Euthanasia

Euthanasia

Literally meaning a good death, it refers to the practice of hastening someone’s death perhaps in order to spare them further suffering

Tony Bland v Airedale NHS trust

• Tony bland (who was crushed during the Hillsborough incident, the crushing caused him to loose most cognitive functions but remained able to independently breathe) asked for life support to be turned off about 3 years after he lost brain function

The ruling:

• the judges debated he moral and ethical issues raised by the case but in the end, they agreed that given the circumstances:

• “It is perfectly reasonable for the responsible doctors to conclude that there is no affirmative benefit to Anthony bland in continuing the invasive medical procedures necessary to sustain his life. Having so concluded, the are neither entitled not under a duty of care to continue such medical care. Therefore, they will not be guilty of murder if they discontinue such care”

• Treatment was stopped and Tony bland died on march 3rd 1993

Voluntary euthanasia

When a persons life is ended at their request or with their consent

Non-voluntary euthanasia

When a persons life is ended without their consent but with the consent of someone respecting their interests e.g., when someone is in a permanent vegetative state

Sanctity of life

A religious concept that human life is made in G-ds image and is therefore sacred in value

Quality of life definition

A largely secular idea that human life has to possess certain attributes in order to have value

Understanding sanctity of life

• Both Voluntary and non-voluntary euthanasia seem to go against the religious belief of sanctity of life

• In Judaism/Christianity, this value comes from being created in the image of god

• Th significance of this is that it is morally wrong to take a life

Jewish proof of sanctity of life

1. And Gd created men in his image; in the image of God he created him; male and female he created them (Bereshit 1:27)

2. And god blessed them, and god said to them, “be fruitful and multiply and fill the earth and subdue it, and rule over the fishes of the sea and over the fowl of the sky and over all the beasts that tread upon the earth” (Bereshit 1:28)

3. You shall not murder (shemot 20:13)

4. The lord gave and the lord took; may the name of the lord be blessed (Iyov 1:21)

5. You shall choose life, so that you and your offspring will live (Devarim 30:19)

Sanctity of life in Christianity

• Catholic Christian’s place weight on the natural law and the teachings of the church in addition to the biblical evidence

• In addition, the church has officially pronounced against euthanasia, particularly in the 1980 declaration on Euthinasia

Quality of life

• Some people view quality of life as more significant than the sanctity of life

• The quality-of-life principle is the view that whether life is valuable depends on whether it is worth living

• I.e., it needs to have certain characteristics in order to be valuable

• E.g., cognitive function, ability to care/provide for yourself (bit more extreme)

5 quality of life commandments - Peter Singer

1. Recognise that the worth of human life varies

2. Take responsibility for the consequences of our decisions (in end-of-life care)

3. Respect a persons desire to live or die

4. Bring children into the world only if they are wanted

5. Do not discriminate on the basis of species

Happiness as the basis for the quality-of-life principle - peter singer

• For many, the basic criterion of weather life is worthwhile is whether or not the persons happiness outweighs hiss or her happiness

• Unhappiness → happiness = bad quality of life

• View held by most utilitarians

• Also used to justify suicide

Autonomy as the basis of quality-of-life principle:

JSM - the liberty principle:

• Mills form of liberalism suggests that taking one’s own life is a matter of personal autonomy

• The only reason for interface would be if doing os would cause harm to others

Consciousness as the basis for quality of life

Jonathan Glover (1941-):

• For life to be worthwhile it must also be conscious

• This means that killing a life is not in itself wrong that life is conscious

• The body is important only in so far as it enables conscious experiences to be possible

• Support non-voluntary euthanasia for PVS patients

The concept of sanctity of life remains a useful concept

• It upholds the intrinsic value of life

• Ensures that basis rights such as the right to life are respected

• Potential for the slippery slope - if some forms of euthanasia are permitted, it may lad to pressure being put on the vulnerable, such as elderly disabled

• Religious peoples can relate it to their own religious ideals (has a textual basis)

• People have a right to life from the UN

• Absolute and without condition

• Universal, can be applied to all peoples

The concept of sanctity of life is no longer useful

• It’s a religious concept that had no place in secular society

• Seems to be at odds with peoples autonomy in cases of voluntary euthanasia, where people with sufficient mental capacity may request death

• Leads to people dying in horrific pain and does not ultimately treat human life with dignity and respect

• Speciesist - no other creature is not allowed to end their life because their life is considered sacred

Applying natural law

Natural law has 4 tiers of law:

• Divine law gives clear guidance against the taking of a life

• For G-D to bring life to an en, not human beings

• ‘A time to be born and a time to die’ (Koehler 3:2)

Natural law - 5 primary precepts:

• Primary precept - preservation of innocent life

• Secondary precept - euthanasia forbidden

• Could be seen. An apparent good which contradicts the real good of allowing life to continue its natural, good given course

Natural law possible consideration

Consideration 1:

• ‘Discontinuing medial procedures that are burdensome, dangerous, extrdocaordinary or disproportionate to the expected outcome can be legitimate’ (Catechism of the Catholic Church, 1992)

• No obligation to give extraordinary treatment to patients

• I.e., those who cannot recover should not be kept indefinitely on life support machines

• It would not be wrong for someone terminally ill to decline extraordinary treatment

Consideration 2:

• Doctrine of double effect

  • Would support the decision by Dr Moor (morphine given to terminally ill patient) in this case

  • The primary intention was to cure the patient, although death is a possibility

  • Obvious problem - difficult to read the doctors mind or rational behind it

Natural law provides a good approach to euthanasia

• prioritises the preservation of life

• Fits with many pre-existing religious ideas on the subject (sanctity of life)

• Absolutist/legalist - we know what to o in all situations with no change

• Double effect allows some flexibility

• Stops people from playing god (taking human life into their own hands)

Natural law does not provide a good approach to euthanasia

• Does not take the nuances off. Case into account (unlike situation ethics)

• Does not give a secular viewpoint (overly reliant on Christian morality)

• Double effect is flawed because intention cannot be proven

• No value placed on quality of life

• Utilitarian argument - a person dying would are the most people happy

• Stops autonomy from the individual (their body their choice)

Applying situation ethics

• Fletcher was a key supporter of Euthanasia

  • “It is harder to justify letting someone die a slow and ugly death, dehumanised, than it is to justify helping them escape such misery” (Fletcher, Humanhood: essays in biomedical ethics)

• For a situation ethicist, it would not necessarily be wrong for the ill man to speed up his own death through the act of Euthinasia

• Although fletcher does not explicitly suggest they should refuse treatment, the implicatio given is that this cold be the mot loving outcome

• Sanctity of life is not absolute as we are always looking to do what is the most loving thing

• ‘Do not kill’ is in the category of Sophia (wisdom)

• Therefore, Euthinasia should as belong in the category of Sophia

Situation ethics and Euthinasia

• SE values quality of life and autonomy over sanctity of life

• Autonomy falls under the category of personalism - one of Fletchers 4 principles

• We should care more about the people and their welfare than the legalist view when making these big ethical decisions

• SE is relativity - ‘love decisions are made situationally and nor prescriptivly’

• In ‘morals and medicine’ (1954), Fletcher argues that the patients medical condition has to be in the starting point for any decisions in medical ethics

Situation ethics is a useful method when discussing Euthinasia

• it prioritises the whole as opposed to the individual when it comes to a big decision like this

• Allows for Euthinasia when compulsion says it is the right thing to do

• Because it is a loving ethics your intentions should be good

• Focuses on the individual aka personalism

• Religious ethics so values quality and quantity of life

• Flexible - can be used in all variations of the situation

• No slippery slope as every situation is different

• Retains personal autonomy

Situation ethics is not a useful method when discussing euthinasia

• too much power is given to the individual

• Love is subjective; therefore it can be hard to make decisions based on SE (Subjective)

• Slippery slope - if you permit it, then it becomes socially acceptable

• No time frame when the situation will end

• Does not value the sanctity of life

• Love is a subjective feeling

• Individualism so doesn’t take feelings of wider society into account

• Can we be trusted with ultimate autonomy?

Autonomy and Euthinasia - mill and singer

Mills non-harm principle:

• while the govenrment or other authority may restrict our freedom if we re about to harm someone else, they have no rights to restrict our freedom with regard to ourselves

Singers preference utilitarianism:

• Humans should be free to pursue their own desires and interests where possible

• This autonomy includes the right to make our own decisions about death

Autonomy and Euthinasia - Jonathan Glover

‘I must be convinced that our decision is a serious one; it must be properly thought out, not merely the result of a temporary emotional state. I must also think your decision is a reasonable one’

• external checks are required as to someone’s state of mind

• Spesifically, that the decision is reasonable and not a temporary emotional Tate

• If someone is making decisions is in a diminished mental state than they are not truly autonomous

Hippocratic oath

• something that doctors take when they become medical professionals which essentially say that they should do no harm ect.

• Can complicate Euthinasia as their promise to do no hark can be broken by euthanising someone

James Rachels

• Says that Euthanasia is permissible

• He says this because life sustaining treatment can be removed ethically, so e should be able to take people’s lives through medical means

• ‘Letting someone die is no different than taking their life’

Rachels view

• both cases are equally bad

• Passive Euthinasia could even be considered more cruel, as death may take longer

• E.g., Tony bland - took 10 days from the removal of the feeding tube until death

• Peter Singer - not always clear cut on what is considered an act or an omisssion