Euthanasia Flashcards
What is euthanasia?
- Translates literally as ‘easy death’, involves the painless killing of an individual in order to prevent further suffering.
- The practise can take many forms, such as passive euthanasia (the removal of life-sustaining drugs or equipment by a medical professional) or active (direct killing of an individual).
- Typically performed on an individual who is terminally ill, yet in some countries the scope of who can qualify for euthanasia has widened.
- In current UK law active euthanasia is illegal, however passive euthanasia, in some forms, is permitted.
What is voluntary/non-voluntary euthanasia?
VOLUNTARY: a person’s life is ended at their request/with their consent.
NON-VOLUNTARY: a person’s life is ended without their consent, but with the consent of someone representing their interests.
What is active/passive euthanasia?
ACTIVE: a treatment is given that directly causes the death of the individual e.g lethal injection.
PASSIVE: death via the withholding of treatment, indirectly causing death e.g withdrawing medical treatment/feeding tubes.
What is the strong sanctity of life view? What do they think about euthanasia?
- Asserts that life is inherently sacred as we are all made in God’s image.
- Those who hold this view believe that human life has intrinsic value, citing scripture such as the Ten Commandments that forbid the destruction of human life.
- Therefore, proponents of the sanctity of life view would certainly deem euthanasia to be morally unacceptable, as it destructs the sacred human life created by God.
How can the strong sanctity of life view be criticised?
○ No longer relevant due to rising secularism Since it is largely a religious concept, sanctity of life is no longer important given the secular nature of twenty-first century medical ethics and society. For example, in the UK in the 2021 census 37.2% of respondents identified themselves as “no religion”.
○ For many it upholds an important religious duty to ‘preserve life’ and is a central act of faith. For a large part of the population, faith is still an important aspect of their life. In the UK the census revealed that 46.2% of respondents identify as Christian. For these, faith also has consequences e.g.. eschatological beliefs.
○ Proponents of the weak sanctity of life principle criticise the strong version by pointing out that although the sanctity of life is found in the Bible, it is only one of many biblical principles and themes. So, although sanctity of life is important in judging the value of life, there are other principles that should also be included, such as Jesus’ emphasis on compassion. The problem with the strong sanctity of life view is that it allows unnecessary suffering and is uncompassionate, seeming to ignore the demands of compassion. In some cases, then, compassion for the quality of life might outweigh the sanctity of life.
○ Although the Bible does have the theme of compassion, that doesn’t mean it can be used to overrule the sanctity of life. The Bible clearly is against killing. There is no exception mentioned for the sake of compassion. Although the Bible says to be compassionate, it doesn’t follow that it is Biblical to go against the sanctity of life when it would be compassionate to do so.
What is the quality of life view? What does this state about the moral acceptability of euthanasia? What did Peter Singer have to say about quality of life?
Quality of life is a person’s total wellbeing, including physical, emotional and social aspects of a person’s life, yet in medical contexts it often focuses in how an individual’s wellbeing may be affected by disease, disability or disorder. Efforts have been made to operationalise and codify this concept in ethical and medical contexts, leading to the development of Quality Adjusted Life Years, which combine length of life with quality of life. These are used in some hospitals as an empirical means of determining quality of life.
Peter Singer: preference utilitarian. Centres QOL around ‘personhood’ - criteria being whether one possesses rationality and self consciousness. distinguishes between ‘humans’ (members of our species) and ‘persons’ (rational and self conscious beings), suggesting that the sanctity of life of ‘humans’ should be reconsidered as they are not able to self actualise and engage in rational thought like ‘persons’. Goes as far as recommending non-voluntary euthanasia for babies whose potential quality of life is low, such as due to being born with an incurable condition like spine bifida.
How can the quality of life view be criticised?
• Peter Singer: preference utilitarian. Centres QOL around ‘personhood’ - criteria being whether one possesses rationality and self consciousness. distinguishes between ‘humans’ (members of our species) and ‘persons’ (rational and self conscious beings), suggesting that the sanctity of life of ‘humans’ should be reconsidered as they are not able to self actualise and engage in rational thought like ‘persons’. Goes as far as recommending non-voluntary euthanasia for babies whose potential quality of life is low, such as due to being born with an incurable condition like spine bifida.
• Controversial, but provides meaningful insight on when euthanasia can be morallyt justified. The moral issue one has when killing someone is that it deprives them of the life they wish to continue living. Conversely, if euthanasia is requested by a competent adult (voluntary euthanasia), the ethical implication is removed as the individual is exercising their own autonomy to determine when their life should end. Preferable from a utilitarian perspective - seems inhumane to force a person to remain alive if it will cause prolonged pain and suffering against their will. Allows one to exercise full autonomy.
• Has capacity to override an individual’s consent. If terminally ill/vegetative state, may not be in a competent enough mental state to make fundamental decisions to end their own lives. Salient in regards to non-voluntary euthanasia, wherein other individuals, often family members, make the ultimate decision as to whether their relative’s life will end. Could lead to dangerous slippery slope.
• Archbishop Fisher: cites a growing trend that whenever euthanasia is legalised, the conditions necessary to qualify gradually extend so more and more people can get euthanised. E.g Holland: euthanasia was first legalised solely for terminally ill patients, but within 10 years it became legal for babies in case of severe illness.could potentially mean that as more people qualify for euthanasia, some elderly or otherwise vulnerable people may feel the pressure to die if they feel like a burden. E.g Canada 2022: two people applied for euthanasia on the grounds that they were in ‘abject poverty’ and could not continue to support themselves while living with their medical condition. Sets a precedent that some people are deserving of death if their ‘quality of life’ falls below specific criteria.
• Not necessarily a moral criticism of euthanasia itself, but rather a criticism of the poor regulation surrounding it.instead highlights the issue with allowing euthanasia in a society which lacks proper support for those who need it, as opposed to criticising euthanasia as an act in itself.
• Evidence to contradict the notion that there is a slippery slope: the number of euthanised babies in Sweden has decreased over time.
How can Situation Ethics be applied to euthanasia? (Four working principles)
- Focuses on what constitutes the most agapeic outcome. Thus euthanasia is acceptable in cases where it is the ‘most loving act’
- Four Working Principles.
o Pragmatism: considers use of resources e.g not justified to keep a terminally ill patient alive with limited resources (which could be used to help others)
o Relativism: each case considered individually- what brings most love and compassion? Killing cannot be an absolute wrong - situational nature.
o Positivism: people before laws. We made up laws to make sure we treat each other humanely, sometimes this involves allowing or helping someone to die.
o Personalise: humanity more than mere biological existence. Respect a person’s autonomy and acknowledge that a person’s life might cease to be instrumentally valuable to them. This is at the heart of situationism.
How can Situation Ethics’ application to euthanasia be criticised? (Four working principles)
- Intuitive: idea of pragmatism applied in medicine frequently anyway, ties with QOL
- W. Barclay’s critique.
- People are not perfectly loving so if given the power to judge what is good or bad, people will do selfish or even cruel things.
- People’s loving nature can be corrupted by power.
- Someone might find it loving to manipulate/pressure someone into or out of euthanasia, perhaps if they will get inheritance to pay for their children’s food or something. Some might find it loving to end their life because they feel like a burden.
- Fletcher + Robinson: Humanity has ‘come of age’ - in the past we needed fixed rules to guide our conduct, because they could not be trusted to understand and act on the nuances and complexities in how a rule could justifiably be bent or broken if the situation called for it.
- However, now people are more civilised, to the point that granting them more autonomy will increase love without risking the stability of society.
- Barclay disagrees: although humanity may appear improved, if given unbridled autonomy to do what they wish, they won’t choose the loving thing and will choose the most selfish thing. Power corrupts. Stanford prison experiment/LOTF.
- It is a well-known feature of human psychology that power is corrupting. The freedom to decide what is good or bad without external supervision of legalistic laws grants humans more power and thereby corrupts them.
How can Situation Ethics be applied to euthanasia? (6 propositions)
Proposition 5: Love justifies its means: Justification of an act comes ONLY through a loving purpose. All moral decisions should have an end in view (otherwise it is meaningless), and so long as this end is loving anything can be justified.
- If the ‘end’ of euthanasia is to alleviate suffering for the individual, then it can be justified,.
Proposition 6: Love’s decisions are made situationally not prescriptively: Promotes a ethical approach which is contextual and situational - love decides on each situation as it arises. Law can destroy love and Fletcher rejects continual, conventional payment to laws because they are too rigid to fit the full facts of life.
How can Situation Ethics’ application to euthanasia be criticised? (6 propsitions)
- Acknowledges that each independent euthanasia case is unique and situational - consequerntialist approach allows for the context of situation to be considered - e.g if euthanasia is most loving in this context.
- Values humans: weak SOL means that human pleasure/happiness is placed at the forefront. ‘Love’ is most important.
- Claims that love is the basis for ethical judgement, however what counts as loving is subjective. The Nazis had a forced euthanasia program against terminally ill patients and also babies they deemed disabled. Love is too subjective a thing to provide a stable basis for ethics.
- Love might be subjective, but agape is not. Agape is more than just love – it involves selfless love of your neighbour; loving your neighbour as yourself. A person would not want to be pressured into euthanasia themselves, so it cannot be agape to pressure your neighbour into it.
- How can we know what the most agapeic solution would be for another? Does quality of life override an individual’s consent? Especially with regards to non-voluntary euthanasia. Can somebody fully know another’s wishes? What if the patience had recently changed their view and not informed their loved one? What if medical breakthroughs happen and action can be take to prolong life, and ensure wellbeing.
- Archbishop Fisher: cites a growing trend that whenever euthanasia is legalised, the conditions necessary to qualify gradually extend so more and more people can get euthanised. E.g Holland: euthanasia was first legalised solely for terminally ill patients, but within 10 years it became legal for babies in case of severe illness.could potentially mean that as more people qualify for euthanasia, some elderly or otherwise vulnerable people may feel the pressure to die if they feel like a burden. E.g Canada 2022: two people applied for euthanasia on the grounds that they were in ‘abject poverty’ and could not continue to support themselves while living with their medical condition. Sets a precedent that some people are deserving of death if their ‘quality of life’ falls below specific criteria.
- Not necessarily a moral criticism of euthanasia itself, but rather a criticism of the poor regulation surrounding it.instead highlights the issue with allowing euthanasia in a society which lacks proper support for those who need it, as opposed to criticising euthanasia as an act in itself.
- Evidence to contradict the notion that there is a slippery slope: the number of euthanised babies in Sweden has decreased over time.
Is there a difference between medical intervention and non-intervention when ending a patient’s life?
LOA: there is a difference.
- Rachels suggests that both an act and omission regarding euthanasia are equally as bad i.e. - both result in the loss of somebody's life. "active euthanasia is not any worse than passive euthanasia." - Common wisdom and experience suggest actively willing and undertaking an act, is very different to doing nothing. For example, often there is an element/degree of active thinking and planning involved in an action you are actively undertaking. With regards to euthanasia, this may mean carrying out a physical action of injecting drugs or turning off a switch. Not only does this take a life, but it may also have implications for the 'doer' e.g. psychological trauma. - Many proponents of Natural Moral Law would draw a distinction, this is because of the intention (interior motive). If carrying out active euthanasia i.e., an act, a moral agent is willingly, consciously, and actively reasoning and taking action to end life. It is not simply allowing a course of action to occur/take place or the consequence of a 'good' act (DDE). - Many proponents of relativist and teleological theories of ethics e.g.. Situation Ethics would not draw a distinction. Situtionists would only consider the result of the act, as both acts and omissions result in the ending of life, the outcome is not significantly changed because of the action. Situation Ethics would be looking to prioritise agape, over anything else! - When looking at the wider implications of the issue, there is a difference between acts and omissions due to its resource use. Omissions i.e. passive euthanasia, will often require many more medical resources due to ensuring a patient's medical needs are being met e.g. drug administration. Do Not Resuscitate (DNRs) is one-way resources can be minimised. CPR will not be attempted if a patient's heart stops. However, other treatment can be attempted. - When euthanasia is both voluntary and active, there is a much greater degree of autonomy. For many, autonomy is essential in end of life decision-making. There is without doubt a clear and stark contrast between actively deciding and undertaking actions to end life e.g., to remove suffering compared to a decision of inaction, which may prolong and endure suffering. Rachels suggests an omission by maybe even more cruel, as death takes longer.
