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Politics of End-Of-Life Care: Active Euthanasia

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Politics of End-Of-Life Care: Active Euthanasia POLITICS OF END-OF-LIFE CARE: ACTIVE EUTHANASIA by Kendra Christine Coombes Submitted in partial fulfilment of the requirements for the degree of Master of Arts at Dalhousie University Halifax, Nova Scotia March 2013 © Copyright by Kendra Christine Coombes, 2013 DALHOUSIE UNIVERSITY DEPARTMENT OF POLITICAL SCIENCE The undersigned hereby certify that they have read and recommend to the Faculty of Graduate Studies for acceptance a thesis entitled “POLITICS OF END-OF-LIFE CARE: ACTIVE EUTHANASIA” by Kendra Christine Coombes in partial fulfilment of the requirements for the degree of Master of Arts. Dated: 22 March 2013 Supervisor: _________________________________ Readers: _________________________________ _________________________________ ii DALHOUSIE UNIVERSITY DATE: 22 March 2013 AUTHOR: Kendra Christine Coombes TITLE: Politics of End-of-Life Care: Active Euthanasia DEPARTMENT OR SCHOOL: Department of Political Science DEGREE: MA CONVOCATION: May YEAR: 2013 Permission is herewith granted to Dalhousie University to circulate and to have copied for non-commercial purposes, at its discretion, the above title upon the request of individuals or institutions. I understand that my thesis will be electronically available to the public. The author reserves other publication rights, and neither the thesis nor extensive extracts from it may be printed or otherwise reproduced without the author’s written permission. The author attests that permission has been obtained for the use of any copyrighted material appearing in the thesis (other than the brief excerpts requiring only proper acknowledgement in scholarly writing), and that all such use is clearly acknowledged. _______________________________ Signature of Author iii DEDICATION PAGE Dedicated to my family, without their love and support I would not be who I am today. I owe my deepest gratitude, love and respect to all of you. I love you all so much. Dedicated to the terminal patients who are suffering on a daily basis in pain and with each passing day are losing their autonomy and dignity; I hope you will have the option to live and end your life in a manner you deem dignified. iv TABLE OF CONTENTS LIST OF FIGURES........................................................................x ABSTRACT.................................................................................xi LIST OF ABBREVIATIONS USED...................................................xii GLOSSARY................................................................................xv ACKNOWLEDGEMENTS..............................................................xvii CHAPTER 1 INTRODUCTION..........................................................1 1.1 Research Question..........................................................2 1.2 Objectives.....................................................................6 1.3 Situating Euthanasia: Philosophical, Medical and Legal Perspectives..................................................................7 1.3.1 Philosophical Arguments........................................7 1.3.2 Medical Arguments.............................................10 1.3.3 Legal Arguments.................................................12 1.4 Chapter Breakdown.......................................................18 1.5 Conclusion...................................................................20 CHAPTER 2 MAPPING THE LITERATURE.........................................21 2.1 Public Policy and EOLC: Active Euthanasia........................21 2.1.1 The Special Committee of the Canadian Senate......22 2.1.2 The House of Lords Select Committee....................23 2.1.3 The New York Task Force.....................................24 2.2 The Facts on AE and PAD (Netherlands, Washington and Oregon) …...................................................................25 2.3 Political Parties and EOLC: Active Euthanasia....................27 2.4 Canadian Institutions and EOLC: Active Euthanasia...........27 2.5 CMA, The Colleges of Physicians and Surgeons…...............28 2.5.1 Collège des Médecins du Québec...........................28 2.6 Medical Schools............................................................29 2.7 Missing from the Literature............................................31 2.8 Conclusion...................................................................31 v CHAPTER 3 METHODOLOGY ........................................................33 3.1 Comparing and Contrasting ...........................................33 3.2 Comparative Politics......................................................33 3.3 Theoretical Frameworks.................................................34 3.3.1 Pressure Group Politics.......................................34 3.3.2 Constructivist Approach......................................35 3.3.3 Rational Choice Approach....................................35 3.3.4 Institutionalism and Structuralism........................37 3.4 Conclusion...................................................................37 CHAPTER 4 POLITICAL PRESSURE GROUP APPROACH TO ACTIVE EUTHANASIA…..........................................................................39 4.1 What are Pressure Groups?…………..………...........................39 4.2 Pressure Groups and the Policy Process….….......................41 4.3 Pressure Groups: Active Euthanasia.................................42 4.3.1 Interest Promotion..............................................43 4.3.2 Communications.................................................43 4.3.3 Legitimizing.......................................................43 4.4 Pressure Groups in Action...............................................44 4.5 Integrated Pressure Groups Active Euthanasia Context.......................................................................45 4.5.1 CMA and the Colleges of Physicians and Surgeons....45 4.6 Peripheral Pressure Groups Active Euthanasia Context........45 4.6.1 The Euthanasia Prevention Coalition......................46 4.6.2 The Council of Canadians with Disabilities (CCD).....47 4.6.3 Citizens United Resisting Euthanasia......................47 4.6.4 Patients’ Rights Council.......................................48 4.6.5 The Farwell Foundation.......................................49 4.6.6 The B.C. Civil Liberties Association.......................49 4.6.7 Compassion & Choices.........................................51 4.6.8 Euthanasia Research and Guidance Organization.......................................................52 4.7 The Influence of Pressure Groups....................................52 vi 4.8 Conclusion....................................................................57 CHAPTER 5 THE CONSTRUCTIVIST APPROACH TO ACTIVE EUTHANASIA.............................................................................59 5.1 The Constructivist Approach……..….……..............................59 5.2 Government Policies’ Influence on Curriculum……...............61 5.3 The Hippocratic/Physicians’ Oath….......................…..........62 5.3.1 The Influence of the Oath.....................................64 5.4 The Medical Associations’ Influence on Medical Students and Physicians..............................................................65 5.4.1 The USAMA........................................................65 5.4.2 The WSMA.........................................................66 5.4.3 The US OMA and MMA.........................................66 5.4.4 The CMA............................................................66 5.4.5 The College of Physicians and Surgeons.................68 5.4.6 The Influence of Medical Associations and Colleges of Physicians and Surgeons...............................68 5.5 Medical Schools and Curriculum....……………........................70 5.6 Physicians and Medical Students: Active Euthanasia...........73 5.6.1 Medical Schools in the USA and the UK.................74 5.6.2 Medical Schools in Germany................................75 5.6.3 Medical Schools in Canada...................................77 5.7 The Influence of Medical Schools on AE and PAD................78 5.8 Constructivism and Society.............................................79 5.9 Conclusion...……............................................……............80 CHAPTER 6 THE RATIONAL CHOICE APPROACH TO ACTIVE EUTHANASIA.............................................................................82 6.1 Empirical Evidence..........................................................82 6.2 Rational Choice Definitions...............................................84 6.3 The Consequences for Physicians in Canada.......................85 6.3.1 Legal Offences....................................................85 6.3.2 Medical Associations and Colleges of Physicians and Surgeons: Offences............................................................87 vii 6.3.3 Colleges of Physicians..........................................88 6.4 Legal Cases in Canada....................................................89 6.4.1 The Influence of Canadian Court Cases...................91 6.5 Influence of the Criminal Code and Provincial Colleges of Physicians and Surgeons................................................91 6.6 Conclusion………..............…….……………………........................93 CHAPTER 7 INSTITUTIONALISM AND STRUCTURALISM APPROACH TO ACTIVE EUTHANASIA.................................................................95 7.1 Institutionalism and Structuralism Definitions....................95 7.1.1 Institution..........................................................95
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