Medical Ethics Anthology Notes

Pg. 50

Third party = anyone else other than the patient. This is typically the doctor or ‘physician’

If euthanasia were to be justified, it would have to be within medicine otherwise it would be hard to regulate. Without this regulation, murder would become socially acceptable

The British Medical Association says that there is a great difference between actively ending a life and administrating a patient their treatment in a way that can cause death

The BMA emphasises that it is the doctor’s duty to ensure that the patient dies with dignity + minimise their suffering

  • Any action to actively end a life or treating them in a way that causes death remains illegal

a) moral crisis in liberal societies [peter singer]

Traditional western view of ‘sanctity of life’ (SOL) is being taken over by the liberal ‘Quality of life’ (QOL) view

  • It prioritises personal autonomy (personal preference over morality and legality

SOL is a much older view that claims that life is a gift / part of natural law

  • This idea can no longer be sensibly sustained

The doctor now has a duty to sustain life where it may not have been possible in the past

  • E.g pneumonia in that past would have just killed people through natural causes instead of trying to keep them alive.

pg. 51

b) three main moral principles

Acts and omissions

Abstaining from completing and act is still an act

  • Some omissions are considered acts

  • Example: If A shoots B but C sees A about to shoot B and does nothing to prevent it, are they to blame?

He says that by doing nothing, C accepts that B is going to die and is ready to accept whatever consequences are going to come with it.

Some argue that “I am only responsible when I am reasonably in a position to do something.”

<Doctors and saving premature babies>

Witholding treatment/letting ‘nature take its course’ is considered passive/non-voluntary euthanasia

Giving treatment but terminating it when the baby has no chance may not be considered non-voluntary euthanasia / murder.

pg.52

Double effect

Two types of intention:

  • Foreseeing an event

  • directly intending/willing it to happen

If someone does an action knowing it may have a bad consequence and they do it anyways - intention is important

If they intend the bad consequence - they are to blame

If they don’t intend the bad consequence then they are not to blame

However this raises questions about finding out a person’s true intentions

  • Is double effect open to abuse because we don’t know a person’s true intentions?

Double effect is considered a bad medicine - if someone foresees death but fails to act it becomes omission and it is a type of indirect euthanasia

Ordinary and Extraodinary means

Considers terms using proportionate + disproportionate means

Natural law = refusing treatment/necessities to survive is considered to be suicide and is a moral sin

A competent patient is within their rights to refuse treatment as long as it is extensive to what they need to survive

If a doctor witholds life-sustaining treatment for patient preference it can be considered professional negligence / wilful killing

Some argue that it is a doctor’s duty to provide the treatment regardless

  • Proportion can be applied ; each situation is viewed individually so whatever is proportional to good consequences is based on the needs of the patient + doctors resources

  • Weak SOL → where death is inevitable, doctors are bound by love/compassion to treat their patient accordingly

  • Strict adherence to ‘thou shalt not kill’ overrides the doctors’ responsibility to their patient.

    • Can direct termination of life be good medicine?

QOL → can extraordinary medical means promote the quality of life?

Factors to consider: length of useful life, state of mind of the patient, resources needed/available

A doctor has to weigh up these factors as well as if there may be a painful surgery or strong medicine that can cause permanent drowsiness.

  • This can cause a lifeless state where the patient feels invaluable

  • John Finnis’s basic goods argument:

    • List of valuable life criteria: play, aesthetic experience, sociability

However there is not an objective list.

2) Law and morality

The liberal model

Changes the public opinion has led to pressure to reform, especially with voluntary euthanasia

The law itself is not a moral guideline but acknowledges everyone has their own personal preferences → Utilitarian principle (greatest happiness for the greatest number of people)

Law aims to protect the person

  • Prevents them from being exploited. The law should hardly interfere

pg.54

The law has to consider general moral feelings. Once legislation occurs, it gives indirect approval to certain behaviour

If voluntary euthanasia were permitted, it would allow other methods of unlawful killings

The BMA is certain it shouldn’t be law + considers it conflicting to the doctor’s role to deliberately kill patients, even at their request

Legalising euthanasia → personal autonomy and the QOL

In Britain, euthanasia is just another version of suicide

  • The question they pose is should people who are trapped in their bodies / an institution they cannot control be allowed to make choices available to the rest of us?

  • 1961 suicide act → makes it illegal to give aid / assistance in a suicide

Netherlands

People argue that the requirements of legal abortions should be similar to euthanasia

Netherland provides euthanasia under certain conditions:

  • Only done by a medical practitioner

  • Patient must have made the request persistently + clearly

  • Request must be freely done without coercion

  • Patient’s condition must be with unbearable pain + no foreseeable improvement

  • Doctor’s should seek a second opinion

Australia

A doctor may discontinue life support at the patient’s request → not considered assisted suicide

c) Objections to legalising euthanasia

Slippery slope argument:

There are always exploits to a weak rule

Good intentions start with bad consequences

pg.56

The slippery slope argument is supported by people who wish to uphold the sanctity of life argument or strictly follow rule or that the results are not in their best interests

0.8% of deaths a year in the Netherlands are non-voluntary euthanasia

The slippery slope argument is used by scaremongers to ban all types of euthanasia

A key example they use of non-voluntary euthanasia is during the Nazi holocaust

People who advocate the sanctity of life argue with abortion

  • It was initially used for extreme cases but it is now just given on demand or used as a ‘birth control’

  • Indicates that it can begin with strict riles but can go out of control overtime

People argue that legalising euthanasia would reduce patients preference

  • Legalising it can harm the doctor-patient relationships and the trust between them

The BMA says: they have emphasised the importance of the patients autonomic rights but this autonomy has limits. The rights of one group cannot be allowed to undermine others

  • What is allowed for one group would affect everyone in society the most vulnerable

pg.57

Many doctors fear that even a slight change with several rules can drastically change society and euthanasia

By removing these barriers, it allows the unthinkable to happen

It can be seen as desireable and even recommended by others

It can also bring a great change to social attitudes of death, illness, old age and disablement

  • Even encourage labelling against certain groups

Euthanasia: Ethical, Legal & Medical Perspectives

1. Third-Party Involvement & Medical Regulation

  • Euthanasia involves a third party (usually a doctor), not just the patient.

  • To be justified, euthanasia must stay within medical regulation to avoid misuse (e.g. legitimising murder).

  • The British Medical Association (BMA) distinguishes between actively ending a life and administering treatment that might unintentionally lead to death.

  • Doctors must ensure death with dignity and reduced suffering, but actively ending a life is still illegal.

2. Changing Moral Values

  • Peter Singer notes a shift from the traditional Sanctity of Life (SOL) to Quality of Life (QOL) values.

  • SOL sees life as sacred and inviolable; QOL prioritises autonomy and personal well-being.

  • Modern medicine now keeps people alive who would have previously died naturally (e.g., pneumonia patients).

3. Three Ethical Principles

a) Acts and Omissions

  • Omitting action can be as morally significant as acting.

  • E.g., failing to stop a murder when able may imply moral responsibility.

  • In medicine, withholding treatment can be passive euthanasia.

b) Double Effect

  • A distinction is made between intending harm vs. foreseeing harm.

  • If harm is foreseen but not intended (e.g. pain relief hastening death), it may be ethically permissible.

  • But true intentions are hard to prove, making this principle controversial and open to abuse.

c) Ordinary vs. Extraordinary Means

  • Natural Law says refusing life-saving treatment = suicide (a sin).

  • Patients can refuse excessive or disproportionate treatment.

  • Doctors must balance patient needs with their own resources and judgment.

4. Law vs. Morality

  • The liberal legal model respects individual choice and tries to minimise harm, not enforce morality.

  • Legalising voluntary euthanasia may open the door to broader forms of unlawful killing.

  • The BMA opposes legalising euthanasia, believing it contradicts a doctor’s healing role.

5. International Approaches

  • Netherlands: Euthanasia allowed under strict criteria (e.g. clear patient request, unbearable suffering, second opinion).

  • Australia: Discontinuing life support at a patient’s request isn’t considered assisted suicide.

6. Objections: Slippery Slope

  • Critics argue legalising euthanasia leads to abuse (e.g. Nazi-era euthanasia, or abortion's evolution from extreme to common cases).

  • Fear that vulnerable people could be pressured or undervalued.

  • May damage trust in doctors and alter societal attitudes toward death, illness, and disability.

Euthanasia: Key Ethical, Medical & Legal Issues

1. What is Euthanasia and Who is Involved?

  • Third party = someone other than the patient (usually a doctor).

  • If euthanasia is to be allowed, it must be done within the medical field to make sure it’s regulated properly.

  • Without clear rules, it might make murder seem socially acceptable.

2. The Role of Doctors (According to the BMA)

  • There’s a big difference between:

    • Actively ending a life (e.g. giving a lethal injection)

    • Giving normal treatment that might unintentionally cause death (e.g. strong painkillers)

  • Doctors should help patients die with dignity and minimise their suffering.

  • However, any act that directly causes death is still illegal in the UK.

3. Moral Crisis in Society (Peter Singer’s View)

  • Western societies are shifting from the belief in Sanctity of Life (SOL) to Quality of Life (QOL).

  • Sanctity of Life = life is sacred and should always be protected.

  • Quality of Life = focuses on personal choice, well-being, and autonomy (having control over your own life).

  • Technology now keeps people alive who would have died naturally before (e.g. treating severe illnesses).

4. Three Main Moral Principles

A) Acts vs Omissions

  • Not doing something (an omission) can be just as serious as doing something (an act).

  • Example: If someone sees a murder about to happen and does nothing to stop it, they may still be morally responsible.

  • In medicine:

    • Not giving treatment = passive euthanasia

    • Giving treatment and then stopping it if the patient can’t be saved may not be considered euthanasia.

B) Double Effect

  • Some actions can have two outcomes: one good and one bad.

  • If a doctor gives painkillers that relieve pain but also shorten life, this is allowed if the death wasn’t intended.

  • The key issue is intention:

    • If a bad effect is intended → it’s wrong.

    • If a bad effect is foreseen but not intended → it may be acceptable.

  • This idea is controversial because we can’t always know someone’s true intentions.

C) Ordinary vs Extraordinary Means

  • Natural Law teaches that refusing life-saving treatment = suicide (which is morally wrong).

  • But patients can refuse overly intense or painful treatments.

  • Doctors must consider:

    • Is the treatment necessary?

    • Does it bring more harm than good?

    • Is it proportionate to the patient’s condition?

  • Doctors have a duty to care, but must also be compassionate when death is inevitable (weak SOL view).

5. Quality of Life (QOL) Considerations

  • Should we always use extreme medical treatments to keep someone alive?

  • Factors doctors may consider:

    • Will the patient recover?

    • Are they mentally aware?

    • Will the treatment cause constant pain or drowsiness?

  • Some patients might survive but feel useless or in a ‘lifeless’ state.

  • John Finnis argues that a meaningful life includes things like play, beauty, and social interaction – but admits we can’t make one fixed list for everyone.

6. Law vs Morality

The Liberal Model of Law

  • Law is not a guide to morality, but should protect people’s rights and prevent harm.

  • Based on Utilitarianism – aiming for the greatest good for the greatest number.

  • Public opinion affects the law, especially with growing support for voluntary euthanasia.

Legal Risks

  • If voluntary euthanasia becomes legal, it might open the door to other kinds of killing (e.g. non-voluntary).

  • The BMA says euthanasia shouldn’t be legal because it goes against the doctor’s role of saving lives.

  • The law must think about the most vulnerable people, like the elderly, sick, or disabled, who might feel pressured.

7. International Laws

Netherlands

  • Euthanasia is legal if strict conditions are met:

    • Patient is in unbearable pain

    • No chance of recovery

    • Patient requests it clearly and freely

    • A second doctor agrees

    • Only doctors can do it

Australia

  • A doctor can stop life support if the patient asks – but this is not seen as assisted suicide.

8. Objections to Legalising Euthanasia

Slippery Slope Argument

  • If we allow one type of euthanasia, it could lead to abuse and other forms of killing.

  • Example: Nazi euthanasia programs, or how abortion went from rare to common.

  • Even with rules, things can get out of control over time.

  • People fear it will change how we value:

    • Life

    • Illness

    • Old age

    • Disability

Other Concerns

  • Could reduce trust between doctors and patients.

  • Might make patients feel like a burden.

  • The BMA says patient autonomy is important but has limits.

  • What we allow for one person can affect everyone else, especially vulnerable people.