End of life

• what is the definition of euthanasia

  - comes from Greek, 'eu' = easy and 'thanatos' = death

  - the deliberate ending of the life of one person by another in order to end suffering

  - also known as 'mercy killing'

  - the campaign for euthanasia is 'death with dignity
• what is voluntary euthanasia


  - the patient makes a choice to die, either during illness or in the form of a living will

  - fully consensual
• why do people want to seek euthanasia

  in most cases the person has a terminal illness where suffering and loss of quality of life and dignity will occur
• what is non-voluntary euthanasia

  - the patients life is ended without their consent

  - person who represents them, e.g. relative, partners, doctors agree to have their life support removed
• what are the 2 ways euthanasia can be brought about

  active - actively administering something, e.g. a lethal injection (intention not to kill, but to ease pain, however results in death)

  passive - witholding life-sustaining treatment
• what is the law like on euthanasia

  Suicide Act 1961:

  - made suicide legal for the first time

  - but made euthanasia (assisted suicide) illegal

  - you can face a murder charge for euthanasia and even aiding/counselling someone in committing suicide
• what are some case studies of euthanasia

  Charlie Gard - an 11 month old baby with a rare genetic condition. the doctors said he had such a slim chance of recovery that they couldn't do much more but keep him alive with a ventilator and feeding tube. his parents were prevented from removing him from the hospital to take him to the US for experimental treatment

  
  

  Diane Pretty - had motor neurone disease and was terrified of dying from choking so asked the european court of human rights if her husband could aid in her death. she was denied due to fear of a slippery slope and died the way she was afraid to
• outline the strong sanctity of life argument

  - taken by vitalists = believe human life is always sacred as it possesses a God-given soul and there are no means which justify termination of human life

  - we are created in God's image and possess a 'spark of divinity'

  - life is a gift from God, and only he can give and take life (Job 1 'the Lord gave and the Lord has taken away)

  - command in Deuteronomy to 'choose life'

  - goes against 10 commandments

  - suicide is blasphemy because it's a deliberate rejection of God's gift and rejects the redemption over death through Christ's resurrection
• what is the weak sanctity of life argument adopted by some Christians

  - killing an innocent person out of love is not murder

  - no one has a duty to endure a life of extreme pain

  - life is a gift and not a burden; it wouldn't be a gift if the giver still had ownership, so we must use it responsibly but can dispose of it when we wish
• what is the doctrine of double effect as a compromise/loophole of NML

  if doing something morally good has a morally bad side-effect, it's ethically ok to do it providing the bad side-effect wasn't intended, e.g. giving a lethal series of morphine injections to ease pain
• what is the acts and omissions distinction


  there is a difference between actively bringing about a death and simply omitting to act to prevent its happening, e.g. giving a lethal injection is worse than not giving life support at all
• what is the quality of life argument

  - instrumentalist view of life; life is only worthwhile if it can fulfil those things which makes life worth living and there's nothing intrinsically good about being alive

  - can be measured using total happiness, average happiness or the higher qualities judgement (person's quality of life judged by certain minimum standards necessary to have a happy life, e.g. memory)

  - if these quality of life criterion are not permitted, the person has the right to die as their life is no longer worth living
• what is the utilitarian view on euthanasia

  Act Utility:

  - a persons happiness should outweigh their pain and suffering

  - adopt quality of life principle

  - weigh up consequences in each situation (for family also)

  Rule Utility:

  - would probably reject active euthanasia as if it was widely adopted, would undermine rule not to kill and also would breach the harm principle

  - however, Mill was an advocate of liberty, and one could argue that taking your life is a matter of personal autonomy
• what is the slippery slope argument and some arguments against it

  - what begins as a legitimate reason to end someone's life will also permit non-lethal conditions

  - MacIntyre and Haldane argued there would be a slide between actual unbearable suffering and fear of discomfort and loss of dignity. Also if QOL is grounds for those who request euthanasia, could also extend to those who don't request it. could lead to eugenics, e.g. Nazi's killing of Jews justified as 'improving society'

  - however it's courts jobs to work out laws and prevent the slippery slope, and in places there it's legal (e.g. Netherlands) there is no evidence of this occurring (Helga Kuhse)
• what are some criticisms on the utilitarian view of euthanasia

  - problems with the Hedonic calculus for act utility (emotions are unquantifiable)

  - no guaranteed outcome

  - people can make recoveries and resume quality of life
• what is Singer's argument against sanctity of life

  - argues we should focus on the quality of life not the sanctity

  - the value of life depends on a person's ability to have desires and preferences (sentience)

  - sets out quality of life commandments, for example: the worth of human life varies, respecting a persons desire to live or die, not discriminating on the basis of species and taking responsibility for the consequences of decisions
• what is the deontological view of euthanasia and a criticism


  - suicide breaks the perfect duty to the self

  - suicide breaches the categorical imperative as you're treating yourself as a means to and end and wouldn't want it to be universalized (wouldn't want everyone who wanted to die to be able to)

  - action based, so active euthanasia and passive euthanasia would not be permitted, as there are parts of passive euthanasia which are active (e.g. switching off life support machine)

  - however could argue rationality gives dignity to humans, and if they lose it, they may request euthanasia

  - no guidance on those who are no longer rational
• what is the view of virtue ethics on euthanasia and some criticisms

  - no explicit stance on euthanasia

  - based on flourishing and eudaimonia, could argue that avoiding extreme indignity associated with terminal illness is flourishing compared to what would happen if you let nature take its course

  - no distinction made between type of euthanasia as long as it's done virtuously

  - patients must have courage, wisdom, pride and friendship

  - advocate tough procedures to avoid slippery slope

  - however clashes between virtues might make a decision impossible (e.g. courage to die but compassion for those who don't want you to) and doesn't advise on right time for euthanasia
• what is the natural law/RCC stance on euthanasia, and the view on ordinary and extraordinary means and some criticisms

  - goes against precept to live and protect the innocent and live in an ordered society (as not all members have been protected)

  - you're not able to refuse ordinary treatment (e.g. food and water) but you are able to refuse extraordinary treatment (e.g. chemotherapy)

  - suicide is not fulfilling your telos or worshipping God as your creator

  - however doctrine of double effect in some circumstances may provide a loophole

  - based on alleged existence of God and Biblical authority (sanctity of life principles) and difference between intending and forseeing is too slim
• what is the situationist stance on euthanasia

  - in some circumstances, euthanasia may be the most loving thing to do (relativism)

  - personalism (people over the rules)

  - pragmatism: passive euthanasia justified as being most compassionate action and best use of resources
• what is the moral autonomy argument


  - the value of life is when we can self-rule and be autonomous

  - for life to be valuable it has to be conscious
• what are further arguments against euthanasia

  - medical science may find a cure for terminal illness

  - hospice movement: palliative care as an alternative (specialised medical care for the terminally ill and their families, provides comfort for the dying and can be given at home)
• Buddhist views on euthanasia

  - contradicts Ahimsa and overrules Buddhist emphasis on compassion

  - euthanasia is seen as 'intentional killing', cutting off a life before the natural process of death has occured

  - act of euthanasia will bring about negative karma and rebirth (seen as a form of delusion and an expression of attachment to the person)

  - pain is impermanent and dying is the ultimate expression of understanding the body decays and we shouldn't be attached to it, so prevents people seeing those realities

  - Tanha: craving non-existence

  - favour palliative care approach, having a good death and psychological and spiritual well-being

  - treat person with loving-kindness and use meditation

  - dying person should reflect on the good deeds they have done and recognise the Anatta and Anicca

  - create a peaceful atmosphere