condensed: euthanasia

problem of definition

the definition of euthanasia has implications about how we view life.

• suicide
• assisted suicide: own actions with help
• physician aided suicide: own actions with help from a doctor
• physician aid in dying: death is hastened but not directly caused by a doctor
• voluntary euthanasia: death caused directly by someone else with consent
• passive euthanasia: removal of life-sustaining treatment to allow natural death
• non-voluntary euthanasia: life is ended with consent of a relative or friend

law and euthanasia

1961 suicide act

suicide is not a criminal offence but still morally illicit. it had two clauses:

1. it is not a crime to commit suicide
2. however, a) a person who helps suicide will be prosecuted and b) if it is proved that they did it, they can be found guilty and go to prison

supports autonomy, but actually supports sanctity of life by criminalising assisted suicide. it does not support vitalism, that all life should be preserved at all costs.

right to self-determination

Diane Pretty was paralysed neck down with Motor Neurone Disease, and asked for assisted suicide.

her lawyers based the case on right to choose. it was rejected in european court of human rights because they support the right to live, not the right to die. she also did not have a life-threatening illness, so there was no dying to assist.

baby charlotte, however, was ordered a DNR if she fell comatose, against parents wishes, because it did not justify the medical assistance she was being given to stay alive. 

physician aid and slippery slope

there is confusion. people say there should be a new act to support physician aided dying. but there is a fear of a slippery slope, because this would permit non-terminal people to die too. some lawyers and philosophers argue:

• slide from actual illness to the fear of unbearable terminal illness.
• if quality of life judges, then those who do not request, or can’t, may be given it too.
• in Holland where it is legal, there is evidence that many die unwillingly. safeguards are difficult. but, Helga Kuhse argued that this argument is a scaremonger tactic, often quoting the nazi regime, she said that that was different because it was not in support of autonomy or mercy, and in holland their society has not gone into chaos. 

sanctity of life

there are many versions of sanctity of life. life is sacred given by god, but modern medicine makes it hard to draw a line where life is no longer worth living.

is weak sanctity of life just a quality of life argument? strong believers argue fiercely.

strong arguments against euth

in politics, pro-life. life is sacred because it has god-given soul. there are no reasons to end life from conception until natural death. 

• life is set apart by god: we are created in the image of god. we have a spark of divinity. the incarnation of jesus supports this: there is value in human life, otherwise jesus would have come as a sheep.
• gift from god: if god is the creator of life, he should be the terminator. only god can choose if we die. life is a gift.
• innocent life is to be respected: “do not murder” is part of the social glue between people. it is a command to choose life.
• life is to be loved and protected: love requires respect and protection of all humans.

according to this, euthanasia is always wrong. biblically, suicide is blasphemy because it rejects god’s gift. 

weak arguments against euth

killing an innocent person out of love is not morally equal to murder. no evil motive. in exceptional circumstances, it is an act of love. 

• no one has a duty to endure extreme pain
• life is a gift, not a burden: we should use this gift responsibly and dispose of it as we have free will to do. we are stewards of this life, so we are in control.

quality of life

an instrumentalist view of life: a life is only worthwhile if a person can do things to make it worth living. nothing good about being alive in itself. it has to have certain attributes to be valuable.

rejection of sanctity of life

peter singer argued this. a person’s ability to have desires and preferences gives priority to humans, not a soul. he has five new commandments:

• realise that the worth of life varies
• take responsibility for the outcome
• respect a person’s desire to live or die
• only have children if they are wanted
• do not discriminate species

he argued a severely defective child is less valuable compared with a dog. 

happiness as a basis

happiness should outweigh unhappiness. this is utilitarian.

• total happiness judgement: if you are in pain, your happiness get greater, so it is not worth it.
• average happiness: if average happiness is high, it is greater. but if that declines permanently, then it is less worth living.
• higher qualities: other standards are necessary for happiness, like memory, relating with people, reason, hope for future. if these are lacking, there is no quality of life. 

autonomy as a basis

the value of life comes from autonomy. John Stuart Mill developed the liberal principle: that humans are the best judge of their own happiness and should be given maximum freedom to live their lives. the problems here are:

• how is harm defined?
• if the person is not mentally sound, is it okay to interfere?
• allows for paternalism, to over-rule their autonomy.

consciousness as a basis

Jonathan Glover argues that being alive is not enough for life to be valuable. killing is not wrong if a person is not conscious. the body is an instrument to enable conscious experience. he supports non-voluntary for PVS patients.

but what about people with dementia or brain damage where consciousness is reduced?

voluntary euth

allowing death/cutting short life

some who argue against euthanasia permit exceptional circumstances, and others say cutting short a life is okay.

consequentialism

the outcome judges of good or bad. acts and omissions is the difference doing something immoral and not doing it. if a doctor stops giving life-saving drugs, he has allowed them to die. for a consequentialist, this refraining is still an act of helping death. both doing and not doing are immoral because the patient dies. 

deontology and doctrine of double effect

the importance of intention. the double effect is this; if an action has a good or evil outcome, they can perform if it:

• action is be good from outset, good effect intended, good effect is purposeful, good reason to permit chance of evil.
• primary intent may be to alleviate suffering, without intending to hasten death.

deontologists do not support euthanasia.

problems

• purity of intention: evil is evil but there is a difference between visiting a relative because you have to and because you want to, changes the action.
• ordinary and extraordinary means: extraordinary? if a person refuses food and water in order to die, they have committed a mortal sin. but if a person refuses surgery, it is within their rights because it is more than whats needed for bare existence. 
• a good person does not deserve to be punished for doing a good thing that turned out bad

non-voluntary euth

doctors cannot be expected to preserve a life at all costs. the issue with acting paternally is with what is the best interest for the patient. what would they say if they were able to?

vegetative state and defining death

if someone is brain dead, are they alive? in the past it was defined by heart beat. today people can be kept alive like this for ages, but it does not mean they are living. death is now defined as no brain activity. but this is hard to diagnose. the brain can function at very low levels to keep the body alive.

deciding patient’s best interests

life is not just a biological fact, it is a moral and evaluative judgement. dead donor rule is death of both brain and body. it must be viewed situationally.

application of theories

natural law

allowing someone to die is okay, cutting short a life is not.

• social stability: euthanasia and suicide undermines citizens maintaining laws. society has failed its duty of care.
• duty to god: primary duty is to god, failing to protect innocent life is not allowed. all forms of euth are wrong.
• no refusal of treatment: a sick person still needs food and water, not necessarily to prolong it. extraordinary treatment is not obligatory if success is not guaranteed, but ordinary is. 
• duty to respect innocent life: no one ceases to be a person. natural law sanctity of life: only self-defence is a reason to kill. a doctor has a duty to save life. 
• doctrine of double effect: only applies as a side fact of pain-relieving treatment and intention must be to help, not kill. 

situation ethics

in some cases it is wrong because it is not the most loving thing, but it is often compassionate to do so. “to justify one, suicide or mercy killing, is to justify the other”.

• pragmatism: each case judged according to its merits. using limited resources to keep a terminally ill patient alive at the cost of others is wrong.
• relativism: killing innocent people is not always wrong because you have to judge the situation. life is given to us to use wisely.
• positivism: no law that states life must be saved at all costs. laws and rules are for humane treatment of each other, this might mean allowing someone to die.
• personalism: respect for autonomy and integrity. their life may no longer to or value to them: respect this. humanity is more than biological existence.