Euthanasia

Question 1

What did the Bible say about the sanctity of life?

Answer 1

• ‘So God created mankind in his own image, in the image of God he created them’. (Genesis 1:27)
• ‘You shall not murder’. (Exodus 20:13)
• ‘The Lord gave, and the Lord has taken away; blessed be the name of the Lord’ (Job 1:21)
• ‘Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God’ (1 Corinthians 6:18)

Question 2

What do the Catholic Church say about euthanasia?

Answer 2

Catholic Christians place weight on the natural law and the teachings of the Church in addition to biblical evidence. In natural law, the primary precept of preserving innocent life establishes the importance of the sanctity of life. In addition, the Church has officially pronounced against euthanasia, particularly in the 1980 Declaration on Euthanasia.

Question 3

Who is Claire Foster?

Answer 3

Claire Foster takes the perspective of Natural Law. Killing someone does not treat suffering - palliative care does that. ‘Love’ is not taking away of life. Legalising Euthanasia does not protect the vulnerable (old, those not able to decide for themselves, lonely, depressed).

Question 4

Who is Paul Badham?

Answer 4

Paul Badham takes the perspective of Situation Ethics. When recovery is not going to happen and there is no chance of quality of life, means should be peovided to be end death. “Treat others as you would like to be treated” is more likely to mean that we want people to help us die. Loving your neighbour might actually be assisting them in dying.

Question 5

Case study - Daniel James

Answer 5

Daniel James - voluntary euthanasia: Daniel James played rugby until a scrum collapsed on him and dislocated his neck vertebrae trapping his spinal cord and rendering him immediately tetraplegic. One year after the accident he went to Switzerlind for Euthanaisa treatment to end his own life. He was supported by his parents saying he had been “an intelligent young man of sound ming” and he was “not prepared to live what he felt was a second class existence”.

Question 6

Case Study - Matt Hampson

Answer 6

Matt Hampson was in the England U21 team preparing for an under 21 Six Nations match against Scotland. When a scrum collapsed he dislocated his neck, severing his spinal cord. His condition requires permanent use of a ventilator to breathe.

Question 7

Case Study - Hannah Jones

Answer 7

Hannah Jones was 13 when she decided she didn’t want a life saving heart transplant. Left drained by debilitating surgery to cure a fatal heart comdition worsened by a lengthy cancer battle she said that she would rather die than undergo more hospital trauma. She fought a legal battle with medics who wanted her to have treatment. At 14, Hannah’s condition worsened and she changed her mind. She went through a six-and-a-half-hour transplant operation at Great Ormond street Hospital.

Question 8

Case study - Tony Bland

Answer 8

Tony Bland - involuntary euthanasia: Tony Balnd was an 18-year-old who suffered crushed ribs and 2 punctured lungs in the Hillsborough disaster. This interruoted the supply of oxygen to his brain which caused catastrophic and irreversible damage, and left him in a constant vegetative state. Due to this, with the support of his parents, he applied for a court order allowing him to “die with dignity”.

Question 9

What is pllaitaive care?

Answer 9

Palliative care is specialist care for people who have a life limiting condition. Hospices offer palliative care. Hospices are experts in pain relief, and medication to make patients comfortable - but their aim is not to cure the patient. Claire Foster said that Palliative care should be the way forward - and showing patients that their life still has value, however limited.

Question 10

What is active euthanasia?

Answer 10

The commonly held wisdom suggests that an act that causes death is wrong, thus active euthanasia, whether by lethal injection or by switching off a machine, is held to be wrong by those who oppose euthanasia.

Question 11

What is passive euthanasia (omissions)?

Answer 11

Passive euthanasia, which involves omissions such as withdrawing a medical treatment or, as in the case of Tony Bland, a feeding tube, is often viewed as trickier. In these cases where it is clear that the patient will not recover, this may be viewed as simply allowing the person to die and this may not always be morally wrong.

Question 12

What examples does James Rachel use to challenge thinking on acts and omissions?

Answer 12

James Rachel provides a thought experiment to suggest that the distinction between actively killing and passively letting someone die may not be helpful:

Case 1: Smith is the legal guardian for his nephew and will inherit a fortune if his young nephew dies before his 18th birthday. (The nephew’s parents have died and left the money in trust for the boy). Smith makes plan to kill his nephew. One evening he drowns the boy in the bath and arranges the scene to look like an accident. The nephew’s death is an ‘act’ of Smith.

Case 2: Jones is also a legal guardian for his nephew and will inherit a fortune if his young nephew dies before his 18th birthday. (The nephew’s parents have died and left money in trust for the boy). Jones resents his nephew but would never intentionally harm him. As he enters the bathroom, he sees his nephew slip and hit his head on the bath and slowly drown. He watches and does nothing to save the boy. The nephew’s death is an ‘omission’; Jones could have saved him.

Question 13

How does James Rachel’s analogies challenge thinking on acts and omissions?

Answer 13

In using this as an analogy for euthanasia, the commonly held view of acts and omissions says that Smith is more guilty than Jones - thus an act is worse than an omission. Yet Rachels disputes this. He argues that both cases are equally bad and when we consider the issue of euthanasia, a passive euthanasia that operates by omission may even be more cruel, as death may take longer. In the Tony Bland case, the removal of the feeding tube meant that death did not occur until 10 days later.

Question 14

Who else challenged the disinction between acts and omissions?

Answer 14

Peter Singer has also challenged the distinction between acts and omissions by arguing that it is not always clear cut. The removal of Tony Bland’s feeding tube, or the turning of the dial that stops the nutrients, is in some senses an action even if the removal of food is an omission. It is not totally clear whether his death is an act or an omission.

Question 15

How do we apply natural law to euthanasia?

Answer 15

Natural Law ethics has 4 tiers of law, where the divine law revealed by God is higher than the natural law derived from reason. For Christians, the divine law from the Bible appears to give clear guidance against the taking of life. It is for God to bring life to an end, not humans. In Ecclesiastes Chp3, it states that there is ‘a time to be born and a time to die’.

The primary precept, the preservation of innocent life could logically lead to a secondsry precept that would prohibit euthanasia. Euthanasia itself could be thought of as an apparent good that would stand in contradiction of the real good of allowing life to continue its natural and God-given course.

Question 16

What are the difficulties of applying natural law to euthanasia?

Answer 16

However, there are a couple of considerations that may complicate the answer given by natural law. Firstly, a distinction can be drawn between ordinary and extraordinary means, as if shown by the quote from the catechism below, which shows a possibke secondary precept that could be drawn. There is an obligation to give all ordinary treatment such as food, water and basic medication, yet there is no obligation to continue extraordinary treatment, which may mean that those who cannot recover should not be kept indefinitely on life-support machines. It would not be wrong for someone who is terminally ill to decline extraordinary treatment.

Secondly, natural law has developed the idea of double effect. In terms of euthanasia, it is permissable for a doctor to give strong pain relief such as morphine, even though this carries a risk of ending the patients life. Provided the intention is to relieve pain, this would be counted as a good action.

Question 17

Who was David Moore?

Answer 17

In 1999, Dr David Moore was cleared by a court of murdering a seriously ill 85 year old cancer patient who had also had a heart attack and a stroke. A dose of morphine had hastened the death of the patient. Outside court, Dr Moor said, ‘All I tried to do in treating Mr Liddell was to relieve his agony, distress and suffering. This has always been my approach in treating my patients with care and compassion. Doctors who treat dying patients to relieve their pain and suffering walk a tightrope to achieve this’.

Question 18

How would the doctrine of double effect support David Moore’s decision?

Answer 18

The doctrine of double effect would support his decision. Double effect hinges on the intention behind the action; a doctor foresees that death is a possibility, but that is not the primary intention. Of course, it is difficult to assess the intention (as this would rely on reading the doctor’s mind!).

Question 19

What would proprtionalists see David Moore’s decision?

Answer 19

Proprotionalists go further than this and argue that the rules of natural law can be broken if there is a significant and proprtionate reason to make an exception.

In euthanasia cases, a proprtionalist such as Daniel Maguire (1931-) argues that in some cases where biological life continues but personhood is greatly diminished, shortening the process of dying is not in itself wrong. This approach is condemned by the Roman Catholic Church but it is not radically different from the idea of double effect, and the issue of determining intention would also apply here.

Question 20

Is the sanctity of life absolute to Fletcher?

Answer 20

For Fletcher, (who served as president of the Eurhanasia Society of America) the sanctity of life is not absolute. 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) but can be broken when love demands it. Sanctity of life would belong in the category of sophia.

Question 21

How would you apply situation ethics to euthanasia?

Answer 21

Situation ethics would value quality of life and autonomy over the sanctity of life. Autonomy is especially significant as ‘personalism’ is one of Fletcher’s four principles; it is people and their welfare rather than the keeping of laws that is at the heart of ethics.

Question 22

What does Fletcher say about the patient and the outcome of euthanasia?

Answer 22

SE is relatavist in its approach - Fletcher states that ‘love’s decisions are made situationally, not prescriptively’. In his 1945 book Morals and Medicine, he argues that the patient’s medical condition has to be the starting point for any decisions in medical ethics. This is a recognition that there are cases where this is the right option.

Fletcher values pragmatism - we should do whatever is likely to work. In the topic of euthanasia there may not be ideal and perfect solutions, but what can be done is to ensure the decisions that are taken are likely to lead to the lesser of the possible evils.

Question 23

Situation ethics is a good approach for euthanasia

Answer 23

• flexibility of SE is very useful in an issue such as euthanasia. It offers general principles, rather than fixed rules - allows us to respond to complex and varrying situations.
• the idea of agape if correctly understood is a good moral principle and puts people first. It is a clear improvement of utilitarian ideas of maximising happiness for the majority.
• SE respects the autonomy of individuals and recognises that the patient is the most significant person in the situation.

Question 24

Situation ethics is not a good approach for euthanasia

Answer 24

- SE can be see as vague. While doing the most loving thing is a good aim, there is little guidance on what this might look like in practice. This may mean that individuals differ as to what is the most loving thing.

• like other teleological theories, SE requires a prediction of future consequences. This id not always possible in complex medical cases.
• SE lacks absolute boundaries and critics of euthanasia are concerned about a slippery slope that may lead to an increase in euthanasia cases, particularly for vulnerable people.

Question 25

Natural Law is a good approach for euthanasia

Answer 25

• Natural Law is committed to the sanctity of life. Life is valuable regardless of anyone’s judgement about its quality. Thus natural law avoids the potential for a less slippery to occur when life becomes increasingly less significant.
• NL prevents individuals from playing God and making decisions about the lives of others.
• Ideas of Double Effect provides some helpful felxibility in an otherwise rigid system. This allows pain relief to continue despite the frailty and vulnerablity of the patient.

Question 26

Natural Law is not a good approach

Answer 26

• Is overly religious and dependent on its Christian roots. It would seem that euthanasia should be allowed nowadays as we are in increasingly secular society.
• NL can be legalistic and absolutist. Each person’s situation is different, but the difficulty with NL is that it insists on a common approach.
• NL requires individuals to live even in extreme pain. A utilitarian would argue that the reduction of pain and a focus on the quality of life would be better than a NL approach.