this idea with an example of a cashier who is given the power to open the safe. Its not that the cashier doesn’t directly want the power, but rather, it would make him a target for robbers. Even though opening the safe while at gun point would be the right thing to do, he’d be “wishing he’d never been given the option of doing it” (Velleman, pg 8). This makes him worse off because he can no longer have the default option, not being forced to open the safe at gun point, without choosing it. Multiple options become available and he is now subject to the pressures of possibility. Relative to euthanasia, this is the most important way of harm. We would be denying a patient the status quo of staying alive by default, with the option of euthanasia looming over his head. Because of this, the patient will now see himself in control of his own survival, which is ordinarily viewed as given to him.

If the patient sees himself as this agent of control, then he will be held responsible for his actions by himself and others. He would then be required to justify his actions, whether it be his continued existence or choice of euthanasia. “The burden of justifying one’s existence might make existence unbearable – and hence unjustifiable.” (Velleman, pg 11) It may be perceived as insecurity, but justifying oneself personally and to others is extremely important to those who are ill. When the gift of “independent activity” is taken from someone, “personal intercourse” and intercourse with others is the only relief left in life. And so, unless he can defend his existence to the “satisfaction of others”, his only reasons for life may disappear. A patient who believes that his terminal illness is not an ample reason for ending his life with be faced with “the burden of proof”. Even if the patient believes that his life is worth living, he may find reasons to assume that those around him think otherwise. Reasons ranging from the financial or the emotional costs of prolonging life may cause him to “rationally judge that he is better off taking the option of euthanasia” (Velleman, pg 12-13). Therefore, Velleman believes that if we offer the option of dying, than we may give patients new reason to choose death.

Through the preceding arguments, Velleman is lead to believe that euthanasia should be permissible in some cases, yet still forbidden in others. However, he doubts that policymakers could define such conditions in which the option of dying would be beneficial and when the option of dying would be harmful. This leads him think that the best solution to the problem is allowing health professionals to decide. They should be given the power to “permit, and never require,” the option of euthanasia “or to grant the patients’ request for it” (Velleman, pg 19). It would be possible define certain conditions when the option should never be offered, but we cannot define conditions when euthanasia should always be offered. If put into effect, caregivers could withhold the option whenever they see fit, even when requested. Velleman claims that we already put so much trust into health professionals that this would serve as an effective solution. However, he still believes that the best policy of euthanasia “is no policy at all.” Velleman states that he is inclined to believe that advances in medical technology have “outrun the capacity of institutional rules to regulate their application.” (Velleman, pg 20) And so, the policy regarding euthanasia should be “weak and vague by design,” left up to the individual health care professionals and the patient in question. (Velleman, pg 20)

Dan W. Brock takes the opposite stance as J. David Velleman, believing that there should be an established institutional right to die, as stated in his article, “Voluntary Active Euthanasia.” He lays out many positive and negative potential consequences of euthanasia, but feels strongest about protecting patients’ right to autonomy. I will briefly explain some potential positive and negative consequences of euthanasia, but will focus more on his direct responses to Velleman’s argument. Some potential good consequences of euthanasia include: giving the general public a broader sense of control over their life and death, showing mercy to suffering patients, and once death is undeniable in certain cases – it’s more humane to do it quickly. Some potential bad consequences of euthanasia include: it’s not compatible with physicians moral and professional commitment as healers; to protect life, and euthanasia could weaken society’s commitment to providing optimal care to the sick.

Brock directly calls out Valleman’s solution to the euthanasia problem and refutes it. Velleman argues that offering the option of euthanasia would make patients worse off than if not given the option at all. This leads Velleman to conclude the best solution is health care professionals having the power to “permit, and never require,” (Velleman, pg 19) the option of euthanasia or to grant the patients’ request for it. In doing so, situations in which there are “unmistakable and over- powering reasons for persons to want the option of euthanasia” (Brock, pg 19) would be the only cases granted it. Brock lists three main reasons why such restrictions wouldn’t lead to the best outcome. First, polls and other evidence tend to show that most Americans do, in fact, believe that euthanasia should be allowed. Consequently, the amount of people made worse off by having the option won’t outweigh those made better by having the option. Second, if people would be made worse off by the option of a right to die, than why don’t we see any consequences of voluntary passive euthanasia? People already have the option to refuse life-sustaining treatment and there is no evidence of harmful effects or public desire to take away such right. How would establishing an institutional right to active euthanasia make any difference? To this argument, Velleman has a refute. He states that the option of refusing life-sustaining treatment to end ones life may be just as harmful as having the option of active euthanasia. However, the proportions of deaths that occur as a result of passive euthanasia is very small, making the side-effects very small as well. Also, these side effects are to be accepted as an unavoidable byproduct of protecting the right not to be assaulted. Assaulted in this case as morally entitled to refuse treatment because we are morally entitled to not be drugged or punctured with needles. Third, there is a wide range of conditions that are reasonably disagreed about in the terms of euthanasia. If Velleman suggests restricting euthanasia to persons whose conditions’ indisputably call for it, than we would be denying the most amount of people who want it.

In conclusion, Velleman and Brock disagree on whether to establish an institutional right to die or not. Velleman argues that establishing such a right would burden those given the option of euthanasia, that to offer an option of dying gives new reasons to end ones life. Because of this, he suggests the solution of a weak and vague euthanasia policy by design, left up to the individual health care professionals and the patient in question. Brock argues for an institutional right to die. He lists possible positive and negative outcomes and directly refutes Velleman’s conclusion with three arguments. Brock and Velleman could go back and forth all day arguing and refuting each other. However, I believe that they disagree in the simple fundamentals of the situation. Brock believes that an individuals well-being and control over his or her own life far outweighs any impact on society, while Velleman believes that even the option would make patients and society worse off overall.