Wiesing-WMA EoL Presentation Vatican-Nov2017

1
Is there a right to determine
one’s own death?
The ethical perspective(s)
Urban Wiesing
WMA European Region Meeting on End of Life Questions
Vatikan, 17.11.2017
Institut für Ethik
und Geschichte der
Medizin
Plurality
• Suicide, assisted suicide and killing on
demand are notoriously controversial since
antiquity until today.
• There is no consensual answer what the
autonomy of a patient means for end-of-life
decisions.
Institut für Ethik
und Geschichte der
Medizin
Plurality
• There is not the one and only ethical theory!
• Deontological ethics, utilitarian ethics,
Aristotelian ethics, care ethics, feminist ethics,
dignity approach, Christian ethics…
• Even within one ethical theory a broad range
of answers!
Institut für Ethik
und Geschichte der
Medizin
Plurality
• From total ban of any restriction of therapy to
liberal positions in favor of killing on demand
and assisted suicide
• All theories come to different conclusion.
• Two examples: Dignity approach, Christian
ethics
Institut für Ethik
und Geschichte der
Medizin
Human-Dignity-Approach?
• No consensus on physician assisted suicide
or killing on demand:
• Does dignity mean that each person has the
right to decide according one‘s own
autonomy?
• Or: You must never decide against the
biological condition of possibility for
autonomy (that’s your life!)?
Institut für Ethik
und Geschichte der
Medizin
Human-Dignity-Approach?
• Good arguments for both interpretations
• No consensus!
Institut für Ethik
und Geschichte der
Medizin
2
End-of-life decisions and Christian
Ethics
• Majority of Christians in industrialized countries is favor
physician assisted suicide/killing on demand, despite
official statements
• Highly controversial opinions among Christian
theologians, priests, bishops, politicians
Institut für Ethik
und Geschichte der
Medizin
End-of-life decisions and Christian
Ethics
• Former Archbishop of Canterbury Lord Carey:
Assisted dying is ‘profoundly Christian and moral’
• Dismisses ‘pain is noble’ claim
Institut für Ethik
und Geschichte der
Medizin
End-of-life decisions and Christian
Ethics
• Desmond Tutu: “I want the right to end my life
through assisted dying”
• Terminally ill people “should have right to choose a
dignified assisted death”
Institut für Ethik
und Geschichte der
Medizin
End-of-life decisions and Christian
Ethics
• Herman Van Rompuy:
• „Former EU president criticises Pope Francis over
euthanasia ban“ (Catholic Herald 15.8.2017)
• “The time of ‘Roma locuta causa finita’ is long
past”
Institut für Ethik
und Geschichte der
Medizin
End-of-life decisions and Christian
Ethics
• Hans Kueng argues as a catholic theologian in
favor of killing on demand and assisted suicide
Institut für Ethik
und Geschichte der
Medizin
End-of-life decisions and Christian
Ethics
• Even within Christianity: Non consensus on end-of-life
decisions.
• Within Christianity: Plurality!
• In a pluralistic, liberal society: One of the
numerous convictions must not be made the basis
of legislation!
Institut für Ethik
und Geschichte der
Medizin
3
Plurality
• It is unrealistic that this plurality will disappear
• The opposite is realistic!
• A political answer is needed!
Institut für Ethik
und Geschichte der
Medizin
The answer to ethical plurality
is a political one
• „Certain decisions are momentous in their impact on the
character of a person’s life—decisions about religious faith,
political and moral allegiance, marriage, procreation, and
death, […] In a free society, individuals must be allowed to
make those decisions for themselves, out of their own faith,
conscience, and convictions.”
• Ronald Dworkin, Thomas Nagel, Robert Nozick, John Rawls, Thomas Scanlon,
Judith Jarvis Thompson, 1997, Assisted Suicide: The Philosophers’ Brief
Institut für Ethik
und Geschichte der
Medizin
The political answer to ethical plurality
• Important decisions of your life (and dying) are
individualized.
• The task of the state is to enable and to protect
them.
Institut für Ethik
und Geschichte der
Medizin
But…
• Despite the ethical plurality on autonomy and
end-of-life decisions:
• There is strong consensus on what should
be prohibited!
• We know that there are end-of-life-decisions
not driven by autonomy.
Institut für Ethik
und Geschichte der
Medizin
Consensus: This should be
prevented
• Premature, affectively influenced decisions
• No one should ask for PAS because of poor
medical treatment or lack of palliative care
• Consensus: (physician) assisted suicide is
complicated
Institut für Ethik
und Geschichte der
Medizin
Empirical ethics on PAS
• No slippery slope
• No decrease of palliative care
• No social discrimination
• No loss of trust in physicians
• Physician assisted suicide: high rate of patients no
longer pursuing assisted suicide (up to 80%)
Institut für Ethik
und Geschichte der
Medizin
4
Empirical ethics
• Supreme Court of British Columbia 2012
• “[…] the research does not clearly show either a
negative or a positive impact in permissive
jurisdictions on the availability of palliative care or on
the physician-patient relationship. […] The evidence
shows that risks exist, but that they can be very
largely avoided through carefully-designed, well-
monitored safeguards.”
Institut für Ethik
und Geschichte der
Medizin
Summary
• There is a plurality of ethical theories and
answers within the theories to end-of-life-
decisions…
• … and no consensus!
• The political answer to plurality: Make those
decisions for yourself, out of your own faith,
conscience, and convictions.
• These decisions are no longer in the scope of
responsibility of a state.
Institut für Ethik
und Geschichte der
Medizin
Summary
• But: There is consensus what should be
prohibited.
• In a pluralistic, liberal society:
• There is no political right to forbid, but a
political need to protect autonomous decisions
and to regulate end of life decisions!
Institut für Ethik
und Geschichte der
Medizin
Is there a right to determine
one’s own death?
The ethical perspective(s)
Urban Wiesing
WMA European Region Meeting on End of Life Questions
Vatikan, 17.11.2017
Institut für Ethik
und Geschichte der
Medizin