No abstract

Physician-assisted suicide laws in Oregon and Washington require the person's current competency and a prognosis of terminal illness. In The Netherlands voluntariness and unbearable suffering are required for euthanasia. Many people are more concerned about the loss of autonomy and independence in years of severe dementia than about pain and suffering in their last months. To address this concern, people could write advance directives for physician-assisted death in dementia. Should such directives be implemented even though, at the time, the person is no longer competent and would not be either terminally ill or suffering unbearably? We argue that in many cases they should be, and that a sliding scale which considers both autonomy and the capacity for enjoyment provides the best justification for determining when: when written by a previously well-informed and competent person, such a directive gains in authority as the later person's capacities to generate new critical interests and to enjoy life decrease. Such an extension of legalized death assistance is grounded in the same central value of voluntariness that undergirds the current more limited legalization.

Has a child been treated unfairly if the only way it can exist is by having an awful life? A principle of parental responsibility can be used to show how the child is wronged.

Most of us believe that we are entitled to treat members of other species in ways which would be considered wrong if inflicted on members of our own species. We kill them for food, keep them confined, use them in painful experiments. The moral philosopher has to ask what relevant difference justifies this difference in treatment. A look at this question will lead us to re-examine the distinctions which we have assumed make a moral difference.