EUTHANASIA

Define euthanasia.

-’A good death’.

Define suicide.

-A person makes a voluntary choice & takes their own life.

Define assisted suicide.

-A person who wishes to die & is helped to die by another person.

Define active euthanasia.

-A treatment given that directly causes the death of an individual.

Define non-voluntary euthanasia.

-Where a terminally ill person’s life is ended without their consent, perhaps bc they’re unable to give consent.

Define passive euthanasia.

-A treatment is withheld & this indirectly causes the death of the individual.

The law & euthanasia.

-Euthanasia although legal in some countries such as Switzerland is illegal in the UK.

-Suicide has been decriminalised but it’s still an offence to assist someone in committing suicide.

-It’s legally wrong to administer active euthanasia - to do smt that directly causes death.

-The Tony Bland case provided a precedent whereby, in certain extreme circumstances, non-voluntary euthanasia is permitted.

Define sanctity of life.

-The idea that life is intrinsically sacred or valuable.

How does sanctity of life respond to euthanasia?

-In Christian ethics, it refers to the idea that life is special & valuable bc it's God-given.

-Despite the belief humans are fallen & damaged by sin, each person is still created in the 'image of God'. Meaning it's morally wrong to take life.

-Each life has intrinsic value regardless of its quality or usefulness to us.

-Suicide is blasphemy as it is a deliberate rejection of God’s gift of life.

-Because people have souls, they must be treated as special.

-God plans each individual human life, we are special.

What are quotes that support the Sanctity of life?

-''So God created humankind in his own image, in the image of God he created them''.

-''You shall not murder''.

-''The Lord gave & the Lord has taken away''.

-’’Breathed into his nostrils the breath of life’’.

What are the arguments for sanctity of life?

-There are concerns that if we don't uphold the supreme value of life this may lead to poorer treatment of patients or ppl feeling they are a burden on resources.

-The idea that life is special in all forms isn't a bad idea. Modern ideas of rights have their origins in this idea & attempt to express a similar sentiment.

-Natural Law upholds the intrinsic value of life. Preservation of innocent life is one of its 5 primary precepts.

-In the Bible, it states that 'The Lord gave & the Lord has taken away'. So in making decisions about life-ending treatments we may be guilty of presuming to know more than God.

What are the arguments against sanctity of life?

-The sanctity of life assumes a religious worldview which many ppl in the 21st century no longer share.

-Sanctity of life says life must be saved at all costs whether there's a good chance of treatment working or whether it's almost impossible. Yet technology & medical knowledge has advanced greatly & we are now able to know which lives can & cannot be saved; we no longer need to value life at all costs.

-Situation ethics rejects overly legalistic interpretations of the sanctity of life. It's far more important to work on a case-by-case basis attempting to do the most loving thing for the ppl involved.

-The suffering of patients may be unnecessarily increased if we preserve life at all costs.

-Peter Singer argues that sanctity of life is part of an old-fashioned traditional ethic that needs to be replaced. It directly goes against autonomy & control. Singer argues that ppl ought to have the freedom to make decisions about their lives for themselves.

What is the slippery slope argument?

-Opponents of euthanasia worry that changes to the law on euthanasia may be the beginning of a slippery slope where respect for life is reduced & pressure may be exerted on those who are vulnerable, such as older & disabled ppl.

-They may agree to euthanasia bc they wrongly feel they are a burden to society.

-Opponents of euthanasia see a precedent for their slippery slope argument in the issue of abortion.

-When abortion was legalised, it was envisaged that it may be a few thousand cases per year for medical reasons. Currently there are over 180,000 abortions in the UK each year.

How does Peter Singer respond to the slippery slope argument?

-Peter Singer has responded to the slippery slope argument for euthanasia.

-He cites a review conducted in the Netherlands where euthanasia is legal.

-There were around 48,000 end-of-life decisions in the time period studied; there were only 2 cases where it was possible that patients' lives had been ended against their will, although equally the 2 cases could also be explain by poor documentation.

Define quality of life.

-The idea that life’s value depends on certain attributes or goods. E.G happiness, autonomy.

How does quality of life respond to euthanasia?

-Quality of life principle takes the view that whether life is valuable depends on whether it's worth living.

-Some thinkers base the decision on whether quality of life exists around possession of life's goods such as happiness & freedom from pain.

-Other argue quality of life can be found in possession of autonomy.

-The utilitarian philosopher Peter Singer takes such a view & argues for replacing the traditional sanctity of life ethics with 5 quality of life commandments.

-Singer argues the value of life depends on a person’s ability to have desires/preferences, not some mystical soul which gives priority to humans.

What are Singer’s 5 quality of life commandments?

-Recognise that the worth of human life varies.

-Take responsibility for the consequences of your actions.

-Respect a person's desire to live or die.

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

-Do not discriminate on the basis of species.

Define autonomy.

-The belief we are free & able to make own decisions.

Define voluntary euthanasia.

-Where a person’s life is ended at their own request.

-Usually done by another individual & is bc of a terminal illness.

What is the principle of autonomy?

-Linked to the quality of life & in direct opposition to the sanctity of life is the principle of autonomy.

-This principle states humans should be free to make decisions about their own future. It's a key feature of utilitarian thinking & can be traced back to J.S Mill's non-harm principle: whilst the government or other authority may restrict our freedom if we're about to harm someone else, they have no right to restrict our freedom with regard to ourselves.

-If we wish to harm ourselves we should be permitted to do so.

-Likewise Singer's preference utilitarianism argues humans should be free to pursue their own desires & interests where possible.

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

How does autonomy link to euthanasia?

-Supporters of euthanasia appeal to the idea of autonomy. It seems to be a key aspect in determining our own lives that we have the ability to determine the time & manner of our own death.

-In the case of voluntary euthanasia, this may appear fairly straightforward; however, leading British philosopher Jonathan Glover has suggested several checks on whether someone should be assisted to die.

-This implies some external judgement to the patient's quality of life as well as their mental state. If they're making a decision in a diminished mental state then they're not truly autonomous.

-The issue of autonomy is more complicated in cases of non-voluntary euthanasia, particularly where a patient, perhaps like Tony Bland, is in a persistent vegetative state. If the patient has given instructions about what their wishes would be if they were in such a case, then arguably their autonomy is being respected.

-Where there are no explicit instructions, opponents of euthanasia worry that ending life may not only disregard the principle of the sanctity of life, but may also lead to a slippery slope where euthanasia is practiced more widely.

What is the Hippocratic Oath?

-Greek physician Hippocrates states it would be wrong for a doctor to do something that would cause the death of a person.

-However in other writings, he suggests it's pointless to continue to treat those who are overcome by a disease & for whom medicine is powerless.

-Roughly speaking, an 'act' which causes death is morally (& legally) wrong but an omission (stopping a treatment where the treatment is prolonging the inevitable death & increasing the suffering of the patient) may not be morally wrong.

Applying Natural Law to euthanasia.

-The key precept of Natural Law argues for the preservation of life.

-Life is intrinsically valuable & shouldn't be shortened. Natural Law is dependent on the Divine Law revealed by God.

-Key texts such as the 10 commandments 'God gives & God takes away' seem to count against euthanasia. Following on from this, it would be difficult for someone to claim they were worshipping God, one of the 5 primary precepts if they were shortening someone's life.

-It could also be argued that the practice of euthanasia would undermine the stability of society; a society where life wasn't valued & couldn't be an ordered society. Ppl may fear hospital treatment. To end life by euthanasia instead of preserving life is an apparent good as opposed to a real good.

-However, the principle of double effect may allow pain relief, such as morphine, even though administering such a drug may shorten life. This is acceptable provided the intention is to relieve pain & the shortening of life is an unintended secondary effect.

-Natural Law also draws a distinction between ordinary & extraordinary means. Thus a sick person is obliged to take treatment by ordinary means, such as food & water, but an extraordinary treatment which is risky & may not work could be refused.

Natural Law gives a good answer on euthanasia.

-It upholds the intrinsic value of life.

-The principle of double effect gives a sensible flexibility to relieve pain when there is no prospect of saving the life.

-It prevents humans from abusing power over others & putting themselves in the place of God.

Natural Law doesn’t give a good answer on euthanasia.

-Its religious foundations make it seem outdated.

-It is legalistic & shows no compassion to the pain & suffering experienced by many terminally ill ppl.

-The focus on sanctity of life means that the concepts of quality of life & individual autonomy aren’t seen as important.

Applying Situation Ethics to euthanasia.

-Situation ethics has 'personalism' as one of its key principles. It is ppl & their welfare rather than the keeping of laws that is at the heart of ethics.

-Situation ethics considers the quality of life as more significant than the sanctity of life.

-Situation ethics rejects legalism in favour of asking what is the most loving thing to do. Rules such as 'do not kill' are Sophia (general rules of wisdom) according to Fletcher, but can be broken when love demands it.

-The theory is relativist in its approach. Fletcher states that 'loves decisions are made situationally not prescriptively'. In his 1954 book, Morals & Medicine, he argues that the patient's medical condition has to be the starting point for any decisions in medical ethics. This isn't a total endorsement of euthanasia, but a recognition that there are cases where this is the right option.

Situation ethics gives a good answer on euthanasia.

-It’s flexible to individual situations, it recognises that no 2 situations regarding euthanasia are the same.

-Agape love, if correctly understood, is about ensuring the best possible outcome for the persons involved.

Situation ethics doesn’t give a good answer on euthanasia.

-Potentially ‘do the most loving thing’ is vague; what the most loving thing is may be subjective - a matter of opinion or perspective.

-Situation ethics has a number of the weaknesses of utilitarianism in that it requires a prediction of the future: what the most loving outcome is may not be absolutely certain.

Why do people support voluntary euthanasia?

-If a person is suffering from terminal illness.

-If a person is unlikely to benefit from a discovery of a cure.

-If a person is suffering intolerable pain.

-If a person has no assistance to end their life.

Arguments for sanctity of life having a meaning in 21st medical century ethics.

-The sanctity of life originates from the Bible. The 1st book of the Old Testament, Genesis, describes how God made Adam &: ‘‘Breathed into his nostrils the breath of life’’ (Genesis 2:7). This didn’t happen with the animals & plants, but only with the human. Genesis also says that ppl are made ‘‘in the image of God’’. ‘‘So God created man in his own image, in the image of God he created him; male & female he created them’’. This means people are in some way reflections of God.

-The sanctity of life principle is based on the Jewish & Christian biblical belief that life is a gift from God & is on loan to humans. If God is the author of life, then it follows that he is the one who determines when it should end as seen in the book of Job in the Old Testament. It isn’t up to the individual whether he or she might add or subtract from his or her life or anyone else’s bc life is a gift or a loan from God. God is providential, who through nature or other means is the only being who may directly terminate a person’s life.

-Thomas Aquinas would argue that the concept of the sanctity of life will always have meaning bc it is linked to the universal principle of NL. Aquinas offered 5 precepts that were universal concepts that were innate in all living beings. One of them is to defend innocent life & another that we should reproduce to continue the species. Aquinas says that these primary precepts apply to all whether religious or not.

-For many the basic criterion for judging whether life is worthwhile is whether at any given moment a person’s happiness outweighs his or her unhappiness. A bad quality of life which unhappiness or pain outweighs happiness. This is the view held by most utilitarians.

Arguments against sanctity of life having a meaning in 21st medical century ethics.

-Peter Singer is a prominent philosopher who has strongly argued that it is time now to abandon the sanctity of life principle in favour of the non-religious quality of life argument. Singer’s arguments develop the notion that the value of life depends on a person’s ability to have desires & preferences & not on some mystical ‘enduring self’ or soul which automatically gives priority to humans above all other animals.

-The quality of life principle takes the approach that a life is only worthwhile it can fulfil those things which make life worth living. There is nothing intrinsically good about being alive except as a meah of enabling us to experience those things which are desired. In other words, human life has to possess certain attributes in order to have value. Singer argues that decisions regarding life & death shouldn’t be made on a belief in an ultimate being that has no objective reality. Instead, we should base decisions on the material situation i.e. that state in which a person is living their life.

-Joseph Fletcher would argue that in order to judge whether something is morally acceptable depends on whether a situation is that the outcome is good or bad. Consequentialists like Fletcher would argue that the sanctity of life principle isn’t helpful in the euthanasia debate as it isn’t as simple as stating that killing is wrong. Each situation & circumstance should be taken on its own & we shouldn’t apply absolute rules such as the sanctity of life to this. Fletcher would argue that euthanasia can be considered a loving & moral action if the outcome is loving.

-Life should be viewed a gift not a burden. If life is given to us as a gift, it is also given so that we may use it responsibly and dispose of it as we wish. It wouldn’t be a gift if the giver still had ownership of it. Therefore, as humans are now owners of God’s gift of life, it is up to them as good stewards of this life to decide when to end it.

Arguments for a person having complete autonomy over their own life & decisions made about it.

-In his work In Rethinking Life & Death, Peter Singer sets out 5 quality of life commandments to replace those of the traditional sanctity of life position. For example, Singer believes we should recognise that the value of human life varies from case to case. Furthermore, we should respect a person’s right to live or die. Singer is saying that a person should have complete autonomy over their own life.

-Joseph Fletcher would argue that in order to judge whether something is morally acceptable depends on whether a situation is that the outcome is good or bad. Consequentialists like Fletcher would argue that the sanctity of life principle isn’t helpful in the euthanasia debate as it isn’t as simple as stating that killing is wrong. Each situation & circumstance should be taken on its own & we shouldn’t apply absolute rules such as the sanctity of life to this. Fletcher would argue that euthanasia can be considered a loving & moral action if the outcome is loving.

-Helga Kushe challenges the slippery slope argument to provide evidence to support their case. Her conclusion is that the slippery slope argument is used by scaremongers to support their complete ban on all forms of euthanasia. Kuhse concludes ‘‘As yet there is no evidence that this has sent Dutch society down a slippery slope’’.

-Life should be viewed a gift not a burden. If life is given to us as a gift, it is also given so that we may use it responsibly and dispose of it as we wish. It wouldn’t be a gift if the giver still had ownership of it. Therefore, as humans are now owners of God’s gift of life, it is up to them as good stewards of this life to decide when to end it.

Arguments against a person having complete autonomy over their own life & decisions made about it.

-The sanctity of life principle is based on the Jewish & Christian biblical belief that life is a gift from God & is on loan to humans. If God is the author of life, then it follows that he is the one who determines when it should end as seen in the book of Job in the Old Testament. It isn’t up to the individual whether he or she might add or subtract from his or her life or anyone else’s bc life is a gift or a loan from God. God is providential, who through nature or other means is the only being who may directly terminate a person’s life.

-The right to self-determination - This distinction was famously illustrated in the Diane Pretty case in 2002. Diane pretty, who was paralysed from the neck down with motor neurone disease, had asked her doctors to assist in her suicide. Her lawyers had presented the case based on the right to self-determination. But her case was not upheld even when taken to the European Court of Human Rights. The reason given was that although the law recognises the right to life, it doesn’t consider its corollary is the right to die.

-Voluntary euthanasia is the start of a slippery slope that leads to involuntary euthanasia & the killing of people who are thought undesirable. In the Neverlands where euthanasia is permitted, there is evidence to indicate that many die against their wishes, this shows that the law cannot easily place safeguards against those who simply choose to ignore them. Therefore, ppl should not have autonomy over their own life.

-NL & Kantian ethics would argue that we don’t have complete autonomy. Kant would argue that the categorical imperative is clear - if we don’t want killing people universalised then we shouldn’t accept euthanasia. Likewise, Aquinas’ precepts say that society would be orderly & innocent life should be protected. Autonomy goes against this.

Arguments for a moral difference between medical intervention to end a patient’s life & medical non-intervention to end a patients life.

-The sanctity of life principle is based on the Jewish & Christian biblical belief that life is a gift from God & is on loan to humans. Followers of this principle would argue there is a moral difference between medical intervention & moral intervention bc any direct action to end a person’s life would mean someone were acting as if they were God. If God is the author of life, then it follows that he is the one who determines when it should end. It isn’t up to the individual whether he or she might add or subtract from his or her life or anyone else’s bc life is a gift or a loan from God.

-The law in the UK clearly states that there is a moral difference between medical intervention & non-intervention. Any act that directly ends a person’s life is illegal. However, as the case of Tony Bland proves, when a person is in a PVS then hydration & nutrition can be withdrawn which will mean the body will not survive. This case study set a legal precedent.

-Thomas Aquinas’ NL theory would suggest there is a moral difference between medical intervention & non-intervention. The principle of double effect suggests that any action must have a ‘good’ intention. The 1st effect must also be ‘good’ for it to be moral. If you directly act to end a person’s life then this would be wrong. The intention is to kill which goes against the primary precept of defending innocent life. However, if treatment was withdrawn or more drugs given with the intention of reducing pain then this is acceptable. The effect may be a quicker death but the initial act & the intention was not to do this.

Arguments against a moral difference between medical intervention to end a patient’s life & medical non-intervention to end a patients life.

-In his work In Rethinking Life & Death, Peter Singer sets out 5 quality of life commandments to replace those of the traditional sanctity of life position. For example, Singer believes we should recognise that the value of human life varies from case to case. Furthermore, we should respect a person’s right to live or die. Singer’s argument suggests that both medical intervention & non-medical intervention are acceptable if the person has a poor quality of life.

-Joseph Fletcher would argue that in order to judge whether something is morally acceptable depends on whether a situation is that the outcome is good or bad. Consequentialists like Fletcher would argue that there is no moral difference between medical intervention & non-intervention if the outcome is positive & loving. Fletcher believes that we should make decisions that are practical, positive, relative & personal. If these conditions are met in both cases then there is no moral difference.

-Jeremy Bentham’s hedonic calculus would look at how much pleasure/hapiness could be gained by both intervention & non-intervention. Utilitarianism is based upon usefulness, therefore, if active euthanasia is the most useful action then it should be carried out. Likewise, if passive euthanasia is the most useful then it too should be carried out. As long as the greatest happiness for the greatest number occurs then both actions are moral.

What are the arguments for euthanasia/assisted suicide?

-Everyone should be able to choose when & how they die. Life should only continue if a person feels their life is worth living.

What are the arguments against euthanasia/assisted suicide?

-Religious argument= Only god can choose when life ends, euthanasia is acting against his will & is sinful.

-Slippery slope argument= Legalising euthanasia can lead to old/disabled/terminally ill feeling like a burden & the pressure to request euthanasia. It may discourage research into cures for terminally ill patients, & doctors may get a diagnosis wrong & cause a patient to wrongly choose euthanasia.

-Medical ethics argument= Legalising euthanasia violates the most important medical ethic. Asking doctors to abandon their obligation to preserve human life damages the doctor-patient relationship. Hastening death on a regular basis leads to lack of compassion when dealing with elderly/disabled/ill people. They think their doctor would kill them off.

Summarise euthanasia.

-The topic of euthanasia raises a number of key issues: it appears to put the concepts of sanctity of life & quality of life into direct opposition.

-It raises issues around autonomy, specifically whether there is such a thing as the 'right to die'; & requires careful distinction between various actions or omissions which may or may not be regarded as euthanasia.

-Ethical theories such as Natural Law & Situation Ethics are applied to this topic.