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An Essay on the Difference Between Palliative Sedation and Physician-Assisted Death Patrick T Wayne State University Wayne State University Dissertations 1-1-2013 A Distinction Without A Moral Difference? An Essay On The Difference Between Palliative Sedation And Physician-Assisted Death Patrick T. Smith Wayne State University, Follow this and additional works at: http://digitalcommons.wayne.edu/oa_dissertations Part of the Bioethics and Medical Ethics Commons, and the Ethics and Political Philosophy Commons Recommended Citation Smith, Patrick T., "A Distinction Without A Moral Difference? An Essay On The Difference Between Palliative Sedation And Physician-Assisted Death" (2013). Wayne State University Dissertations. Paper 858. This Open Access Dissertation is brought to you for free and open access by DigitalCommons@WayneState. It has been accepted for inclusion in Wayne State University Dissertations by an authorized administrator of DigitalCommons@WayneState. A DISTINCTION WITHOUT A MORAL DIFFERENCE? AN ESSAY ON THE DIFFERENCE BETWEEN PALLIATIVE SEDATION AND PHYSICIAN-ASSISTED DEATH by PATRICK T. SMITH DISSERTATION Submitted to the Graduate School of Wayne State University, Detroit, Michigan in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY 2013 MAJOR: PHILOSOPHY Approved by: _________________________________________ Advisor Date _________________________________________ _________________________________________ _________________________________________ _________________________________________ © COPYRIGHT BY PATRICK T. SMITH 2013 All Rights Reserved DEDICATION This work is dedicated to my immediate family. First, to my lovely wife, Dr. Johnelle Ryan Smith and two beautiful children, Gabrielle Carsyn and Caleb Alexander, thank you for your patience and encouragement along the way. I hope in the days ahead the times we missed as a family while I was working on this project will be rewarded with many years of exciting opportunities together. I could not have done this without each of you. And to my parents, Willie Frank Smith, Sr. and Carolyn Smith, thank you for your unwavering support of all my endeavors throughout the years. I am so grateful to have you as parents and hope to have made you proud to have me as your son. Special thanks, of course, goes to Frank Jr. and the Gadson clan, Jerome, Monique, Imani, and Nia. Our times together as a family during the breaks made all the difference in reenergizing me to complete this work. ii ACKNOWLEDGEMENTS In accomplishing any task of this nature, there are many people who have contributed to its completion who need to be acknowledged. I want to make special mention of three groups of people whose support and assistance were directly involved in my research, professional development in medical ethics, preparation and completion of this dissertation. First, I want to thank Sister Giovanni, President/CEO and Mary Beth Moning, the Executive Director, both of Angela Hospice Home Care, for giving me the opportunity to serve as the Ethics Coordinator at such an august institution. This has provided a “real-life” context to think about the issues surrounding End-of-Life medical ethics. It has been a privilege and a joy. And thanks also goes to the Angela Hospice Ethics Committee who has supported and encouraged me to use my training as a philosopher to make a distinctive contribution to our interdisciplinary team. Second, my delightful colleagues at Gordon-Conwell Theological Seminary have offered feedback on ideas, helped with technical matters of formatting, and encouraged me to finish well. The administration and my division colleagues have been especially gracious in accommodating my schedule and adjusting institutional responsibilities in order for me to complete this process. Special mention must go to certain individuals: John Jefferson Davis, Richard Lints, Carol Kaminski, Dennis Hollinger, David Gill, David Wells, and Ed Keazirian. iii Last, but certainly not least, my dissertation committee has been especially helpful in shaping the direction of this project. I am so grateful to have worked with such a fine group of scholars and practitioners as Professor Bruce Russell, Professor John Corvino, and Professor Eun-Jung Katherine Kim. My outside reader, Dr. James S. Boal, M.D., Medical Director of Angela Hospice, has proven particularly insightful in helping me understand certain clinical and empirical matters in end-of-life and hospice care that are essential to doing philosophical bioethics well. It has been a pleasure to work with him over the years. I count him as a colleague and a friend. Professor Bruce Russell has been an excellent philosophical mentor and friend since I started graduate work in philosophy. I am so grateful for his relentless insistence that the smallest details be put in order in any of my work. He has made me a much better and more careful philosopher than I otherwise would have been. I have learned much from him. His fingerprints on this project and my philosophical thinking in general should be evident to those acquainted with his work. I am grateful for his patient support and ongoing encouragement over the years even in the midst of profound disagreement on occasion. It has been a pleasure to have worked with him. I am honored to say that I was his student. I consider him as my primary philosophical mentor. iv TABLE OF CONTENTS Dedication ....................................................................................................................... ii Acknowledgements ...................................................................................................... iii CHAPTER 1 – Palliative Sedation, Physician Assisted Death, and an Inconsistency Argument ......................................................................... 1 CHAPTER 2 – The Nature of Physician Assisted Death in a Health Care Context .................................................................................................. 26 CHAPTER 3 – A Survey of Some Arguments Against Physician Assisted Death ....................................................................... 73 CHAPTER 4 – The Challenge of the Inconsistency Argument for Palliative/ Terminal Sedation ................................................................................ 129 CHAPTER 5 – An Indefensible Wedge Argument .................................................... 152 CHAPTER 6 – Toward a More Defensible Wedge Argument ................................. 180 Bibliography ............................................................................................................... 233 Abstract ...................................................................................................................... 247 Autobiographical Statement .................................................................................... 249 v 1 CHAPTER 1 PALLIATIVE SEDATION, PHYSICIAN-ASSISTED DEATH, AND AN INCONSISTENCY ARGUMENT Contemporary Scene Currently in the United States, Oregon, Washington, and Montana stand alone in legalizing some form of physician-assisted suicide (PAS). While these represent a relatively small number of states, according to one prominent proponent and advocate of PAS it “will probably soon become legal on a state- by-state basis, culturally tolerated, and openly practiced.”1 It appears there will be ongoing and increased pressure for other states to follow suit so that those who are terminally ill can exercise the full scope of their autonomy and “die with dignity” through PAS. Further, some would say that if suicide, or less pejoratively self-killing, can be justified in some settings then voluntary active euthanasia ought to be justifiable in some cases as well.2 That is, if these patients deem it a fit end to their lives given their unique circumstances and specific personal life journeys. A growing number of medical and health care professionals, many moral philosophers, several theologians and clergy from various traditions, and 1 Margaret Pabst Battin, “Is a Physician Ever Obligated to Help a Patient Die?” Ending Life: Ethics and the Way We Die (New York: Oxford University Press, 2005), 88. 2 Michael Tooley, “In Defense of Voluntary Active Euthanasia and Assisted Suicide,” Contemporary Debates in Applied Ethics, edited by Andrew I. Cohen and Christopher Heath Wellman (Malden, MA: Wiley-Blackwell, 2005) 161-178. 2 ordinary citizens support the view that PAS and voluntary active euthanasia (VAE) should be a legitimate, and in some cases a morally obligatory, palliative care option that should be provided for patients at the end of their lives under carefully prescribed circumstances. 3 For examples, Margaret Battin, a philosopher and ethicist, and Timothy Quill, a medical doctor, in their affirmation of this point write, “Relief of suffering—and with it the freedom to face dying as one wishes—must be available to suffering patients now” [emphasis added].4 One can provide further examples from religious thinkers in reference to the aforementioned point. The Episcopal Bishop, John Shelby Spong comes “at the issues of assisted suicide, active euthanasia, and the freedom to die with dignity from a specifically religious position.”5 Not only does he think these should be legal practices but also that they “should be acclaimed as both moral and ethical—a human right, if you will.” He has committed to “work through ecclesiastical processes of [his] church and all the forces of organized 3 This point is substantiated in a recent volume compiled on the topic. See Timothy E. Quill and Margaret P. Battin, eds. Physician-Assisted Dying:
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