In this chapter, I consider the idea that physician-assisted death might come into question in the cases of psychiatric patients who are incapable of making autonomous choices about ending their lives. I maintain that the main arguments for physician-assisted death found in recent medical ethical literature support physician-assisted death in some of those cases. After assessing several possible criticisms of what I have argued, I conclude that the idea that physicianassisted death can be acceptable in some cases of psychiatric patients (...) who lack autonomy ought to be taken into account in assessing the moral and legal acceptability of physician-assisted death. (shrink)

The practice whereby terminally ill patients choose to end their own lives painlessly by ingesting a drug prescribed by a physician has commonly been referred to as physician-assisted suicide. There is, however, a strong trend forming that seeks to deny that this act should properly be termed suicide. The purpose of this paper is to examine and reject the view that the term suicide should be abandoned in reference to what has been called physician-assisted suicide. I argue that there are (...) no good conceptual or philosophical reasons to avoid the suicide label. I contend that intending one’s death is essential to the nature of suicide, and this intention is normally required on the part of the terminally ill patient when she knowingly takes a life-ending drug. Additionally, the analysis shows that any plausible strategy that avoids the term suicide is counteracted by the way in which advocates of the practice want to make it legal. (shrink)

All too often in applied ethics debates, there is a danger that a lack of analytical clarity and precision in the use of key terms serves to cloud and confuse the real nature of the debate being undertaken. A particular area of concern in my analysis of the bioethics literature has been the uses to which the key terms “suicide,” “assisted suicide,” and “euthanasia” are put. The modest aim of this article is to render a contribution to the applied ethics (...) debate on these topics by seeking to delimit the scope and meaning of these terms. The criteria of specificity, non-arbitrariness, consistency (between various terms), and the avoidance of strong pejorative presuppositions, supply the main standards guiding my adoption of usages. (shrink)

The illusion that Kant respects persons comes from ascribing contemporary meanings to purely technical terms within his second formulation of the categorical imperative, “[A]ct so that you treat humanity, whether in your own person or in that of another, always as an end and never as a means only”. When we realize that “humanity” means rational nature and “person” means the supersensible self (homo noumenon), we find that we are to respect, not human selves in all their diversity (homo phaenomenon), (...) but rational selves in all their sameness, in their unvarying conformity to the universal principles of pure practical reason. Contemporary individualism gets no support from Kant. (shrink)

Contemporary moral philosophy and much contemporary moralizing almost radiate respect for persons. Thomas Nagel is one of many who take its primacy for granted. In a review of Scanlon he says.

The impediment of individuals affected by mental illness at risk of suicide is well justified. But the impediment to rational suicide is complicated by the conflict between defending life and defending autonomy, as illustrated by the various philosophical approaches to the ethical dimension of suicide. In this article we argue that, insofar as punctual in nature and limited in scope, paternalistic intervention of the autonomous individual is also justified. To do so, we will use the distinction between shallow and deep (...) autonomy, as well as complicating factors from recent medical literature: the question of ambivalence and the cry for help model. We will also pay special attention to the ethical implications of new strategies for risk detection that use artificial intelligence applied to social network databases like Facebook. Although preliminary evidence suggests these are effective tools, their lack of transparency, regulation and consent puts civil liberties and rights at risk. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

In this essay, I describe Bob Veatch’s career from the perspective of a colleague and friend. Bob and I started our professional careers at the same time and quickly came into professional contact. With Bob’s move from the Hastings Center to the Kennedy Institute, we became colleagues and worked for almost a decade on our book on death and dying. He was an outstanding co-editor and author. I believe he knew more about the philosophically connected issues in this area of (...) bioethics than anyone publishing in the area, and it was an area of intellectual interest that he pursued throughout his career. Beyond bioethics, Bob and I shared our shared love of contemporary bluegrass music, especially the songs of The Seldom Scene. Bob studied them much as he studied bioethics—with deep knowledge and seriousness. He was just a scholar by nature and with excellent training and experience. If we were to create a Hall of Fame for bioethics, Bob might be the first person elected. (shrink)

A diagnosis of schizophrenia is often taken to denote a state of global irrationality within the psychiatric paradigm, wherein psychotic phenomena are seen to equate with a lack of mental capacity. However, the little research that has been undertaken on mental capacity in psychiatric patients shows that people with schizophrenia are more likely to experience isolated, rather than constitutive, irrationality and are therefore not necessarily globally incapacitated. Rational suicide has not been accepted as a valid choice for people with schizophrenia (...) due in part to a belief that characteristic irrationality prevents autonomous decision-making. Since people with schizophrenia are often seen to lack insight into the nature of their disorder, both psychiatric and ethical perspectives generally presume that suicidal acts result directly from mental illness itself and not from second-order desires. In this article, I challenge notions of global irrationality conferred by a diagnosis of schizophrenia and argue that, where delusional beliefs are unifocal, schizophrenia does not necessarily lead to a state of mental incapacity. I then attempt to show that people with schizophrenia can sometimes be rational with regard to suicide, where this decision stems from a realistic appraisal of psychological suffering. (shrink)

Suicide prevention is a National Health Service priority in the United Kingdom. People with mental illness are seen to represent one of the most vulnerable groups for suicide and recent British Government policy has focused on prevention and management of perceived risk. This approach to suicide prevention is constructed under a biomedical model of psychiatry, which maintains that suicidal persons suffer from some form of disease or irrational drive towards self-destruction. Many react to the idea of self-inflicted death with instinctive (...) revulsion, which has prevented serious discussion of the concept of rational suicide, particularly in relation to those with schizophrenia. The idea that there may be circumstances in which suicide can be viewed as rational is discussed within the biomedical approach to ethics and wider literature primarily in relation to physical disease, terminal states and chronic pain. It is not deemed a viable choice for those who are considered ‘non-autonomous’ due to the controlling forces of mental illness. I propose that suicide is not a consequence of mental illness per se, and that it may be seen as a rational response to a realistic perspective on the course and consequences of living with schizophrenia. The denial of dialogue about the validity of suicidal ideation for people with schizophrenia has led to negative consequences for people with serious mental illness in terms of justice and recognition of person-hood. (shrink)