Euthanasia

Question 1

suicide

assisted suicide

Answer 1

Suicide - when a person dies as a direct result of his or her own voluntary action.
Assisted Suicide - when a person dies as a direct result of his or her own voluntary action but with the help of another person. Different to voluntary euthanasia in that their condition does not have to be life threatening and they may have many reasons to want to die.

Question 2

active

passive euth

Answer 2

active - giving something

passive - taking something away

Question 3

voluntary
non voluntary
involuntary

Answer 3

Voluntary euthanasia - when another person at their request and with their consent directly causes a person’s death.

Involuntary euthanasia - where someone provides the mean to end someone else’s life where there is an expressed wish not to. E.g. Hitler used this on mentally disabled/Jews.
• Involuntary euthanasia is ‘like a child’s visit to the dentist, it is imposed for ‘his or her own good’ but against his or her wishes’ - Mel Thompson, Ethics

Non-voluntary euthanasia - when a person’s life is ended without their consent, but with the consent of someone representing their interests. E.g. a doctor may decide a person in a persistent vegetative state should have his/her life sustaining treatment removed.

Question 4

law

Answer 4

• Suicide was legalised in 1961 in the UK.
• One of the clauses specified assisted suicide should remain illegal, with euthanasia falling into that category.
• Passive euthanasia is only allowed in PVS situations, must be accompanied by legal proceedings.
• Legal to use the ‘law of double effect’.
o E.g. a cancer sufferer. They may be prescribed high doses of morphine to get rid of the pain, but the side effect may be hastened death.
• Hippocratic Oath is one of major reason why euthanasia is illegal:
o ‘I will give no deadly medicines to anyone if asked, nor suggest any such counsel’
o Must be taken by all doctors, euthanasia deemed a potential destruction of Dr/Patient relationship.

Question 5

self determination/autonomy - diane pretty

Answer 5

o Paralysed neck down with motor neurone disease, asked doctors to aid her in her suicide.
o Lawyers presented the case based on right to self-determination.
o Argued under the Human Rights Act, 1998.
o Case taken to European Court of Human Rights, they concluded that although the law recognises the right to life, it does not consider in its corollary the right to die.

Question 6

self determination - baby charlotte

Answer 6

• Baby Charlotte, 2005
o Born prematurely with severe brain damage.
o High Court ordered the doctors to not resuscitate her if she fell into a coma as they claimed her underlying condition did not justify the medical assistance she was being given to stay alive.
o Suggests a limit to the idea that life is sacred.

Question 7

slippery slope argument

Answer 7

John Haldane and Alasdair MacIntyre, who argue:
• Supporters of the Bill slide between a condition of actual unbearable suffering and merely the fear of the suffering etc.
• If quality of life is grounds for euthanasia for those who request it, this could be extended to those who don’t request it e.g. Hitler and the mentally disabled.
• Many in euthanasia-legalised countries die against their wishes and purely due to pressure they feel etc. How do we prevent this?

Question 8

criticisms of slippery slope argument

Answer 8

• Helga Kuhse challenged the slippery slope argument, stating that it is used by scaremongers to support the complete ban of euthanasia.
• The most frequently used example to support the slippery slope argument is that of the Nazi practice of euthanasia during the Holocaust as a form of eugenics to ‘improve society.
• Kuhse argues that ‘the motivation behind these killings was neither mercy nor respect for autonomy; it was, rather, radical prejudice and the belief that the racial purity of the Volk required the elimination of certain individuals and groups’.
• She also states that there is a ‘social experiment’ going on in the Netherlands concerning active, voluntary euthanasia and that there is ‘no evidence’ this has sent the Dutch society down a ‘slippery slope’.

Question 9

sanctity of life - origins

Answer 9

• Based on the idea that there is a supreme value to human life.
• Religious origins of Sanctity of Life
o Genesis 1:27 – Imago dei
• Human features set us apart from other creatures, we possess similar aspects to God e.g. ability to love, sentient ability.
• We are rational beings.
• Incarnation reaffirms the intrinsic value of every human life in its relationship with God.

o Old Testament
• Highlights specialness in humanity
• God makes covenants with mankind, giving human obligation. Gives us divine purpose and design, distinguishes human.
• Genesis highlights human’ dominion over creation

Question 10

sanctity of life - xian thinkers and JC

Answer 10

• Lactanius (240-320AD) said God has made humankind as a sacred animal and so human kind has dignity.

o Creation and Jesus
• Teachings about God’s purpose in creating the world as well as purpose of Jesus coming to die for humanity highlights worth of humanity.

Question 11

strong sanctity of life - life is set apart from god and is a gift from god

Answer 11

• Life is set apart by God
o Imago dei and sensus divinitatis
o Genesis 1:27
• Life is a gift from God an is on loan to humans
o God should determine when life ends as he is the author of life
o Job 1:21(‘naked I came from my mother’s womb, and naked shall I return there’)
o Accepting euthanasia is to undermine sanctity of life by developing a ‘culture of death’ (Pope John Paul II)

Question 12

strong sanctity of life - bible

Answer 12

• Should always respect innocent life
o No murder is against 10 Commandments and social glue.
o Deuteronomy 30:19-20 commands us to ‘choose life’
• Life must be loved and protected
o Parable of Good Samaritan (Luke 10:29-37) shows we must protect all humans.
• 1 Corinthians 6:19 - Refers to the body as a temple of the Holy Spirit.

Question 13

weak sanctity of life - bible

Answer 13

• No one has a duty to endure a life of extreme pain
• Life is a gift not a burden
o Humans are owners of God’s gift of life; it is up to them as good stewards of this life (Genesis 1:28) to decide when to end it.

Question 14

weak sanctity of life - singer

Answer 14

• We put down animals that are in pain, why are humans different? (Singer)
• The value of human life depends on a person’s ability to have desires/preferences, not a soul etc. (Singer and John Locke)

Question 15

weak sanctity of life - random

Answer 15

• Killing a person out of love is not morally equivalent to murder.
• Murder implies an ulterior motive, euthanasia can imply kindness so is not the same and not always wrong.
• It does not take any consideration of the quality of the person’s life.
• It seems cruel and against the idea of a God of love to force a person in PVS to continue ‘living’
• It is only due to the rise in technological advances that we have been able to keep such people alive
• It is hard to uphold SofL when we cannot truly call someone in PVS alive.
• Double effect arguably goes against sanctity of life, as does DNRs, war (including holy wars) and suicide.

Question 16

singer - quality of life, 5 principles

Answer 16

• Human life does not have intrinsic value; it is only valuable when it has usage/qualities attached to it.
• Peter Singer outlines 5 quality of life principles to replace SofL
1. Recognise that the worth of human life varies (not intrinsic)
2. Take responsibility for the consequences of your decision
3. Respect a person’s desire to live/die (autonomy)
4. Bring children into the world only if they are wanted
5. Do not discriminate on the basis of species (all sentient beings)

Question 17

factors that lead to QofL argument

Answer 17

o	Fear
•	Fear of death
•	Fear of loss of control
•	Fear of loss of body use/speech
o	Dignity
•	Reliant on others for everyday personal things
o	Control
•	Having none
•	Being taken advantage of
•	Wanting control over death itself
o	Burden
•	Guilt
•	Everyone looking after you
•	Drain on people and resources

Question 18

quality of life - personhood: greeks

Answer 18

• Zoe – spiritual life
• Psuche – psychological life
• Bios – physical life
seeking to distinguish between human bodies which are alive despite having lost key features of humanity and those who have them and thus, whose life should be preserved

Question 19

quality of life - personhood: glover

Answer 19

o Jonathan Glover argues being alive is not sufficient for life to be valuable.
• Supports non-voluntary euthanasia for PVS patients.
• However…
• What about cases such as brain damage and Alzheimer’s? Limited consciousness, should they be euthanasia?

Question 20

quality of life - personhood: locke

Answer 20

• A person is someone who has an ability to think and reflect
• May rule out people in PVS
• Sentience includes the principle of reciprocity, should be able to give and take in a relationship

Question 21

quality of life - personhood: selling and fletcher

Answer 21

• A person is one who is able to relate to other and has moral standing (Selling)
• Fletcher includes a variety of characteristics such as self control and self awareness

Question 22

quality of life - autonomy: JS Mill

Answer 22

• Developed the liberal principle.
• Individuals should have full autonomy in matters that do not concern others.
• ‘His independence is, of right, absolute. Over himself, over his body and mind, the individual is sovereign’.

Question 23

quality of life - autonomy: kung

Answer 23

• ‘As a Christian and theologian, I am convinced that the all-merciful God, who has given men and women freedom and responsibility for their lives, has also left to dying people the responsibility for making a conscientious decision about the manner and time of their deaths’.

i. e. - we have free will, should be able to decide death
- god has given us freedom and responsibility for our own lives inc. conscientious decision about manner and time of deaths

Question 24

criticisms of quality of life

Answer 24

• It does not accept the special nature of humanity
• It is a relativist concept and we all have different ideas about what constitutes a good QofL. Could lead to slippery slope argument. If you allow euthanasia for people in PVS etc. then surely you could use it for disabled people?
• QofL can vary day to day. Cannot be sure how one will cope with an illness.
• People may feel pressured to request an early death.
• Some argue that doctors should not ‘play God’
• Could ruin Dr/Patient relationship.

Question 25

consequentialism

Answer 25

* Reject the distinction made by deontologists between acts and omissions. * The acts and omissions principle distinguishes between willing to do x and omitting to do x. They believe failing to give a patient life-preserving drugs and allowing him to die is morally equivalent to giving a patient drugs which hasten death if both actions have the same outcome of the death of the patient. * Whilst they claim to just judge the outcome, they do assume there are some significant non-consequential factors e.g. the duties of the doctor to be responsible for its patients.

Question 26

double effect

Answer 26

• A person may morally perform an act that will produce good and evil if: o The action in itself from the outset is good o The good effect and not the evil is intended o The good effect is not produced by means of the evil effect o There is proportionately good reason to permit the evil effect

Question 27

double effect e.g. jodie and mary

Answer 27

o Doctors wanted to save the life of Jodie, a morally good action. o The death of Mary was a bad consequence of saving Jodie but it was not the means; it was a foreseen but unintended by-product of saving Jodie. o The doctors intended to save the life of Jodie; it was not to kill Mary. o Saving the life of Jodie is morally as significant as the death of Mary.

Question 28

double effect vs consequentialism: purity of intention

Answer 28

C: • An evil act is an evil act, no matter what the intention. • Deceit can degrade an apparent act of kindness e.g. child visiting grandparent because he wants to vs. has to. DE • A good intention can justify an act.

Question 29

double effect vs consequentialism: arbitrariness

Answer 29

C • Argue against deontological viewpoint by stating life is not that simple. DE • Distinguish between intended foreseen effects and unintended foreseen effects. • It is logically possible to have prior intentions.

Question 30

double effect vs consequentialism: ordinary vs. extraordinary means

Answer 30

C • View deontologist argument as leading to more suffering and loss of dignity over what ‘extraordinary’ means. DE • Believe that it is wrong to directly kill.

Question 31

double effect vs consequentialism: proportionality and rofl

Answer 31

C • If prolonging life brings about disproportionate suffering, then surely the deontologist should permit direct killing? DE • Argue that outcomes are important, but that the consequentialist underestimates the importance of means the very subjective nature of quality-adjusted life year (takes into account the quantity and quality of life generated by healthcare interventions). Who decided what constitutes a worthwhile life?

Question 32

natural law and euth: 4 types of law and 5 primary precepts

Answer 32

``` • 4 Types of Law o Eternal law o Divine law – scripture and revelation against euthanasia o Natural law o Human law ``` • 5 Primary Precepts o Ordered society → slippery slope. Can lead to euthanasia on demand. Pressures, confusion over duty of doctor o Preserve life - Focus for euthanasia. Augustine and Aquinas argue suicide is a failure of one’s duty to protect innocent life. (H, is bad quality of life a life at all?) o Reproduce o Education o Worship God, euth is worshipping yourself

Question 33

overall natural law and euth

Answer 33

• NL is focused on doing morally good actions and avoiding evil, means it is deontological. • By doing this, you will fulfil God’s plan and purpose. o Primary precepts are all in line with divine law and the purpose of human life as part of God’s plan. o Catholics believe the purpose is to live a loving life. Euthanasia ends the possibility of love and pursuing any other precepts, it rejects God. use of reason will mean that human laws cannot allow euthanasia. euthanasia is an apparent good, not a real good

Question 34

RCC on euth

Answer 34

o Euthanasia is wrong, life is sacred and gift from God, ‘which they are called upon to preserve and make fruitful’ (Declaration on Euthanasia, 1980) o ‘Such an action on the part of a person is to be considered as a rejection of God’s sovereignty and loving plan’ (Declaration on Euthanasia, 1980) o Deem euthanasia an apparent good/short term good, does not lead to flourishing as it only considers the individual, not the society as Aquinas emphasised. Slippery slope can lead to undermine order in society and value of human life (eudaimonia is aim for society). o Make a distinction between killing and letting die in exceptional circumstances when treatment is futile. Burdensome treatment should not be offered at the end of a person’s futile life. • Everyone has a duty to lead his or her life in accordance with God’s plan. (Sacred Congregation for the Doctrine of the Faith, Vatican 1980)

Question 35

criticism of RCC on euth

Answer 35

* NL assumes human life has reason and the higher capacities associated with human life. * If someone is brain dead/in a permanent coma, they are no longer able to fulfil their purpose and no longer have defining characteristics of personhood. * What is difference between active euth and letting someone die? James Rachels highlights how ‘the decision to let a patient die is subject to moral appraisal in the same way that a decision to kill him would be subject to moral appraisal’. * However… euthanasia could stop another person from pursuing their purpose…

Question 36

NL on ruth: interior vs exterior

Answer 36

o Acting in a good way for the wrong reason is to perform a good exterior act but a bad interior act. o E.g. helping an old lady cross the road (good exterior act) to impress someone (bad interior act) is wrong. o It should be done out of charity, not for the sake of admiration of others.

Question 37

NL on euth: double effect

Answer 37

o Intention is not to kill o Aim is to end life, means good death/mercy killing o It may have good secondary implications of relief of suffering but we must focus on the intention. o Palliative care involves double effect. The primary purpose is palliative care but the secondary effect is shortening life.

Question 38

SE and euth, general

Answer 38

* Fletcher served as the president of the Euthanasia Society of America from 1974-76. * Combines consequentialist ideas and the weak sanctity of life principle. * There will be some occasions where euthanasia is wrong because it is not the most loving thing to do and others when it is compassionate and just. * Fletcher refers to euthanasia as death control, like birth control, and saw it as a matter of dignity. His views are based on autonomy, rejects NL approach to medical care. * ‘Indeed, to justify one, suicide or mercy killing, is to justify the other’ – (Fletcher, Humanhood: Essays in Biomedical Ethics)

Question 39

SE and euth: factors that shape view

Answer 39

1. Rejects legalistic approach to moral-decision making. All about the experience of the person involved and all those affected in that situation – links to QofL. 2. Agape – unconditional love in the service of others e.g. Simon Binner and Diane Pretty case.

Question 40

SE and euth: human criteria

Answer 40

• Fletcher identifies positive human criteria to judge if a human is a purpose: o Minimal intelligence – IQ of 20/40 o Self awareness and self control o Sense of the passage of time – future/past o Concern for others o Communication o Control of existence o Curiosity o The possibility of change o However… what does it mean for the mentally ill?

Question 41

SE and euth: working principles

Answer 41

o Pragmatism • Must examine each case according to its merits, no intrinsic laws which prohibit euthanasia • Unjustifiable to use limited resources to keep a terminally ill patient alive at the expense of other parents’ welfare o Relativism • No absolutes, must apply agape to each case, judge according to love and compassion. • Weak sanctity of life – life is given to us to use wisely o Positivism • There is no law which states life must be preserved at all costs, laws invented by humans. • Want to treat one another humanely, may involve allowing someone to die (passive euth) or helping them shorten their life (voluntary active euth) o Personalism • Must respect people’s autonomy and integrity • Humanity is more significant than mere biological existence • ‘It is harder to justify letting someone die a slow and ugly death, dehumanised than it is to justify helping him escape from such misery’.

Question 42

quality of life: personhood - Mary Anne warren

Answer 42

- feel pain and consciousness - ability to reason - act beyond instinct - complex communication - sense of self

Question 43

self determination/autonomy - Simon binner

Answer 43

Binner, 57, was diagnosed with aggressive motor neurone disease in January 2015 His wife was against euthanasia, but Binner chose to end his life at a clinic in Basel, Switzerland, in October 2015. I won’t join any campaign or celebrate his “choice”. But I will not condemn anyone for making the same one. - his wife

Question 44

e.g. tony nicklinson

Answer 44

he 58-year-old was paralysed from the neck down after suffering a stroke in 2005 and described his life as a "living nightmare". He lost his High Court case to allow doctors to end his life. "I am saddened that the law wants to condemn me to a life of increasing indignity and misery." Mr Nicklinson's family solicitor said that he refused food and consequently, died.

Question 45

criticisms of current law

Answer 45

o However... • Could chemo not be deemed deadly medicine? • Increasing demand for the legalisation of euthanasia in the UK o Works efficiently in several Scandinavian countries o In a poll in 2007, 82% of the GB population agreed euthanasia should be legalised.

Question 46

which theories do you apply to euthanasia

Answer 46

situation ethics | natural law