Rebecca Dresser and John Robertson argue, in essence, that it is impossible for a competent individual to foresee his or her future own interests as an incompetent patient. Living wills and advanced directives appear to provide clarity to family members, and give direction as to how to treat an incompetent patient, but in reality these documents merely confuse the debate even more, as evidenced by end-of-life care court cases such as Terri Schiavo. Different people have different needs at different stages of their life, just like a child has different interests than an adult, and they must be treated with this in mind by the law. No one can predict his or her future in its totality. The current interests of the incompetent patient should be evaluated by physicians, family members, and the courts, rather than the individual's projected assessment of his or her own interests in the future. Also, the authors argue that living wills do not sufficiently take into consideration the emotional needs of families to have a say in how the ailing individual is treated, but make the treatment dependent merely upon a piece of paper.
The cool prose with which Dresser and Robertson advance their "current interests" argument obscures the fact that, given the emotional time when a patient is facing the end of life, it is very difficult for families to come to a competent assessment of the patient's interests. Family members, believing they have the patient's current interest at heart, may ignore medical advice that, ironically, the patient him or herself was better able to evaluate when competent. Also, family members will inevitably be in conflict about what constitutes a quality life, given the morally and religiously contentious nature of this issue. If the patient when competent believed a quality life was not 'hooked up to a machine,' and the family had religious objections to life termination is it really in the incompetent patient's current interests to let the family 'win' after he or she cannot articulate these concerns? What if the family disagrees -- the lack of a clear answer when life begins or ends seems to argue in favor of leaving this decision up to the patient. Dresser and Robertson's 'current interests' argument is essentially decision-making about the end of life by committee, as everyone except the incompetent patient gets to 'weigh in' on the decision-making process regarding the patient's end of life. This was what transpired in the Terri Schiavo case, as Schiavo, a young woman, had left no clear directives as to what she considered a quality life.
In essence, all of us are always making decisions that will affect our future selves, and the dying or terminally ill, or simply anyone who writes a living will, should have the ability to make decisions in the same fashion. No, these decisions may not be perfect any more than other life decisions about our future selves' physical health -- from the way we eat, to our choices to smoke, drink, live, love, and work. However, the idea that at some point families have a right to intervene because of their feelings, however well-intentioned, and circumvent our decisions about how people die seems to go profoundly against our individualistic orientation as a society at best, and to be, in the long run, more divisive to the family relationships amongst the living members of a family, as was manifest in the Schiavo case.
First do no harm." This principle of the Hippocratic Oath has made many bioethicists and religious leaders leery about supporting Physician-Assisted Suicide (PAS), including Adrienne Asch and the U.S. Bishop's Committee. Asche argues about the socially constructed nature of disability and health, and stresses that health and physical perfection cannot be viewed as absolutes, and that there is a fundamental difference between autonomy over one's own body (having an abortion, for example) and taking the life of a fully-fledged human being. If PAS is allowed, human life will be cheapened, and those individuals, such as the disabled, whose right to life is already viewed as suspect, will be called further into question. The U.S. Bishops stress that God alone can take a life and their belief system invalidates abortion as well as the practice of PAS. Asche and the U.S. Bishops fear that questioning the inherent value of life and the right of another human being to take a life under the approval of the state is a slippery slope, and might yield a 'Brave New World,' where the human race is 'culled' into perfection, at the beginning of life, at its end, and also when disability threatens life's perfection.
However, as troubling as PAS may be, when an individual is competent enough to make decisions about his or her own health and life, unlike a child, for example, the issue becomes more troubling. Should Asch have the moral right enforce her view that a life has valued upon an individual who is sick and wishes to die, or does she even have the right to pressure families to make decisions about a child or an elderly patient's needs -- in a society such as ours that values autonomy and privacy, where when life begins and ends is still uncertain, to shut down all dialogue and refuse consideration on a case-by-case basis seems an imposition of Asch's or the Bishop's agenda upon the private lives of others. They cannot live in the bodies and in the lives of the people whose existences they wish to dictate, however well-meaning their ideas about elevating the experience of individuals with disabilities or guarding the sanctity of life. Ultimately, these anti-PAS policies seem to impose a single, uniform definition about the quality and sanctity of life upon all individuals, in the interest of creating a more tolerant or virtuous society, without taking into consideration the personal suffering this might cause.
Making PAS illegal has another terrible consequence -- terminally ill, ill, or simply depressed individuals, knowing that PAS is illegal, might take matters into their own hands, rather than discuss the matter with their physician, because they know the doctor would be legally obligated to report their suicidal ideation. This might drive them to desperate measures, while if they could discuss suicide openly with a doctor or counselor, they might realize that circumstances were not as bleak as they feared. While there have been some anecdotal cases of physicians who did not dissuade their patients from suicide in countries where PAS is legal, it is likely that the vast majority of physicians would only support PAS in dire circumstances, and use a discussion of the issue to address the patient's depression and concerns about his or her quality of life and care and pressure him or her to stay alive and to take positive actions to sustain life.
Julian Savulescu claims, "Enhancement, far from being merely permissible, is something we should aspire to achieve." For example, Savulescu argues that selecting 'the best' sperm or embryos in terms of in-vitro fertilization is acceptable, arguing that parents have a responsibility to the future of society to create the best children they possibly can, given what they know of their genetic information. For example, if a woman is contemplating artificial insemination, better to use the sperm of a Noble-Prize winner, suggests Savulescu, rather than the sperm of a random donor. Screening for genetic defects functions as a kind of genetic 'improvement' of the human race. After all, if people believed in letting nature take its course, they would not make use of such technology. All forms of changing the human environment are enhancement to some degree, from improved maternal and even postnatal nutrition to a woman's decision to adopt a child because she fears passing on a gene for hemophilia.
Firstly, to some extent it…