Abstract
This paper compares and critically comments upon certain aspects of the Canadian Law Reform Commission Report,Euthanasia, Aiding Suicide and Cessation of Treatment, and the United States Presidential Commission Report,Deciding to Forego Life-Sustaining Treatment. It focuses on their positions on euthanasia and on the general principles, values, and procedures that ought to govern practices of foregoing life-sustaining treatment. The paper first comments on the recent debate over the moral relevance of the killing/letting die distinction, since this issue appears crucial in assessing the rationality of the current, absolute prohibitions of direct killing in medical contexts, embodied both in law and in codes of ethics. This issue bears upon a question in the closing section—whether the withdrawal of foods and fluids is ever morally permissible.
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Reference notes
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research,Deciding to Forego Life-Sustaining Treatment: Ethical, Medical and Legal Issues in Treatment Decisions (U.S. Government Printing Office, Washington, D.C., 1983). The Law Reform Commission of Canada, Working Paper 28,Euthanasia, Aiding Suicide and Cessation of Treatment (Minister of Supply and Services Canada, 1982) and this Commission's final report, number 20, of the same title.
The classic statement and elaboration of this argument against the moral relevance of the killing/letting die distinction per se is James Rachels, “Active and Passive Euthanasia,”New England Journal of Medicine, vol. 78, 1975.
For the classic analysis of judgments of causation in practical life see H.L.A. Hart and A.M. Honore,Causation in the Law Oxford University Press, Oxford, England, 1959.
Working Paper, p. 59.
These points are best appreciated by consulting the statement of general principles contained in The Working Paper, Part Three, particularly Section III, and the discussion of cases in Part Four, Section III.
Final Report, p. 25. See also pp. 12–13 for the statement of general principles.
See the U.S. Commission Report, Ch. 4.
See the U.S. Commission Report, pp. 65–73.
See the U.S. Commission Report, pp. 89–90, 132–136, and 189–190.
For a somewhat more extensive treatment of this issue, from which I have here benefited and borrowed, see Joanne Lynn and James Childress, “Must Patients Always be Given Food and Water,” Hastings Center Report, Vol. 13, No. 5, Oct. 1983, pp. 17–21.
Barber and Nejdle v. Sup. ct., 2 Civil No. 69350, 69351, Ct. of App. 2nd Dist., Div. 2, Oct. 12, 1983. This case is reviewed in considerable detail in Bonnie Stienboch, “The Removal of Mr. Herbert's Feeding Tube,” The Hastings Center Report, Vol. 13, No. 5, Oct., 1983.
“In the Matter of Conroy,” Sup. Ct. N.J. App. Div., A-2483-82, July 8, 1983. I take this quotation from George Annas, “Nonfeeding: Lawful Killing in CA, Homicide in NJ,” The Hastings Center Report, Vol. 13, No. 6, December, 1983. Annas contrasts and comments upon “Barber and Nejdle” and “Conroy” but without reaching any firm conclusions. The case of Conroy is due to be reviewed by the New Jersey Supreme Court.
Quoted in Steinbock, “The Removal ...,” p. 16.
Steinbock, “The Removal ...,” p. 16.
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Winkler, E. Decisions about life and death: Assessing the Law Reform Commission and the Presidential Commission Reports. J Med Hum 6, 74–89 (1985). https://doi.org/10.1007/BF01142302
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DOI: https://doi.org/10.1007/BF01142302