Download EUTHANASIA EXAMPLE EXAM ANSWERS

EUTHANASIA
EXAMPLE EXAM
ANSWERS
Euthanasia: active or passive, voluntary, involuntary and
non- voluntary
Jan 2012
AO1 Explain what is meant by active and passive Euthanasia, and why
some people might want euthanasia. (30 marks)
The term Euthanasia has its roots in Ancient Greece and is literally translated to
mean ‘good death’. There are many different types of euthanasia but all revolve
around the debate as to whether a terminally ill person has a right to end their
own life or request someone else to do so on their behalf to avoid having to go
through the final stages of a disease, which will ultimately result in their death.
Some believe a person has a right to choose to die with dignity.
Euthanasia can be categorized into two forms – passive and active. Active
euthanasia occurs when medical professionals, or another person, deliberately do
something that causes the patient to die. An example of this would be the assisted
suicide of Peter Smedley.
Passive euthanasia occurs when the patient dies because the medical professionals
either don't do something necessary to keep the patient alive, or when they stop
doing something that is keeping the patient alive e.g. the switching off of lifesupport machines, disconnecting a feeding tube, deciding not to carry out a lifeextending operation or not giving life-extending drugs
Many people make a moral distinction between active and passive euthanasia.
They think that it is acceptable to withhold treatment and allow a patient to die,
but that it is never acceptable to kill a patient by a deliberate act. Many in the
medical profession agree and value the distinction as it allows them to provide a
patient with the death they want without having to deal with the difficult moral
problems they would face if they deliberately killed that person. The are plenty of
religious and non-religious people that would agree with Arthur Clough’s
statement ‘thou shalt not kill but needst not strive, officiously, to keep alive.’
However some people think this distinction is nonsense, since stopping treatment
is a deliberate act, and so is deciding not to carry out a particular treatment.
Switching off a respirator requires someone to carry out the action of throwing
the switch. If the patient dies as a result of the doctor switching off the respirator
then although it's certainly true that the patient dies from lung cancer (or
whatever), it's also true that the immediate cause of their death is the switching off
of the breathing machine.
In active euthanasia the doctor takes an action with the intention that it will cause
the patient's death. In passive euthanasia the doctor lets the patient die - when a
doctor lets someone die, they carry out an action with the intention that it will
cause the patient's death so there is no real difference between passive and active
euthanasia, since both have the same result: the death of the patient on
humanitarian grounds Therefore for some the act of removing life-support is just
as much an act of killing as giving a lethal injection
Some philosophers go even further and say that active euthanasia is morally better
because it can be quicker and cleaner, and it may be less painful for the patient.
One of the classic ideas in ethics is that of acts and omissions. It says that there is
a moral difference between carrying out an action, and merely omitting to carry
out an action. Simon Blackburn provides an example in the Oxford Dictionary of
Philosophy to illustrate this point - ‘suppose I wish you dead, if I act to bring
about your death I am a murderer, but if I happily discover you in danger of
death, and fail to act to save you, I am not acting, and therefore, according to the
doctrine, not a murderer.
However the philosopher James Rachels uses the analogy of ‘the killings in the
baths’ to prove that the acts and omissions doctrine doesn't always work. He
considers two cases: Smith will inherit a fortune if his 6 year old cousin dies. One
evening Smith sneaks into the bathroom where the child is having his bath and
drowns the boy. Smith then arranges the evidence so that it looks like an accident.
Compare this to Jones who will inherit a fortune if his 6 year old cousin dies. One
evening Jones sneaks into the bathroom where the child is having his bath. As he
enters the bathroom he sees the boy fall over, hit his head on the side of the bath,
and slide face-down under the water. Jones is delighted; he doesn't rescue the
child but stands by the bath, and watches as the child drown. According to the
doctrine of acts and omissions Smith is morally guiltier than Jones, since he
actively killed the child, while Jones just allowed the boy to die. In law Smith is
guilty of murder and Jones isn't guilty of anything. However, most people would
regard any distinction between their moral guilt as splitting hairs.
There are many philosophers that respond negatively to this analogy arguing that
we can't compare the case of a doctor who is trying to do their best for their
patient with Smith and Jones who are obvious villains. The Smith/Jones case
partly depends on us paying no attention to the intentions of Smith and Jones. But
in most cases of right and wrong we do think that intention matters, and if we
were asked, we would probably say that Smith was a worse person than Jones,
because he intended to kill.
AO1 Explain the differences between voluntary, involuntary and non-voluntary
euthanasia
The term Euthanasia has its roots in Ancient Greece and is literally translated to
mean ‘good death’. There are many different types of euthanasia but all revolve
around the debate as to whether a terminally ill person has a right to end their
own life or request someone else to do so on their behalf to avoid having to go
through the final stages of a disease, which will ultimately result in their death.
Some believe a person has a right to choose to die with dignity.
Euthanasia can be categorized into voluntary, involuntary and non-voluntary
forms. Euthanasia can be voluntary even if the person is no longer competent to
assert her wish to die when her life is ended e.g. you might wish to have your life
ended should you ever find yourself in a situation that has robbed you of all your
rational faculties. In such cases, whilst still competent, people express the
considered wish to die if they ever found themselves in a situation such as this.
Then the person who ends your life in the appropriate circumstances acts upon
your request and performs an act of voluntary euthanasia.
There is a close connection between voluntary euthanasia and assisted suicide,
where one person will assist another to end her life – for example, when A obtains
the drugs that will allow B to suicide. The case of 71-year-old British millionaire
Peter Smedley, who travelled to Switzerland’s Dignitas clinic for an assisted death,
is a good example of voluntary euthanasia. Smedley decided he wanted to die
because he had motor neurone disease, a progressively debilitating disease.
Knowing that there was no hope and that things would get worse, Smedley
requested that a Dignitas representative gave him a lethal dose of barbiturate to
drink, after consultation with his family and a Swiss doctor.
Euthanasia is non-voluntary when the person whose life is ended cannot choose
between life and death for herself – for example, because she is hopelessly ill or
handicapped new born infant, or because illness or accident have rendered a
formerly competent person permanently incompetent, without that person having
previously indicated whether she would or would not like euthanasia under certain
circumstances.
An example of this is Tony Bland, who was the victim of the 1989 Hillsborough
disaster in which many football fans were crushed to death. He survived but was
left in a persistent vegetative state (PVS) in which it was thought he would never
recover. In this state the body can breathe and main organs function properly. In
Bland’s case he could open his eyes but did not respond to anything around him.
He could not feed but could digest food so needed to have food and water
provided through a feeding tube. There was no cure for Tony’s condition but he
was not dying. The question, which eventually ended up in court, was whether or
not it was right to remove artificial feeding and lead to death through starvation
and dehydration. For the first time in an English court, it was decided that
artificial feeding through a tube is a medical treatment and that to discontinue the
treatment would be in accordance with good medical practice. His life support
machine was switched off on 22 February 1993 and he died on 3 March.
Euthanasia is involuntary when it is performed on a person who would have been
able to give or withhold consent to her own death, but has not given consent –
either because she was not asked, or because she was asked but withheld consent,
wanting to go on living. Whilst clear cases of involuntary euthanasia would be
relatively rare, it has been argued that some widely accepted medical practices
(such as the administration of increasingly large doses of pain-killing drugs that
will eventually cause the patient’s death, or the unconsented-to withholding of
life-sustaining treatment) amount to involuntary euthanasia.
So with involuntary euthanasia the person wants to live but is killed anyway. This
is usually considered to be murder but not always. E.g. if a soldier has their
stomach blown open by a shell burst. They are in great pain and screaming in
agony. They beg the army doctor to save their life. The doctor knows that they
will die in ten minutes whatever happens. As he has no painkilling drugs with him
he decides to spare the soldier further pain and shoots them dead.
At the beginning of the 21st century the Hague (the Dutch Parliament) claimed
that Euthanasia in The Netherlands is "beyond effective control", in response to
a report which shows that one in five assisted suicides is without explicit consent
(involuntary euthanasia). British opponents of assisted suicide say that the figures
are a warning of the dangers of decriminalising euthanasia, as Holland did in 1984.
A follow-up survey found that the main reason for not consulting patients was
that they had dementia or were otherwise not competent. Michael Howitt Wilson,
of the Alert campaign against euthanasia, said: "A lot of people in Holland are
frightened to go into hospital because of this situation."
Ethical issues involved in legislation about euthanasia;
issues concerning quality of life and their relevance to the
euthanasia debate
June 2009
Explain the ethical issues involved in legislation about euthanasia.
There may be situations where people are in terrible pain or have such a profound
sense of indignity because of their mental deterioration that they wish while they
still have the chance to express a choice, to bring about death more quickly.
There are several arguments in favour of legalising voluntary euthanasia. Recently
The Falconer report came to the conclusion that assisted dying should be offered
as a choice to terminally ill patients. The Commission on Assisted Dying, chaired
by the former Lord Chancellor Lord Falconer, says a choice to end their own lives
could be safely offered to some people with terminal illnesses, provided stringent
safeguards were observed.
Some philosophers state that voluntary euthanasia is not murder. In his article
“Why physicians should aid the dying” Gregory E. Pence argues that killing
humans who don't want to live is not wrong. It isn't wrong to help the dying to
die, because they are actually dying. You are simply speeding up the process. This
is therefore, not murder.
Another argument often given for legalising voluntary euthanasia in some form is
that the act can be considered to be merciful. Voluntary euthanasia shows mercy
for those suffering with intolerable pain from an incurable disease. The English
humanist Thomas More argued in his famous 1516 book Utopia that when a
patient suffers a ‘torturing and lingering pain, so that there is no hope, either of
recovery or ease, (they may) choose rather to die, since they cannot live but in
much misery’. Voluntary euthanasia is a merciful opportunity to end needless
suffering – one which we offer to animals and should offer to humans as well.
Even the courts in Britain lean some way towards this view when they make the
decision not to prosecute the families of those terminally ill patients who travel to
Switzerland to die at the hands of Dignitas – deeming that to do so would ‘not be
in the publics interest’. This is because it is recognised, and there is often evidence
provided to support the claim, that the intention of the support given is on
compassionate grounds and to allow loved ones a merciful death.
Some in favour of legalising voluntary euthanasia argue that the act gives people
greater autonomy (freedom). John Stuart Mill argues that if it doesn’t affect
someone else’s freedom, individuals should have full autonomy. “Over himself,
over his body and mind, the individual is sovereign (ruler)”. We expect to have
control over our bodies in matters of life, and it should be the same in matters of
death. The VES (voluntary euthanasia society) argues that every human being
deserves respect and has the right to choose his or her own destiny, including how
he or she lives and dies. This is supported by the Swiss lawyer and founder of
Dignitas Ludwig Minelli who claims that the human right to self-determination
gives human beings the right to choose how and when they die. The controversial
American doctor Jack Kevorkian has said ‘in my view the highest principle in
medical ethics – in any kind of ethics – is personal autonomy, self-determination.
What counts is what the patient wants and judges to be a benefit or a value in his
or her own life. That’s primary’
In 1994 the British Medical Journal published a survey that showed some doctors
already help patients to die. Doctors can legally give pain relieving treatment in
doses that will bring about people’s deaths more quickly and, in certain
circumstances, such as in the case of the brain dead or comatose, they may also
withdraw or withhold treatment even though a person will die if they do so. The
VES holds that it would be more honest and much safer if voluntary euthanasia
was legal and regulated. They argue that there is no ethical difference between
withdrawing treatment and delivery a lethal injection.
Finally those in favour of legalising voluntary euthanasia in the UK argue human
beings should be able to maintain their dignity up until the ends of their lives. This
is not simply a matter of pain, but of self-respect. If someone’s standard of living
is such that they no longer want to live, then they should be able to end their life
and, if necessary, be assisted in doing so.
For every ethical issue deemed to be in favour of legalising euthanasia there is a
counter argument provided to state why under no circumstance should the law in
the UK be changed. When a person asks for death, can we be sure that the person
isn't crying out in despair, rather than making a definitive decision? In desperate
moments, someone may feel that they want their life to end – that the pain is too
great and life too agonising – but perhaps those moments will pass and they will
be glad that no-one acted on their pleas. Can doctors be sure that they know and
understand all the facts? Any euthanasia process would have to be able to
establish, beyond any doubt, the true intentions of the patient who is requesting
euthanasia and that the patient is fully aware of the situation.
As well as this there is a fear over the possibility of mistakes being made. Suppose
that someone chooses death because they have been diagnosed with a fatal,
incurable and painful illness. Then after the person has died, it becomes apparent
that the diagnosis was wrong. There is an area of doubt here that could lead to
terrible mistakes. Refusing to allow voluntary euthanasia safeguards us against this.
Those against legalising voluntary euthanasia in some form would look to the
situation in the Netherlands where there are reports that the system is frequently
abused. At the beginning of the 21st century the Hague (the Dutch Parliament)
claimed that Euthanasia in The Netherlands is "beyond effective control", in
response to a report which shows that one in five assisted suicides is without
explicit consent (involuntary euthanasia). British opponents of assisted suicide say
that the figures are a warning of the dangers of decriminalising euthanasia, as
Holland did in 1984. A follow-up survey found that the main reason for not
consulting patients was that they had dementia or were otherwise not competent.
Michael Howitt Wilson, of the Alert campaign against euthanasia, said: "A lot of
people in Holland are frightened to go into hospital because of this situation."
The conviction of Harold Shipman for multiple murders – where he, as a GP,
murdered dozens of elderly patients over a period of many years – highlights the
power of doctors, especially over the elderly. A voluntary euthanasia system could
allow such people even more scope for murder, by manipulating patients and
documentation.
And finally the ‘slippery slope argument’ is a compelling argument against the
legalisation of euthanasia. It warns that once the door to legalising euthanasia in
the UK is slightly opened it will never shut and may in fact open fully. Nearly a
fifth of Swiss nationals opt for euthanasia in their own homes because they have a
‘weariness of life’. If legalised in the UK this would of course not be an option.
But the government will be wary of how in 1967 nobody would have predicted
there would be over 200, 000 abortions in the UK a year - and often for social
reasons. Some go as far to claim that the road to euthanasia is a similar road that
led to Auschwitz – meaning that we may create a society that has no room or
tolerance for those that suffer – the disabled, the sick and the elderly. Elderly
relatives could quite easily think of themselves as a burden to their families and
ask for voluntary euthanasia out of a sense of duty to their family.
The role of hospices and palliative care (as alternatives to
euthanasia)
Jan 2011
AO1 Examine the role of each of the following in the care of the dying:
palliative care, hospices and voluntary euthanasia. (30 marks)
The term Euthanasia has its roots in Ancient Greece and is literally translated to
mean ‘good death’. There are many different types of euthanasia but all revolve
around the debate as to whether a terminally ill person has a right to end their
own life or request someone else to do so on their behalf to avoid having to go
through the final stages of a disease, which will ultimately result in their death.
Some believe a person has a right to choose to die with dignity.
Many consider voluntary euthanasia an appropriate method of care for those
dying with a terminal or degenerative disease. Euthanasia can be voluntary even if
the person is no longer competent to assert her wish to die when her life is ended
e.g. you might wish to have your life ended should you ever find yourself in a
situation that has robbed you of all your rational faculties. In such cases, whilst
still competent, people express the considered wish to die if they ever found
themselves in a situation such as this. Then the person who ends your life in the
appropriate circumstances acts upon your request and performs an act of
voluntary euthanasia.
There is a close connection between voluntary euthanasia and assisted suicide,
where one person will assist another to end her life – for example, when A obtains
the drugs that will allow B to suicide. The case of 71-year-old British millionaire
Peter Smedley, who travelled to Switzerland’s Dignitas clinic for an assisted death,
is a good example of voluntary euthanasia. Smedley decided he wanted to die
because he had motor neurone disease, a progressively debilitating disease.
Knowing that there was no hope and that things would get worse, Smedley
requested that a Dignitas representative gave him a lethal dose of barbiturate to
drink, after consultation with his family and a Swiss doctor.
An alternative approach to caring for the dying can be found in the realm of
palliative care and hospices. Hospices take a holistic approach to supporting those
in the final stages of their life. Palliative care for the terminally ill with a holistic
emphasis is concerned with the physical, emotional and spiritual well being of the
individual and often support for families as well. A specialist building or centre
may be known as a hospice, but the word relates primarily to the quality of care
received therein. It provides dignity in dying but has limited accessibility due to
funding. Competent palliative care may well be enough to prevent a person feeling
any need to contemplate euthanasia. The key to successful palliative care is to treat
the patient as a person, not as a set of symptoms, or medical problems. The
World Health Organisation states that palliative care within hospices affirms life
and regards dying as a normal process; it neither hastens nor postpones death; it
provides relief from pain and suffering; it integrates the psychological and spiritual
aspects of the patient.
The patient's family and friends will need care too. Palliative care aims to enhance
the quality of life for the family as well as the patient. Effective palliative care gives
the patient and their loved ones a chance to spend quality time together, with as
much distress removed as possible. They can (if they want to) use this time to
bring any unfinished business in their lives to a proper closure and to say their last
goodbyes. The spiritual care offered may be important even for non-religious
people. Spiritual care should be interpreted in a very wide sense, since patients and
families facing death often want to search for the meaning of their lives in their
own way.
Palliative care (non-hospice) involves the removal of pain / reduction of
symptoms – it is similar to the hospice movement in that it offers an alternative to
legalising euthanasia in some form. The aim of the Liverpool Care Pathway, as
discussed later in the essay, is to make use of the excellent practice that exists in
hospices and take that practice into a hospital setting. At the end of life the
purpose of palliative care is to improve the quality of life of the patient during the
final stage. It does not treat the illness, or try to keep the individual alive for
longer but it does aim to provide dignity in dying. An example of this would be
pain relief in a hospital.
It does not take a holistic approach to treating the
patient it simply reduces the pain through the use of drugs. Non-Hospice
Palliative care plays a major part as an alternative to Euthanasia because it reduces
the extreme pain that patients completing euthanasia experience. However as the
treatment does not go beyond simple pain relief, it will always be limited as an
alternative to Euthanasia, because it does not consider the other issues (apart from
pain) that the patients suffer i.e. lack of dignity, loneliness etc. As a result of this
palliative care has developed a more holistic approach.
The Liverpool Care Pathway is an integrated care pathway that is used at the
bedside to drive up sustained quality of the dying in the last hours and days of life.
It is a means to transfer the best quality for care of the dying from the hospice
movement into other clinical areas, so that wherever the person is dying there can
be a fair and right model of care. The LCP has been implemented into hospitals,
care homes and in the individuals own home. The LCP is not the answer to all our
needs for care of the dying but it may be a step in the right direction. It is
recommended as a best practice model, most recently, by the Department of
Health in the UK. "The LCP affirms the vision of transferring the model of
excellence for care of the dying from hospice care into other healthcare settings.
We have demonstrated a process that inspires, motivates and truly empowers the
generic workforce in caring for the patient and their family in the last hours or
days of life." (Deborah Murphy, National Lead Nurse-LCP)
However the LCP has faced a lot of criticism recently in the press as a national
audit found that half of those on the pathway are never told that life-saving
treatment has been withdrawn. The study suggests that in total, around 57,000
patients a year are dying in NHS hospitals without being told that efforts to keep
them alive have been stopped. It also reveals that thousands of dying patients
have been left to suffer in pain, with no attempt to keep them comfortable while
drugs were administered. Jeremy Hunt, the Health Secretary, described the
disclosures from records held by 178 NHS hospitals as "totally unacceptable".
Critics of the pathway - which can involve the withdrawal of drugs, fluids and
food, and the administration of powerful pain relief - say it is being used to hasten
the deaths of the terminally-ill and elderly, in a form of "back-street euthanasia".
Other doctors, nurses and charities for the dying have come to the defence of the
approach, which they say is intended to help ensure that people can die in dignity
and comfort, instead of enduring invasive and painful treatment.
AO2 ‘Hospices make euthanasia unnecessary.’ Consider how far you agree
with this view. (15marks)
Many would agree with the statement that good palliative care is the alternative to
euthanasia. If it was available to every patient, it would certainly reduce the desire
for death to be brought about sooner. Hospices and hospice home-care support
are seen as viable alternatives to euthanasia for the terminally ill. Those who want
to die but do not have a terminal illness, are usually lonely or depressed and
therefore Hospice treatment is a realistic alternative for a number of reasons.
Firstly, the greatest fear held by the dying is not physical pain, but the fear of
being abandoned either by family, society, or both. Most patients who request
suicide change their minds once satisfactory pain control is established.
Secondly, the World Health Organisation (WHO) recommends that governments
devote specific attention to cancer pain relief and palliative care before
considering laws allowing euthanasia. People use the principle of autonomy as a
justification for voluntary euthanasia. The real alternative to euthanasia and
assisted suicide (EAS) is to provide autonomy, with loving and competent care for
the dying or disabled person.
Thirdly, non-psychiatric physicians are not reliably able to diagnose depression let
alone to determine whether the depression is impairing judgment. Psychological
distress, particularly depression, is a major risk factor for suicide and for requests
to hasten death. For the relatively healthy individual who supports the legalising of
euthanasia, the reason is fear that they, themselves, might want it sometime in the
future: fear of cancer and other debilitating diseases or disabilities; fear of
becoming a burden to one's family; fear of surviving without really living; and,
perhaps most of all, fear of severe, uncontrolled pain. Hospices remove this fear.
Opponents of euthanasia believe that the development of modern methods of
palliative care makes its legalisation unnecessary. This addresses one of the greatest
fears that humans have namely the fear of pain. It does not, however, address all
the issues.
However there are also counter arguments that will claim the Hospice Movement
on its own does not provide an alternative to voluntary euthanasia and both
should exist within society to allow people to make an informed decision as to
how they spend their final days. Providing palliative care can be very hard work,
both physically and psychologically. Ending a patient's life by injection is quicker
and easier and cheaper. This may tempt people away from palliative care.
Those who reject hospice care as an alternative to Euthanasia argue that suffering
does not just mean being in actual physical pain. It can mean being a total victim,
unable to look after yourself, being uncomfortable, being unable to do anything,
having to put up with all kinds of tubes in your mouth and nose, and having to
put up with embarrassments like being doubly incontinent, or constantly
vomiting. Hospices, although helpful in this area, do not solve the indignity that
this type of suffering brings, nothing can.
Perhaps the strongest argument against hospices providing an alternative to
euthanasia relates simply to supply and demand. Because hospices are funded for
privately and through the raising of funds there is just not enough beds for the
amount of people who would wish to die in a hospice. It seems unfair then to
provide the opportunity to some and not others.
In conclusion it would appear that the hospice does provide an alternative for
some patients, but certainly not all. This is highlighted by the number of people
who had the opportunity of going into hospices but instead chose Switzerland.
The Liverpool Care Pathway, if organised and controlled correctly and ethically,
may indeed provide a way forward and take the good experience people have of
hospices into other care settings. However there will always be some who believe
they have the right to self determination and would far rather their lives were
ended in the comfort of their own home, rather than on an industrial estate in
Zurich.
Arguments for and against euthanasia with reference to
religious and ethical teachings
(This section focuses mainly on the religious arguments for and against, as the
ethical arguments are provided in an earlier essay. However please note that some
extra notes on the utilitarian approach are provided at the end of this section)
AO1 Explain religious arguments against and in favour of euthanasia.(30
marks)
Many religious perspectives towards the issue of euthanaisa work from
interpretation and application of sources e.g. Church teaching, the Bible etc. There
is some diversity both within and between religious traditions however all
Christian Churches agree that Voluntary Euthanasia is wrong. Some liberal
Christians and others informed by their consciences may consider ways in which
euthanasia could be considered acceptable based on Christian principles e.g.
agape, compassion etc.
Roger Crook captures the Christian perspective that the human being is not
simply a biological entity but a person, in the image of God and Christ. Death
marks the end of personhood in this life. Biblical teachings prohibit killing e.g. the
sixth commandment states “you shall not murder” (exodus 20:13). Jesus ministry
was about healing and providing care for the sick, needy and the weakest
members of society.
At the Second Vatican Ecumenical Council, the Roman Catholic Church
condemned crimes against life such as murder, genocide, abortion and euthanasia.
For the Church and its followers believe life is sacred and a gift from God and to
take a life opposes God’s love for that person, and rejects the duty of a person to
live life according to God’s plan.
A distinct argument is made about suffering and its role in Christian theology.
Jesus died in pain on the cross, and human suffering at the end of life connects us
to the suffering that Jesus felt – such pain is often referred to as ‘salvific pain’ in
that it is necessary for us to achieve salvation. This does not mean that Christians
should refuse to take painkillers or should actively seek pain, but it does grant
suffering the possibility of having a positive effect on the individual. It provides
the chance that he or she may grow closer to God. In an article on euthanasia
Thomas Wood writes that while suffering can seem meaningless, is terrible and
never sought, it is not the worst evil – it can be on occasion for spiritual growth
and it can have moral effects on those in attendance. It can have meaning in the
context of a life lived in faith. Mark 10:40-45 states that ‘those who are last will be
first’ and Christians are expected to ‘pick up your cross and follow me’.
Catholics, and most other Christians, do agree however that excessive treatment
should be avoided. So the withdrawal of unduly burdensome treatment in cases
where it would not lead to any improvement in the patient’s underlying condition
and could not prevent death is considered acceptable. In such circumstances it
may be considered morally responsible to withhold or withdraw treatment and
allow death to occur.
The doctrine of double effect also provides an exception to the rule that all forms
of euthanasia are wrong. The RC Church and doctors agree that it is good practice
to give patients x amount of morphine to alleviate the pain knowing that over a
lengthy period of time it will shorten the persons life. The patient dies indirectly, a
secondary affect of curing the pain.
The Catholic theologian Hans Kung takes a different approach to the Church
when he states: ‘I am convinced that the all-merciful God, who has given men and
women freedom and responsibility for their lives, has also left to dying people the
responsibility for making a conscientious decision about the manner and time of
their deaths” For Kung, when you die is an individual choice. God gave you the
ability to choose and you should use that God given right. God is all-loving and
will understand.
The protestant Joseph Fletcher is an active advocate of the patient’s ‘right to die’
on the basis that Christian faith emphasises love for one’s fellow human being,
and that death is not the end for Christians. Acts of kindness may embrace
euthanasia, for instance when a human being is dying in agony, as a response to
human need. Followers of Situation Ethics would agree with the sentiments of its
founder Fletcher if the most loving result is achieved by allowing the patient to
die. The quality of life is to be valued over biological life and death may be
thought of as a friend to someone with a debilitating illness.
EUTHANASIA AND UTILITARIANISM
(Extra notes which could go with the earlier essay on the ethical issues surrounding the
legalisation of euthanasia – or in the same way those notes could be added to this
question if it came up)
Involuntary euthansia
Most modern utilitarian’s oppose involuntary euthanasia for it goes against the idea of
human freedom and autonomy, central to the ideas of John Stuart Mill. Mill argued that
‘the greatest good of the greatest number’ only makes sense if humans are free.
Involuntary euthanasia could be also be viewed as wrong from a utilitarian perspective
if we take the slippery slope argument. Hospitals are places of care. Doctors are care
workers. People need both and both rely on trust. Now imagine if involuntary
euthanasia were legal. The sick might fear going to their doctor or to hospital. The
resulting spread of disease would go against the greatest good for the greatest number
principle. Such arguments seem to be supported by the Hague in relation to fears in the
Netherlands as well as concerns over how the Liverpool Care Pathway is being
interpreted by medical staff.
Some argue that Singer and other modern day utilitarian’s do not analyse the benefits
of the act of caring for the terminally ill for humanity in general. Some argue that a
society that values all human life is less likely to commit crimes against the person.
Utilitarian’s, like Peter Singer, who support involuntary euthanasia. They wish to
remove the idea that human life is sacred in order to achieve the maximization
principle. The de-sanctification of human life would allow all sentient beings to be
part of the
welfare calculus, which many modern utilitarian’s use instead of the
hedonic calculus. Singer argues that keeping people who have a poor quality of life alive
is costly to society, to other sick people and to the environment. The amount of money
spent on healthcare for terminally ill patients is disproportionate. Money would be
saved if these people were euthanised. The greatest good for the greatest number
principle would result, as money used for caring for the terminally ill would be used for
cases where there is a good chance of recovery.
Keeping someone alive on a life
support machine can be very expensive; however, giving someone a
lethal injection
doesn’t cost much.
Another benefit of involuntary euthanasia is the reduction in stress caused to relatives
and friends of a terminally ill person. Many relatives give up a lot of their life caring for
the terminally ill. For some it can be a soul-destroying experience. They give up work
or take temporary or part-time jobs. Their lifestyle is affected. However, it can be
argued that carers get happiness and pleasure looking after the weak and vulnerable.
They do it out of a sense of love and duty.
Non-voluntary and voluntary euthanasia
Many utilitarian’s would accept non-voluntary euthanasia. The principle of mercy, the
alleviation of suffering, is an important part of a theory called negative utilitarianism or
painism. Painism is the view put forward in 1990 by Richard Ryder that it is pain and
not pleasure that determines utility. Thus the prevention of pain is the only moral issue
that should determine a moral decision. Ryder rejects all ideas of the aggregate of
pleasure (making the amount of pleasure the basis of a moral decision
When Ryder talks about pain he means more than just a passing physical discomfort.
He means suffering that lasts and ruins human happiness and so the only moral
objective/aim should be the reduction of suffering.
Ryder’s painism raises the issue of the principle of double effect. When is it legitimate
to euthanatize in order to reduce pain and suffering? Ethicists that favour the principle
of double effect ague that there is a clear line between deliberately taking life and
hastening death by alleviating suffering. Yet some scholars are not so sure. For
example: A very sick person is no longer able to swallow properly and is in constant
need of hydration through a tube. This person is slowly dying. At what point is it
acceptable, in order to stop suffering, for the hydration to stop? Is the chief motive the
prevention of a slow, lingering death, or is it the deliberate termination of that person’s
life? Perhaps the two motives are wrapped up together? Or perhaps they are, in the
end, the same? Who should judge?
When dealing with euthanasia, the importance of Ryder’s negative utilitarianism can be
seen. The suffering person’s life should never be ended on the basis of the relief of
pain for the greater number (so killing someone because the rest of their family would
be relieved of a burden is wrong). It should only be used if the suffering of that
individual is so great that life no longer becomes worth living. Ryder argues that this
pain must always be extreme. He also says that other sentient beings should be
protected from extreme pain, as well as humans.
Mill’s views can be used to support voluntary euthanasia as his theory focused on the
need for human choice and freedom of choice. Modern society allows individuals to
make choices for themselves – e.g. they choose where they live, what they buy and
where they buy it. Why then shouldn’t that choice include when and where they die?
Mill gave support for this view in On Liberty. He wrote: Over himself, over his own body and
mind, the individual is sovereign.
Some argue that Mill’s views were not that straightforward. Mill was against voluntary
slavery and prostitution as both involve the decision of someone to give up his or her
freedom. It can be argued that euthanasia is the ultimate sacrifice of freedom. In Mill’s
understanding of the natural world, it cannot be claimed that the death of a person sets
them free. Death is final.
Yet there is a counter argument based on Mill’s support for the death penalty: “Is it,
indeed, so dreadful a thing to die?” This position could be seen as showing sympathy for
those suffering from serious illnesses. However, elsewhere Mill rejects the idea of
sympathy as a basis for moral decision making.
Jeremy Bentham actually asked for euthanasia as he lay on his death bed and had
written that the issue of assisted suicide for the suffering creates sympathy for those
involved. Yet sympathy is not, for Bentham, a virtue but rather a principle to be
condemned. So, as with Mill, there are mixed signals being sent. Today many
utilitarian’s are in favour of making euthanasia legal in some circumstances. They base
this support on the welfare of the individual and the general good of society.
Can Euthanasia ever be said to be good?
AO2 ‘Euthanasia can never be good’ To what extent do you agree with this
statement? (15 marks)
To evaluate the extent to which Euthanasia is good it is necessary to be clear what
is meant by ‘good.’
Many deontological religious thinkers define ‘good’ as being compliant with the
law of God, and therefore a Catholic would see ‘good’ as being compliant with
Roman Catholic Church teaching. Under this definition it is difficult to see how
‘Euthanasia can be good.’ Simply because the teaching of the Catholic Church is
extremely anti- euthanasia. Firstly they believe in the Sanctity of Life the idea
that all human life is sacred. Various Biblical passages point to this. E.g. the
commandment ‘do not kill.’ Dame Cicely Saunders sums this church teaching up
eloquently from the hospice position. "You matter because you are you. You
matter to the last moment of your life, and we will do all we can, not only to help
you die peacefully, but also to live until you die."
Secondly the Biblical teaching declares that Euthanasia is wrong. Pope Benedict
himself declared "Scripture, in fact, clearly excludes every form of the kind of selfdetermination of human existence that is presupposed in the theory and practice
of euthanasia."
Clearly then Euthanasia is not compliant with the teaching of the Church and
therefore under this definition can never be ‘good.’
Other teleological thinkers such as Jeremy Bentham disagree with the
understanding of term good. Bentham defines ‘good’ as being the maximisation of
happiness and minimisation of pain. As such euthanasia could be said to be good
when the result of an euthanasia brings maximum happiness and minimum pain.
For example he may see the future pleasure of a terminally ill patient being
affected by the amount of pain they experience at the end of their life- so the
‘good’ decision might be to assist this person with suicide and allow their last
moments of life to be without pain. An example of this would be the assisted
suicide of Peter Smedley. In this circumstance they would be in favour of
Euthanasia. Bentham would also consider physical disabilities of the illness a
major drawback, as they rule out many pleasures. Bentham would ask "Can they
still enjoy life? If the answer to this is ‘no’ then clearly euthanasia would result in
the most happiness and least amount of pain- it can then be said to be ‘good.’
Although Bentham would not claim euthanasia can be ‘good’ in every occasionusing this definition he does at least establish it can be ‘good’ on some occasions.
From this it is possible to conclude that the extent to which euthanasia can never
be good depends on how you define the term ‘good.’ If you accept that ‘good’ is
defined as bringing the most happiness and least amount of pain. It would seem
that euthanasia can be good on a number of occasions, and therefore it unfair to
say it can never be good. This definition of good seems to be the best way
forward as it is the most flexible and is able to deal with many complex scenarios
which may arise.
Do humans have a right to choose to die?
AO2 ‘Human beings should be able to decide when to die.’ Discuss how
far you agree with this statement. (15 marks)
This essay will evaluate the arguments both for and against this statements and
ultimately conclude that ‘Human beings should be able to decide when to die.’
Christianity a first glance clearly rejects the idea that human beings have the right
to decide when to die. Their teaching on the Sanctity of Life highlights that no
human has the right to decide when to die. At the Second Vatican Ecumenical
Council, the Roman Catholic Church condemned crimes against life such as;
Murder, genocide, abortion, euthanasia, or wilful suicide. They clearly feel that
“life is sacred and a gift from God” As such, for a human being to decide when to
die life opposes God’s love for that person, and rejects the duty of a person to live
life according to God’s plan. I feel this particular Sanctity of Life argument is
undermined the fact that God gave us the capacity to make our own free choices
and I will return to this point later in the essay from the position of Hans Kung.
However a further argument used regularly in support of ‘the rejection of humans
choosing when they should die’ is found in Christian theology; this is that Jesus
died in pain on the cross, and human suffering at the end of life connects us to
the suffering that Jesus felt. This does not mean that Christians should refuse to
take painkillers or should actively seek pain, but it does grant suffering the
possibility of having a positive effect on the individual. It provides the chance that
he or she may grow closer to God. In an article on euthanasia Thomas Wood
writes that while suffering can seem meaningless, is terrible and never sought, it is
not the worst evil – it can be on occasion for spiritual growth and it can have
moral effects on those in attendance. It can have meaning in the context of a life
lived in faith. As such they would feel that human suffering is preferable to
humans choosing the time, and nature, of their own death. I feel it is possible to
dismiss this teaching from the point of view of the crucifixion. Surely the self
sacrifice of Jesus on the cross highlights that he chose the time, and nature of his
own death, in order to redeem humanity.
There are however some thinkers within the Christian tradition that believe that
Human beings should be able to decide when to die. For example the
Theologian Hans Kung. “As a Christian and a theologian I am convinced that the
all-merciful God, who has given men and women freedom and responsibility for
their lives, has also left to dying people the responsibility for making a
conscientious decision about the manner and time of their deaths” As Kung
points out, when you die is an individual choice. God gave you the ability to
choose and you should use that God given right. God is all-loving and will
understand. From a faith perspective this is a refreshingly honest approach to
Euthanasia and self determination.
Kung highlights that each person has the right to control his or her body and life
and so should be able to determine at what time, in what way and by whose hand
he or she will die. Behind this lies the idea that human beings should be as free as
possible - and that unnecessary restraints on human rights are a bad thing. And
behind that lies the idea that human beings are independent biological entities,
with the right to take and carry out decisions about themselves, providing the
greater good of society doesn't prohibit this. Allied to this is a firm belief that
death is the end.
This appears to be a strong argument and John Stuart Mill was in agreement with
this position. He focused on the need for human choice and freedom of choice.
Modern society allows individuals to make choices for themselves – e.g. they
choose where they live, what they buy and where they buy it. Why then shouldn’t
that choice include when and where they die? Mill gave support for this view in
On Liberty. He wrote: Over himself, over his own body and mind, the individual
is sovereign.
In conclusion I feel that Kung and Mill establish that the ‘right’ to self
determination succeeds in showing ‘Human beings should be able to decide when
to die’ and this is highlighted in the declaration of human rights where the rights
to privacy and freedom of belief include a right to die as they give a person the
right to decide how and when to die. I conclude the individual is indeed sovereign
over himself.