Visiting scholar lectures on the state of the global debate over the legalization of euthanasia.

John Keown, Rose. F. Kennedy Professor of Christian Ethics at the Kennedy Institute of Ethics at Georgetown University and Mary Ann Remick Senior Visiting Fellow at the Notre Dame Center for Ethics and Culture, is broadly considered to be the world’s leading authority on the ethics and law pertaining to euthanasia.  His published works include Debating Euthanasia (Hart 2012)and Euthanasia Examined: Ethical, Clinical, and Legal Perspectives (Cambridge 2002).

Keown delivered a lecture, “Euthanasia: An International Perspective,” on December 8 at the Eck Hall of Law.  The event was sponsored by University Faculty for Life.

Euthanasia, Keown began, is defined as “the intentional shortening of a patient’s life by a doctor because death is thought to benefit the patient.”  This can take a variety of forms: active, passive, voluntary, non-voluntary, and involuntary.

Active euthanasia is closely associated with lethal injection and is sometimes being referred to as mercy killing.  Passive euthanasia, on the other hand, involves the withholding of treatment in order to shorten the patient’s life.

Voluntary euthanasia involves the request of a competent patient, while involuntary euthanasia is against a patient’s wishes.  Non-voluntary euthanasia is performed on an incompetent patient.  Technically distinct from euthanasia but closely connected is physician-assisted suicide (PAS).  Keown explained that this is “the intentional assistance of a patient’s suicide by a doctor because it was thought death would benefit the patient.”

After defining these key terms, Keown turned to the contemporary legal landscape.  Voluntary active euthanasia (VAE) and PAS are generally illegal, though there are some exceptions.  For example, VAE is legal in the Netherlands, Belgium, and Luxembourg, and PAS is legal in Oregon, Washington, Vermont, Montana, and New Mexico.  Internationally, the debate over euthanasia is becoming more and more intense in Canada, the United Kingdom, and the United States.  The campaign for the relaxation of laws prohibiting euthanasia has also had the effect of making PAS more common.  Even in locales where these practices remain illegal they may take place ‘underground.’  The Internet has become a medium where assistance is provided to those who do not have access to lawful suicides.  Emily Jackson, Keown’s interlocutor in Debating Euthanasia, argues that euthanasia and PAS should be legalized in order to allow for regulated dying rather than allowing these practices to happen underground.

Keown devoted most of his lecture to addressing Jackson’s arguments as she makes them in Debating Euthanasia.  He identified six major flaws in her position: ethical vagueness, evasion, conflation, inadequate response, inadequate response, and failure.

Ethical vagueness reflects the fact that it is unclear what principle Jackson’s argument ultimately rests on.  Her position, Keown argued, seems to be built upon respect for autonomy, beneficence, or both, but this is never made explicit in her argument in Debating Euthanasia.  The problem with building a case for the legalization of euthanasia on the grounds of respect for autonomy is, Keown said, that autonomy is valued precisely in so far as its exercise makes for the wellbeing and flourishing of the human beings who possess it.  Building an argument upon beneficence implies that the central question in discerning whether a patient will be euthanized is whether or not death would benefit the patient.  The ethical vagueness of Jackson’s argument raises an important question: in the case of a patient who lacks autonomy, for whom it is thought that death would be to his benefit, what could justify depriving him of that benefit? Keown returned to this question later when addressing the logical slippery slope argument against legalization of euthanasia.

Keown then explained  that Jackson evades confronting the principle of the inviolability of life.  This principle, which the House of Lords Select Committee on Medical Ethics in 1994 described as “the cornerstone of law and social relationships” which “protects each one of us impartially, embodying the belief that all are equal,” holds that all innocent human life is inviolable and ought not to be destroyed.

Jackson’s argument also suffers from a conflation of intention and foresight; a misunderstanding of the principle of double effect.  The basic function of this principle is to distinguish between outcomes which are intended, and outcomes which are merely foreseen as likely, but unintended, consequences of one’s conduct.  A proper understanding of the relationship between intention and foresight is vital for any consistent and sound argument on the ethical status of euthanasia and PAE.

Jackson also fails to meet the challenge of the logical slippery slope argument with regards to euthanasia.  The argument goes like this: if autonomy and beneficence justify voluntary active euthanasia, then beneficence alone justifies non-voluntary active euthanasia.  If part of the calculation justifying euthanasia is the desire to prevent suffering out of beneficence, then if confronted with a patient who lacks the autonomy to make an informed and free decision to pursue euthanasia but whose life is deemed “not worth living,” a doctor would be compelled to perform euthanasia on the grounds of beneficence alone.  An example of this type of case might involve a patient in an unconscious state who lacks autonomy.  Keown argued that Jackson is unable to offer a successful response to this argument, and that her argument necessarily entails the legalization of non-voluntary active euthanasia as well as voluntary active euthanasia.

The next argument that Jackson fails to meet is the empirical slippery slope argument.  This is related to the difficulty, if not impossibility, of drafting and policing exceptions to legalized euthanasia.  The basis for euthanasia, once legalized, may require that a patient make a voluntary, informed, and persistent request and that a patient be enduring unbearable suffering.  No matter how the legislation is phrased, it remains vague and open to interpretation.  The empirical slippery slope is that the legalization of voluntary active euthanasia leads to an increased incidence of involuntary euthanasia.  Multiple government-sponsored surveys in the Netherlands testify to this empirical argument, indicating that since euthanasia was legalized in that country there has been an unacceptably high number of unreported and involuntary instances of euthanasia.

Keown’s final critique was that Jackson fails to offer a concrete and convincing plan that builds a coherent case in principle in favor of euthanasia and that answers reasonable concerns about legalization leading to increased involuntary deaths from euthanasia.  Keown concluded that Jackson’s argument simply fails to achieve what is seeks to achieve, namely, an effective assisted dying law.

Alex Slavsky is a sophomore theology and philosophy major who wishes you a Merry Christmas. Contact him at aslavsky@nd.edu.