Euthanasia

what is Euthanasia?

bringing about the death of a person in a painless and gentle way for their benefit. Sometimes called ‘mercy killing’.

What were the attitudes towards euthanasia from Epictetus and Plato?

both euthanasia and suicide were acceptable options for individuals who no longer believed that they had any quality of life.

what did the Early Christian Church have to say about Euthanasia?

opposed to killing human beings in every context. Natural law argued against euthanasia because this went against the primary precept of preservation of life

what is the sanctity of life argument?

the belief that human life is made in God’s image and therefore sacred.

is euthanasia legal in the United Kingdom?

no, rising numbers of UK citizens travel to Swiss Dignitas Clinic in order to have an assisted suicide legally.

what is assisted suicide?

A deliberate act that causes death, undertaken by one person with the primary intention of ending the life of another person, in order to relieve the second person’s suffering

what is physician assisted suicide?

A quailified doctor prescribes a drug which assists a person to take their own life

what is active euthanasia?

Someone (i.e relative or doctor) brings about another person’s death for the second persons benefit, at their request

what two factors are primarily considered when making decisions concerning euthanasia?

quantity of life and quality of life. As technology evolves, there are now new issues such as whether treatment should be given or taken away that could extend years of life (even if those years of life are painful)

what does the term Quality of Life mean?

refers to a persons total wellbeing, including physical, emotional and social aspects of a person’s life.

how is quality of life assessed?

By a concept of Quality Adjusted Life Years- this was set out by the national institute for Health Care Excellence. using factors to consider such as level of pain the person is in, their mobility and general psychological state. they then look at available drugs to treat the person’s condition and decide whether a certain drug will bring good value for money in the treatment of the patient. After considering factors such as these, a cost effectiveness assessment will have to be considered- do the years of life extended match up to the price that is spent on drugs and treatments?

what are the ethical questions that surround Quality of LIfe?

the questions around QOL assume that an individuals life can be quantified, specifically when tests are used to determine the value of persons remaining life- this is disagreeable to many people.

the decision about the value of a person’s life is put in the hands of a doctor- this gives a great deal of power to that doctor- ethically justifiable?

if such power is given to a doctor- this may change the nature of the doctor patient relationship. people may not have confidence in their GP or specialist which may affect their treatment or state of mind

why may Christians argue for the Sanctity of Life?

Genesis 2:7- God breathes life into Adam

this implies that there is a special bond between God and humankind, something that is different from the rest of creation. the gift of life is precious as it reflects something of the nature of god, and therefore to take away someones life is to commit murder and in a way, take away some part of God as the creator

what are implications of the belief that some humans are made in the image of God?

means humans are dependent on God for their lives, because God is in control of every individual’s life

It means that humans are in a relationship with God

It means each human life has unique dignity, because humans are created by God, this dignity is intrinsic, whether at the beginning or end of life. life is an entrusted gift, not a possession

it means all humans are equal, women= men adults= children, healthy= sick. as we care all made of the same god like materials

what implications does the sanctity of life argument have on euthanasia?

patients in PVS, are still living human beings and they should continue to have intrinsic value and should be treated the same as anyone else. it would be wrong to treat their lives as worthless and to conclude that they would be ‘better of dead’

patients who are old or sick, and who are near the end of earthly life, have the same value as any other human being.

people who have mental or physical handicaps have the same values as any other human being.

what arguments disagree with the idea that life is sacred?

all humans have autonomy- human beings have the power to make real decisions on their own, specifically about whether they continue to live or die.

for this person, then euthanasia is a valid, freely chosen option at the end of her life. it is a tool for achieving the goal that she has chosen.

what is the Doctrine of Double Effect?

Where a doctor acts with good intentions (i.e giving a drug to help a patient’s bad condition) but where bad consequences arise (the drug harms the patient).

According to the DODE, when is it morally permissible to perform an act that has both good and bad effects?

1. the act to be done must be good in itself or at least indifferent

2. the good effect must be obtained by means of the bad effect

3. the bad effect must not be intended for itself, not permitted

4. there must be a proportionately grave reason for permitting the bad effect

from this we can see, that the most important thing is the intention in the mind of the doctor in judging the moral correctness of his/ her action.

what is passive euthanasia?

A person (usually a doctor) allows another person to die painlessly by withdrawing treatment, which indirectly brings about that person’s death.

what is involuntary euthanasia?

A decision is made to end the life of a person, either without their knowledge or against their wishes.

what is non-voluntary euthanasia?

A decision is made to end the life of a person who is not in a position to make that decision themselves.

What is DNR Status?

Do not resuscitate means that a doctor does not have to try to restart a patients heart if it stops. it can be thought of as a form of passive euthanasia. the purpose is to stop unnecessary suffering for a patient. this supersedes the default that every patient consents to treatment.

what ethical problems with DNR occur?

1. listing patients as DNRs without their consent- problems arise when their is insufficient discussion between the patient and medical experts.

2. a patient may request that CPR is attempted, even if the doctors think there is a very remote chance that it would do any good. the team would have to respect this choice, but would wish to have an honest discussion with the patient before hand

3. doctors might decide that they will not inform a patient of a DNR order. for instance if the patient is not mentally competent there might be no point informing them, in this case notes must be kept, explaining why patient was not informed.

4. health services are being forced to cut costs- DNRs might be an easier way to do this.

what is an advance directive?

also called a ‘living will’, in which a person states their wishes about dying before they become incapable of doing so. they are legally binding by the Mental Capacity Act of 2005.

what is the main benefit of Advance directives?

puts the patient in control of what happens to them in certain situations or circumstances

what is the ethical issue concerning advance directives?

if the patient has written an advance directive some time previous to the occasion when it is needed, he may have changed his mind but not got around to updating the document. medical staff would not necessarily know this and would have to treat him according to wishes expressed in document

what is the slippery slope argument?

some worry that by legalising euthanasia, more people will do it and attitudes towards it will become more blase. additionally, the line between euthanasia for physical illness and mental illness will become blurred.

explain Christian views against euthanasia using bible passages?

Genesis 1:26- let us make humans in our image. Sanctity of life argument

Exodus 20:13- the sixth commandment says simply ‘You shall not commit murder’.

explain Christian views for euthanasia using bible passages

The armour bearer of Judge Abimelch assisted his master in dying. to avoid the indiginity of dying at the hands of a woman, abimelch asked for the armour bearer to kill him, and he did.

other various accoutns of suicide in the Bible such as King Anitophel

explain how some christians may justify euthanasia?

take the teachings of Jesus on love as a general principle, which they then use to justify euthanasia as the most ‘loving thing’ in a particular situation. for them euthanasia may be the most compassionate response to the suffering of a family member or close friend.

what is the position of the CofE on euthanasia?

strong opposition to any change in the law or medical practice to make assisted suicide permissible or socially acceptable. The Church argued that suffering must be met with compassion and commitment to high-quality services and effective medication.

what is pallative care?

Caring for a person with an incurable disease so that they can maintain some sort of quality of life and are not in pain in the final stages of their lives.

what is the roman catholic churchs position on euthanasia?

they regard euthanasia as morally wrong. i has always taught the absolute and unchanging value of the commandment ‘you shall not kill’ as euthanasia is a form of murder.

they believe in the intrinsic value of human life, and this value does not depend on whether people are happy or are social useful. they are valuable simply because they are human and made in the image of God.

although they teach that humans have free will, their freedom does not extend to ending their own lives as only god has the right to give and take life, so euthanasia and suicide are both unacceptable

what does Natural Law think about euthanasia?

goes against the primary precept of preservation of life.

believes in the sanctity of life argument

however, if a patient wants to stop having treatment for an illness they may do so according to natural law, because proposed treatment may go beyond what is reasonable or necessary for existence and such treatment would be taking extraordinary means to preserve their life

outcomes as a result of DODE are allowed as long as the death of the patient is foreseen but not intended

what is proportionalism?

Proportionalists still hond onto the sanctity of life argument and consider intrinsic evils to be wrong. but they take a holistic view of principles, acts, intentions and consequences, they grant that there can be proportionally good reasons to make exceptions to well- established secondary precepts. essentially they weigh the goods or values against the evils or disvalues.

Explain how natural law may be perceived as outdated?

• Aquinas’ Natural law ethics and the sanctity of life principle are increasingly seen as outdated. Sociologically, we could claim these ethical principles were created to be useful in the socio-economic conditions of their time. Ancient and Medieval society was more chaotic, strict rules were important to hold society together and because people were not educated nor civilised enough to be trusted with the freedom to interpret their application. It made sense to create strict absolutist ethical principles to prevent society from falling apart. This would explain the primary precepts. They served a useful function in medieval society.

• Applied to euthanasia, we can argue it was useful to simply ban all killing in medieval times, because violence and killing was much more common and therefore needed to be strongly restricted. People were less self-controlling and less educated, so they needed clear simple rules to follow.

• The issue clearly is that all of these socio-economic conditions have changed. So, the primary precepts are no longer useful. They were designed for a different time and are now increasingly outdated. Society can now afford to gradually relax the inflexibility of its rules and think about how they might be reinterpreted to better fit modern society.

what are criticisms of natural law on euthanasia?

the distinction between using ordinary means of care and avoiding extraordinary. To withdraw extraordinary means is to recognise a patient is dying and expressing an unspoken but deliberate willingness to shorten burdensome suffering

distinction between omission and commission. if one considers consequences rather than motive, the outcome is the same.

DODE may be judged in Natural law to aim at one good end (the alleviation of pain) while the secondary effect (hastening death) is judged to be foreseeable but unintended. this seems superficial?

natural laws absolutist principles can be cruel in failing to take account of patient choices and circumstances. law ought to recognise the right of the terminally ill person to end their life with the assistance of a physician, but NL would have us deny the wish for euthanasia of thousands suffering a prolonged death.

natural law plays little attention to the fact that medicine is increasingly playing God in extending life well beyond what is ‘natural’. therefore it is inconsistent to say that we ought not to play god in terminal care when it might be argued that we do so in much of modern medicine anyways

natural law presumes that there is amoral law underpinning state laws prohibition euthanasia and that without fixed principles there will be slippery slope that pressurises the elderly into thinking of themselves as a burden and nudges them towards euthanasia. this is simply not the case in places like Switzerland where adequate safeguards are in place to ensure against coercion or pressure

the primary precept of preservation of life condemns many to suffer extreme suffering and loss of personal dignity. their biographical life ( a sense of life worth living) might be over but their biological one persists.

what does situation ethics think about euthanasia

• Fletcher was president of the euthanasia society of america.

• Situation ethics would judge that euthanasia can be morally good, in situation where it maximises agape. 

• In situations where it would maximise agape to avoid euthanasia, it would be wrong, however. 

• For example, if someone has a very low quality of life and an autonomous wish to die, it seems that Fletcher would accept euthanasia. 

• However if someone is pressured into euthanasia by their family who are greedy for inheritance or by society making them feel like a failure or a burden, or if they have a short-term issue like Singer’s example of a lovesick teenager, Fletcher would think it wrong to allow euthanasia in such cases.

what are the strengths of situation ethics applied to euthanasia

the four principles of situation ethics combine to offer a system which is principled, but not rule bound. patient autonomy and agapeic reasoning are central in cases concerning euthanasia.

individual conscience, patient welfare and the right to decide are central to Situationists. Agapeic reasoning doesn’t arrive with a rule book, but decides with all of the factors in play with an individuals case.

for situationists- the ends justify the means.

rigidity in church ethics when wider society changes it views can cause tensions. Situation ethics welcomes the autonomy of the individual patient having the freedom to make their own decisions. Chaplains can support them in loving and non-judgmental way.

one benefit over utilitarianism is that situation ethics puts motives of love for actions alongside consequences. where utilitarians judge actions of their usefulness in delivering favourable outcomes. situationists balance motives and consequences, when consequences are unpredictable, one can then fall back on having acted with the right motives.

agapeic love motivates people to perfom self-sacrifical acts of loving kindness. when combined with a pragmatic mindset, Situationists can work well with a wide range of people and so allow religious values to work in a wider healthcare system and in public policy and law

what are the weaknesses of situation ethics applied to euthanasia

as Legislators recognise, framing a law to legalise euthanasia. it can lead to a slippery slope where doctors and relatives coerce patients into thinking it is the honourable thing to do, so that they are not a burden.

we need absolutes like the sanctity of life. leaving it up to individuals to assess ethical judgments on case-by-case presumes that they are fully self-aware and competent. Yet, precisely because euthanasia is an end of life decision, many patients are in and out of consciousness, or rely on the judgment of their next of kin, or doctors. situation ethics stress on relativism raises questions- can relatives always know the wishes of their loved ones?

situation ethics is essentially a version of act utilitarianism. over reliance on ones ability to predict the future outcomes of a given situation, an arrogant disregard for wisdom accumulated in rules and a lack of consistency in decision making

situation ethics seems to depart from mainstream Christian ethics in its disregard for the sanctity of life in the euthanasia debate.

human nature is too self-interested and there are doctors and relatives who could manipulate their loved ones into requesting euthanasia, so naively liberalising the law may actually lead to coercion of, rather than love towards, so elderly patients.

What are Singers views on euthanasia

• Peter Singer says that the sanctity of life is based on outdated Christian views and thus should be re-evaluated. He takes a utilitarian view, that what remains to value in life without sanctity, are things like happiness or the satisfaction of pleasure.

• Singer argues that the reason killing is wrong is that it violates the preferences or interests of a being to continue living.

What is the counter to singers argument concerning quality of life

• Archbishop Fisher argues that if Euthanasia is allowed for quality of life, then some elderly or otherwise vulnerable people might be tempted to die because they feel like a burden. Western culture values success, self-sufficiency and beauty. Those who fall short can feel miserable as a result. If we allow euthanasia, such people might feel encouraged to die because they feel like failures.

• Adding to Fisher’s argument, In 2022 in Canada there was a controversy over two high profile cases of people with medical conditions for which they received insufficient financial support applying for euthanasia. One called Denise saying they have applied for euthanasia “because of abject poverty”.

• Pope Francis criticised Canada’s system as part of a tragic culture of treating the elderly and disabled as disposable, “patients who, in place of affection, are administered death”.

Counter Pope Francis argument

His criticisms are not against euthanasia itself per se, they are more critical of the societies in which euthanasia are administered.

For example, canada made mistakes in allowing doctors and nurses to raise the option of euthanasia before trying other means, something which places like Belgium outlaw.

What is Singerse response to the slippery slope argument

• Singer’s response

• Must combine quality with autonomy – this will prevent slipping down the slope to ‘involuntary euthanasia’

• Singer says the slippery slope made sense to worry about back in the 70s, before we had real data. 

• People who receive euthanasia in Oregon are disproportionately white, educated and not particularly elderly, so euthanasia does not especially target vulnerable people.

• Singer adds that there is no creep of euthanasia becoming more widespread. He points out how in Oregon only one in three thousand deaths are by euthanasia. Genetic screening allowing mothers to know if their baby has a condition before its born and aborting it meant the post-birth non-voluntary euthanasia numbers dropped from 15 in 2005 to 2 in 2010.

What are Nozicks attitudes towards euthanasia

• Nozick took a deontological/absolutist view of autonomy.

• He argued for the principle of ‘self-ownership’, that each person owns their body and can do what they want with it.

• If someone wants euthanasia then that is up to them, no matter the reason.

• If a doctor then wants to help them die, there is nothing ethically wrong with that.

• Voluntary euthanasia is therefore always morally acceptable.

What are the counters to Nozicks attitudes towards euthanasia?

• There are ethical downsides to allowing anyone to die who wants to.

• Singer points to the example of a love-sick teenager who wants to die for short-sighted reasons.

• Mill and Singer take a consequentialist view of autonomy to solve this issue.

• Singer claims we can ‘safely predict’ they will get over their issues.

• Allowing autonomy in euthanasia for absolutely any reason would lead to many people dying when they themselves would have ended up regretting that. That doesn’t seem like it actually enables autonomy.

• Being allowed to do something you’d regret due to temporary short-sighted emotions is not autonomy. Humans can have lapses in judgement where they act uncharacteristically. It’s not autonomy to allow people to die due to such desires. 

• Philosophers argue we should understand autonomy in terms of a person’s ‘ideal’ desires, meaning what they would want will full knowledge and without any non-rational distractions like intense emotion.

• Thinking of autonomy as being free to act on literally any desire we might have, ignores the fact that humans are often irrational. When acting based on intense emotions, we aren’t acting autonomously, we’re acting animalistically.

• Singer concludes we need to make sure that autonomy is rational.

What were W. barclays critiques on fletchers approach to euthanasia?

• People are not perfectly loving so if given the power to judge what is good or bad, people will do selfish or even cruel things. 

• People’s loving nature can be corrupted by power. 

• Someone might find it loving to manipulate/pressure someone into or out of euthanasia, perhaps if they will get inheritance to pay for their children’s food or something. Some might find it loving to end their life because they feel like a burden.