Medical Ethics 3 Flashcards
Arguments around Childlessness and the right to have a child
- infertility can bring emotional pain to couples, some accept its God’s will while others try to find ways of having one regardless
- NML may be used to argue against fertility treatment although there are psychological costs to infertile couples to be without child
- D. Gareth Jones in ‘Vaulting People’ (1999), use of treatments like IVF does not constitute an “abrogation of the marriage bond” and
while “artificial means can be pursued for unworthy motives or in a grossly excessive manner, neither is inevitable” - problem of discarded embryos: when accidental miscarriages occur there is no moral question, though can an embryo lost in vitro be
judged differently - Jones claimed discarded embryos are the ”unintended end result of a life-affirming process”, linking to Aquinas’ view on double effect, though most Catholics would claim this violates the sanctity of life
*we cannot “extrapolate ethical guidelines from biblical silence to solve dilemmas at the frontiers of contemporary scientific debate”
Surrogacy
- can bring potential for emotional trauma, if say the father forms a bond with the surrogate
- can break the “one flesh” principle
- can damage marital relationships
- Though could be seen as a lifeline to infertile couples
- Genesis 16, Sarah suggests Abraham impregnates Hagar as she was unable to conceive. Once Ishmael is born of Hagar, there begin tensions between Hagar and Sarah. Sarah gives birth to Isaac and tensions rise again
- John Stott (1999):: “In surrogacy, even if both sperm and ovum are contributed by the married couple, a physical and emotional bonding
takes place between the ‘mother’ and the child she is carrying, which may be hard to break” - if the God-given method of conception is heterosexual intercourse, is it moral to circumvent this to conceive
Catholic Church on Contraception
- only recently open to flexibility because of Zika virus
- NML: every act of intercourse must be open to the possibility of conception
- Augustine: contraception introduced moral corruption to relationships
- not all Christians agree, though IUD and morning after pill cannot be considered Christian options because they act after sex and destroy
a child
Society for the Protection of the Unborn Child
(2002): “when a human sperm fuses with a human egg to form an embryo, a human life begins”
so using emergency contraception is unethical
Medical care and resources
resources: easier to access than ever
* boundaries between life and death becoming increasingly unclear and problems brought by increasing life span (Alzheimer’s patients
have no hope of returning to previous quality of life, are younger patients needing same treatments for other conditions given priority?)
- D. Gareth Jones: three factors come into play when considering allocation of resources: complexity of procedures, competition for
resources and age of patients. It is reasonable that the needs of younger patients come first. Claims this is consistent with Christian
teaching, as death is an inevitable part of life not to be feared.
D. Gareth Jones on resources quotes
- “society has an obligation to help people from youth to old age, but by the same token it does not have an unlimited obligation to
continue the extension of life in old age” - “we are confronted by an actual person and not by life in general. We cannot, therefore, escape from the question of whether the life
before us is a personal life, or whether it has a future as a personal life”
Tony Bland
- Liverpool supporter involved in the Hillsborough disaster, in which 96 were crushed
- Tony survived with serious injuries: part of his brain was starved of oxygen leaving hum in a vegetative state; his body was kept alive
artificially but his brain was dead - the law at the time prohibited his removal from life support, so the Airedale NHS Trust applied to the court for permission to remove
the machines keeping him alive, though many objected as there was a small chance he could make a a partial recovery - a ruling was made that the doctors could remove Tony’s feeding tube
- he died 11 days after the tube was removed, 4 years after the incident
- This was a non-voluntary euthanasia as he did not give permission. It was an active euthanasia as an action was taken to end his life
Noel Conway
- a retired lecturer who was terminally ill and launched a legal challenge for the right to die, claiming that the 1961 Suicide Act
condemns him to an undignified and terrifying death - his motor neurone disease gradually reduced his mobility until he would be completely entombed in his own body
- supported by organisation Dignity in Dying, instructed the law firm Irwin Mitchell to seek permission for a judicial review in the high
court of the ban on assisted suicide
Care Not Killing Alliance
- a campaign group arguing the current laws protect the weak and vulnerable from being exploited or coerced
- chief executive Dr Gordon MacDonald said “no major disability rights organisation or doctors’ group” supported changing law and
there was “no safe system of assisted suicide and euthanasia anywhere in the world” - “the safest law is the one we have”
- aims to improve palliative care, ensure laws against assisted dying remain in place, influence public opinion against assisted dying
Hippocrates and Euthanasia
(Hippocratic oath): “I will not prescribe a deadly drug to please someone, nor give advice that may cause his death”
Francis Bacon and Euthanasia
“Physicians are not only to restore health, but to mitigate pain and dolours; and not only when such mitigation may
conduce to recovery, but when it serves to make a fair and easy passage”
Living Will / Advance Decision
allows you to express your wishes to refuse medical treatment in future. It is sometimes referred to as a living
will. Relevant if you were unable to make or communicate your own decisions. Legally binding.
Holland and Euthanasia
about a thousand assisted deaths take place each year, and organisations such as the Dignity in Dying campaign
for a similar practice in the UK
* Dignity in Dying along with most other pro-euthanasia groups would not support ending a life against that person’s will
Pope Francis on Euthanasia
- it is a “false sense of compassion to consider it an act of dignity
- “This is playing with life”
Gregory E. Pence
in his article “why physicians should aid the dying”
* killing humans who don’t want to live is not wrong
* it is not wrong to help the dying to die because they are already dying
* death is already inevitable so euthanasia can hardly be murder- very consequentialist
Thomas More on Euthanasia
1516 ‘Utopia’
* when a patient suffers a “torturing or lingering pain, so that there is no hope, either of recovery or ease, [they may] choose rather to
die, since they cannot live but in much misery”
* voluntary euthanasia is merciful and relieves suffering- it should be offered to animals and humans
John Stuart Mill and Euthanasia
if granting it does not diminish somebody else’s, then individuals should have full autonomy
* “Over himself, over his body and mind, the individual is sovereign”
* we expect control over our bodies in life, we should have the same in death
Jack Kevorkian
“the highest principle in medical ethics- in any kind of ethics -is personal autonomy, self determination”
* controversially helped 130 people to die
* filmed himself killing Thomas Youk, who had consented to this, and was sentenced to 10-25 years in prison
Palliative Care
the care of patients with a terminal illness, not with the intent of curing them, but to relieve their symptoms
* advocates of voluntary euthanasia would argue that euthanasia should be one option among many available for a competent adult
who is able to make their own decisions
Euthanasia happens despite being illegal
- 1994 British Medical Journal survey: some doctors already help patients die
- doctors can legally give pain relieving treatments in doses high enough to kill patients, they may also withdraw or withhold treatment
of brain dead or comatose patients - they may not help someone die at the patient’s request
- The Dying in Dignity group holds it would be more honest and safer if voluntary euthanasia was legal and regulated
- they argue there is no difference between withdrawing treatment and administering lethal injections
QOL and Euthanasia
- humans should be able to maintain their dignity until the ends of their lives
- this is not a matter of pain but of self respect
- if someone’s standard of living is such that they want to live no longer, they should be able to end their lives with assistance if necessary
- the quality of life worth living can only be determined by the patient
- control over life and death gives them dignity
Arguments against Euthanasia
- a request for death may be a cry for help, a desperate moment may make one feel they want death but it could pass
- Motives: any euthanasia process would have to have established the patient’s true intentions beyond reasonable doubt. Otherwise, there is
a risk of misinformed decisions. You can never be 100% sure of another persons intentions and they may be unable to give the informed
consent necessary to make a decision about the end of their life. - Mistakes: it is possible that a person is misdiagnosed and then euthanised. Prohibiting voluntary euthanasia prevents this.
- Abuse of the system: Jonathan Glover 1977 notes people who feel themselves to be burdens to their families sometimes commit suicide.
They could also be pressured into asking for assisted death by scheming relatives.
Jonathan Glover on Euthanasia
- stance concentrates on value of life
- example of two planets, one of which must be destroyed. On one grows a single vegetable; the other, nothing. Those who chose to save
the vegetable planet recognise life’s intrinsic value.
Harold Shipman
-was a GP who murdered dozens of elderly patients
-a voluntary euthanasia system could make this sort of crime even easier, allowing doctors to manipulate patients and documentation
