Etica & Politica/ Ethics &
Politics, 2004, 2
http://www.units.it/etica/2004_2/BACCARINI.htm
The
Right to Die with Dignity. A Discussion of Cohen-Almagor's Book
Elvio Baccarini
|
abstract Cohen-Almagor's book
represents a remarkable contribution to the discussion of the right to die with
dignity. It offers the discussion of a wide range of topics. They include: the
terminology respectful of human dignity (where, for example, 'post-coma
unawareness' is suggested instead of 'permanent vegetative state'); the question
of autonomy; the sanctity-of life – quality of life debate; criticism of some extreme
quality-of-life position; criticism of Ronald Dworkin's distinction between
critical and experiential interests and the consequences this author draws from
it; active and passive euthanasia; the Dutch experience and the Oregon Death
with Dignity Act; and many others. The book is discussed from a basically
sympathetic view, where some details are focused on as meriting some further
examination. Some remarks are offered to indicate the complexity of the
definition of autonomy; a defense of Dworkin's
argument is offered; an insistence on the necessity to rely on moral conferring
features is remarked. |
1. Raphael Cohen-Almagor offers us
a really comprehensive, rich of background information and critically
considered discussion about questions of death and the choice of death in the
context of the medical practice (1). His book includes several chapters on the topic, and I
will discuss some of them. I am very much sympathetic with most of
Cohen-Almagor's argumentation. However, I leave to a direct reading the possibility
to appreciate in details most of the numerous virtues of the book. Here I
address those parts of the book that, in my opinion, deserve some further
discussion. I think that this is the best way to express the richness and the
wide range of virtues exemplified in this book.
In the Introduction, Cohen-Almagor ponders the most general terms of the debate between those that hold the sanctity of life principle and those that hold the principle of autonomy as inspiring and shaping the discussion on the right to die. Supporters of sanctity of life find human life as inviolable, and do not accept reasons to terminate it. Supporters of the autonomy-based approach allow the interested subjects to decide about whether life has still any meaning for them. This implies (with some qualifications, as we will see later) the right to choose death.
Now, I think we can fairly be
satisfied with the definition of the sanctity of life doctrine, which is, by
itself, put in very clear terms. There is still a problem with the rival
doctrine. What is exactly 'autonomy', that that is to be respected?
Cohen-Almagor says the following: «Choosing the best option or thinking
correctly is not a requirement for autonomy so long as we assess the
alternatives carefully. The emphasis is not on deciding on the best options or
on holding true opinions, but rather on the way in which we come to hold our
convictions and make our decisions» (2). The crucial thing for autonomy is the possibility that
an individual has to reflect about her own beliefs and ideas, as well as the
ability to form ideas about them, in order to decide how to live. In order to
make choices we need a range of options to choose.
This is the conception of autonomy
frequently adopted by liberals, like Cohen-Almagor. Although this is not very
usual in books on bioethics, it seems to me that the concept of autonomy
deserves a little more theoretical and analytical specification. It may be
useful, for example, to distinguish this concept from that of Immanuel Kant, in
order to specify the superiority of the present concept (3). According to Kant, autonomy
is the property of an agent who makes decisions according to pure practical
reason, and acts according to the unconditioned duty. If the subject acts by
following her natural inclinations, she is not autonomous. A consequence of
this, according to Kant, is that if the subject chooses death in order to avoid
pain, she follows a natural inclination and is not autonomous. This is
obviously not the case if one follows the concept of autonomy endorsed by
Cohen-Almagor. In his case, it is enough that the individual considers the
different options and chooses for one of them. If the subject reflectively
evaluates that her life, perhaps due to strong pain, is not any more valuable,
or does not find any more meaning in it, then she is allowed to choose death.
But this may be exactly the choice to surrender to a natural inclination, i.e.
of heteronomy and not of autonomy, as a Kantian would say. As it is known,
there are influential Kantian arguments against suicide that rely on this
complex interpretation of autonomy, and these arguments, although reformulated,
are used in contemporary debates, as well (4).
Another point may be this one. An
individual can be in the position of not having ever thought about diverse
opportunities in her life. She was raised in a conservative community, and she
acknowledged only one moral outlook in her life. It seems to me that there may
be a sense in which we can say that there is some practical necessity in what
she does. There are no really available opportunities to her, because she has
never had a real opportunity to reflect about different options. Is her choice
autonomous? If not, does she deserve the right to choose in matters of death?
Intuitively, it does not seem to me that she deserves this right less than an
individual raised in a multicultural community, distinguished by multicultural
education. But, the second individual satisfies Cohen-Almagor's definition of
autonomy, while the first does not. At least, this seems to me.
These are obviously questions at a
rather abstract theoretical level, and I do not find as crucially relevant, in
a book on the right to dignity which has strong applicative interests, the
absence of the more detailed discussion of the questions that I have raised. In
his background discussion, the author reflects on prominent philosophers in the
liberal tradition, like John Rawls and Joseph Raz.
2. Cohen-Almagor shows concern for
the correct way of language usage, in a way that it is not damaging the
patients' interests. He opposes the usage of the expressions 'terminal' and
'persistent vegetative state'. Instead of 'persistent vegetative state',
Cohen-Almagor proposes 'prolonged unawareness' and 'post-coma unawareness'. The
term 'coma' is limited to cases where three elements are present: closed eyes,
no utterances of meaningful sounds, and no adequate motor reaction to external
stimuli. The terms suggested by Cohen-Almagor are intended to be mere technical
terms that need to substitute the term 'vegetative' which dehumanizes patients,
and is offensive to their dignity, as well as to the dignity of their loved ones.
Cohen-Almagor finds a connection between the use of the term 'vegetative state'
to the term vegetable, which is ethically impermissible. An equivalent way of
thinking is developed by Cohen-Almagor in relation to the expression
'terminal'. This term suggests a picture in which the medical staff is only
waiting for the death of the patient, while, on the other hand, human life
deserves full respect and care until the last moment.
This part of Cohen-Almagor's book
is interesting from various standpoints. One of them that is surely remarkable
is the indication that authors that accept the right to choose in matters of
death are not, by this same fact, expressing a loss of respect, or
consideration for human life. Cohen-Almagor considers with great balance the
respective weight of the value of autonomy, as well as that of human life in
general. This is one of the greatest merits of the book.
When discussing post-coma
unawareness patients (a condition that comprises reversible damages of the
brain cerebrum, that is the possibility of a way back to a meaningful life and
which must be distinguished from brain death), Cohen-Almagor indicates that it
is not acceptable to take as a normal clinical practice to deny forms of care
to them. In the case of brain death (which includes the death of the brain
stem), there are irreversible damages that do not permit to return to a
meaningful life. Cohen-Almagor urges hospitals as a policy not to cease
treatment of post-traumatic post-coma unawareness patients younger than 50
years old within a period of less than two years. The two-year waiting period
should be regarded as the minimum period of evaluation before forgoing hopes
for patients’ rehabilitation and return to some form of cognition. The study
provides data and human stories from the Israeli experience as well as from
England, Canada, the United States and other countries to substantiate this
argument.
3. In the third chapter
Cohen-Almagor considers the debate between the sanctity of life doctrine and
the quality of life doctrine. The former attributes value and absolute
protection to human life as such. The latter considers the content of life, as
the value-attributing feature. I will show in some details Cohen-Almagor's
criticism of some exemplifications of the quality of life doctrine, in
particular, those of Helga Kuhse and Peter Singer. In their opinion, life can
be evaluated, so that, for example, the life of a mature, autonomous, and
healthy person is more valuable than that of an anencephalic infant. Kuhse and
Singer refute the criterion of evaluation of life that refers to species
belonging. What matter are value-conferring features, like those indicated
above.
Cohen-Almagor opposes this view.
According to him, «What makes people worthy of respect is their humanness, the
fact that people are people, whether or not they have a capacity for
self-determination, adoption of ideals, or a sense of the future. When human
life begins, it is important that it will continue with dignity and with
respect. We give people respect because we value life as such, in itself» (5). This is
not to take a stance for the denial of physician-assisted suicide. It may
happen that life becomes for us so painful that we choose death as a better
option.
Cohen-Almagor finds Kuhse's and
Singer's position incoherent. On the one hand, they do not attribute full
protection to the life of infants (in virtue of the absence of actual
value-conferring features); on the other hand, they require that society
engages in allocation of resources for disabled people. In fact, they qualify
their statement related to the protection of children. They say that they are
denying full protection only to the life of disabled infants. This, according
to them, permits to allocate resources so that adult disabled people are helped
in a better way.
Cohen-Almagor thinks that the adoption of Kuhse's and Singer's proposal originates dangerous social consequences. One of them is the irresponsibility of the parents who may too easily adopt infanticide. Or, mothers can be irresponsible in their pregnancy, not renouncing to elements in their life that may be dangerous for the future person, in virtue of the fact that they may make use of infanticide if something goes wrong.
Cohen-Almagor declares himself as a
speciesist, and he cares first of all about our own species, us human beings.
He thinks that newborn infants have a right to life, merely in virtue of the
fact that they are human. According to him, there is nothing worrying in this,
and he says «it is only a human and preferable inclination to think first about
our fellow humans. It is also natural for an elephant to think first and
foremost about its fellow elephants» (6). Cohen-Almagor opposes some very radical Singer's
stances, for example, that the killing of a chimpanzee is a more serious act
than the killing of a human being with intellectual defects. Moreover,
Cohen-Almagor thinks that there is a mistake in Singer's proposal when he
attributes no moral weight to the killing of a human life deprived of
intellectual capacity. The mistake is due to the fact that this life can, nevertheless,
be evaluated as deserving dignity by other people in virtue of, for example,
love of family members, or religious reasons.
This is the part of Cohen-Almagor's
book that I find most questionable. Let's start from the last part. It is true
that there is something disturbing in the
terminology in the description Singer gives to his theory. However, it
seems to me that some aspects of Cohen-Almagor's criticism of Singer's stance
are overstated. First, it seems to me that Singer does not exclude the
possibility that some lives may have to be respected even when losing the value
conferring feature. Singer explicitly says that a life may deserve protection
in virtue of the fact that some people may attribute value to it. When, in his
Practical Ethics, he says that newborn infants do not possess value conferring
features, he adds that there is a difference between newborn infants with
serious defects, and healthy newborn infants. In the second case, we have an
event that is a happy event for people in full possession of rights (7). We can
see, surely, an important omission, in Singer's explanation of his theory. This
is the exclusive statement that only the life of a healthy infant can represent
a joyful event for the parents. However, there is something relevant, and its
presence in Singer's thought deserves to be remarked, contrary to what
Cohen-Almagor does. It is the fact that value can be attributed indirectly to
some beings. The indirect way is the value attributed by people in full
possession of a moral status. But if this is permitted, then the consideration
of some people for some beings may represent a reason to attribute value to all
newborn infants, and to all human beings, independently of the fact whether
they are defective or not. It seems to me that Singer's rhetoric is directed toward
those people who do not want to permit cases of euthanasia absolutely, like the
defenders of the sanctity of life doctrine. But, it would be quite incoherent
with what he says to interpret that euthanasia becomes something that can be
imposed on parents that do not want it, or that it is legitimate to declare a
life as fully losing value despite the attitude of the parents, as it may
appear from Cohen-Almagor's criticism of Singer.
Second, it seems to me that there
is not such a plain contradiction in engaging for the euthanasia of defective
newborn infants (when it corresponds to the wish of the parents), and the
statement that this is (also) in order to help in a better way defective
adults. This discussion reminds that regarding prenatal screening, opposed by
people who fear that this practice may create a presumption contrary to
disabled people. Philip Kitcher convincingly shows that this is mistaken
attitude (8). He
indicates examples of situations where programs directed toward the reduction
of the incidence of genetic disabilities come together with an increasing of
the support for disabled people already born. If this is true, I do not see any
serious reason to deny that the permission of euthanasia (provided the consent
of the parents) in the case of newborn defective infants can come together with
the sustain of a program of support for adult disabled people.
In relation to a kind of
slippery-slope argument that Cohen-Almagor offers, according to which parents
may come too easily to adopt infanticide, or, mothers may behave irresponsibly
during their pregnancy, in virtue of the fact that they may make use of
infanticide if something goes wrong, I must say that I do not find the
arguments really convincing. It appears to me that most of the people have a
strong emotional attitude toward their children, and that infanticide can be
only a last resort in desperate cases, as far as we know about radical features
in human behavior. In any case, if the attitude changes becoming a worrying
social occurrence, it is possible to change the rules when this becomes a clear
and present danger. As for the possibility of increasing the irresponsibility
of the pregnant woman, I do not see any reason why the permission of
infanticide would have any effect on this attitude, more than this is done by
abortion.
I do not find Cohen-Almagor's
declaration for speciesism convincing as well. I think that there are reasons
to privilege our fellow members of our species, but the reason cannot be the
simple appeal to the naturalness of this. I guess that it is a wide shared attitude
to evaluate with particular strength humanity as related to the possibility of
critical moral thinking. But if this is true, we cannot embrace a behavior
simply because it is followed by other animals, that act only instinctively.
This would be to renounce to a relevant aspect of humanity. A moral attitude is
adopted in a way respectful of humanity only reflectively. But it appears too
limited a reflection that appeals to a similarity of an attitude with that
shared by animals not capable of critical thinking.
However, I must say that I do not embrace Singer's and Kuhse's version of the quality of life doctrine, and I think that valid arguments can be offered against it. This is the reason why, although I am not very much convinced by Cohen-Almagor's criticism of these authors, I am, nevertheless, very much in sympathy with his proposal for only limited legitimation of quality-of-life considerations in the evaluation about whether it is morally appropriate to end a life.
Cohen-Almagor does not refute all
possible kinds of consideration of quality of life. Although there is a sense
in the preservation of life, this is not absolute. «The Kantian view that
conceives of people as ends rather than means leads to the conclusion that life
is not sanctified when the continuation of life harms human dignity and
contradicts the patient's best interest» (9). The concept of quality of life is subjective, and the
crucial question is about the will of the patient. However, there are three
fundamental elements in determining quality of life, i.e. consciousness, lack
of suffering, and dignity. The relative importance of each of them depends on
single patients. Considerations of quality of life have implications in various
directions: the financial aspects, the doctor-patients relationship,
relationships with the surroundings, the effects on the patients themselves.
4. As usual in the discussions
about the right to dignity, Cohen-Almagor discusses active and passive
euthanasia. Some authors find this distinction relevant, in particular in
virtue of the moral significance of the difference between killing and letting
die. Cohen-Almagor thinks that the will of the patients to die with dignity (in
the way they find dignified) deserves serious consideration. «Medicine and
ethics should address their needs. Although this is not an easy task, the
solution must not be beyond our reach, either medically or ethically. That
solution might change the nature of medicine, but the nature of medicine is not
a static concept» (10). However, Cohen-Almagor does not advocate active
euthanasia but rather physician-assisted suicide, in virtue of possible abuses.
There is one specific case when
Cohen-Almagor opposes active euthanasia with a particular motivation, and this
is in the discussion with Ronald Dworkin (11). Dworkin distinguishes
between experiential interests and critical interests. The former are related
to a subject who is aware of what happens to her, and wants to find pleasure in
the fulfillment of her desires. The latter are related to the accomplishment of
a worthwhile life. Dworkin thinks that critical interests render human life
valuable, and, therefore, it is their satisfaction and protection that matters.
Related to the question of the present discussion, Dworkin says that many
people do not want to be remembered for the part of their life that they found
degrading. The most interesting and controversial part of the discussion regards
cases of Alzheimer's disease. Dworkin compares the part of the life of the
subject that has expressed some wishes when she was able to do this, in
particular wishes not to live in a situation like that included in the
Alzheimer's disease, and the life in that condition. In the former case, we
have critical interests of the subject (the accomplishment of a life plan), in
the latter only experiential interests (like avoiding pain, or that of getting
a piece of bread with butter). In Dworkin's opinion, there is nothing valuable
by itself in the latter case, and this is the reason why the wish expressed by
the subject in the former condition has to be respected.
Cohen-Almagor criticizes this
proposal. He thinks that life can be valuable even in the case of an advanced
condition of Alzheimer's disease. Moreover, he says that the present desires of
the subject have to prevail on those formulated earlier. The crucial argument
is that it is not true that our directives are predetermined and unchangeable,
and we are not able to know how our lives will look in front of death.
Cohen-Almagor thinks that the notion of unchangeable and unified personality is
questionable. «Indeed, the very idea of autonomy reflects our ability and
desire to construct and reshape realities, to reevaluate values and ideas, to
renounce to old beliefs, and to accommodate ourselves to new situations» (12). In
particular, Cohen-Almagor questions Dworkin's statement that human beings, as
rational agents, can establish in advance what will be their preference. On the
contrary, Cohen-Almagor thinks that human beings are not only thinking
creatures. People sometimes act, or are pushed to act, on the ground of their
sentiments, instincts, impulses, and, in general, by factors that it is
difficult to explain rationally. All this opens the question whether advanced
directives are invalid when the patient is incompetent. «It is usually assumed
that the justification for giving the competent person power over decisions to
be made in the future, when he or she is incompetent, is that the competent
person is best situated to identify what those future interests will be. The
problem, however, is that the incompetent patient's interests are no longer
informed by the interests and values he or she had when competent» (13).
Cohen-Almagor's solution is now quite different from Dworkin's. Dworkin says
that it is respectful of the human being to show full consideration for her
advanced directives, because they are related to her exercise of autonomy.
Cohen-Almagor thinks that no such mechanical attitude may be taken. «Doctors,
family, and others involved in the care of incompetent patients should be able
to examine whether patient interests would best be served by actions contrary
to the living will, in situations in which the incompetent patient appears to
have an interest in further life» (14). In brief, by using Dworkin's
terminology, Cohen-Almagor says that the experiential interests in the present
are more important than critical interests voiced in the past. «What may seem
experiential in one stage of life might in a marred, limited life become
critical to our being. For some demented patients the taste of vanilla ice
cream and the smell of lilies might be essential to the definition and
conception of life» (15).
I find questionable this part of
Cohen-Almagor's discussion, and the reasons for my worry are the same as those
I indicated when debating the question of speciesism. Cohen-Almagor attributes
high moral consideration to human life as such. This is the reason why he finds
that all moments of human life deserve equal consideration. On the other hand,
the same as, I think, is Dworkin's opinion, it seems to me that some criteria
and distinctions have to be established. In my opinion there are specific
value-conferring and right-conferring features of human beings that are crucial
in establishing our moral status. These are, primarily, the capacity to be
rational and reasonable (in Rawls's terminology) (16). This does not mean that
human life has not value in some conditions, but it does mean that some
considerations of moral priority may be put forward, and these considerations
are different from Cohen-Almagor's, while they are apt to support Dworkin's
view.
If it is rational and reasonable
capacities that are the primary value-conferring features to human beings, the
will of the human being, while she was able to formulate her life plan, has
priority over other considerations. The life condition that comes after the
person has lost cognitive capacities deserves moral respect, but primarily in
virtue of the human being that was owner of a high moral status. In the case of
conflict, the most pressing considerations are overriding. In the specific
case, this is the respect of the will of the person when she was able, as a
reasonable and rational person, to formulate a life plan, and she did this.
More precisely, in the case of the Alzheimer, the will of the person in the
full possession of her mental capacities must be respected. It is true, as
Cohen-Almagor says, that a life plan is not unchangeable. However, a life plan
is changeable if the person is still able to formulate, or rethink about it.
When a subject loses the capacity to be rational and reasonable, she does not
have any more a life plan, and cannot reformulate it. Her life plan comes to
the end, and the relevant problem is, as Dworkin says, the way this end will
look like. The dilemma is whether the end will look like the person wanted, or
in another way. It is true, as well, that there are life conditions when a
person finds as valuable things that she even did not consider as relevant
earlier. I can speak about my personal experience in a case that is banal as
compared to the dramatic situations discussed here. When I was in the army and,
for weeks, had the possibility to eat only the (rather disgusting) food we had,
I found a pleasure, and a value, in vanilla ice in a way that I never imagined
earlier. Here I agree with Cohen-Almagor. There are life situations when we
reshape our life plan, because the conditions are new, and previously even not
imaginable. However, I am ready to agree with this if we are speaking of
someone who is still a rational and reasonable person. In the other case, I
would disagree with the attitude of attributing a life plan to a subject. In
particular, I do not find convincing Cohen-Almagor's statement that «What may
seem experiential in one stage of life might in a marred, limited life become
critical to our being. For some demented patients the taste of vanilla ice
cream and the smell of lilies might be essential to the definition and
conception of life». Unfortunately, in the stage of life we are discussing,
nothing has the possibility to become critical, and there is, unfortunately, no
more definition and conception of life. There is exactly what is indicated by
Dworkin, the presence of experiential interests. Otherwise, it would be
required to attribute a definition and conception of life to other animals with
similar cognitive capacities, which is, I think, unconvincing. This is not
enough to say that human life, in any stage, may become morally comparable to
the life of other animals. As I said, I think there are reasons to attribute a
special concern for human life, anyway. However, there is a privilege for the
will expressed in some moments of life, in comparison to desires existing in
another moment of life. This is the case of moral dilemma, and, like in every
situation of moral dilemma, the choice is tragic.
5. One of the great merits of
Cohen-Almagor's book is the verification of euthanasia in practical life. In
order to possess direct evidence, Cohen-Almagor investigated the Dutch
situation. He found there a set of troublesome results. Although there is a
wide agreement on the acceptability of euthanasia, people do not seem to
endorse the practice with the required reflectivity. Cohen-Almagor found that
it is not always the patient who makes the requirement for euthanasia.
Sometimes, doctors propose it, and sometimes the family initiates the request.
On some occasions, there were no requests, and patients were put to death. In
other cases, patients' requests were not durable and persistent as they need to
be. The guidelines indicate a term too open to interpretation, like unbearable
suffering. Another reason for worrying is the large amount of unreported cases
of euthanasia. All these troublesome aspects suggest to Cohen-Almagor a
cautious attitude toward euthanasia. His answer is the proposal to restrict, as
far as possible, the choice to die to the practice of physician-assisted
suicide, that gives patients control over their lives until the last moment,
and provides a further mechanism against abuses. Cohen-Almagor is ready to
concede euthanasia just in two cases: « (1) the patient who asked the
euthanasia is totally paralyzed, from head to toe, unable to move any muscles
that could facilitate assisted suicide; (2) the patient took oral medication
and the dying process is lasting for many ours» (17).
Cohen-Almagor's contribution to
this part of discussion is extremely relevant, and I do not know of any other
author who shows such a conscientious approach to the problem. The direct
inquiry in Netherlands is precious. However, perhaps a comparative analysis may
be useful. Kuhse provides comparative data between Netherlands and Australia.
According to her data 3.5% of death in Australia (1996) are caused by lethal medication without the
request of the patient, while in Netherlands (1995) this is 0.7%, less than in
Australia. In Australia 22.5% of deaths are due to the withdrawal of treatment
without the request of the patient, while in Netherlands the total amount of
deaths due to withdrawal is 12.5% (18).
This, obviously, is not a reason to
suspend caution in Netherlands, and not a refutation of Cohen-Almagor's
conclusion related to the suspicion about euthanasia, and privileging
physician-assisted suicide. Perhaps, this is the most reasonable attitude.
However, the data indicated by Kuhse may suggest that a less restrictive, but
regulated situation, is preferable to a more restrictive situation, because
this one may represent a suitable ground for practices left to behavior less
respectful of patient's will.
There is some continuity between
the discussion of the Netherlands's case, and the discussion of the Oregon
Death with Dignity Act. This is the other chapter that Cohen-Almagor dedicates
to the practical verification of the regulation of choosing death. I will not
discuss this chapter in detail, although I think that some parts of it are of
notable relevance. First of all, there is the interesting consideration that
speaks against some worries related to physician-assisted suicide. For example,
the third report of the Oregon Death with Dignity Act indicates that
twenty-seven patients have chosen death, where «fifteen of them were women;
twelve men. Patients with a college education were more likely to choose
physician-assisted suicide than those without a high-school education; patients
with post baccalaureate education were more likely to choose physician-assisted
suicide» (19). It seems
that these data refute some fears that the permission of physician-assisted
suicide will represent a danger for the discriminated population (20). The
number of women that have chosen physician-assisted suicide is just a little
higher than that of the men, while people of higher level education are more
apt to choose this practice. Furthermore, the prominent consideration for the
choice of physician-assisted suicide is the fear to lose autonomy, the
decreased ability to participate in enjoyable activities, loss of the control
of bodily functions, and being a burden to the loved ones. Although we must
interpret this data with due caution, this seems to refute the attitude of
those who think that adequate reduction of pain is a valid substitute for
physician-assisted suicide.
6. In the remaining part of the book, Cohen-Almagor goes to his conclusions, where, among else, he offers some remarkable guidelines for a successful application of the dignified death policy. In the Appendix he offers a discussion about allocation of resources.
Cohen-Almagor's book is a complete,
interdisciplinary discussion of the question of the right to die with dignity.
It may be of great interest to people coming from different experiences. Its
language, and the methodology adopted by the author, makes possible to read it
for a wide range of potential readers. An exceptional merit of the book is that
it provides a balanced view that never renounces to pay due attention to human
life, as well as to human dignity.
Note.
(1) R. Cohen-Almagor, The Right to Die with Dignity. An Argument in Ethics, Medicine and Law,
New Brunswick and London, Rutgers University Press, 2001.
(2) R. Cohen-Almagor, The Right to Die with Dignity, 2.
(3) I. Kant, Fundamental Principles of the Metaphysics of Morals, 1785, http://ethics.acusd.edu.texts/Kant/MM/Part2.html
.
(4) J. David Velleman, A Right to Self-Termination?, “Ethics”, 1999. Cohen-Almagor i fact
appeals to Kant’s concept of autonomy (pp. 3-4), but does not seem to face
fully the specific meaning that this author attributes to “autonomy”.
(5) R. Cohen-Almagor, The Right to Die with Dignity, 68.
(6) R. Cohen-Almagor, The Right to Die with Dignity, 70.
(7) P. Singer, Practical Ethics, Cambridge, Cambridge University Press, 1979, 32.
(8) P. Kitcher, The Lives to Come. The Genetic Revolution and Human Possibilities,
New York, Touchstone, 1996, 85, 236-238.
(9) R. Cohen-Almagor, The Right to Die with Dignity, 72.
(10) R. Cohen-Almagor, The Right to Die with Dignity, 84.
(11) R. Dworkin, Life’s Dominion. An Argument about Abortion, Euthanasia, and Individual
Freedom, New York, Alfred A. Kopf, 1993.
(12) R. Cohen-Almagor, The Right to Die with Dignity, 100.
(13) R. Cohen-Almagor, The Right to Die with Dignity, 103.
(14) R. Cohen-Almagor, The Right to Die with Dignity, 103.
(15) R. Cohen-Almagor, The Right to Die with Dignity, 111.
(16) J. Rawls, Political Liberalism, New York, Columbia University Press, 1993,
48-54.
(17) R. Cohen-Almagor, The Right to Die with Dignity, 157.
(18) H. Kuhse, From Intention to Consent, in Battin, M.P., Rhodes, R. e Silvers A.
(ed. by), Physician Assisted Suicide.
Expanding the Debate, London, Routledge, 1998, 65-75.
(19) R. Cohen-Almagor, The Right to Die with Dignity, 171.
(20) This fear is expressed in relation to
the African-American community in P. A. King, L. A. Wolf, Lessons for Physician-Assisted Suicide from the African-American
Experience, in Battin, M. P., Rhodes, R. e Silvers A. (ed. by), Physician Assisted Suicide. Expanding the
Debate, cit., pp. 91-112. The argument can, obviously, be extended to any
other traditionally discriminated community.