What is the sanctity of life and what is its relevance to the modern world?
o The Sanctity of life is seen as the most precious gift of a human being. This may be grounded in religious teachings (that human beings are created in the image and likeness of God), or in an observation about the qualities of human life (humans are rational free beings), or both.
o Jewish and Christian traditions emphasise the preciousness of human life with the idea of the sanctity of life, the idea that humans are made in the image and likeness of God. This sanctity means that human life shouldn’t be sacrificed.
o The concept that life is sacred is important to those who are opposed to euthanasia and is often associated with religious beliefs about the preservation of ending life before its natural end.
o Preserving the sanctity of life may be a matter of obedience to religious authority.
Discussions about the sanctity of life are centred on a number of associated ideas:
–That life taking is wrong in religion as it’s too precious and untouchable.
–That in taking one life other human lives are endangered as the status of life is undermined.
–That with life there are always unexpected possibilities which end once life is gone.
–That once the ending of life is justifiable, life is undermined in a societal sense- once euthanasia is countenanced, elderly patients may fear hospitals as places where people can choose death for them. It sets a potentially destructive precedent that gives someone else authority to end another person’s life.
o However some argue that taking a life is arguably a moral thing to do, the lesser of two evils, a necessary act to protect a greater number of lives. Some people are required to give up their lives for the good of theirs- such as soldiers fighting to protect their country.
What is the quality of life?
o Jewish and Christian traditions emphasise the preciousness of human life with the idea of the sanctity of life, the idea that humans are made in the image and likeness of God, and the idea that God has a divine destiny for human lives.
o The Greek physician Hippocrates may have been the originator of the Hippocratic Oath, but he seems to have been in favour of a form of euthanasia in cases of incurable patients.
o He suggested a doctor should ‘refuse to treat those who are overmastered by their disease realizing that in such cases, medicine is powerless’.
o There are a few Christians who supports euthanasia, such as Joseph Fletcher, but a key non-religious argument is that euthanasia has traditionally been prohibited on supernatural grounds related to the afterlife, something about which we can know nothing for certain, and therefore something that people reasonably hold different beliefs about.
What is personhood?
–The extent to which a life has some quality about its often linked to the extent to which there is a personhood. If the human body is living but many or most of the higher functions are missing, should the body continue to be considered a moral person of worth as much as someone who is healthy?
–The idea of personhood seeks to distinguish between human bodies which are still living despite the loss of the key defining features of humanity and human beings which we should preserve as they retain such features. Personhood is usually linked to capacities.
The permanent loss of the awareness of self and others and of the world could justify euthanasia.
–Technology today allows the extraordinary continuation of life but it could be wrong to perpetuate such a life against all odds. Switching off life support machines isn’t considered euthanasia in most cases today. But, there remains a question around who decides on the definition of personhood and how reliable the assessment of personhood might be. A wrong decision might lead to the death of someone about to recover.
What is the autonomy and the right to die?
- -A person facing an incurable deteriorating illness has the option of taking their own life, but to do so they would lose what time they had left with some quality of life.
- -John Stuart Mill argued that in matter’s that don’t concern others, individuals should have full autonomy. We expect to have control over our bodies in matter of life, and supporters of euthanasia say it should be the same I matters of death.
- -Advocates of euthanasia argue that true autonomy is having the right to choose the time and way you die. The loss of freedom and autonomy might lock them into a situation where they can no longer act as they wish, to finish life, deprived of the ‘dignity’ of their own choices of a good death.
- -Opponents of euthanasia argue that autonomous ‘right to die’ could become an indirect threat to others, especially those with low self-esteem as they may see themselves as a burden. Freedom come with reasonable limitations and responsibilities; the right to free speech doesn’t permit inciting violence. If freedom puts others in danger, then it’s restricted. The right to die might lead to improper harm for others- it might make it easier for bad people to get rid of elderly relatives. There are already cases where doctors use their power to end a life against a person’s will.
What is voluntary euthanasia?
o Voluntary euthanasia is when a person’s life is ended painlessly by a third party at their own request.
o Hippocrates wrote ‘I will not prescribe a deadly drug to please someone, not give advice that may cause his death’. The Hippocratic Oath has informed the ethical code of doctors. Killing a patient seems opposed to do what a doctor should do. A doctor should heal and assist people in living a healthy life.
o Jonathan Glover (‘Causing deaths and saving lives’, 1977) suggests several factors that should be considered before deciding what to do when faced with a request:
1. The helper should be convinced the decision is serious: properly thought through and not the result of a temporary state.
2. The helper should think the decision is reasonable. If a person says their life isn’t worth living but the helper thinks it’s, this needs further discussion before a decision is made.
3. The circumstances in which the request comes need considering. Are they liable to change or will unaided suicide never be possible?
o Glover says, “to refuse to provide help is a very serious denial of the person’s autonomy over the matter of his own life and death, and is only to be justified by appealing to either the future of his life or to side effects” (Glover, causing Deaths and Saving Lives, 1977).
o Glover questioned whether we can reliably know how committed a person is to such a request, given their pain. He suggests it may not be possible to ever be really sure what a person truly wants in a neutral sense.
o Voluntary euthanasia is often a focus of campaigns for legal change, particularly by those who believe it should be something that people may be assisted with, with some medical support as an alternative to the more violent and unreliable methods available to a person who commits suicide without access to medical expertise.
o There are three common reasons given for not permitting voluntary euthanasia, which Glover calls side effects:
1. Allowing voluntary euthanasia could lead to involuntary euthanasia, as in the situation in Nazi Germany when people were ‘euthanatized’ (murdered) if they had serious illnesses or disabilities.
2. Allowing voluntary euthanasia would lead to people being discouraged from going to hospital for treatment.
3. Allowing voluntary euthanasia would detrimentally affect end-of-life palliative care as the focus would switch to decisions about ending life, not comforting the patient.
o He rejects all three however, he suggests the Nazi policy didn’t come from a voluntary euthanasia campaign but an evil ideology that devalues certain people’s lives. He argues that we don’t know how people would behave so can’t assume they would fear going to hospital, and he suggests that it’s unlikely that thoughts about ending a life would detract from comforting a person.
o He concludes that while voluntary euthanasia may be morally permissible in principle, this should be subject to the side effects-what actually happens as a result.
What is non-voluntary euthanasia?
o Non-voluntary euthanasia is euthanasia without request. A person is unable to ask to die and another person acts to end their life on their own behalf.
o Glover distinguishes non-voluntary euthanasia from involuntary euthanasia. With involuntary euthanasia a person is killed against their wishes, such as when disabled people were killed by Nazi doctors- this is regarded as murder. Non-voluntary euthanasia should be in the interest of the person who dies, and not anyone else.
o An issue for non-voluntary euthanasia is who decides that euthanasia should be carried out- family members or doctors? Another issue is whether the state reached is definitely irreversible, or whether there might have been an unexpected or miraculous change in condition where death isn’t chosen. Some argue euthanasia is a decision of defeat which shouldn’t be taken.
o The ‘slippery slope’ argument, in the context of euthanasia, is about unintended consequences that might happen if a course of action is followed. Can we be sure that mistakes will not occur? Suppose that someone chooses death as they’ve been diagnosed with a fatal, painful and incurable illness. Then, after the person has died it becomes apparent the diagnosis was wrong. Once death has occurred there is no going back. Whilst life remain that are always possibilities.
What is Aquinas’ natural law approach?
- -Aquinas’ natural law thinking is concerned with morally good actions and the goodness of those actions is determined by the extent to which they accord with the eternal law, a law with a higher authority, and a process of reasoning helps determine what’s right and wrong.
- -Natural law thinking is concerned not simply with the physical body, but the whole person and their ultimate end, which Aquinas would understand to be linked to God’s ultimate plan for the person and Heaven.
- -The Catholic Church thus concludes euthanasia is wrong as life is sacred and a gift from God ‘which they are called upon to preserve and make fruitful’ (Declaration on Euthanasia, 1980).
- -The taking of life through euthanasia disobeys divine law. The end of life also ends the possibility of that person bringing love into this world, or love being brought by others in response to that person. It ends the possibility of pursing any other precepts: to educate, live in a community, reproduce, and to worship God. To take a life according to the Catholic Church, opposes God’s love for that person, and rejects the duty of a person to live life according to God’s plan.
- -Natural law thinking explains euthanasia is an apparent good that seems to relieve good which is related to the intrinsic nature of life, which in Christian thought is related to the person’s place in the mystery of God’s greater plan, which includes the people around the person, wider society and life in Heaven.
- -The doctrine of double effect could consider palliative care as the principle purpose, even though as a secondary effect, life ends sooner than otherwise. The intention is not to kill, or to give a person power to end their life, but rather to relieve pain through reasonable means.
- -But there are different circumstances where humans might not be the sort of person natural law assumes. E.g. if the being has none of the higher capacities associated with a human life-decision making, reasoning and so on; such as in the case of a brain dead or permanent coma, then might it be considered that this body should no longer be considered in the same way? They no longer have the capacities to fulfil their purpose, no longer have the defining characteristics of personhood. This might form the basis of a justification for euthanasia. Vague
What is Fletcher’s situation ethics and euthanasia?
o Fletcher’s situation ethics rejects legalistic approaches to moral decision making. It’s grounded in the situation, the experience of the person involved and all those affected in that situation. It’s also grounded in love, and more specifically an unconditional (and non-romantic) love that is for, or in the service of others.
o It’s the situation of the person that ethics start from according to Fletcher.
o Joseph Fletcher served as president of the Euthanasia Society of America. He expressed many of his ideas in his book- ‘Moral and Medicine’. In this book he specifically sets out to argue that there were no absolute moral standards to guide medical treatment, that the ethical thing to do was always guided by the patient’s condition and situation.
o He argues that the usual rules about ‘do not kill’ are not the place to start when making a moral decision.
o For Fletcher (‘Situation ethics’, 1966) the question of the quality of life was more important than the sanctity of life. If a person loses most of their human features, Fletcher argues that it could be considered compassionate to aid a person to end their own life. It could be considered moral to end the life of a being that’s not considered a human person.
Does the religious concept of the sanctity of life have any meaning in twenty-first century medical ethics?
- -The absolute ban on taking life that ancient religions have left us precludes the medical science we now have, the ability to know with confidence when life can be saved and when death is inevitable, and the knowledge we have that our body might continue to survive even when consciousness has gone forever, as when a person is in a vegetative state.
- -Arguably, the absolute sanctity of life seems based on outdated knowledge and practices. Perhaps the religious concept of sanctity fails to adapt the new medical technologies that enable life to be prolonged.
- -But medical science has it limits. Doctors who are experts in palliative care find it difficult to predict when death is inevitable. Death may be extremely likely but there can be considerable uncertainty about time frames. Patients sometimes recover, even if just for a time, when its least expected.
- -Outside of religion, there are also social taboos to protect life. Modern thought has led us to conclude that all life matters far more than in ancient times. The advent of ideas like democracy and modern notions of dignity and equality, as found in the UN Declaration of Human Rights, are an attempt to affirm all lives.
- -Sanctity as concept is universally appreciated, as the basic urge to respect all life has meaning worldwide. You don’t necessarily need to believe in God or a divine purpose to feel strongly that everyday life can have meaning and should be respected, recognised and protected.
Should a person have complete autonomy over their own life and the decisions made about it?
- -Atheists argue that if autonomy is important throughout life, then it’s also important towards the end of our life too.
- -Critics disagree with this ‘free decision-making’ notion. Such experiences often overwhelm people emotionally to the degree that the rational decisions-making bound up with autonomy is no longer meaningful. Perhaps when advocates of euthanasia talk about choosing the end-of-life circumstances, they really meaning allowing desperate people to make desperate decisions, not free ones.
- -The outcome of euthanasia is also important because if it became a cultural norm. Will such culture cause fear among the elderly and vulnerable? Will it create a risk that the process that permit death will be in danger of abuse or misuse? Rights insure duties on others to enable those rights and the duty to help those who wish for death could be morally difficult to justify, although conscience clauses might work here in the way that they do for issues like abortion. Freedom to be euthanized raises questions about the nature of freedom and rights. Perhaps one person’s freedom becomes another’s duty. Perhaps individual freedom is, in truth, an illusion in that our choices about ourselves have impacts on others.
