Euthanasia
AUTONOMY AND EUTHANSIA
Autonomy: Literally ‘self-ruling’ – the belief that we are free and able to
make own decisions.
Linked to quality of life and in direct oppositions to the sanctity of life.
This principle states that humans should be free to make decisions
about their own future.
It is a key feature of utilitarian thinking and can be traced back to J.S.
Mill’s non-harm principle – whilst the government or other authority may
restrict our freedom if we are about to harm someone else, they have
no right to restrict our freedom with regard to ourselves.
If we wish to harm ourselves, we should be permitted to do so.
Likewise, Singer’s preference utilitarianism argues that humans should
be free to pursue their own desires and interests where possible – this
autonomy includes the right to make our own decisions about our
death.
Supporters of euthanasia appeal to the idea of autonomy
It is 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, Glover has suggested several checks on whether someone
should be assisted to die.
“I must be convinced that your decision is a serious one; it must be properly
thought out, not merely the result of a temporary emotional state. I must also
think your decision is a reasonable one”.
If the patient is making the decision in a diminished mental state, then
they are not truly autonomous.
The issue if autonomy is more complicated in cases of non-voluntary
euthanasia, particularly where a patient, perhaps like Tony Bland is in a
persistent vegetive state (PVS)
PVS: A disorder of consciousness in which patients with severe brain
damage are in a state of partial arousal rather than true awareness.
If the patient has given instructions about what their wishes would be if
they were in such a case, the arguably their autonomy is being
respected.
,Is there a distinction between a medical intervention to end life and medical
non-intervention to end life?
THE HIPPOCRATIC OATH
The Greek philosopher Hippocrates states that it would be wrong for a
doctor to do something that would cause the death of a person.
However, in other writings, he suggests that it is pointless to continue to
treat those who are overcome by a disease and for whom medicine is
powerless.
He suggested a doctor should “refuse to treat those who are
overmastered by their disease realizing that in such cases, medicine is
powerless”.
It is this distinction that 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 a treatment where the treatment is prolonging the
inevitable death and increasing the suffering of a patient) may not be
morally wrong.
“I will neither give a deadly drug to anybody if asked for it, nor will I make a
suggestion to that effect” – part of the Hippocratic oath taken by doctors.
RACHELS ON ACTS AND OMISSSIONS
Rachels has offered a thought experiment to suggest that the
distinction between actively killing and passively letting someone die
may not be helpful.
Two examples:
1. Suppose Smith will inherit a fortune if his young nephew dies. One
evening he drowns his nephew in the bath and arranged the scene to
look like an accident. The nephew’s death is an ‘act’ of Smith.
2. Suppose Jones will also inherit a fortune if his nephew dies. As he enters
the bathroom, he sees his nephew slip and hit his head and slowly
drown. He watches and 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. He certainly would be legally, but is he actually worse morally?
Rachels argues that both cases are equally bad and when we consider
the issue of euthanasia, passive euthanasia by omission may even be
cruller (taking a patient off medication) as death may take longer.
GLOVER ON ORDINARY AND EXTRAORDINARY MEANS
, Glover suggests that the distinctions 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.
Glove suggests there are 5 options with regard to euthanasia – different
options as to what someone might do with regards to euthanasia.
1. Take all possible steps to preserve life. – we do this in the UK
2. Take all ordinary steps to preserve life but not use extraordinary means.
– if someone is nearly dying doctors may decide to not medically treat
them (maybe because it won’t work)
3. Not killing but taking no steps to preserve life. – like taking someone off
treatment eg
4. An act which, while not intending to kill, has death as a possible
foreseen consequence. – e.g., taking someone off chemotherapy
because it’s not working?
5. The deliberate act of killing. – what some countries have as legal
NATURAL LAW AND EUTHANASIA – opposes euthanasia
The key precept of Natural Law argues for the preservation of life – life is
intrinsically valuable and should not be shortened.
Natural Law is dependent on the divine law revealed by God – key
texts such as the Ten Commandments “God gives, and God takes
away” seem to count against euthanasia.
Following on from this, 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 also be argued that the practice of euthanasia would
undermine the stability of society – a society where life was not valued
could not be an ordered society as people may fear hospital
treatment.
To end life by euthanasia instead of preserving life is an apparent good
as opposed to a real good.
HOWEVER, the principle of double effect may allow pain relief, such as
morphine, even though administrating 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.
AUTONOMY AND EUTHANSIA
Autonomy: Literally ‘self-ruling’ – the belief that we are free and able to
make own decisions.
Linked to quality of life and in direct oppositions to the sanctity of life.
This principle states that humans should be free to make decisions
about their own future.
It is a key feature of utilitarian thinking and can be traced back to J.S.
Mill’s non-harm principle – whilst the government or other authority may
restrict our freedom if we are about to harm someone else, they have
no right to restrict our freedom with regard to ourselves.
If we wish to harm ourselves, we should be permitted to do so.
Likewise, Singer’s preference utilitarianism argues that humans should
be free to pursue their own desires and interests where possible – this
autonomy includes the right to make our own decisions about our
death.
Supporters of euthanasia appeal to the idea of autonomy
It is 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, Glover has suggested several checks on whether someone
should be assisted to die.
“I must be convinced that your decision is a serious one; it must be properly
thought out, not merely the result of a temporary emotional state. I must also
think your decision is a reasonable one”.
If the patient is making the decision in a diminished mental state, then
they are not truly autonomous.
The issue if autonomy is more complicated in cases of non-voluntary
euthanasia, particularly where a patient, perhaps like Tony Bland is in a
persistent vegetive state (PVS)
PVS: A disorder of consciousness in which patients with severe brain
damage are in a state of partial arousal rather than true awareness.
If the patient has given instructions about what their wishes would be if
they were in such a case, the arguably their autonomy is being
respected.
,Is there a distinction between a medical intervention to end life and medical
non-intervention to end life?
THE HIPPOCRATIC OATH
The Greek philosopher Hippocrates states that it would be wrong for a
doctor to do something that would cause the death of a person.
However, in other writings, he suggests that it is pointless to continue to
treat those who are overcome by a disease and for whom medicine is
powerless.
He suggested a doctor should “refuse to treat those who are
overmastered by their disease realizing that in such cases, medicine is
powerless”.
It is this distinction that 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 a treatment where the treatment is prolonging the
inevitable death and increasing the suffering of a patient) may not be
morally wrong.
“I will neither give a deadly drug to anybody if asked for it, nor will I make a
suggestion to that effect” – part of the Hippocratic oath taken by doctors.
RACHELS ON ACTS AND OMISSSIONS
Rachels has offered a thought experiment to suggest that the
distinction between actively killing and passively letting someone die
may not be helpful.
Two examples:
1. Suppose Smith will inherit a fortune if his young nephew dies. One
evening he drowns his nephew in the bath and arranged the scene to
look like an accident. The nephew’s death is an ‘act’ of Smith.
2. Suppose Jones will also inherit a fortune if his nephew dies. As he enters
the bathroom, he sees his nephew slip and hit his head and slowly
drown. He watches and 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. He certainly would be legally, but is he actually worse morally?
Rachels argues that both cases are equally bad and when we consider
the issue of euthanasia, passive euthanasia by omission may even be
cruller (taking a patient off medication) as death may take longer.
GLOVER ON ORDINARY AND EXTRAORDINARY MEANS
, Glover suggests that the distinctions 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.
Glove suggests there are 5 options with regard to euthanasia – different
options as to what someone might do with regards to euthanasia.
1. Take all possible steps to preserve life. – we do this in the UK
2. Take all ordinary steps to preserve life but not use extraordinary means.
– if someone is nearly dying doctors may decide to not medically treat
them (maybe because it won’t work)
3. Not killing but taking no steps to preserve life. – like taking someone off
treatment eg
4. An act which, while not intending to kill, has death as a possible
foreseen consequence. – e.g., taking someone off chemotherapy
because it’s not working?
5. The deliberate act of killing. – what some countries have as legal
NATURAL LAW AND EUTHANASIA – opposes euthanasia
The key precept of Natural Law argues for the preservation of life – life is
intrinsically valuable and should not be shortened.
Natural Law is dependent on the divine law revealed by God – key
texts such as the Ten Commandments “God gives, and God takes
away” seem to count against euthanasia.
Following on from this, 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 also be argued that the practice of euthanasia would
undermine the stability of society – a society where life was not valued
could not be an ordered society as people may fear hospital
treatment.
To end life by euthanasia instead of preserving life is an apparent good
as opposed to a real good.
HOWEVER, the principle of double effect may allow pain relief, such as
morphine, even though administrating 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.
