The current impasse in the old debate about the morality of euthanasia is mainly due to the fact that the actual source of conflict has not been properly identified—or so I shall argue. I will first analyse the two different issues involved in the debate, which are sometimes confusingly mixed up, namely: (a) what is euthanasia?, and (b) why is euthanasia morally problematic? Considering documents by physicians, philosophers and the Roman Catholic Church, I will show that (a) ‘euthanasia’ is defined (...) by the intention to bring about a patient’s death, and (b) the distinction between what is intentional and what is not does not represent the morally problematic reason against euthanasia. Therefore, although the debate on euthanasia so far has mainly focussed on the distinctions ‘active /passive’ and ‘intentional /unintentional,’ I argue that neither constitutes the genuine source of the controversies. I will clarify what the source of controversies is, and outline the minimal requirement for an argument against euthanasia. (shrink)

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)

Technology and terminology often detract from a reasoned appraisal of the euthanasia option, especially in those discussions that argue for euthanasia's incorporation into a beneficence-based medical model. “Beneficent euthanasia,” assuming there is such a thing, poses special challenges to the traditional provider-patient relationship. These challenges argue for well-defined limits of beneficence and a more equitable distribution of responsibility between participants. We should not allow technology and terminology to generate an unrealistic portrayal of patient death and its ramifications. Participants need to (...) acknowledge their roles in the decision to kill and the obligations that those roles entail. Perhaps we can reach ethical consensus concerning euthanasia by first reasserting our span of control over the technology that can extend the near-death period and by openly discussing euthanasia's implications. (shrink)

Counterfactuals about what a patient would consent to, if he were able to consent, are often cited as justifications, or partial justifications, for acts of euthanasia. In virtue of this fact, they deserve special scrutiny by moral philosophers. ;In Chapter I, I examine terminology that is essential to further understanding the relationship between euthanasia and counterfactual consent. I propose a definition of 'euthanasia', an analysis of 'consent', and I present a brief description of counterfactuals. ;In Chapter II, I consider two (...) questions. The first is, "When it is appropriate to invoke counterfactual consent in an attempt to justify an act of euthanasia?" By making use of an improved version of the voluntary, nonvoluntary, and involuntary distinction among acts of euthanasia, I am able to determine when it is appropriate to cite counterfactuals about consent in an attempt to justify an act of euthanasia. The second is, "to what end is counterfactual consent used?" I contend that counterfactual consent does morally justify some acts of euthanasia, and defend an argument for this claim. Finally, I look at the role of counterfactual consent as a possible legal justification for acts of euthanasia. ;In Chapter III, I use possible world semantics to analyze counterfactual consent. Traditional counterfactuals are determined to be true if in the closest world at which their antecedent is true, their consequent is also true. Counterfactuals about consent have a less straightforward reading. I consider and reject several possible ways of reading counterfactuals about consent, before settling on the correct reading of counterfactuals about consent. ;In Chapter IV, I consider evidence for the truth of claims about counterfactual consent. I consider and reject the claim that no counterfactual is either true or false. I examine both Living Wills and the practice of surrogacy, neither of which offers sufficient evidence for the truth of claims about counterfactual consent. ;In Chapter V, I contrast counterfactual consent with actual consent. I review and refute the arguments for the claim that actual consent is preferable to counterfactual consent. I conclude by presenting a principle about the relationship between actual and counterfactual consent. (shrink)

En la actualidad se defiende con mucha frecuencia la llamada humanización de la muerte" como alternativa frente al vitalismo médico y ante cualquier defensa de la eutanasia voluntaria activa. Esta postura se justifica asumiendo una diferencia moral significativa entre "hacer algo" y "dejar que algo ocurra", entre "matar" y "dejar morir". En la presente comunicación presentaré un esbozo de los fundamentos sobre los que descansa tal distinción a la vez que cuestionaré su relevancia moral cuando se aplica a situaciones eutanásicas (...) complejas.Today, so-called "humanisation of death" is frequently defended as an alternative to medical vitalism and to any defence of active voluntary euthanasia. This position is justified by the assumption of a difference between "doing something" and "allowing something to happen", or between"killing" and "letting someone die". This paper presents an outline of the foundations on which this distinction lies, and questions its moral relevance when applied to complex situations of euthanasia. (shrink)