Ronald Lindsay

This dissertation argues that assisted suicide and voluntary active euthanasia are, in certain cases, almost always morally permissible, and prevention and prohibition of AS and VAE are almost always morally unjustified. Specifically, AS and VAE are morally permissible when: the person seeking death is competent and has no moral obligations to others the discharge of which would be rendered significantly more difficult by her death through AS or VAE, and the person requires assistance in dying because she is incapable of bringing about her own death effectively. ;This argument is predicated on an analysis of the implications of the principle of respect for autonomy. In preventing someone from receiving necessary assistance in dying, one is compelling that person to live. That person's autonomy has been eliminated as, on balance, she would prefer not to pursue any of the choices that remain open to her. She would prefer death to anything else, yet that is the critical choice that is foreclosed to her. ;Given the significant autonomy interests at stake, this dissertation also argues for the legalization of AS and VAE for certain classes of individuals. Recognizing that for purposes of efficient administration of the law there cannot be a precise match between those for whom AS and VAE would be legally available and those for whom it would be morally permissible, we contend that by legalizing AS and VAE for the terminally ill and the severely, incurably disabled the set of lawful candidates for AS or VAE will include few individuals for whom AS and VAE would be morally impermissible. Furthermore, the arguments commonly offered against legalization are unconvincing. Abuses, such as manipulation of the terminally ill, can be controlled, if not eliminated, by proper safeguards. Moreover, the self-correcting mechanisms of democracy make a tumble down the slippery slope into mass nonvoluntary or involuntary euthanasia highly improbable

In lieu of an abstract, here is a brief excerpt of the content:Gonzales v. Oregon and the Politics of MedicineRonald A. Lindsay (bio)Throughout 2005, the morbid joke on Capitol Hill was that the twin inevitabilities of "death and taxes" had been replaced by "death politics and taxes." There seemed to be some truth in this observation given the highly publicized intervention by some members of Congress in the Schiavo case and the continuing controversy over government regulation of end-of-life care. The Supreme Court's recent decision in Gonzales v. Oregon (74 U.S.L.W. 4068 (17 January 2006)) has resolved one of the critical issues relating to this controversy by holding that a physician may prescribe controlled substances to provide assistance in dying if such a practice is authorized by state law and not expressly prohibited by federal law. However, other issues remain. In fact, the Court's decision has underscored some of the reasons why there is not only continuing controversy over end-of-life care, but also over other aspects of the practice of medicine. First, it is apparent there is no consensus among health care professionals about the precise boundaries of the legitimate practice of medicine. Second, the regulation of the practice of medicine traverses ill-defined legal territory. In particular, there is significant uncertainty concerning the implications of some regulations as well as the allocation of regulatory authority between and within state and federal governments. This uncertainty leaves substantial room for political maneuvers.Before discussing the politics of medicine, it is worth looking at the regulation of controlled substances in some detail both because this review will provide the necessary background for understanding the ruling in Gonzales v. Oregon and because it will illustrate the uncertainty resulting from multiple sources of regulatory authority.Federal and State Regulation of Controlled SubstancesSince the Pure Food and Drug Act of 1906, the federal government has regulated certain aspects of the distribution and administration of drugs deemed susceptible to abuse. The current primary vehicle for federal regulation is the Comprehensive Drug Abuse Prevention and Control Act, enacted in 1970, of which Title II is known as the Controlled Substances Act (CSA) (21 U.S.C. § 801 et seq.). A [End Page 99] "controlled" substance is just that, a substance that is regulated under the CSA. The CSA classifies controlled substances in five categories or schedules based on their potential for abuse, their accepted medical use, and the risks associated with their use under medical supervision. Schedule I substances have a high potential for abuse and have no currently accepted use in medical treatment. Schedule II-V substances are approved for medical use but are subject to a descending hierarchy of restrictions on their use. To give a lawful prescription for a controlled substance, a physician must be registered with the appropriate federal agency, currently the Drug Enforcement Administration (DEA). Moreover, to be valid, such a prescription must be issued for "a legitimate medical purpose" (21 U.S.C. § 830(b)(3)(A)(ii)).There is little dispute that the primary purposes of the CSA are to control drug abuse and to eliminate illicit trafficking in drugs. In accomplishing these objectives, there is a division of responsibility among various federal agencies, in particular the Department of Health and Human Services and the Department of Justice. Of particular relevance to the controversy in Gonzales v. Oregon is the Attorney General's authority to revoke a physician's registration for prescribing controlled substances if the physician's registration would be inconsistent with the public interest.All 50 states have their own statutes and regulations that address various aspects of the distribution and administration of controlled substances. Most states have adopted versions of the model Uniform Controlled Substances Act, which largely mimics federal law, but several states have placed additional restrictions on a physician's ability to prescribe controlled substances, including time limits on the validity of a prescription and limits on the quantity of a drug that can be prescribed. States are the primary, but by no means the exclusive, source of regulation of medical practice in general. States license physicians, establish boards and agencies to regulate the actions of physicians, and promulgate rules and guidelines to which physicians...

: Common morality theory must confront apparent counterexamples from the history of morality, such as the widespread acceptance of slavery in prior eras, that suggest core norms have changed over time. A recent defense of common morality theory addresses this problem by drawing a distinction between the content of the norms of the common morality and the range of individuals to whom these norms apply. This distinction is successful in reconciling common morality theory with practices such as slavery, but only at the cost of underscoring the limits of common morality theory, in particular its inability to resolve disputes about the moral status of entities. Given that many controversies in bioethics center on the disputed status of various entities, such as embryos and nonhuman animals, this is an important limitation. Nonetheless, common morality theory still can be a useful resource in diminishing moral conflict on issues that do not involve disputes over moral status

: There is a concern that genetic engineering will exacerbate existing social divisions and inequalities, especially if only the wealthy can afford genetic enhancements. Accordingly, many argue that justice requires the imposition of constraints on genetic engineering. However, it would be unwise to decide at this time what limits should be imposed in the future. Decision makers currently lack both the theoretical tools and the factual foundation for making sound judgments about the requirements of justice in a genetically transformed society. Moreover, focusing on the uncertain inequities of the future may result in failure to give priority to more pressing inequities of the present. Especially in a country that recently has enacted tax legislation that will widen existing wealth disparities, concern about the distant threat of a genetic aristocracy appears misplaced

Prior to passage of the Oregon Death with Dignity Act, opponents of assistance in dying argued that legalization would have serious harmful consequences. Specifically, they argued that the quality and availability of palliative care would decline, that the harms of legalization would affect certain vulnerable groups disproportionately, that legal assisted dying could not be confined to the competent terminally ill who voluntarily request assistance, and that the practice would result in frequent abuses. Data from Oregon's decade-long experience decisively refute the first three predictions. As to abuses, the record is not quite as clear, but if an appropriate framework for analysis is utilized, the most reasonable conclusion is that the risks of abuse do not outweigh the benefits of legalization. To the extent projected harmful consequences are relevant to the debate over legalization, Oregon's experience argues in favor of legalization of assistance in dying.

An organization's management control system can play an important role in influencing ethical behavior among employees. In this paper a theoretical framework of control is developed by linking various ethics related control mechanisms reported in the literature to the primary components of a management control system. In addition, the findings of a survey of the Financial Post's Top 1 000 Canadian industrial and service companies are reported. The survey investigated organizations' use of ethical codes of conduct, whistleblowing systems, ethics committees, judiciary boards, employee training in ethics, and ethics focused corporate governance and reward systems. The findings indicate that ethics related control mechanisms, particularly codes of conduct, are being used by a good number of organizations. However, closer analysis of the data suggests that many companies may only be paying lip service to the importance of promoting ethical behavior.

few areas of public policy have been fraught with as much controversy as bioethics. Each novel development in biomedical technology seems to spark rancorous disputes. Those averse to new technologies often express the concern that the new technology is 'unnatural' or requires us to 'play God'. Slogans such as 'Frankenfoods' and 'sanctity of life' substitute for reasoned argument. This is an ambitious book that seeks to reframe the debates surrounding current controversies in bioethics. Carefully examining and dissecting claims made by many policy-makers and ethicists on topics such as assistance in dying, genetic engineering, and embryonic stem cell research, bioethicist Ronald A Lindsay shows that all too often these claims are based on instinctive reactions, beliefs that lack factual support, and religious or ideological dogma. After describing in detail the proper way to approach and resolve a dispute in bioethics, Lindsay proceeds to analyse several different cutting-edge issues. Through his insightful analysis, Lindsay demonstrates how to achieve pragmatic, progressive solutions to these controversies. An antidote for misguided thinking, "Future Bioethics" illuminates the way forward to bioethics policies appropriate for the 21st century.

Prominent among the arguments against the legalization of assisted suicide is the contention that legalization will have a disproportionately adverse, or “disparate,” impact on various vulnerable groups. There are many versions of this argument, with different advocates of this argument focusing on different vulnerable groups, and some advocates confusedly blending slippery slope and social justice concerns. Also, the weight placed on this argument by its various advocates is not uniform, with some including the argument in a list of multiple, apparently similarly persuasive, reasons for not legalizing assisted suicide, while others place significant reliance on it and yet others advance the argument without any clear indication of its importance. Nonetheless, the various versions share a common core: One reason assisted suicide should not be legalized is that members of certain vulnerable groups are more likely to be pressured into requesting it, whether directly by those hostile or indifferent to their interests, or indirectly by social circumstances, such as an inability to pursue other healthcare choices.

Even if there is a common morality, many would argue that it provides little guidance in resolving moral disputes, because universally accepted norms are both general in content and few in number. However, if we supplement common morality with commonly accepted factual beliefs and culture-specific norms and utilize coherentist reasoning, we can limit the range of acceptable answers to disputed issues. Moreover, in the arena of public policy, where one must take into account both legal and moral norms, the constraints on acceptable answers will narrow the extent of reasonable disagreement even further. A consideration of the debate over legalization of assisted dying supports this claim.

Prominent among the arguments against the legalization of assisted suicide is the contention that legalization will have a disproportionately adverse, or “disparate,” impact on various vulnerable groups. There are many versions of this argument, with different advocates of this argument focusing on different vulnerable groups, and some advocates confusedly blending slippery slope and social justice concerns. Also, the weight placed on this argument by its various advocates is not uniform, with some including the argument in a list of multiple, apparently similarly persuasive, reasons for not legalizing assisted suicide, while others place significant reliance on it and yet others advance the argument without any clear indication of its importance. Nonetheless, the various versions share a common core: One reason assisted suicide should not be legalized is that members of certain vulnerable groups are more likely to be pressured into requesting it, whether directly by those hostile or indifferent to their interests, or indirectly by social circumstances, such as an inability to pursue other healthcare choices.