LIFE AND DEATH ISSUES IN BIOETHICS: ABORTION, PERSISTENT VEGETATIVE STATE, AND THE DEFINITION OF DEATH By Ian Keith McDaniel Submitted to the graduate degree program in Philosophy and the Graduate Faculty of the University of Kansas in partial fulfillment of the requirements for the degree of Doctor of Philosophy. ________________________________ Chairperson Dr. John Symons ________________________________ Co-Chairperson Dr. Donald Marquis ________________________________ Dr. Dale Dorsey ________________________________ Dr. Ben Eggleston ________________________________ Dr. Erin Frykholm ________________________________ Dr. Paul Scott Date Defended: December 4, 2015 ii The Dissertation Committee for Ian Keith McDaniel certifies that this is the approved version of the following dissertation: LIFE AND DEATH ISSUES IN BIOETHICS: ABORTION, PERSISTENT VEGETATIVE STATE, AND THE DEFINITION OF DEATH ________________________________ Chairperson Dr. John Symons ________________________________ Co-Chairperson Dr. Donald Marquis Date approved: December 8, 2015 iii Abstract This dissertation is comprised of three papers which consider prominent issues in bioethics. The three topics can be briefly stated as: 1) a refutation of the responsibility objection to abortion, 2) a rejection of the orthodox bioethical arguments attempting to justify removal of artificial nutrition and hydration from persistent vegetative state patients, and 3) a demand to revise the current orthodox criteria for determining death. The Responsibility Objection to Abortion is a common and prominent objection to abortion in general. The objection claims that a woman is responsible for the fetus growing inside her body as a result of her willing participation in sexual activity. I argue that the Responsibility Objection to Abortion fails to establish that a woman must provide care to her unborn fetus. I do so by examining the various iterations in which the responsibility objection has been presented and then identifying the particular conception of responsibility that each iteration of the objection must be utilizing in order to ground the particular version of the objection. My contention is that once examined in this manner I am able to demonstrate that each iteration of the objection is unable to establish an obligation to provide care on the part of a pregnant woman to her unborn fetus. Thus, the responsibility objection ceases to be a serious objection to a woman’s reproductive freedom. The second paper in this work considers arguments within the orthodox bioethical framework which seek to justify the removal of life-saving medical treatment (LSMT), especially in the form of artificial nutrition and hydration (ANH), from patients in persistent vegetative states (PVS). I first outline the orthodox bioethical framework which seemingly requires the continued feeding of PVS patients. I then focus upon a prominent case of removing ANH from a iv PVS patient, the case of Theresa Marie (Terri) Schiavo. Seven prominent arguments seeking to justify the removal of Terri’s ANH are considered. I conclude that each of these arguments fails to justify removing Terri Schiavo’s ANH within the established bioethical framework. Proponents of removing ANH from PVS patients such as Terri Schiavo will have to seek alternate approaches to defending their view which rejects the orthodox bioethical framework utilized throughout the discussion. In particular, so long as the right to life is based upon an individual being an innocent human being, removal of LSMT from PVS patients will remain unjustified. The demand for revised criteria for determining death arises due to the inadequacy of the orthodox criteria currently used to determine death, which are reducible to whole brain death. I argue that whole brain death is an inadequate criterion for the death of a human being within the framework of orthodox bioethics. I first consider the conflict between whole brain death and the plausible definitions of death the criterion of whole brain death is intended to reflect. Second, I consider the possibility that whole brain death can be justified as a criterion for death without the need for a definition of death. Third, I consider arguments that whole brain death is analogous to decapitation (long recognized as the death of the decapitated individual). Each of these three arguments for the continued use of whole brain death as the criterion of death are shown to be flawed. Utilizing these arguments presented against whole brain death I suggest revised criteria for determining death that are able to overcome the failures of whole brain death. v Acknowledgements I feel I would be remiss if I did not take the opportunity afforded to me here to acknowledge the positive contributions those who have made possible the completion of this work which is the culmination of the past ten years. The first people I wish to acknowledge are my parents, without whose love and support I would not have been able to embark upon my initial journey from the mountains of Virginia to the plains of Oklahoma. Thank you both for all that you have done for me over the years. Your contributions to the completion of this project begin in the same place I did. Thank you for taking the time to listen to me as I worked through the arguments presented in the following pages. The mere fact that you were listening was often enough. My only wish is that you could both have seen this project successfully completed. I would like to acknowledge the support of my other family and close friends; your frequent comments of support and your willingness to talk about my work may seem inconsequential, but the frequent discussions of these projects kept them fresh in my mind. Sometimes these little nudges were exactly what I needed to overcome the inertia I was feeling and to continue making progress toward completion. I would like to acknowledge the contributions of the faculty and staff of the philosophy department at the University of Kansas, in particular my dissertation and thesis advisers, whose guidance and careful scrutiny have molded me into the scholar I am today and without whose patience and understanding I could not have reached this successful end. I would like to acknowledge the help and support of the faculty and staff of the philosophy department at Oklahoma State University. Your generous support and guidance in the early years of my graduate career prepared me to take on the challenges I faced in the years since leaving Stillwater. Without your contributions this work would never have come to fruition. vi Table of Contents THE RESPONSIBILITY OBJECTION TO ABORTION ............................................................. 1 I. INTRODUCTION ................................................................................................................... 2 II. CONCEPTIONS OF RESPONSIBILITY ............................................................................. 4 III. FOUR ITERATIONS OF THE RESPONSIBILITY OBJECTION ..................................... 6 IV. NEITHER HARM, NOR NEGLIGENCE, NOR TACIT CONSENT ................................. 7 V. REJECTING THE CARE VERSION OF THE RESPONSIBILITY OBJECTION ........... 13 VI. CERTAIN OBJECTIONS AND REPLIES........................................................................ 17 VII. CONCLUSION ................................................................................................................. 23 AN ANALYSIS OF HOW ORTHODOX BIOETHICS FAILS TO ADEQUATELY JUSTIFY REMOVAL OF ARTIFICIAL NUTRITION AND HYDRATION FROM PVS PATIENTS. ... 26 I. INTRODUCTION ................................................................................................................. 28 II. THE CASE OF THERESA MARIE (TERRI) SCHIAVO .................................................. 28 III. FRAMING THE DEBATE................................................................................................. 30 IV. ARGUMENT 1: TERRI SCHIAVO IS DEAD.................................................................. 34 V. ARGUMENT 2: TERRI SCHIAVO HAS THE RIGHT TO REFUSE ANY AND ALL TREATMENT IN HER CONDITION AND HAVE THAT TREATMENT WITHDRAWN 38 VI. ARGUMENT 3: ANH IS MEDICAL CARE AND AS MEDICAL CARE IT IS NOT OBLIGATORY......................................................................................................................... 47 vii VII. ARGUMENT 4: ANH IS EXTRAORDINARY CARE AND SO CAN BE WITHDRAWN OR WITHHELD ............................................................................................ 52 VIII. ARGUMENT 5: REFUSING TO FORCE-FEED TERRI SCHIAVO VIA ANH IS ANALOGOUS TO REFUSING TO FORCE-FEED TERMINAL CANCER PATIENTS .... 56 IX. ARGUMENT 6: TERRI SCHIAVO’S RIGHT TO PRIVACY IS BEING VIOLATED BY CONTINUING TO FEED HER, SO THE REMOVAL OF HER FEEDING TUBE IS JUSTIFIED ............................................................................................................................... 59 X. ARGUMENT 7: NO ONE WOULD CHOOSE TO BE IN A PVS. ................................... 64 XI. CONCLUSION................................................................................................................... 68 DETERMINING DEATH ............................................................................................................ 70 I. INTRODUCTION ................................................................................................................. 71 II. WHOLE BRAIN DEATH UNDER THE DEFINITIONS-CRITERIA-TESTS MODEL: THE UDDA .............................................................................................................................