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Date of Award

10-1997

Degree Type

Thesis

Degree Name

Doctor of Philosophy (PhD)

Department

Philosophy

Supervisor

Dr. W. Waluchow

Abstract

This thesis is an investigation of the moral responsibility of physicians in assisted death. I begin with a discussion of the problem that drives the debate concerning end of life decision making. I conclude that the problem faced by those attempting to make decisiosn at the end of life is the bad death. A bad death is marked by a long, debilitating, incapacitating, dying process. Given the problem of the bad death, I discuss what responsibilities the physician might have toward a dying patient. I conclude that the responsibility of a physician is to the wellness of his or her patient, whether that patient is dying or not. For the dying patient, continued existence, or a bad death may count as harm, and a good death as a benefit. Since promoting wellness for a patient means maximizing the benefits and minimizing (or eliminating) the harms, wellness for a dying patient might mean the avoidance of the bad death and the active pursuit of the good death, which I call death management. Since the physician's responsibility is to promote wellness, the physician has a responsibility to promote the good death for a dying patient. Much of my argument hangs on the concept of "dying". I argue for a particular definition of dying and the conceptual distinction between death management and suicide. I defend the claim that physicians have a responsibility to provide death management against the moral difference thesis which holds that it is morally worse to actively kill someone than to merely let that person die. I argue against this thesis and defend instead the moral equivalence thesis which holds that there is no moral difference between bare acts and bare omissions. I also discuss the doctrine of double effect, which represents a potential challenge to my argument. However, I show that the doctrine of double effect is, in fact, not applicable to cases of death management. I condlude with a brief look at some of the concerns should death management become a social policy or legally sanctioned practice. My replies are necessarily brief, but sufficient to show that these concerns are not fatal to the legitimacy of death management.

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