End of Life Option Act
Miriam Schulman
With California’s lawmakers considering a new physician-assisted death bill, the End of Life Option Act, the Emerging Issues Group at the Ethics Center talked this week about whether organizations such as medical associations should take a position on the legislation.
As the Los Angeles Times describes the bill:
Drawing on Oregon's law, it would require, among other things, determinations by two doctors that the patient is expected to die within six months. The doctors would have to certify that the patient is mentally competent and can take the medicine without help and meets a long list of other criteria. There would be a 15-day waiting period between the doctors' agreement and the issuing of the prescription. Also written in are safeguards against coercion and a requirement that the state track such cases, to help gauge whether the law is working properly and how often it is being used.
Whatever our personal views on the advisability of the bill, we focused on whether medical associations or other similar groups should weigh in on the debate. For context, our assistant director of health care ethics, Ryan Holmes, pointed to the thinking of noted bioethicist E. Tristram Englehardt. Englehardt argued that because of the pluralistic nature of society (and by implication, clinicians), unless medical associations have a specific moral ethos (e.g. Christian Bioethics or Libertarian Bioethics) there is no way they can speak for all of the views of their members.
Englehardt was particularly interested in the question of how ethical disputes could be resolved in a pluralistic society. He observed:
Modern Western secular, ethical reflection is distinguished by two insights: first, the centrality of the respect for freedom in the moral life, and, second, the recognition of the difficulty if not the impossibility of establishing by rational argument, or by common assent, any particular concrete view of the moral life. These two insights, I will argue, are synergistic. The first discloses the most general sense of what it means to speak of an ethical order. That is, if one is concerned to resolve disputes regarding proper moral conduct without recourse to force, respect of freedom is central to such a practice. Or, to restate a point, the most general understanding of ethics and the one requiring the fewest assumptions, and therefore the one undergirding a pluralist society, is that of ethics as a mode for resolving issues without recourse to force but, rather, by appeal to reason and to peaceable manipulations.
It is through those appeals to reason, we concluded, that organizations like medical associations can best enter into the public conversation on the End of Life Option Act.
The Ethics Center itself has grappled with the question of whether to advocate for particular causes. We’re “for” ethics, but as a center, we don’t come down on how best to achieve a particular ethical result. This posture allows us to convene people with opposing views and to use a shared ethical language for talking through the issues. In short, we don’t take positions as a center, although individuals working for and with the Center do take such positions. Ultimately, this seemed to us like the best approach for medical associations, as well.