6.1 Medical Ethics (EUTHANASIA)

Question 1

Active Euthanasia

Answer 1

An action taken to end a life, for example a lethal injection.

Question 2

Passive Euthanasia

Answer 2

Allowing someone to die by withholding treatment or food.

Question 3

Palliative Care

Answer 3

Measures to make a terminally ill patient comfortable and alleviate pain and other symptoms.

Question 4

Euthanasia

Answer 4

Allowing the doctors to end the lives of their patients.

Illegal in UK for a doctor to actively kill their patient - they may take the decision to facilitate a patient’s death by some other means e.g. withdrawing life-preserving treatment.

Question 5

Assisted dying

Answer 5

The person controls their own death with the assistance of a third party.

Illegal in the UK

Question 5

Voluntary Euthanasia

Answer 5

Carried out by the request of the person dying e.g. if life has become unbearable and they have no hope of recovery.

Arguments against:
- While people are in pain/depressed/medicated they may not be thinking clearly enough to make a valid choice.
- May lead to a slippery slope of people feeling pressured into agreeing to euthanasia in belief that their family members don’t want to look after them.

Question 6

Non-voluntary Euthanasia

Answer 6

Involves individuals not capable of understanding the choice between life and death e.g. someone with severe down syndrome. Here the choice is being made for them ‘IN THEIR BEST INTERESTS’

Arguments against:
- A person may not be able to express a choice about life and death, but this does not mean that they do not have quality of life.
- You can’t rule out the possibility of future treatments.

Question 7

The British Medical Association (BMA) argument

Answer 7

BMA argues that there is a difference between actively ending someone’s life and allowing a patient to die with dignity.

The BMA is AGAINST active euthanasia but ACCEPTS passive euthanasia.

Question 8

Moral crisis in liberal societies, example of a case.

Answer 8

Wilcockson refers to Singer’s argument that modern liberal societies focus more on quality of life than sanctity of life.
Doctors face increasingly difficult decisions.
Example:
Charlie Gard Case in 2017. Parents challenged the decision of the medical professionals at Great Ormond Street Hospital that it was in Charlie’s best interest to withdraw mechanical ventilation and to allow him to die.
The high court refused to intervene.
Charlie was transferred to a hospice and died the day after medical ventilation was withdrawn.

Question 9

1. Acts and omissions

Answer 9

an ACT: performed by an agent who actively intervenes to bring about a foreseeable outcome e.g. active euthanasia

an OMISSION: A failure to act but with an awareness of what the result of not acting will be e.g. passive euthanasia

WILCOCKSON - argues that a failure to act does not absolve you from moral responsibility e.g. a pacifist refuses to shoot someone, their failure to act is an active moral decision.

CATHOLIC CHUCH - no distinction between an act and an omission e.g. withholding treatment from Charlie Gard was closer to active than passive euthanasia.

Question 10

Three moral principles

Answer 10

ACTS AND OMISSIONS, THE DOCTRINE OF DOUBLE EFFECT, ORDINARY AND EXTRAORDINARY MEANS

Wilcockson argues that the three moral principles used by doctors arise out of the Hippocratic Oath and draw on the distinction between active and passive euthanasia.

Question 11

2. The doctrine of double effect

Answer 11

Draws a distinction between foreseeing an outcome (death) and choosing to act specifically to bring about that outcome. Thus, administering lethal pain killing drugs is moral, provided the person giving drugs does not primarily intend to kill the patient.

WILCOCKSON - critical on the grounds that the doctrine could easily be open to abuse - no real distinction between intending to act and foreseeing the consequences of an action.

Question 12

3. Ordinary and extraordinary means

Answer 12

CATHOLIC POSITION - allow people to die as God would have them die. NL, a person who refuses water is committing suicide.

We have a duty to accept healthcare (ORDINARY MEANS), but we do not have to go to extremes and keep ourselves going when this is simply prolonging the dying process (EXTRAORDINARY MEANS).

Treatment is considered ‘extraordinary’ if it has been determined that it is not going to work to keep the person alive or to reverse the course of the disease.

Providing food, water and palliative care is an ordinary means.

Withdrawal of treatment is letting nature take its course - BMA approves as long as the patient is mentally able to make that decision.

Question 13

Proportionate means

Answer 13

Any treatment that offers reasonable hope of benefit to the patient.
Judged holistically within the context of the whole person: physical & mental health, personal, financial and social circumstances.
A treatment is not too burdensome when it offers benefits that outweigh the burdens to the patient and others

Question 14

Disproportionate means

Answer 14

Any treatment that either offers no reasonable hope of benefit or carries burdens or risks disproportionate to its expected benefits.

Question 15

Proportionate and disproportionate means - explained

Answer 15

• WILCOCKSON argues it may be better to refer to proportionate and disproportionate means as it allows doctors to decide on a case-by-case basis what is in the best interest of the patient.
• Distinction becomes difficult with ‘non competent patients’ e.g. severely ill baby with no chance of recovery. The WEAK SoL arguement would say a doctor must act with care/compassion, making the baby as comfortable as possible while not prolonging treatment.

Question 16

Applying the Quality of life argument to scenarios and potential challenges

Answer 16

QoL argument relies on UTILITARIAN arguments and considers a variety of factors, weighing the side effects of medication against benefits to the patient.

BUT it is hard to set clear criteria: doctors need to consider available resources as well as what makes someone’s life valuable.

Question 17

Argument 1 against legalising euthanasia: The Wedge Argument

Answer 17

The ‘thin end of the wedge argument’ refers to the concern that legalised euthanasia would lead to other forms of killing becoming accepted and legal.
If voluntary euthanasia becomes legal, involuntary euthanasia could become legal too.

CRITIC PETER SINGER: there is no empirical evidence for a wedge effect e.g. Netherlands where euthanasia is controlled under strict conditions.

Question 18

Argument 2 against legalising euthanasia: Undermining personal autonomy

Answer 18

BMA voiced concerns that legalising euthanasia in order to respect individual autonomy actually UNDERMINES it.

The trust between the doctor and the patient would be broken, and society’s attitudes towards disability, age and illness would change.

Question 19

Liberal view of ethics based on Mill’s Harm Principle

Answer 19

• The liberal view of ethics is based on Mill’s harm principle.
• The liberal principle of personal autonomy means that I have the right to make my own decisions about how I lead my life - in medical ethics this means the right to refuse/choose my treatment.
  LAW: rules prescribed by the state in order to protect society. Citizens have a duty to obey these laws.
  MORALITY: deals with issues of right and wrong and shared values in society.
  LIBERALS: draw a distinction between private (morality) and public (law) spheres. The function of the law stays within the harm principle. If a law becomes a moral guideline it leads to what he calls the ‘tyranny of the majority’.

WILCOCKSON argues this may not be possible in practice.
Based on BMA argument, doctors do not want euthanasia to be legalised becuase it goes against the role of doctors, which is to save patients.