Résumés
Abstract
John Arras argues against the legalization of physician-assisted suicide and active euthanasia on the basis of social costs that he anticipates will result from legalization. Arras believes that the legalization of highly restricted physician-assisted suicide will result in the legalization of active euthanasia without special restrictions, a prediction I grant for the sake of argument. Arras further anticipates that the practices of physician-assisted suicide and euthanasia will be abused, so that many patients who engage in these practices will lose out as a result. He refers to these losses as social costs to legalization. But the social costs at play in typical public policy debates are borne by individuals other than the agent who engages in the controversial activity, specifically by people who cannot be held responsible for enduring those costs. Even if plausible interpretations of Arras’ predictions about the abuse of the practice are granted, legalization of physician-assisted suicide or euthanasia brings no social costs of this latter sort. For this reason, and also because a ban on euthanasia is unfair to those who would profit from it, the losses in utility brought about by legalization would have to be very great to justify a ban.
Keywords:
- physician-assisted suicide,
- physician-assisted death,
- euthanasia,
- slippery slope,
- paternalism
Résumé
John Arras se positionne contre la légalisation du suicide assisté par un médecin et celle de l’euthanasie active sur la base des coûts sociaux, qu’il anticipe comme résultat probable de cette légalisation. Arras croit que la légalisation hautement balisée du suicide assisté est le premier pas vers la légalisation de l’euthanasie active sans restriction particulière, une prédiction que je tiens pour acquis pour les besoins du raisonnement. Arras anticipe également des abus au niveau de la pratique du suicide assisté et de l’euthanasie, par les médecins, qui pourraient avoir des conséquences négatives sur de nombreux patients qui s’engagent dans ces processus. Il fait référence à ces conséquences négatives en parlant des coûts sociaux de la légalisation. Mais les coûts sociaux en jeu dans les débats publics courants sont issus de l’implication d’autres personnes que celles de l’agent qui s’engage dans l’activité controversée, plus particulièrement par celles des personnes qui ne peuvent être tenues responsables de porter le fardeau de ces coûts. Malgré certaines interprétations plausibles des prédictions d’Arras à propos de ces abus, la légalisation du suicide assisté par le médecin ou l’euthanasie ne soulève pas ce type de coûts sociaux. Pour cette raison, mais également puisque bannir l’euthanasie n’est pas équitable pour ceux qui pourraient en tirer bénéfice, les pertes calculées en utilité devraient être considérable pour justifier une interdiction.
Mots-clés :
- suicide assisté par le médecin,
- mort assisté par le médecin,
- euthanasie,
- pente glissante,
- paternalisme
Veuillez télécharger l’article en PDF pour le lire.
Télécharger
Parties annexes
Acknowledgements
Thanks to George Panichas, Dan Doviak, Jukka Varelius, Isabelle Marcoux, Jocelyne St-Arnaud, Roberto Andorno, Renaud Boulanger, and the editors at BioéthiqueOnline for very valuable suggestions on earlier drafts that much improved the paper.
Bibliography
- 1. Arras J. Physician-Assisted Suicide: A Tragic View. Journal of Contemporary Health Law & Policy. 1997;13:361-89.
- 2. Kamisar Y. Some Non-Religious Views Against Proposed ‘Mercy-Killing’ Legislation. In: Horan DJ, Mall D, editors. Death, Dying, and Euthanasia. Frederick, Maryland: University Publications of America; 1980[1958]. p. 406-79.
- 3. Kamisar Y. Are Laws Against Assisted Suicide Unconstitutional? The Hastings Center Report. 1993;23(3):32-41.
- 4. Kamisar Y. Against Assisted Suicide - Even a Very Limited Form. University of Detroit-Mercy Law Review. 1995;735:1-17.
- 5. Kamisar Y. The Reasons So Many People Support Physician-Assisted Suicide - and Why These Reasons are not convincing. Issues in Law and Medicine. 1996;12(2):113-31.
- 6. Kamisar Y. Physician-Assisted Suicide: The Problems Presented by the Compelling, Heartwrenching Case. The Journal of Criminal Law and Criminology. 1998;88(3):1121-46.
- 7. Fletcher J. Is Euthanasia Ever Justifiable? Controversies in Oncology. 1982;297.
- 8. Callahan D, White M. The Legalization of Physician-Assisted Suicide: Creating a Regulatory Potemkin Village. Richmond Law Review. 1996;30(1):1-83.
- 9. Steinbock B. The Case for Physician Assisted Suicide: Not (yet) Proven. Journal of Medical Ethics. 2005;31:235-41.
- 10. Snyder L, Sulmasy DP. Physician-Assisted Suicide. Annals of Internal Medicine. 2001;135:209-16.
- 11. Baumrin B. Physician, Stay Thy Hand. In: Battin M, Rhodes K, Silver A, editors. Physician-Assisted Suicide: Expanding the Debate. New York: Routledge; 1998.
- 12. Pellegrino E. Doctors must not Kill. Euthanasia: The Good of the Patient, the Good of Society. Frederick, Maryland: University Publishing Group; 1992. p. 27-41.
- 13. Kass LR. Neither for Love nor Money: Why Doctors Must Not Kill. Public Interest. 1989;94:25-46.
- 14. Cantor NL.On Kamisar, Killing, and the Future of Physician-Assisted Death. Michigan Law Review. 2004;102:1793-842.
- 15. Waterfield B, Marszal A. Belgian Serial Rapist Will Not Be Euthanasized. The Telegraph. Jan 6, 2015.
- 16. Waterfield B. Euthanasia Twins ‘Had Nothing to Live for’. The Telegraph. Jan 14, 2013.
- 17. Waterfield B. Belgian MPs Vote to Extend Euthanasia to Children of all Ages. The Telegraph. Feb 13, 2014.
- 18. Varelius J. Medical Expertise, Existential Suffering and Ending Life. Journal of Medical Ethics. 2014;40:104-7.
- 19. Levene I, Parker M. Prevalence of Depression in Granted and Refused Requests for Euthanasia and Assisted Suicide: A Systematic Review. Journal of Medical Ethics. 2011;37:205-11.
- 20. Ganzini L, Goy ER, Dobscha SK. Prevalence of Depression and Anxiety in Patients Requesting Physicians’ Aid in Dying: Cross Sectional Survey. British Medical Journal. 2008;337(7676):973-5.
- 21. Battin MP, van der Heide A, Ganzini L. Legal Physician-Assisted Dying in Oregon and the Netherlands: Evidence concerning the impact on patients in “vulnerable” groups. Journal of Medical Ethics. 2007;33:591-7.
- 22. Ganzini L, Nelson HD, Schmidt TA, Kraemer DF, Delorit MA, Lee MA. Physicians’ Experiences with the Oregon Death with Dignity Act. The New England Journal of Medicine. 2008;8(342):557-64.
- 23. Finlay G, George R. Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups—another perspective on Oregon’s data. Journal of Medical Ethics. 2011;37:171-4.
- 24. Chambaere K, Rietjens JAC, Smets T, Bilsen J, Deschepper R, Pasman HRW, et al. Age-based Disparities in End-of-Life Decisions in Belgium: a population-based death certificate survey. BMC Public Health. 2012;12(447).
- 25. Smets T, Bilsen J, Cohen J, Rurup M, Deliens L. Legal Euthanasia in Belgium: Characteristics of All Reported Euthanasia Cases. Medical Care. 2009;47(12):1-6.
- 26. Onwuteaka-Phlipsen B, Brinkman-Stoppelenburg A, Penning C, de Jong-Krul GJF, van Delden J, J. M., van der Heide A. Trends in End-of-Life Practices Before and After the Enactment of the Euthanasia Law in the Netherlands from 1990 to 2010: A Repeated Cross-Sectional Survey. Lancet. 2012;380:908-15.
- 27. Rietjens JAC, van der Maas PJ, Onwuteaka-Philipsen B, van Delden J, J. M., van der Heide A. Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt And What Questions Remain? Journal of Bioethical Inquiry. 2009;6:271-83.
- 28. Chambaere K, Bilsen J, Cohen J, Onwuteaka-Philipsen B, Mortier F, Deliens L. Physician-assisted Deaths Under the Euthanasia Law in Belgium: A population-based survey. Canadian Medical Association Journal. 2010;182(9):895-901.
- 29. Rachels J. The End of Life: Euthanasia and Morality. Oxford: Oxford University Press; 1986.
- 30. Callahan D. When Self-Determination Runs Amok. The Hastings Center Report. 1992;22(2):52-5.
- 31. Pellegrino ED. Physician-Assisted Suicide and Euthanasia: Rebuttals of Rebuttals The Moral Prohibition Remains. The Journal of Medicine and Philosophy. 2001;26(1):93-100.
- 32. Handy S. The Road Less Driven. Journal of the American Planning Association. 2006;72(3):274-8.
- 33. Gaus GF. Justificatory Liberalism: An essay on Epistemology and Political Theory. New York: Oxford University Press; 1996.
- 34. Sider T. Asymmetry and Self-Sacrifice. Philosophical Studies. 1993;70:117-32.
- 35. Dworkin R, Nagel T, Nozick R, Rawls J, Scanlon T, Thomson JJ. Assisted Suicide: The Philosophers’ Brief. The New York Review of Books. 1997;44:41-7.
- 36. Marty ME, Hamel RP. Some Questions and Answers. In: Hamel RP, editor. Choosing Death: Active Euthanasia, Religion, and Public Debate. Philadelphia: Trinity Press International; 1991.
- 37. Mill JS. On Liberty. Rapaport E, editor. Indianapolis, IN: Hackett Publishing Company; 1978[1859].
- 38. US SC. Washington v. Glucksberg. West’s Supreme Court reporter. 1997;117:2258.
- 39. Rubenfeld J. The Riddle of Rape-by-Deception and the Myth of Sexual Autonomy. The Yale Law Journal. 2013;122(6):1372-443.
- 40. Lombard N. Paternalism vs. Autonomy: Steps Toward Resolving the Conflict Over Experimental Drug Access Between the Food and Drug Administration and the Terminally Ill. Journal of Health and Biomedical Law. 2007;3(1):163-89.
- 41. Roemer JE. A Pragmatic Theory of Responsibility for the Egalitarian Planner. Philosophy and Public Affairs. 1993;22(2):146-66.
- 42. Andersen E. What is the Point of Equality? Ethics. 1999;109(2):287-337.
- 43. Buchanan A, Brock DW. Deciding for Others. The Milbank Quarterly. 1986;64(Supplement 2):17-94.
- 44. Pereira J. Legalizing Euthanasia or Assisted Suicide: The Illusion of Safeguards and Controls. Current Oncology. 2011;18(2):38-45.
Parties annexes
Remerciements
Merci à George Panichas, Dan Doviak, Jukka Varelius, Isabelle Marcoux, Jocelyne St-Arnaud, Roberto Andorno, Renaud Boulanger, et les éditeurs de BioéthiqueOnline pour leurs commentaires sur les versions précédentes de ce manuscrit, qui ont vraiment permis d’améliorer l’article.