Euthanasia

• Suicide: When a person dies as a result of their own voluntary action 
• Physician assisted suicide: When a person dies as a direct result of their own voluntary but with the help of a physician 
• Assisted suicide: When a person dies as a direct result of their own voluntary action but with another person's help 
• Physician aided dying: When a person’s death is hastened but not directly caused by the aid 
• Voluntary euthanasia: When a person’s death is directly caused by another person at their request and with their consent  
• Non-voluntary euthanasia: When a person’s death is ended without their consent but with the consent of someone representing their interests  
• Passive euthanasia: When a physician withdraws life-sustaining treatment which indirectly causes death 
• Physician aided suicide: When a person acts deliberately to bring about a person’s death 
• The law and euthanasia  

  Until 1961, suicide in the UK was illegal but then came the suicide act of 1961... 

  • It is no longer a crime to commit suicide  
  • A person who aids or abets the suicide of another shall be liable for up to 14 years in prison 

  Many think this law does not support the principle of autonomy, but it does hold a vitalist position that all life is sacred. 
• Case Study: Diane Petty

  Diane Pretty was suffering from MND and paralyzed from the neck down, so she asked her doctors to assist in her suicide based on the right to self-determination. However, the courts did not uphold her case because the law recognizes the right to live, not the right to die, and that her condition was not life-threatening. 
• Case Study: Baby Charlotte

  Baby Charlotte was born prematurely and with severe brain damage. The courts, against the parents’ wishes, ordered the doctors not to resuscitate the baby if she fell into a coma because her condition was life-threatening and diminished quality of life. 
• “... enable a competent adult who is suffering unbearably as a result of a terminal illness to receive medical assistance to die at his own considered and pesistent request; and to make provision for a person suffering from a terminal illness to receive pain relief medication.”  - Assisted Dying for the Terminally Ill Bill, 2004  
• One of the main objects to these types of proposals is the slippery slope as argued by John Haldane and Alasdair McIntyre... 

  • Slide from actual suffering to fear of suffering 
  • Quality of life argument could be extended to those who do not request it 
  • Where euthanasia is permitted, there is evidence to indicate that many die against their wishes as it is hard for the law to safeguard them 

  However, Helga Kushe challenges the slippery slope argument by the lack of empirical evidence and argues that it is simply used to scare people against euthanasia. 
• Sanctity of life  

  There are two different types of sanctity of life... 

  • Strong sanctity of life: the belief that human life is always valuable from the moment of conception until natural death. As a strong principle there are no exceptions. All innocent human life must be equally protected. 
  • Weak sanctity of life: the belief that although human life is always valuable, there may be situations where it would cause more harm than good to continue with it. 
• Bible Quotes that support strong sanctity of life:

  “So God created mankind in his image” 

  “The Lord gave and the Lord has taken away” 

  “You shall not murder” 

  “’Be fruitful and increase in number’” 
• Bible Quotes that could be argued to support weak sanctity of life:

  “... to offer your bodies as a living sacrifice” 

  The Parable of the Good Samaritan 
• Case Study: Dr David Goodall 

  • Australian ecologist and botanist  
  • Aged 104 he left his home in Australia and flew to Switzerland to end his life in a euthanasia clinic  
  • He did not suffer from a serious illness, but he wished to bring forward his death due to his diminishing independence  
  • He said: “My abilities have been in decline over the past year or two, my eyesight over the past six years. I no longer want to continue my life. I'm happy to have the chance tomorrow to end it” 
• Case Study: Dr David Goodall

  • Dr Goodall’s decision to end his life was hastened by a serious fall in his apartment last month. He was not found for two days. Later, doctors said he needed to engage in 24-hour care or be moved to a nursing home. 
  • His friends said: “He’s an independent man. He doesn’t want people around him all the time, a stranger acting as a carer. He doesn’t want that. He wants to have intelligent conversation and still be able to do the same things like catching the bus into town” 
• Should Dr David Goodall have ended his life in a euthanasia clinic? YES

  Utilitarians

  • A bad quality of life is one which unhappiness or pain outweighs happiness. 
  • If you have a bad quality of life, then your life is no longer worth living and can be ended. 
  • If you meet the following minimum standards necessary (personhood) to live a happy life, your life can be ended:  
  • Memory 
  • Ability to form relationships 
  • Ability to reason  
  • Hope for the future
• Should Dr David Goodall have ended his life in a euthanasia clinic? YES

  John Stuart Mill

  • Taking your own life is a matter of personal autonomy. 
  • The value of life comes from the ability to determine your future. 
  • Humans are the best judge of their own happiness. 
  • Others shouldn’t interfere with someone else’s autonomy unless they are causing harm to others. 
• Should Dr David Goodall have ended his life in a euthanasia clinic? NO

  People who believe in the Sanctity of life 

  • Life is holy, special and sacred and has intrinsic worth 
  • Religious people would say it is a gift from God 
  • Whilst others sat that life is special because people have free will and reason 
  • No one has the right to take away life  
  • Slippery slope allows people to be treated as disposable  
• Should Dr David Goodall have ended his life in a euthanasia clinic? NO

  Jonathan Glover

  • Being alive is not itself a sufficient condition for life being valuable. 
  • For a life to be worthwhile, it must be conscious. 
  • This means that killing a life is not in itself wrong, it is only wrong if that life is conscious.  
• “The Sanctity of life has no meaning in 21st century medical ethics”  

  1. Medical science can help us decide when sanctity is no longer a factor as the person no longer exists. Protecting people is one thing, but keeping human bodies alive when the person has gone is another. 
  2. Doctors who are experts in palliative care find it difficult to predict when death is inevitable. Patients sometimes recover, even if just for a time, when it is least expected. 
• “The Sanctity of life has no meaning in 21st century medical ethics”

  3. Daniel Maguire argued that the use of euthanasia to shorten the time taken to die by not prolonging life is considered legitimate, as humans can still have power over this without denying the sanctity of life. 

  4. Peter Singer (Preference utilitarian) believes that the traditional sanctity of life ethics must collapse as people now believes that the low quality of a person’s life, as judged by the person, can justify them take their life or justify someone else doing it for them. 
• “The Sanctity of life has no meaning in 21st century medical ethics”  

  5. Sanctity as a concept may have religious origins, but the basic urge to respect all life is one that has currency in many worldviews, religious and non-religious. 

  6. In an era of democracy and in a time where we recognize there is diversity and plurality of religious belief, should the dogma of the sanctity of life be used to inform law? 
• “People should be given the autonomy to choose when their own lives end” 

  1. Advocates of euthanasia argue that our death is a defining aspiration of our life and a defining feature of human identity. To choose is to be free from enslavement. If autonomy is important throughout life, then it is surely important towards the end of our life. 
  2. Philosophers link moral responsibility with our ability to make rational decisions and human beings can be thought of as moral creatures because they can choose when and how to act in life, rather than simply act out of instinct. 
• “People should be given the autonomy to choose when their own lives end” 

  3. Our desire to choose when we die might be understandable but for the vast majority of people, it is a wish that can never be fulfilled. In many instances, death comes as a surprise, unexpectedly and often out of the blue with no time to prepare. 

  4. Does my freedom to choose the nature and time of my death oblige other people to facilitate my decision? 
• “People should be given the autonomy to choose when their own lives end” 

  5. How can we really talk of people being free to choose when presented with their own morality and their own suffering? Such experiences often overwhelm people emotionally to the degree that rational decision-making bound up with autonomy is no longer meaningful.

  6. Will allowing people to choose when they die cause fear among the elderly and vulnerable? Will it create a risk that the processes that permit death will be in danger of abuse or misuse? 
• Quality of life: human life has to possess certain attributes in order to have value. These attributes might include experiences of happiness, having autonomy and being conscious.  
• Strengths of Quality of Life:

  • Consciousness 
  • Glover argues that being alive is not a sufficient condition for life being valuable, it must also be conscious. This means that he supports unvoluntary euthanasia for PSV patients. 
  • Autonomy 
  • Life is valuable if you can determine one’s future (self-rule). Mill – people should have autonomy to make decisions unless they are infringing on other people’s happiness. 
• Strengths of Quality of Life:

  • Rejection of the sanctity of life principle 
  • Singer – sanctity of life cannot be used only because quality of life is more important.  
  • Happiness 
  • Some judge happiness to determine whether a life is worthwhile. A utilitarian usually will make one of the following judgements... 
  • Total happiness judgement (happy = greater quality of life) 
  • Average happiness judgement (average happiness maintained = greater quality of life) 
  • Higher qualities judgment (minimum standards to live a happy life = greater quality of life) 
• Weaknesses of Quality of Life:

  • How do you judge consciousness? Murder? 
  • Choosing to die is God’s choice; Harming others by dying; How do we judge autonomy and how we are of sound mind? 
  • His views of speciesism are unethical because one cannot judge people to be more worthy than others as well as contradicts happiness principle. 
  • Happiness is subjective (Wilde) and changeable. It is also hard to judge people’s happiness. 
• Case Study: Dr David Moor 

  Dr David Moor is on trial accused of murdering 85-year-old George Liddel with an overdose of morphine. Liddel has recently been discharged from hospital after treatment for bowl cancer. He was bedridden, having suffered a stroke and a heart attack, and was doubly incontinent, deaf, diabetic and anemic. 
• Case Study: Dr David Moor

  The prosecution says that Dr Moor is guilty of murdering Liddell by giving him an overdose of morphine. The Detective Superintendent at the time, Colin Dobson of Northumbria Police said... “To a police officer and the criminal justice system, the terms mercy killing, and euthanasia is meaningless. If you shorten someone’s life by minutes, that’s murder”. 
• Case Study: Dr David Moor  

  The defense states that Dr Moor is not guilty because the morphine he gave Mr. Liddell was to relieve his pain and was in no way a lethal dose.
• Dr Moor said: “In caring for a terminally ill patient, a doctor is entitled to give pain-relieving medication which may have the incidental effect of hastening death. All I tried to do in treating Mr. Liddell was relieve his agony, distress and suffering. This has always been my approach to treating my patients with care and compassion. Doctors who treat dying patients to relieve their pain and suffering walk a tightrope to achieve this.” 
• “There is no moral difference between killing (active) and letting die (passive)? - YES

  • If the treatment is disproportionate to the expected benefits, then it is permissible to withhold it. 
  • If killing and letting die were morally equivalent, the argument goes, then we would be responsible for the deaths of those whom we fail to save as we are for the deaths of those whom we kill. 
• “There is no moral difference between killing (active) and letting die (passive)? - YES

  • It appears that to kill someone (active euthanasia) is morally worse than simply to let someone die (passive euthanasia). So those who oppose active euthanasia may regard passive euthanasia as morally permissible on the grounds that in the one case the agent causes death, whereas in the other he merely allows nature to take its course. 
• “There is no moral difference between killing (active) and letting die (passive)? - NO

  • To try to make the distinction simply in terms of what one actively does - ‘acts’ - and what one does not - ‘omissions’ - is clearly implausible as an account of what should be permissible and what should not. This is because we can be just as responsible for what we omit to do as for what we actually do. 
• “There is no moral difference between killing (active) and letting die (passive)? - NO

  • Some people say that if you allow one type of euthanasia, whether that be through medical intervention (active euthanasia) or medical non-intervention (passive euthanasia) then this will be the first step on a slippery slope, and the value of human life will be depreciated.