Medical Ethics 1 Flashcards
Sanctity of Life Principle
means that life is special to God, sanctity means purity or holiness, the value of life exceeds all other values, intrinsic value
• each person is born with rights, especially the right to life, and is a unique individual- all of these lives are equal
• human beings are special in God’s eyes
• God created us personally
• humans are made in the image and likeness of God in order to care for the earth, almost like ’mini gods’, no other part of creation can claim to be mad imago dei
• God is the Lord of Life, has given life to everyone and so it is his decision when life should begin or end
• life is sacred because it comes from God, meaning we have a responsibility to protect it and use it in the way that God would want
Quality of Life Principle
a descriptive term referring to emotional, social and physical wellbeing and the ability to function in the everyday sense
• Health-related quality of life analyses: measure the impact of treatments and disease processes on these holistic aspects of a person’s life
• measured using specially designed instruments which measure the ability to function everyday
• rather than using the existence of God to claim that life is intrinsically sacred, argues that life’s value depends on extrinsic factors
Quality of life analyses
are helpful for:
• investigating the social, emotional and physical effects of treatments and disease processes on people’s daily lives
• analysing the effects of treatment or disease from the patient’s perspective
• determining the need for social, emotional and physical support during illness
-therefore, they help to decide between different treatments, monitor the success of treatments from the patient’s perspective, and to plan and coordinate care packages
Personhood
can be defined as:
• being capable of rational thought (newborn baby? severely disabled?)
• having a form of consciousness that enables them to feel pain or pleasure (animals?)
• self-awareness (baby? severely disabled?)
• having human genetics/being human
• being able to survive independently as a human (those on life support? dependent on parents?)
Peter Singer on Q/SoL
• suggests that quality of life overrides sanctity of life when making decisions relating to life and death
• this would make judgements relativist rather than absolutist, enabling the amount of pain involved, the closeness of death and whether life holds any pleasure for the individual to be taken into account
• in ‘Practical Ethics’ (1979), argues a person is not necessarily a homo sapien. When we talk about sanctity of life, we mean that it applies to human persons
• he quotes Ronald Reagan in 1983: “the real issue is whether to affirm and protect the sanctity of all human life, or to embrace a social ethic where some human lives are valued and others are not”
(When does life begin?) Conception
• the argument given by opponents of abortion who claim that a pre-embryo should be considered a person at this point
• others disagree as the chromosomes do not develop until the third day and half of all fertilised eggs do not attach themselves to the wall of the womb and therefore cannot become babies
(When does life begin?) Physical Sign
• some say the foetus should be considered human when there is a physical sign
• from the 22nd day the heart beats and by the 42nd the foetus is recognisably human
• some argue the foetus is human when the brain has developed activity, implying that the brain has some form of consciousness- a crucial part of a human
• others argue that when the foetus has developed organs it should be considered human, but what organs and at what stage of development?
(When does life begin?) Consciousness
• may be suggested as a definition of personhood as it cannot be applied to all living tissues
• relates to ability to feel pleasure, pain etc
• this would have to include many animals, but some would not consider these to be persons
• some may consider rationality and the ability to develop complex language as features of personhood
• perhaps it is consciousness and self-awareness, which would include our sense of past and future
• however, very young babies do not have this and many would consider them to be people
(When does life begin?) Viability
• some say that a foetus should be considered a person when ‘viable’
• as in, when it can survive independently from its mother
• currently in the UK a foetus is seen as ‘viable at 24/25 weeks
• however, it is very difficult to draw the line between what is a foetus and what is a bundle of tissue; the age at which a foetus becomes viable is constantly reducing
• many people (who we would consider to be persons) depend on medical technology to survive, such as dialysis; they are not viable, but they are persons
Ensoulment
• the moment at which a soul is attached to a being
• is a different suggestion as to when the foetus or embryo becomes human- it is based on religious ideas which claim it becomes a person upon receiving a soul
• Augustine maintained that a soul was implanted at 46 days, though he condemned abortion at any stage
• Aquinas maintained that souls of girls were implanted at 90 days and boys at 40 days
• in the 17 century, the RC Church stated that ensoulment took place at conception, meaning that a fertilised egg is a person
Mary Anne Warren
• 1991, argued birth marks the point of moral status
• Singer’s ‘A companion to Ethics’) : “birth, rather than some earlier point, marks the beginning of true moral status’- if a foetus is a person, then so is sperm
• birth provides the clearest boundary
• many countries allow abortion in exceptional circumstances up to birth but regards the deliberate killing of the baby after birth as murder
• Warren’s argument is vulnerable as the foetus of a foetus of 24 weeks is viable and if aborted is likely to live outside the womb and has to be left to die
• it can also be argued that a foetus has the potential to become a person, so should be treated as one
-though, potentiality does not constitute actuality; the potential to win a battle is not the same as winning it
-still unclear when a potential human would become a clear human
When do humans become persons and enter the moral community?
• the status of human life between conception and birth is central to the abortion debate- whether a fertilised egg qualifies as a person in moral decisions is disputed
• cells and tissues would not otherwise be considered persons- very few people would argue that cancer cells, bacteria and viruses should be protected just because they are alive
• if a foetus or an embryo qualifies as a person, then abortion is equivalent to murder
• Pope Pius IX in 1896: declared a foetus is a person from conception, abortion is murder, supported by the fact that all necessary genetic material is present at conception and the development thenceforth is continuous
• however, Judith Jarvis Thomson in ‘A defence of abortion’ (1971): accepts that there’s a continuous development but suggests that there is a point at which it is not a human being
Judith Jarvis Thomson’s ‘A Defence of Abortion’
• accepts that a foetus has a right to life but argues that abortion can be acceptable
• uses the analogy of waking up next to a famous violinist with a fatal kidney ailment which only you have the correct blood type to help
• the Society of Music Lovers has kidnapped you and connected you to the violinist so that he can be cured in nine months, unless you chose to disconnect him, which will result in his death
• “[I]f you do allow him to go on using your kidneys, this is a kindness on your part, and not something he can claim from you as his due”
• so, an abortion does not violate the foetus’ right to life but only removes something which the foetus is not owed
• However, only applies if the pregnancy resulted from non-consensual sex, otherwise the analogy is unsound, as its persuasiveness applies only if the situation is randomly sprung upon a woman, though in having sex one knows what they’re potentially allowing to happen- responsibility
The Bible on abortion
• does not even mention it
• it was so unthinkable that there was no need to mention it in the criminal code
• it was a taboo
Psalm 139
“you created my inmost being; you knit me together in my mother’s womb…your eyes saw my unformed body”
• acknowledges that God is omniscient and knows what David is doing always, as well as David’s thoughts
• contemplates the origin of his life and concludes that God is responsible for forming him
• so, Christians believe that God knows and plans the existence of each individual human life, that everyone is made individually and deliberately, so everyone has value and should be treated with dignity
Genesis and the Sanctity of Life
• Genesis 1:27: “God created man in his own image”
• this happened after the rest of creation was in place. asserting that our responsibility is limited and that God has true dominion, we are only to be ministers of God’s plan
• Genesis was most likely written post exile by Levitical priests to redefine Jewish identity after amidst cultural and religious changes
• in Babylonian society, the king was seen as the deity
• by claiming that every human was made imago dei, Genesis authors were creating a new model for society
• Human Dignity: results from the imago dei doctrine, it is innate and does not rely on our actions because it is given to all humans by God, is not a characteristic but of divine origin
• This is a moral absolute, that life is protected, because human value results from an divine act of creation
The incarnation and medical ethics
• central Christian doctrine that God became man and dwelt among men to save them
• Jesus’ life began when “he was conceived by the Holy Spirit and born of the virgin Mary” (Nicene Creed), showing that incarnation began with conception and not in the manger
Gresham Machen
-in ‘The Virgin Birth of Christ’ (1958): “the human life would not be complete unless it began in the mother’s womb. At no later time, therefore, should the incarnation be put, but at that moment when the babe was conceived.”
Catholic View on the sanctity of life
• the strong or Catholic version of the sanctity of life holds that life is of intrinsic or inestimable worth
• applies in every condition in which humanness is shown from conception to the grave
Universal Declaration of Human Rights
• in 1947, the UN produced this universal declaration of human rights
• a statement with which all religions, cultures, belief systems and philosophies could agree
• Article 1: all human beings are born free and equal in dignity and rights
• Article 3: everyone has the right to life, liberty and security
Hippocratic Oath
“I will use my power to help the sick to the best of my ability and judgement; I will abstain from harming or wrongdoing any man by it”
Biblical examples of protecting life
• Deuteronomy 5:17: “you shall not murder”
• Luke 10:27: “love your neighbour as yourself”
• Matthew 19:17: “if you want to enter eternal life, keep the commandments”
Ronald Dworkins’ ‘Life’s Dominion’ 1993
• employs Greek terms to clarify the distinction between the biological description of a human being and what makes a human being as a person
• Zoe- life as an animal
• Bios- life as an account of a person’s actions and history
• there is no philosophical problem determining what makes a homo sapien, but there is regarding when bios begins
Aristotle in ‘Ethics, Book 1’
• concludes with a proverb: ‘one swallow does not make a summer’
• to be a person comprises a series of diverse experiences over time and we cannot point to a moment when someone becomes a person
• the question remains what distinguishes bios from mere zoe
Basic goods
are intended to be that which constitutes a worthwhile life as a person
John Finnis on Basic Goods
(Natural Law and Natural Rights 1980)
lists seven equal basic goods
• the desire for a life free from mental and physical pain
• knowledge
• play
• aesthetic experience
• sociability
• practical reasonableness
• religion (that which binds us together in collaboration and community, not necessarily relative to sacred things)
-makes clear that these are not moral goods, but goods which make up a valuable life
Joseph Fletcher on Basic Goods
(Situation Ethics 1966): lists “indicators of humanhood”
• self awareness
• self-control
• sense of the future
• sense of the past
• capacity to relate to others
• concern for others
• communication
• curiosity
John Locke on Basic Goods
• reduces all possible basic goods to one: the ability to think and reflect
• “we must remember what a person stands for; which I think, is a thinking intelligent being that has reason and reflection…impossible for any one to perceive without perceiving that he does perceive” (An Essay Concerning Human Understanding 1690)
• however, does not deal well with the problem of knowing whether a ‘person’ qualifies as such, e.g. in a coma or before birth
Helga Kushe
• Sanctity of life says it is never permissible to intentionally kill a patient but that it is sometimes permissible to refrain from preventing their death
• however, this can lead to confusion as these decisions are based on quality of life principles rather than sanctity of life ones
• “If we want to go beyond definitional ploys, we must accept responsibility for making life and death decisions on the basis of the quality of life”
(QoL qualities) Desires
• the will to live, is a classical utilitarian view, promoting happiness and avoiding pain
• a person who has no desire to live and takes their own life arguably does no wrong since there is no harm done to themselves
• However: many object on indirect utilitarian grounds, others may feel the pain of someone’s death
• some argue that desires are often unreliable, e.g. a temporary state of depression
• also, direct utilitarianism based on desires gives no satisfactory reason why a person may not kill another to satisfy their desires, though on indirect utilitarianism we can refer to the pain and anxiety of a society in which killing anyone to satisfy oneself is permissible
(QoL qualities) Preferences
• Singer argues for preference utilitarianism as it gives direct reasons why a person’s life is respected according to his or her preference to live or die
• this permits the taking of another’s life if that is his or her wish or preference without having to determine the complexities of rights
• it protects those whose preference is not to be killed
(QoL qualities) Autonomy
• Liberalism: J.S. Mill in ‘On Liberty’ (1859): liberty is the means by which a person determines their morality and values. An expression of liberalism is the ability to take one’s own life without interference from the state even if others regard this to be immoral
• Existentialism: Jean-Paul Sartre: freedom differentiates humans from other things, creating an authentic human life and those who abrogate their freedom live a false life in bad faith (“mauvaise fois”). Free acts help establish freedom for others
• Kant: categorical imperative: an act can only be morally permissible if it can be reasonably imagined to be done by everyone else also. There is a universal moral law which ensures individuals are respected for their own sake. Though autonomy is crucial to being a human, it does not permit every sort of behaviour
• however: personal autonomy may be overvalued at the expense of the community; fail to take into account the collective morality of society; might permit antisocial behaviour from those who hold extreme views which are themselves anti-liberal
(QoL qualities) Rights and Contract
• Egoism: Thomas Hobbes in ‘Leviathan’ (1651): humans are no different from animals and survival is the right to preserve one’s own life, even at the expense of others. Everyone has a right to everything, even the bodies of others
• however, this recognises that the likely anarchy which would follow this is not in best interest, so we sacrifice our right to all things in exchange for protection. The role of a state is to ensure that the exchange of rights for contract is maintained
• Hume: if a person withdraws from the social contract and takes their own life, they are only exercising their right and do not harm society
• distinguishes between natural rights (right to life) and human rights (established through the social contract)
(QoL qualities) Life as a Conscious Being
• Jonathan Glover in ‘Causing Death and Saving Lives’ (1977): indirect utilitarians faith to credit the intuitive value we place on life
• he adopts Locke’s standpoint and suggests that life is always valuable providing it is conscious. Killing is therefore not intrinsically wrong, but is because of its direct and detrimental effect on consciousness
• an instrumentalist view of the body, the body is important as it enables conscious experience
• “unattractive to those of us who, in our own case, see a life of permanent coma as in no way preferable to death. From a subjective point of view, there is nothing to choose between the two”
John Harris in ‘The Value of Life’ 1985)
”there would be no reason to suppose that our list [of reasons for life to be valuable] bore any relation at all to the account that might be given of the value of life by non-human people”
Jerome Wernow in ‘Bioethics and the future of medicine’ (1955)
-gives reasons why QOL is rejected in favour of SOL
* QOL permits too much group pressure and power
* QOL leads to a slippery slope or wedge argument whereby killing humans initially for good reasons results in corrupt reasons being adopted
elsewhere
* QOL reduces autonomy, a person may fell burdensome or worthless and lets themself be killed
* fail to treat humans with equal dignity
Potentiality
- some believe a foetus has the status of a person because it is a potential person
- therefore, anything with the potential to be a human is one
- raises the issue of whether sperm and eggs should be included
Pre-existence
- Hindus, Sikhs and Buddhists believe in reincarnation
- reincarnation relies on pre-existence- the belief that the soul has lived before each new life
- it is a returning life and not newly created with each incarnation, therefore life is valuable because the soul has already lived
Critics of Conception as the beginning of life
- Thompson: accepts there is continuous development in foetal growth but suggests there is a point at which it is not a human being: “There is continuous growth from acorn to oak tree, but, an acorn is not an oak tree”
- Glover: to call a foetus a human at the point of conception stretches the term beyond normal boundaries
- apply equally to the primitive streak criteria
Primitive Streak
- is present from the fourteenth day after fertilisation
- provides the structure around which embryonic structures organise and align themselves
- before this, it is unclear whether one or more individuals will form, and at this point it becomes clear which cells will form the placenta and which the embryo
- nervous system develops at this point, evidencing the beginning of primitive sensation
- the law recognises the change in the foetus at this point; embryo research cannot take place after 14 days
