Please enable JavaScript.
Coggle requires JavaScript to display documents.
Euthanasia - Coggle Diagram
Euthanasia
Key ideas
Sanctity of life
- A belief in the value and sacredness of life that is shared amongst believers
- For Christians this value comes from being created in the image of God
- This makes it morally wrong to take life
Biblical support
- 'So God created mankind in his own image, in the image of God he created them' (Genesis) - God's divine image is what gives human life value
- 'You shall not murder' (Exodus) - the command against taking a life is one of the Ten Commandments
- 'The Lord gave, and the Lord has taken away' (Job) - only God has the right to decide when to give and take away life
- Catholics also place weight on natural law - the primary precept of preserving innocent life establishes the importance of the sanctity of life
- The Catholic Church has officially pronounced against euthanasia, particularly in the 1980 Declaration on Euthanasia
Sanctity of life remains a useful concept
- It upholds the intrinsic value of life in a culture where we increasingly dehumanise others through our interactions in the real world and online
- The sanctity of life ensures the basic human rights such as the right to life are respected, particularly in cases where those involved are not able to speak up for themselves
- Those who campaign against euthanasia worry about the potential of a slippery slope - that even some forms of euthanasia being permitted may lead to pressure being put on the vulnerable, such as the elderly or disabled - these people point to a similar decline in respect for life when abortion was legalised, campaigners against euthanasia worry about a growth in cases
Sanctity of life is no longer a useful concept
- Sanctity of life is a religious concept that is out of place in an increasingly secular society - it is estimated over 50% of people in the UK no longer believe in God
- The concept of sanctity of life seems to be at odds with people's autonomy in cases of voluntary euthanasia, where people who have sufficient mental capacity may request death
- Interpreting sanctity of life as saving life at all costs is self-defeating - it leads to people dying in horrible pain and does not ultimately treat human life with dignity and respect
- Sanctity of life demands that all life must be saved at all costs - but given medical and technological advances, we are now far better placed to know where treatment may lead to improvement and where it is pointless, we do not have to treat all people
Quality of life
- The quality of life principle takes the view that whether life is valuable depends on whether it is worth living
- Some thinkers argue quality of life requires characteristics such as happiness and freedom from pain, others argue quality of life can be found in possessing autonomy
Utilitarian Peter Singer argues for replacing the traditional sanctity of life ethics with five quality of life commandments:
- Recognise that the worth of human life varies
- Take responsibility for the consequences of your decisions (to save or end life)
- Respect a person's desire to live or die
- Bring children into the world only if they are wanted
- Do not discriminate on the basis of species
Autonomy and euthanasia
- Supporters of euthanasia appeal to the idea of autonomy - it seems to be a key aspect in determining our own lives that we have the ability to determine the time and manner of our own death
- In the case of voluntary euthanasia, this may appear straightforward, however Jonathon Glover has suggested several checks on whether someone should be assisted to die - this implies some external judgement as to the patient's quality of life as well as their mental state, if they are making the decision in a diminished mental state then they are not truly autonomous
- The issue of autonomy is more complicated in cases of non-voluntary euthanasia, particularly where a patient is in a persistent vegetative state (PVS), such as Tony Bland
- If the patient has given instructions about what their wishes would be if they were in such a case, such as a DNR or living will, then arguably their autonomy is being respected
- Where there are no explicit instructions, opponents of euthanasia worry that ending life may not only disregard the principle of the sanctity of life, but may also lead to a slippery slope where euthanasia is practiced more widely
People should have autonomy over their own lives and decisions
- Situation ethics supports the idea of autonomy - it is a key aspect of the idea of personalism that we allow individuals to make decisions about what is in their own interest
- Many of the arguments against autonomy are based on a religious notion of the sanctity of life, which becomes irrelevant if God does not exist - autonomy seems a more appropriate concept for an increasingly secular society
People should not have autonomy over their own lives and decisions
- Natural law would reject the view that autonomy is the most important consideration in issues such as euthanasia - life is viewed as God-given and preservation of life is one of the five primary precepts
- Autonomy is not a concept that is supported by the Bible - there are specific commandments against the taking of life, the idea being that the time of birth and death is something appointed by God
- Autonomy is a difficult concept to apply in a traumatic and stressful time - it is very difficult for someone in extreme physical or mental agony to have the clarity of thought to make good decisions about the end of their life - similarly in non-voluntary cases, particularly those involving vulnerable people, there is a risk of decisions being made that are not in the person's best interests as has happened with DNRs
Acts and omissions
The Hippocratic Oath
- Hippocrates stated that it would be wrong for a doctor to do something that would cause the death of a person
- However he also suggested that it is pointless to continue to treat those who are overcome by a disease and for whom medicine is pointless
- This distinction provides the background for the modern discussion of acts and omissions
- An act which causes death is morally and legally wrong but an omission - stopping treatment where it is prolonging an inevitable or increasing suffering - may not be morally wrong
James Rachels: Challenging acts and omissions
- James Rachels has offered a thought experiment to suggest that the distinction between actively killing and passively letting someone die may not be helpful:
- Smith will inherit a fortune if his young nephew dies, so he drowns his nephew in the bath and arranges the scene to look like an accident - the nephew's death is an act of Smith
- Jones will also inherit a fortune if his young nephew dies, as he enters the bathroom, he sees his nephew slip and slowly drown, he does nothing to save the nephew - the nephew's death is an 'omission'
- The traditional idea of acts and omissions says that Smith is guiltier than Jones - however Rachels argue that both cases are equally bad
- Rachels argue passive euthanasia by omission may even be crueler as the death may take longer
- Peter Singer has also challenged the distinction between acts and omissions by arguing that it is not always clear cut
- The removal of Tony Bland's feeding tube, or the turning of the dial that stops the nutrients, is in some senses an action even if the removal of food is an omission
Jonathon Glover: Ordinary and extraordinary means
- Jonathon Glover suggests that the distinction between acts and omissions may not be so clear cut
- This is because our actions and our omissions may involve ordinary and extraordinary means depending on whether the proposed treatment is something ordinary such as food and water, or whether it involves highly expensive medical technology which would be an extraordinary means
- Natural law would draw a distinction between acts and omissions - key to this theory is the intention of the agent who takes action
- While double effect may allow an act that leads to death, this is only in the context of this being an unintended consequence - the primary action is to relieve pain
- Situation ethics does not draw a great distinction between acts and omissions - it is pragmatic in its approach
- The consequences are the most significant aspect in ethics and the outcome does not significantly change whether someone's life is ended by an act or omission - their pain is relieved either way
- If anything, an act that leads to death may be quicker and kinder
There is a significant distinction between acts and omissions
- For natural law thinkers, actions matter - preserving innocent life rules out acts that directly lead to death, although the idea of double effect allows that some actions may lead to the death of an individual
- The distinction between acts and omissions takes seriously the issue of moral agency - if we were to allow active euthanasia, we would need doctors and other medical professionals to carry this out, this would conflict with the Hippocratic Oath and cause anxieties for those physicians who are involved
There is no significant distinction between acts and omissions
- Situation ethics challenges the distinction between acts and omissions - there are cases where agape requires the compassionate response of helping someone to end their life, whether this is by an act or an omission is not morally significant
- A teleological approach that focuses on reducing pain and suffering would favour euthanasia by whichever method was most helpful in alleviating suffering
- One practical difficulty is that withdrawal of treatment is often a lengthy process and leads to medical resources being allocated to those who will not recover - while it sounds harsh, allowing active euthanasia could speed up the inevitable process, therefore freeing resources to focus on those who may recover
- The idea of double effect is complex and not entirely coherent - if the negative consequence is foreseen then how can it truly be unintended?
Glover suggests there are at least five options with regard to euthanasia:
- Take all possible steps to preserve life
- Take all ordinary steps to preserve life but not use extraordinary means
- Not killing but taking no steps to preserve life
- An act which, while not intending to kill, has death as a possible foreseen consequence
- The deliberate act of killing
Applying natural law
- The key precept of natural law argues for the preservation of life - life is intrinsically valuable and should not be shortened, this logically leads to a secondary precept which would prohibit euthanasia
- Euthanasia could be thought of as an apparent good that would stand in contradiction of the real good of allowing life to continue its natural and God-given course
- Natural law is dependent on the divine law revealed by God - key texts such as the Ten Commandments and 'God gives and God takes away' (Job) seem to count against euthanasia
- It would be difficult for someone to claim they were worshipping God, one of the five primary precepts, if they were shortening someone's life
- It could be argued that the practice of euthanasia would undermine the stability of society - a society where life is not valued could not be an ordered society, eg people may fear hospital treatment
- Natural law draws a distinction between ordinary and extraordinary means - therefore an ill person is obliged to take treatment by ordinary means, such as food and water, but an extraordinary treatment which is risky and may not work could be refused
Natural law provides a good approach to euthanasia
- Natural law is committed to the sanctity of life - life is valuable regardless of anyone's judgement about its quality - therefore natural law avoids the potential for a slippery slope to occur when life becomes increasingly less significant
- Natural law prevents individuals from playing God and making decisions about the lives of others
- The idea of double effect provides some helpful flexibility in an otherwise rigid system - this allows pain relief to continue despite the frailty and vulnerability of the patient
Double effect and proportionalism
- The principle of double effect may allow pain relief, such as morphine, even though administering such a drug may shorten life
- This is acceptable provided the intention is to relieve pain and the shortening of life is an unintended secondary effect - however it is difficult to assess the intention of someone
- Proportionalists argue the rules of natural law can be broken if there is a significant and proportionate reason to make an exception
- Proportionalist Daniel Maguire argues that in some cases where biological life continues but personhood is greatly diminished, shortening the process of dying is not in itself wrong
- This approach is condemned by the Catholic Church but it is not radically different from the idea of double effect, and the issue of determining intention would also apply here
Natural law does not provide a good approach to euthanasia
- Natural law is overly religious and dependent on its Christian roots - euthanasia was often practiced in the ancient world prior to the dominance of Christianity - it would seem that euthanasia should be allowed nowadays given that we are in an increasingly secular society
- Natural law can be absolutist and legalistic - each person's situation is different, but the difficulty with natural law is that it insists on a common approach
- Natural law requires that individuals continue to live even when they are in extreme pain - a utilitarian would argue that the reduction of pain and a focus on the quality of life would be better than a natural law approach
- In addition to the rejection of quality of life, natural law does not place sufficient weight on human autonomy - this seems odd as surely the person concerned should be absolutely central to decisions about euthanasia
- It could be argued that double effect may in some ways be euthanasia by default, it relies on us knowing the intention of the doctor - this distinction is not always easy to see between euthanasia, which natural law rejects, and causing deaths as a secondary effect of pain relief
-
- Voluntary euthanasia: A person’s life is ended at their request or with their consent
- Non-voluntary euthanasia: A person’s life is ended without their consent but with the consent of someone representing their interests
- Active euthanasia: A treatment is given that directly causes the death of an individual
- Passive euthanasia: A treatment is withheld and this indirectly causes the death of an individual