euthanasia

explain sanctity of life

• human life is made imago dei

• because we have souls, we are unlike other species so we should be treated differently→ so euthanasia isn’t permitted

• euthanasia goes against natural law (preserve life)

name 2 quotes for sanctity of life

1. “god created mankind in his own image" → genesis

2. “you shall not murder” → 10 commandments

how does catholic church feel about euthanasia in response to sanctity of life

• catholic church understands that the time before death can be painful (physically and psychologically) which makes people want to end it

• however, god has planned all of our lives out and to commit suicide is blasphemy→ rejects god’s gift of life

• suffering brings us closer to god

name 2 quotes about the catholic church and sanctity of life

1. “suffering has a special place in god’s plan of salvation.” → declaration of euthanasia

2. pope john paul 2: euthanasia creates a culture of death and devalues dignity and respect of all humans

name 5 reasons sanctity of life in medicine

1. bauby
   shows that even during extreme suffering, there is reason to be alive
   

2. slippery slope
   euthanasia may lead to pressure being put on the vulnerable (elderly and disabled). may make them feel like an inconvenience and leave them to dying early
   similarly to abortion, it was anticipated a few thousand would happen a year on medical grounds but 180,000 happen a year in the uk
   

3. science has limits
   even doctors who are experts in palliative care can find it difficult to predict when death is inevitable. patients can recover when least expected
   

4. protects lives
   liverpool care pathway. science has led us to conclude that life matters even more than in ancient times
   

5. secular
   while it has religious connotations, the belief of respecting human life is secular and universal. we don’t need to believe in God to recognise life has meaning→ aquinas thinks we can see this in natural law

name 3 reasons sanctity of life shouldn’t stop euthanasia

1. maguire
   god being the only person to choose who can die and when suggests we are his property.
   a good death should be valued over a natural one. if the dying process has begun, we should be able to speed it up
   if we are already dying, we would still be respecting sanctity of life
   

2. singer
   quality of life should be considered as more important.
   when someone can’t make a decision about their own life, someone else should do it for them
   why should we follow christian laws in a democratic and multi-cultural society
   however: life has value to the wider society over the person. like their family, friends, or it could inspire more people → but, people don’t wanna see their loved ones suffering so it may be justified
   

3. dworkins
   humans want our neighbours to live but we want them to live happily
   euthanasia affirms eudaemonic quality of being alive (contentment and flourishing).
   if a person couldn’t be flourishing, it would be wrong to preserve that life
   

4. improvement in science
   we have the knowledge and technology to be able to know when life can or can’t be saved. we also have the knowledge to understand the body can survive but the mind hasn’t → this seems unfair.
   sanctity of life seems based on outdated practices and giving someone a slow painful death is unfair
   

5. life should be a gift
   life should be a gift not a burden. we should be allowed to dispose of it responsibility. it wouldn’t be a gift if the giver (god) kept ownership of it and told us how to use it

explain what happened to bauby

• french journalist had a massive stroke

• left him with locked in syndrome (fully conscience but almost completely physically paralysed) → could only move left eyelid

• he learnt to communicate by blinking with a speech therapist

• assistant would recite alphabet slowly in order based on frequency of letter used

• he would blink when the desired letter was broken → continued until word was formed

• each word took several minutes but he made an entire memoir in 14 months

• called the diving bell and the butterfly

explain quality of life

• secular concept that suggests human life has to possess certain attributes to have value

• there is nothing intrinsically good about being alive → it is about enabling us to experience things

• singer: we need to place quality > sanctity

what is singer’s view on quality of life

we need to:

1. recognise life’s values vary

2. take responsibility for consequences of decisions

3. respect a person’s desire to live or die

4. bring children into the world if they’re wanted

5. don’t discriminate based on species
   

• decisions about life or death shouldn’t be based on god and the afterlife, it needs to be on the material situation (state person is in)

• a lot of illnesses (mental or physical) remove dignity
  

• judgements should be made by doctors if the person can improve or not → prevents temp depressed people

what judgements need to be made for quality of life for singer

1. total happiness judgement: if a person is in a painful state, their happiness won’t increase if the longer they life so they can end their life

2. average happiness judgement: when happiness declines from their average permanently, then life can be ended

3. higher qualities judgement: life needs to be judged from minimum qualities like: memory, ability to have relationships, ability to reason, ability to hope for a future
   → if can’t be done, then life can be ended

name 3 strengths of quality of life argument

1. personal approach
   more loving and personal approach as it respects god-given dignity
   gives us the chance to have a good death without suffering- keeps dignity
   

2. secular
   more fitting for a multi cultural society. over 50% of people in the UK don’t believe in god and so it makes sense that we don’t use christian laws
   

3. improvement in science
   we have the knowledge and technology to be able to know when life can or can’t be saved. we also have the knowledge to understand the body can survive but the mind hasn’t → this seems unfair.
   sanctity of life seems based on outdated practices and giving someone a slow painful death is unfair
   
   other sanctity of life weaknesses

name 4 limitations for quality of life argument

1. harms doctor patient relationship
   doctors could put DNR on patients files without their consent. in 2000, laws were made after healthy patients discovered they had DNR on their files without consulting with them or family
   → also liverpool care pathway
   

2. slippery slope
   euthanasia may lead to pressure being put on the vulnerable (elderly and disabled). may make them feel like an inconvenience and leave them to dying early
   similarly to abortion, it was anticipated a few thousand would happen a year on medical grounds but 180,000 happen a year in the uk
   

3. personhood contradictions
   person in PVS (persistent vegetive state) has issues of personhood.
   a person who’s been pronounced brain dead is no longer a person if they have no reactions and are incapable of thought
   → however, severely mentally disabled person may also exhibit these tendencies and they are considered a person

other sanctity of life strengths

explain personal autonomy

• person should be allowed to make decisions about when and how they die

• argued that everyone owns their body and life and the state should not enter this

• international law guarantees the right to life and quality of life → this can be used to support euthanasia
  → right to life = right to death
  → we should be free to decide when and how to die → e.g. through a living will (made prior when you are well and says what you want to happen to you when you are unwell or unable to make a decision)

• if you are able to make a decision about your life with a competent mind then your decision should be respected

• gov can restrict freedom to harm someone else but not able to control what we do with ourselves

how can personal autonomy be protected to make sure the person is competent

glover: external checks should be made about person’s state of mind to make sure they have a reasonable decisions and it is not from a temporary emotional state

what quote is there about personal autonomy?

mill: over himself, over his body and mind, the individual is sovereign

name 4 strengths of personal autonomy

1. secular
   many arguments against are from religious beliefs in sanctity of life. irrelevant is god doesn’t exist. over 50% of people don’t believe in god so autonomy seems more appropriate
   

2. situation ethics
   more info later
   

3. more personal
   respects our god given dignity and free will. gives us the chance to have a good death rather than suffering
   

4. life should be a gift
   life should be a gift not a burden. we should be allowed to dispose of it responsibility. it wouldn’t be a gift if the giver (god) kept ownership of it and told us how to use it

name 4 limitations of personal autonomy

1. never enough information
   we can never make an informed decision about constantly developing science. what if depression clouds the person’s judgement? what if a cue is found after the death?
   however; we should focus on what we actually know rather than hypotheticals. we know suffering will def continue, we don’t know about a cure
   

2. natural law
   doesn’t meet primary precepts. life is given by god and so sacred so would be wrong to take it
   

3. kant
   if we don’t think killing should be universalised then we shouldn’t accept euthanasia
   

4. no decision to die is rational
   since our evolutionary interests are to survive, no decision to die is ever rational. clearly there is some sot of depression clouding judgement. autonomy is hard to apply in stressful times and someone in mental/physical agony won’t be able to make a good decision
   however: there are some rational decisions to choose a quick death over a slow one. → diane pretty

explain voluntary euthanasia

• person requested to be killed

• voluntary can be done even when the person isn’t competent at the same time→ can be decided prior to the events you’d want to die in this situation
  → e.g. locked in

when should voluntary euthanasia be permitted

1. suffering from terminal illness

2. unlikely to benefit from discovery of cure for that illness

3. intolerable pain or extremely burdened by illness

4. has an enduring, voluntary and competent wish to die

5. unable to end life without assistance

give an example of voluntary euthanasia

diane pretty

motor neurone disease and faced painful death she wanted to avoid

wanted to die at home and quickly with family

european court of human rights allowed her to

explain involuntary euthanasia

• made on behalf of patient

• in past, death was defined as the heart stopping pumping.
  → however, now a person can be kept alive by machines

• new definition of death is when there is no brain activity

• a patient in PVS used to be deemed dead if even if brain was functioning, however, that diagnosis is hard to make now since brain can function as low levels

• this leads to an issue where sustaining life might not be best decision for patient

• each case has to be individually considered

issue: liverpool care pathway

give an example of involuntary euthanasia

tony bland

doctors asked high court for permission to withdraw artificial nutrition and hydration from him

family supported by saying he would not want to be kept alive in that state (PVS)

court allowed it

explain liverpool care pathway

• LCP was set up to provide end of life palliative care

• it was designed to ensure that dying patients received appropriate and compassionate treatment

• due to overcrowding and lack of resources, they began to misuse the pathway

• after a while, allegations of withdrawal of treatment and being denied food came out

• it classed people as terminally ill even though they weren’t actually.
  → done without proper medical review or speaking to families

• this led to thousands of patients dying needlessly

explain acts and omissions

active euthanasia: lethal injections, switching off a machine, etc

passive euthanasia: withdrawing treatment like food (e.g. tony bland)

passive euthanasia is viewed as morally better in cases where people aren’t going to recover

rachels thought experiment

explain rachels thought experiment

case 1: smith is the legal guardian of his nephew and will inherit lots of money if his nephew dies. one evening he drowns him in the bath and makes it look like an accident.
this is an act

case 2: jones is the legal guardian of his nephew and will inherit lots of money if he dies. he sees his nephew slip and hit his head on the bath and slowly drown. he watches and does nothing
this is an omission

commonly held view smith is worse, yet rachels disagrees

he thinks jones is worse since the death will take longer

→ tony bland: removal of feeding tube meant death took 10 days

what does singer think of acts and omissions?

its too hard to distinguish between acts and omissions

removal of tony bland’s feeding tube is an action even if removal of food is an omission

what does natural law think of acts and omissions?

• it is about the intention of someone who takes the action

• if the act leads to death, that can be justified if that’s the unintended consequences

• if the primary goal is to relieve pain then it’s okay

what does situation ethics think of acts and omissions?

• doesn’t draw a distinction between acts and omissions as that doesn’t really matter

• the consequences are the most significant aspect rather than the act itself

• their pain is relieved either way- if anything an act that leads to death sooner is better

name 3 reasons why there is a difference between acts and omissions

1. uk law
   there is a moral difference between acts and omissions. an act to end a person’s life is illegal. however, in tony bland’s case, it proves when a person is in a PVS, hydration and nutrition can be withdrawn which means body can’t survive
   

2. affecting doctor patient relationship
   allowing active euthanasia will affect doctor patient relationship. it would also conflict with hippocratic oath a lot
   

3. natural law
   doctrine of double effect suggests that any action must have a good intention. first effect must be good for it to be moral. if you directly ended the person’s life this would be wrong. the intent to kill goes against defending innocent lives
   → if treatment was giving drugs with intention of reducing pain, then that would be fine

name 3 reasons acts and omissions are different

1. active euthanasia helps resources
   allowing active euthanasia could be better as it would speed up the inevitable process. allows resources to focus on those who can recover
   

2. situation ethics
   there are cases where agape is required to help someone end their life. whether its by an act or omission is insignificant. it just matters what the most loving outcome is
   

3. singer
   value of human life varies case-by-case. we should respect a person’s right to live or die. both acts and omissions are acceptable if there’s a poor quality of life

how is natural law applied to euthanasia

• doesn’t look at the people involved but the act of euthanasia itself

• natural law is based on our innate sense of right and wrong- taking a life is wrong.

• it goes against 3 primary precepts: order in society, protect life, worship god

• it does allow patients to refuse treatment if it is above what is needed to sustain life (ordinary and extraordinary treatments)
  

• weak sanctity of life argument: human life holds value and is special. but quality of life and personal autonomy also matters

• strong sanctity of life argument: all human life is absolutely sacred and must be preserved at all costs regardless of suffering, quality of life or personal autonomy
  

• all human life has telos and euthanasia prevents this being reached. violation of natural processes of living and dying

what primary precepts does euthanasia go against? why?

1. protect life
   whatever state a person is in, they never stop being a person
   death can only be seen as heart stopping beating
   self defence is the only reason to kill
   

2. worship god
   disrespects gift of life and breaks 10 commandments (do not kill)
   

3. order in society
   euthanasia is a sign that society has failed to care for all its members
   people may feel like they are a burden on family or nhs leading to death

what are ordinary treatments?

hydration, nutrition, oxygen

what are extradordinary treatments?

procedures like chemotherapy, organ transplants, repeated surgeries, experimental therapies

must have low chance of success and when person has low chance of survival

explain doctrine of double effect application

• allows patient to die as a side effect of pain relieving treatment

• intention must never be to cause death as that would be morally wrong

• even passive euthanasia is wrong if the intention is to cause death (liverpool care pathway)

name 3 strengths of natural law application to euthanasia

1. universal application
   natural law theory unites diff cultures and religions as its based on an innate sense of what is right and wrong.
   preservation of life is valued by most countries and euthanasia is illegal in most countries
   

2. some flexibility
   allows non-treatment options but keeps its value of life. allows for pain relief of patient
   

3. avoids slippery slope
   applied regardless of the situation and anyone’s personal opinion on the situation. stops euthanasia leading to pressure on vulnerable

name 4 limitations of natural law being applied to euthanasia

1. too hard to judge what is natural anymore
   if a person is being kept alive by artifical means, how is that natural?
   if someone is in a coma for years with little brain activity, is it right for presevation of life to be priority? would that person be dead if nature took its course
   modern medicine has blurred lines between what is natural and what isn’t
   

2. too difficult to judge intention for dde
   if doctor gives pain killers to relieve suffering, only they will ever know if they intended to kill or not. too hard to tell what interior acts ae
   

3. too legalistic
   each situation is different and natural law insists on same approach. it insists that they continue to live even if they’re in extreme pain. this removes personal autonomy
   → utilitarian would argue quality of life is better
   

4. naturalistic fallacy
   just because something in nature is a certain way that doesn’t mean that’s how things need to be. humans shouldn’t have to follow a particular course just because nature does

explain situation ethics application

• taking life out of love for person is acceptable

• doesn’t agree with quality of life argument as it can justify the killing of mentally ill patient who continues their pain unbearable

• when the suffering becomes unbeaable, euthanasia is justified

• physical suffering is easier to identify as psychological can change

• it wouldn’t be loving to euthanise someone who wants to because they’re mentally low, but it would be for terminally ill

• euthanasia may be the best way to serve agape for person and their family

how do the foundations of situation ethics link to this?

1. pragmatism
   each case has to be judge individually. it wouldn’t be fair to keep someone in PVS alive and would be more compassionate to euthanise
   → especially if that was using up limited resources
   

2. positivism
   laws and rules created by humans help good treatments of each other. this might mean allowing someone to be passively euthanised
   

3. relativism
   it judges each situation relatively based on weak sanctity of life and love. killing innocent people is wrong but justifiable in some situations. absolute laws like do not kill should be made relative
   

4. personalism
   situation ethics requires respect for personal autonomy.principle of love means acknowledging someone’s life might have no value to them and they would like suffering to stop

name 4 strengths of situation ethics as an approach to euthanasia

1. individual
   love is the foundation to allow the best result for each situation. in one case, medical intervention to end life might be the most loving thing to do. in another, continuing treatment might be
   

2. flexible
   offers general principles rather than fixed rules which allow us to respond to complex situations
   

3. modern science
   helps us know who or who isn’t worth treating and who will die regardless of treatment
   

4. good values
   puts love and personal autonomy above anything else

name 3 limitations of situation ethics application

1. kant
   requires prediction of the future and consquences. there could be a cure or help for this. we can’t possibly predict. we need to make decisions based on duty rather than possible consequences we can’t precict
   

2. too subjective
   what might actually be the most loving thing to some people might actually not be the most loving thing to do. a cure might come out after their death so the most loving thing could be to keep them alive
   

3. too easy to take advantage of
   laws can’t be made in the gov based on this. making euthanasia legal can lead to people taking advantage of the situation and putting pressure on people to die under the justification that it’s the most loving thing to do. however: even if it wasn’t allowed, people will still break the law to help people die