Euthanasia

Question 1

What is the definition of euthanasia?

Answer 1

Literally ‘a good death’

Question 2

What is the definition of suicide?

Answer 2

A person makes a voluntary choice and takes their own life

Question 3

What is the definition of active euthanasia?

Answer 3

A treatment is given that directly causes the death of the individual

Question 4

What is the definition of non-voluntary euthanasia?

Answer 4

Where a severely or terminally ill person’s life is ended without their consent, perhaps because they are unable to give consent

Question 5

What is passive euthanasia?

Answer 5

A treatment is withheld and this indirectly causes the death of the individual

Question 6

What is an example of a case of euthanasia?

Answer 6

-The Tony Bland case provided precedent whereby, in certain extreme circumstances, non voluntary euthanasia is in effect permitted.
-This is also an example of passive euthanasia, which involves the withdrawal of treatment that is keeping a patient alive. This indirectly causes death

Question 7

What is the sanctity of life?

Answer 7

-The sanctity of life is a key aspect of religious ethics. In Christian ethics, it refers to the idea that life is special and valuable because it is God given
-Despite the belief that humans are fallen and damaged by sin, each person is still created in the ‘image of God’. This means that it is morally wrong to take life
-Each life has intrinsic value regardless of it’s quality or usefulness to us

Question 8

What references from the Bible are often used to support the idea of sanctity of life?

Answer 8

-‘So God created humankind in his own image, in the image of God he created them’ (Genesis 1:27). This image of God is understood in various ways such as the capacity for rationality, the divine speak within humans, or the ability to make moral decisions
-‘You shall not murder’ (Exodus 20:13). The command against taking a life is one of the 10 commandments. Although it is possible to debate whether the commandment is about murder specifically or killing more generally, the principle of the importance of respecting life is upheld
-‘The Lord gave, and the Lord has taken away; blesses be the name of the Lord’ (Job 1:21). It is for God to decide the moment of birth and the moment of death; it cannot be a human decision as our lives are not our own but God’s

Question 9

What is the quality of life?

Answer 9

-The quality of life principle takes the view that whether life is valuable depends on whether it is worth living. Some thinkers base the decision on whether quality of life exists around possession of life’s goods such as happiness and freedom from pain
-Others argue that quality of life can be found in possession of autonomy.
-The utilitarian philosopher Peter singer takes such a view and argues for replacing the traditional sanctity of life ethics with 5 quality of life commandments

Question 10

What were Peter singer’s 5 quality of life commandments?

Answer 10

1. Recognise that the worth of human life varies
2. Take responsibility for the consequences of your decisions (to save or end life)
3. Respect a person’s desire to live or die
4. Bring children into the world only if they are wanted
5. Do not discriminate on the basis of species

Question 11

What is the principle of autonomy?

Answer 11

-It’s in direct opposition to the sanctity of life
-This principle states that humans should be free to make decisions about their own future. It is a key feature of utilitarian thinking and can be traced back to J.S Mill’s non-harm principle:
-Whilst the government or other authority may restrict our freedom if we are 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 that humans should be free to pursue their own desires and interests where possible
-This autonomy includes the right to make our own decisions about our death

Question 12

How do euthanasia and autonomy link?

Answer 12

-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 and manner of our own death.
-In the case of voluntary euthanasia, this may appear fairly straightforward; however, the leading British philosopher Jonathan Glover has suggested several checks on whether someone should be assisted to die
-This implies some external judgement as to the patients’s quality of life as well as their mental state. If they are making the decision in a diminished mental state then they are not truly autonomous

Question 13

Where does autonomy become more complicated?

Answer 13

-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, but may also lead to a slippery slope where euthanasia is practiced more widely

Question 14

What is the hippocratic oath?

Answer 14

-The Greek physician Hippocrates states that it would be wrong for a doctor to do something that would cause the death of a person
-However, in other writings, he suggests that is is pointless to continue to treat those who are overcome by a disease and for whom medicine is powerless
-It is this distinction that provides the background for the modern discussion of acts and omissions.
-Roughly speaking, an ‘act’ which causes death is morally (and legally) wrong but an omission (stopping a treatment wheee the treatment is prolonging the inevitable death and increasing the suffering of the patient) may not be morally wrong

Question 15

What does James Rachel’s say about acts and omissions?

Answer 15

-Suppose smith will inherit a fortune if his young nephew dies. One evening he drowns his nephew in the bath and arranges the scene to look like an accident. The nephew’s death is an ‘act’ of Smith
-Suppose Jones will also inherit a fortune if his young nephew dies. As he enters the bathroom, he sees his nephew slip and hit his head and slowly drown. He watches and does nothing to save the nephew. The nephew’s death is an ‘omission’; Jones could have saved him
-The traditional idea of acts and omissions says that Smith is guiltier than Jones. He certainly would be legally, but is he actually worse morally?
-Rachel’s argues that both cases are equally bad and when we consider the issue of euthanasia, passive euthanasia by omission may even be crueller as death may take longer

Question 16

What does Glover say about ordinary and extraordinary means?

Answer 16

-He suggests that the distinction between acts and omissions may not be so clear cut. This is because our actions and our omissions may involve ordinary and extraordinary means depending on whether the proposed treatment is something ordinary such as food and water or whether it involves highly expensive medical technology w which would be an extraordinary means

Question 17

What are the 5 options Glover suggests with regards to euthanasia?

Answer 17

1. Take all possible steps to preserve life
2. Take all ordinary steps to preserve life but not extraordinary means
3. Not killing but taking no steps to preserve life
4. An act, while not intending to kill, has death as a possible foreseen consequence
5. The deliberate act of killing

Question 18

What would we question about Glover’s 5 options?

Answer 18

-We may debate what is or not extraordinary means
-Peter Singer also questions the distinction between acts and omissions. Using the Tony Bland case, he asks us to consider whether the removal of the feeding tube was an ‘act’ that led to his death, or an ‘omission’ ie they were now omitting to feed him

Question 19

How would we apply natural law to euthanasia?

Answer 19

-The key precept of Natural law argues for the preservation of life. Life is intrinsically valuable and should not be shortened. Natural law is dependant on the Divine law revealed by God
-Key texts such as the 10 commandments 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 weee shortening someone’s life
-It could also be argued that the practice of euthanasia would undermine the stability of society. People 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 a pain relief, such as morphine, even though administering such a drug may shorten life. This is acceptable provided the intention is to relieve pain and the shortening of life is an unintended secondary effect
-Natural law also draws a distinction between ordinary (natural) and extraordinary means. Thus a sick person is obliged to take treatment by ordinary means, such as food and water, but an extraordinary treatment which is risky and may not work could be refused

Question 20

Why can it be argued that natural law gives a good answer on euthanasia?

Answer 20

-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 and putting themselves in the place of God

Question 21

Why can it be argued that natural law does not give a good answer on euthanasia?

Answer 21

-It’s religious foundations make it seem outdated
-It is legalistic and shows no compassion to the pain and suffering experienced by many terminally ill people
-The focus on sanctity of life means that the concepts of quality of life and individual autonomy are not seen as important

Question 22

How would we apply situation ethics to euthanasia?

Answer 22

-Situation ethics has ‘personalism’ as one of it’s key principles. It is people and 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 it’s approach. Fletcher states that ‘love’s decisions are made situationally, not prescriptively’. He argues that the patient’s medical condition has to be the starting point for any decisions in medical ethics. This is not a total endorsement of euthanasia, but a recognition that there are cases where this is the right option

Question 23

Why can it be argued that situation ethics is a good approach to euthanasia?

Answer 23

-It is 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

Question 24

Why can it be argued that situation ethics is not a good approach to euthanasia?

Answer 24

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

Question 25

What is the case for sanctity of life?

Answer 25

-There are concerns that if we do not uphold the supreme value of life this may lead to poorer treatment of patients or people feeling they are a burden on resources
-The idea that life is special in all forms is not a bad idea. Modern ideas of rights have their origins in this idea and attempt to express a similar sentiment
-Natural law upholds the intrinsic value of life. Preservation innocent life is one of it’s 5 primary precepts
-In the Bible, it states that ‘The Lord gave and the Lord has taken away’. In making decisions about life ending treatments we may be guilty of presuming to know more than God

Question 26

What is the slippery slope argument?

Answer 26

-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 and pressure may be exerted on those who are vulnerable, such as the elderly or disabled
-They may agree to euthanasia because 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
-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 wheee it was possible that the patients life had been ended against their will, although equally the 2 cases could also be explained by poor documentation