EUTHANASIA
Key Term: ‘Euthanasia’ an illegal practice in the UK, though under UK law a fully
competent person has the right to refuse treatment.
The issue is a complex one and this is mirrored in the various key terms that
are applied in the euthanasia debate:
‘involuntary euthanasia’ - applies to those who are unable to request their own
death, usually because they are mentally incompetent. Doctors and family make the
decision on their behalf. This term could be applied to the case of a comatose patient
or someone in a ‘Permanent Vegetative State’ (PVS). Yet to kill people, without their
consent, simply because they are old, handicapped, or ‘unwanted’ is not euthanasia, it
is straightforward murder! WHY? Because ‘involuntary euthanasia’ must meet two
aims: (1). Death must end suffering and (2). It must be in the patient’s own interest.
‘voluntary euthanasia’ occurs when a mentally competent person requests their
own death. Many ethicists argue that this should be permissible because it is
equivalent to assisted suicide. Many, like the ‘Voluntary Euthanasia Society’,
campaign to make ‘voluntary euthanasia’ legal so that a person may be assisted in
their own death in order to end their suffering or pain. This is the root of the modern
interpretation of euthanasia as a ‘mercy killing’. The two principles used which
attempt to justify ‘mercy killing’ are (1). the principle of the Quality of Life, and (2).
the principle of autonomy.
‘direct euthanasia’ - an intentional act of mercy killing which involves something
specific to end it like a lethal injection.
‘indirect euthanasia’ - an intentional act of mercy killing by which death occurs as
a side effect of treatment. The intention, however, is to end life.
‘active euthanasia’ - this is the same as ‘direct euthanasia’
‘passive euthanasia’ - this is not killing but letting die: it allows a person to die by
withholding or stopping treatment that sustains life. The RC Church is not
comfortable with what it believes is sometimes acceptable, i.e. withholding treatment
being described as ‘passive euthanasia’. It all depends on the intention of the act. If a
patient has a terminal illness and is going to die in a short time then to withhold
treatment which could be considered extraordinary, burdensome or disproportionate
is acceptable because no one has a right to kill, but neither is there an obligation to
prolong life indefinitely. The issue here is really about weighing up the benefits and
burdens of treatment from a patient’s perspective. Yet this cannot really be described
as ‘passive euthanasia’, since it does not seek directly to end life but allows the
person’s foreseen death to take its natural course, its intention being to avoid
burdensome and disproportionate treatment. However, withholding treatment like
switching off life support or failure to put someone on a life support machine that
directly leads to the death of a patient is ‘passive euthanasia’ and is seen as wrong in
the eyes of the RC Church. This is because the RC Church sees the use of things like
life support machines as ‘ordinary means’ that are used to keep people alive who are
not brain dead and not suffering from a terminal illness.
Christian Response
The Christian response will begin by pointing to a change in the meaning of the word
‘euthanasia’. The Church is sensitive to the language used in this area of medical
ethics. In the past, ‘euthanasia’ meant ‘dying well’ or ‘a good or easy death’ ( ‘eu’ is
Greek for ‘well’ or ‘good’ ‘thanatos’ is Greek for ‘death’), one achieved after a good
life and without violence. Today, however, it is usually understood as ‘mercy killing’.
This change is significant in itself, because it emphasises bringing certain lives to an
end, whereas the original meaning emphasised ending your natural life well. The
modern definition of euthanasia, therefore, appears to accept that a person’s poor
quality of life is reason enough to allow them to die.
Biblical Evidence
Christians will appeal to the Bible, as the Word of God, for their argument on
euthanasia. They will begin with the doctrine that God is Creator, and from this will
flow two fundamental beliefs: (1). Human life is sacred and (2). Life is a gift from
God.
(1). In Genesis 1: 27 God said, ‘Let us make human beings in our own image’, this
means that of all creatures created by God, human beings are unique and the most
precious in God’s eyes. Therefore, human life is sacred and should not be done away
with or thrown away.
(2). In Genesis 2: 7, ‘God took some soil from the ground and formed a man out of
it; he breathed life-giving breath into his nostrils and the man became a living
being’. This shows that life is a gift from God and so people are responsible for
respecting and cherishing that gift. Furthermore, if life comes from God then human
beings do not have absolute autonomy over their own living and dying; God’s
authority must be adhered to in this matter, according to Christians. This approach
rejects the principle of autonomy proposed by J. S. Mill who said, ‘over his own body
the individual is sovereign’. Christianity teaches that we simply do not have this
freedom, since God is sovereign over life. In the Book of Job, Job states: ‘The Lord
gave, and now he has taken away. Blessed be the name of the Lord.’ Christians
believe it is wrong - a refusal of our place in God’s plan – to be able to choose the
time of our own dying. This is not up to us, but to God; this is confirmed in Psalm 139
which states: ‘The days allotted to me have all been recorded in your book, before
any of them began.’ Any intervention that deliberately seeks to end life prematurely
is wrong.
(3). The Sixth Commandment states: ‘Thou shall not murder’. Murder is the
deliberate killing of a human being, so the deliberate bringing about of the death of a
person, irrespective of whether they gave their consent, is wrong because it goes
against the divine law which Christians must obey. This is why most Christians argue
against direct euthanasia which induces death by a deliberate administration of a
lethal injection. Direct euthanasia is the same as active euthanasia (see the article by
James Rachels): the deliberate intention to end life. So, in the case of a Persistent
Vegetative State (PVS) patient, most Christians would be against the use of a lethal
injection even though death would result in about 30 minutes. Forms of passive
euthanasia which the RC Church see as wrong are the turning off of life support
machines or the failure to put people on them; again, this is because such ‘omissions’
lead directly to a patient’s death.
Christian Church Teaching – C of E and RC.
(1). Sanctity of Life .v. Personal Autonomy
There are several key points given in the ‘Joint Submission of the C. of E and RC
Churches to the House of Lords Select Committee on Medical Ethics’ (1993).
The ‘submission’ indicates that the ‘sanctity of life’ overrides the right to ‘personal
autonomy’ so that the Churches do not recognise ‘a right to die at one’s own
choosing’.
(2). The distinction between ‘killing’ and ‘letting die’
While the Churches believe that a person’s autonomy is not absolute ‘Neither of our
Churches insist that a dying or seriously ill person should be kept alive by all
possible means for as long as possible.’ In other words, both Churches support the
distinction between ‘killing’ and ‘letting die’.
In order to support this distinction the Churches first appeal to the Principle of
Double Effect. For example, ‘the administration of morphine is intended to relieve
pain. The consequent shortening of life is foreseen but unintended. If safer drugs
were available, they would be used: pain would be controlled and life would not be
shortened.’ Here the deliberate intention is pain relieve, the second, foreseen but
unintended effect is the shortening of the patient’s life. The important thing here is the
intention of the act, since it was to relieve pain, it is not euthanasia.
Secondly, treatment can be withheld from the dying patient, if that treatment is
deemed disproportionate, burdensome, and extraordinary. ‘Death, if it ensues, will
have resulted from the underlying condition …, not as a direct consequence of the
decision to withhold or withdraw treatment.’ A judgement is made that the benefits
of a form of treatment or surgery are outweighed by the patient’s advanced terminal
illness and the treatment’s effect on the quality of life of the patient. To withdraw
treatment in such a situation is, again, not a form of euthanasia.
(3). The Hospice Movement
The Churches believe that the request to be allowed to die is really a request for love,
care and pain control. All these aspects are met within the hospice. As Christians
‘our duty is to be with them, to offer appropriate physical, emotional and spiritual
help in their anxiety and depression, and to communicate through our presence and
care that they are supported by their fellow human beings and the divine presence.’
The idea of the hospice is to provide a place where the patient can have their
pain controlled so that they are able to have time to prepare for death, emotionally and
spiritually – to put their house in order, so to speak – because Christian’s believe that
death is an event in life, not the end of life.
(4). Comatose and Permanent Vegetative State Patients
One of the most difficult issues in health care ethics is the care of permanently
comatose (eyes never open) patients and PVS (eyes may be open, closed, or vary, but
remains ‘unconscious’) patients. The Churches do not have an official position on this
issue, since it is so difficult to determine. At best, as ‘article 16’ of the Joint
Submission stated each instance must be ‘dealt with on a case to case basis’
Most Christians who take a view on this issue use the language of the
ordinary/extraordinary-means tradition.
The scenario: a patient in a permanent state of coma or PVS is given artificial
nutrition and hydration through a naso-gastric tube, an intravenous line, or directly
through a tube into the stomach.
The issue: is this artificial nutrition (1) medical treatment and therefore extraordinary
means in the case of a permanent state of coma and PVS or is it (2) feeding and
therefore ordinary means like other aspects of nursing care?
Let us take each viewpoint in turn:
(1) The first view argues that artificial nutrition must be weighed, like any other
medical treatment, in terms of the benefits as well as its burdens to the patient.
If one is permanently unconscious then, it is argued, long-term artificial
nutrition is extraordinary means (too burdensome), and does not bring
enough benefit to the patient since all artificial nutrition does is sustain
respiration and circulation – the physical aspects of life. It is argued that
respect for life and even the sanctity of life means respect for human life in its
totality – physical, mental, social, and spiritual dimensions. If all potential for
mental and social life has ceased, and if the patient’s spiritual and eternal life
is being stalled at death’s door, then prolonging the physical aspects of life
alone is not in the patient’s best interests and ought to be stopped.
(2) The second view argues that artificial nutrition is not medical treatment, but is
part of the basic nursing care of patients. Artificial nutrition is ordinary
means, and therefore, the duty of the hospital. The argument is that the
hospital has a duty to feed the patient like it would any other vulnerable
patient who could not feed themselves. Such a defence, tries to uphold the
view that Christians ought to respect life in its most tragic and unproductive
cases. By keeping such patients alive we are saying to all the vulnerable
members of society that we care for them in a divine way, not based on their
functional capacities (instrumental value), but rather highlighting their
inherent dignity as human beings: that is, human life, in and of itself, has
intrinsic value.
Implications of the two views:
a). the second view is really a criticism of the first view and its reliance on the
concept of personhood and quality of life. The idea that ‘human being’ and ‘human
personhood’ can be split seems to de-value respect for human beings as such. There
may also be a concern that the first view opens the door to euthanasia for those that
society does not deem to be ‘persons’ and even to drive down costs of health care. In
other words, those who argue for the second view, would imply that the first view
could be the ‘thin end of the wedge’ or a ‘slippery slope’ argument.
b). while the first view weighs up the benefits to the patient or not, the second
view does not. The second view does not weigh up the benefits and burdens to the
patient, but to the society which cares for them. By keeping a patient alive society
benefits by attesting to its respect for human life (the comatose or PVS patient in the
hospital bed acts as the guarantor - is the reminder – of/to society in its respect for
life). This view is saying that all life – no matter its circumstance or quality – is
worthwhile. Yet is it true that all life is worthwhile and should be preserved at all
costs?
Daniel Maguire (RC) argues against this when he says that life is a basic
good but not an absolute good. He means that life should be respected, but argues that
it does not have to be prolonged in every circumstance. He engages in what is called
proportionalism – an ethical theory that says a principle (like the ‘sanctity of life’)
can be good but there can be proportionate reasons for going against it. Life, in other
words, is not totally sacrosanct.
The argument to preserve life in all cases appears to understand the term ‘life’
as ‘biological life’ and make it equivalent to ‘sanctity of life’. The problem with this
approach is that it argues that biological life as a separate function (the life of a
permanently comatose patient) has intrinsic value and should always be preserved
independently of any capacity for conscious experience. (This is called ‘vitalism’ by
philosophers). By making the ‘sanctity of life’ a form of ‘biological life’ it is hard to
deny, from a Christian perspective, that this life ought always to be preserved. But
Christians are NOT ‘vitalists’. Something, therefore, has gone wrong in the reasoning
of the second viewpoint above!
(a). the second viewpoint goes wrong because it does not weigh up the benefit
to the patient of the continuance of artificial nutrition. Once this is taken on board, it
becomes clear that at some point continuance in physical life offers the person no
benefit – and on these grounds artificial nutrition can be stopped.
(b). the second viewpoint also has no room for a consideration of personhood
because it identifies the ‘sanctity of life’ with ‘biological life’ alone. This is to accept
that there is not only a distinction between human being and human personhood but
that they are also separate entities. This must be rejected from a Christian standpoint.
Rather, one should say that the person is always an incalculable value (personhood is
difficult to determine), but that at some point continuance in physical life offers the
person no benefit. Indeed, to keep ‘life’ going can easily be an assault on the person
and his or her dignity.
Roman Catholic Church Teaching
Suffering is part of God’s Plan
In their ‘Declaration on Euthanasia’ 1980, the RC Church affirmed that suffering has
a special place in ‘God’s saving plan’. ‘Suffering’, it went on to say, ‘is in fact a
sharing in Christ’s Passion and a union with the redeeming sacrifice which he
offered in obedience to the Father’s will.’
The RC Church is not saying that pain relief should not be used, but it is
saying that the dying ought to accept suffering as part of what it is to die as a human
being and not to be so afraid of suffering that a request to be allowed to die is always
made. In effect, this stance is a criticism of modern society’s attempt to sanitise
human culture from the experience of pain. Pain control should not be used so
intensively that it induces complete unconsciousness, rather pain should be controlled,
as far as possible, to enable the patient to fulfil moral, family and religious duties
before death.
Other Christian Points of View
Situation Ethics
Joseph Fletcher (C of E) outlined his theory in a book published in 1966. Fletcher
begins by rejecting an ethical approach to right and wrong based upon a variety of
rules. The only rule is Jesus’ command to ‘love’. The only rule that ought to be
followed is: ‘Always do the most loving thing’. Love is the only thing that is
intrinsically good, not life, or happiness etc. The only way of doing the most loving
thing is to analyse the situation one is in. Finally, ‘situation ethics’ is a teleological
theory like utilitarianism, in so far as ‘the end justifies the means’. Anything can be
done if it brings about the most loving thing.
It is clear that euthanasia can be justified using such a theory.
(i). It could be shown that the most loving thing to do in the situation of a dying
patient is to allow them to die as early as possible, since this is the most loving thing
to do given the situation of the patient (their bodily control, pain, dignity etc) and their
family.
(ii). Giving a lethal injection to a PVS patient could be justified, because it is more
loving to be allowed to die in 30 minutes than to starve over 2 weeks after the
removal of artificial nutrition. This is because the only intrinsic good is love not life.
(iii). Fletcher supports the distinction between ‘human being’ and ‘human person’.
His characteristics of personhood are:
-
self-awareness
self-control
sense of the future
sense of the past
capacity to relate to others
concern for others
communication
curiosity
It is clear that in situations where the above characteristics of personhood are absent
Fletcher would be able to justify the practice of euthanasia because there is no person
to kill; only biological life remains.
Jesus’ Mercy and Compassion
A consideration of Jesus’ compassion for those who suffer is related to the ‘situation
ethics’ approach. Following the general example of Jesus, Christians could argue that
it is truly compassionate to end the suffering of people through euthanasia. However:
Jesus put God’s authority above human autonomy. It is clear that dependence upon
God and not on one’s own power is what Jesus believed. From his pronouncements
on discipleship and his commending of the ‘Woman who touched his cloak’ and the
‘Widow’s offering’ this is clear enough. It can also be argued that a deterioration of
control over one’s body and destiny was understood and accepted by Jesus. In John’s
Gospel (21: 18) he says:
when you were young you put on your own belt
and walked where you liked; but when you grow
old you will stretch out your hands, and somebody
else will put a belt round you and take you where
you would rather not go.
The point here is that Jesus sees it as a natural occurrence in life that we become frail
and dependent on others. This may, of course, be something young and able bodied
people fear but not only is it our lot as human beings, but the real point is that in a
society that truly cares for its most vulnerable members this would not matter since
we place ourselves into the hands of those who care. It is about TRUST. In this
respect, human society should mirror God’s care for us. There ought to be pain
control, love, care and the possibility to withdraw treatment, but not euthanasia. In
light of this, it could be argued that a request for euthanasia which is based on a fear
of total lack of control over one’s own body (especially in a gradual wasting disease
e.g. Diane Pretty) is misplaced, because it is a failure to accept dependence upon
others, especially God. In the end, Christians would argue, we are not isolated
individual beings, but members of a community of love: the Church.
EUTHANASIA
UTILITARIAN RESPONSE
Applying Bentham to the issue of Euthanasia
Utilitarianism is a consequentialist theory of ethics: that is, a theory concerned with
the result of an action - its outcome or consequences. Only those actions which are
deemed to bring about the greatest happiness (pleasure) are to be undertaken. In many
respects, when utility is used to determine a course of action in medical ethics, it is the
benefit of a procedure or treatment which must be weighed up and judged. If a certain
procedure brings benefits (happiness) which outweigh any pain that can be measured,
then it is to be done. Thus, whether an action is good/bad, right/wrong depends on its
outcome. There are several implications of this:
● There can be no moral absolutes( i.e. things that are always right or wrong
whatever the circumstances).
● Nothing is inherently right or wrong, except pleasure and pain.
● Actions have only instrumental value (i.e. help us get something else that
we want) rather than intrinsic value (i.e. valued purely for their own sake).
Remember! Bentham was an ACT Utilitarian. He did not allow the using of prior
knowledge and experience to determine the course of action one ought to take. Each
situation must be judged on its own merits.
The hedonic calculus is used to measure the amount of pain or pleasure an act will
bring to the greatest number. In the case of a terminally ill cancer patient, there is not
really much pleasure involved. The request for euthanasia will be weighed up in terms
of the suppression or termination of pain, in an attempt to achieve pleasure.
● The intensity of, in this case pain, must be calculated. The patient will be suffering
huge amounts of emotional pain – the effect the illness is having on them leading to
depression because of the irreversible nature of their condition and a fear of lack of
control over their own life. The patient’s family will be in great distress, because they
may not be able to bear seeing their loved in such pain. The patient may also be in
much physical pain, since drugs to relieve pain are available but not always
administered correctly or efficiently. If the decision to request euthanasia is based
upon the great intensity of this pain, then the pleasure of ending it through ‘indirect’,
or even ‘direct’ euthanasia will achieve happiness for all concerned. The patient will
be able to rest in the knowledge that their struggle is over and seeing their relative at
peace will bring relief and hence pleasure to the family.
● The duration of the pain must be accounted for too. The emotional pain of the
patient and their family will surely be prolonged if the patient cannot choose
euthanasia. Obviously, no one is pleased when a family member dies, but the family
may take pleasure in the future knowing that their loved one’s death was not a
prolonged, lingering death; it was quick and painless. A utilitarian following the
calculus may, on these grounds, recommend a form of ‘direct euthanasia’ such as
lethal injection in the case of a PVS patient, in the knowledge that they will die in 30
minutes rather than ‘indirect euthanasia’ – the withdrawing of artificial nutrition –
which could take as long as 3 weeks. The reason for this is that for the utilitarian, the
end justifies the means. There is, in other words, no moral difference between giving
a lethal injection and withdrawal of treatment, since both achieve the same end: the
death of the patient. Today, such an argument is supported by James Rachels in his
article ‘Active and Passive Euthanasia’. (Remember, for a utilitarian, the means by
which something is achieved are non-moral, i.e. not morally significant – the only
thing that is good is the outcome of an action!)
● The certainty of the pleasure is relevant in this case. It is certain that there is much
pain, both emotional and physical, in the case of a terminally ill patient and his/her
family. This may even increase, if a request for euthanasia were made but not granted.
So it could be argued that to grant a request for euthanasia would certainly increase
the amount of pleasure felt by all concerned. However, it could also be argued that, it
is difficult to measure the certainty of the pleasure, since in the future the family may
actually come to regret their decision to agree to the ‘killing’ of their relative.
● The fecundity of the act of euthanasia is also relevant. If your loved one dies then
the family are ‘free’ to pursue their own lives. This can be productive of pleasure in
so far as by ‘getting on with their lives’ pleasure will result. Secondly, the patient may
have left a will so that their early death will result in a financial settlement being
shared out among the family. The spending of this money, it could be argued, can
produce more pleasures.
● The extent of the pain, or future pleasure, affects the patient, the family and
possibly others too. For instance, if the patient was granted their wish to die at a time
of their own choosing, the hospital’s resources could be used to treat many more
patients whose lives were possibly not in danger. This would, in its own right,
increase the pleasure of many more people – not only the patients, but also their
families and friends. This in turn would outweigh the pain of the initial death of the
patient who requested euthanasia. The extent of pleasure would also increase through
the act of euthanasia, since the relief felt at their loved one’s death would be shared by
all family members.
After consulting the Calculus it is clear that the request for euthanasia ought to be
granted.
J. S. Mill
Euthanasia
How might one apply Mill’s version of utilitarianism to the issue of abortion?
●
The first thing to note is Mill’s principle of autonomy (self-determination):
“Over himself, over his own body and mind, the individual is sovereign.”
The essence of this principle is that there is no authority above your self when it
comes to power over one’s own life. This is directly opposed to the Christian view
that people do not have the authority to choose the time of their own dying, because
that would be to claim God’s authority for oneself – it would be to play God.
However, for the utilitarian God is not a part of the moral universe and so human
beings are in authority and there is no higher authority to consult.
The principle of autonomy is central to the issue of euthanasia and, for Mill,
autonomy is absolute. In this respect, if a patient requested euthanasia through the use
of ‘direct’ means, such as a lethal injection, then it ought to be granted since it is an
expression of an individual’s sovereignty over their own life. Mill would also agree to
the current UK law which allows a ‘fully competent’ person to refuse medical
treatment.
Mill would be in agreement with the RC and C of E Churches in their use of
the Principle of Double Effect. Yet the grounds for this agreement would be different
in the case of Mill. Whereas the Churches’ use of the principle is at pains to point out
that the intention of appealing to the principle of double effect is to highlight that the
patient’s death is foreseen but unintended, Mill would see no difference between what
ethicist’s call ‘active’ and ‘passive’ euthanasia. This is because the outcome ( the only
thing Utilitarians are interested in) of both forms of euthanasia bring about the same
result: the death of the patient.
● The next thing to consider is Mill’s distinction between higher and lower pleasures.
In the case of terminally ill patients and those who are comatose or in a PVS,
Mill’s distinction is highly relevant. In the first place, it is clear that personhood is
related to higher pleasures. It is arguable that permanently comatose and PVS patients
cannot experience the higher pleasures since these are the pleasures of the mind.
Personhood is about the conscious, rational life of the mind and about the ability to
have relationships with others. These characteristics are lacking in comatose and PVS
patients and so on these grounds euthanasia is justified. ‘Active’ euthanasia will be
preferable to ‘passive’ euthanasia. In the case of a PVS patient Mill would opt for
lethal injection (‘active’ euthanasia) over the withdrawal of artificial nutrition, since
passive euthanasia would prolong the suffering of the patient and his/her family. The
end here justifies the means, the end being the patient’s death not any moral scruple
about direct acts of killing! However, it may be the case that Mill might be sometimes
against such action (since he is a rule utilitarian) if he followed the rule that it is
wrong to kill innocent people? It all depends on whether the patient is a person!
Mill’s use of the ‘higher’ and ‘lower’ pleasure distinction relies on the
principle of the Quality of Life. This is highly relevant in the case of the terminally ill
patient. Justification for voluntary euthanasia is often based on the poor quality of life
of the patient, which is a life of pain and depression, and of a gradual loss of the
ability to control one’s own destiny. The certainty that in a short time a person will
lose the ability of bodily control or communication – in the case of Diane Pretty –
will, on the basis of Mill’s principle of autonomy alone allow euthanasia to take place.
The argument in this case would be that the patient ought to be able to exercise his/her
autonomy over their own body before that ability was taken away from them by
illness. After all, this is similar to acting on a ‘living will’. It also seems a
commonplace that Mill would always agree that euthanasia should be an option for
those terminally ill patient’s who do not want to go on ‘living’ because their lives are
so poor in quality. If they are dying anyway, surely a shortening of the dying process
is the most compassionate course of action. In this respect, Mill would again support
the widespread use of pain control through the use of morphine which can shorten the
life of the patient. But he would also support ‘active’ euthanasia and the use of lethal
injection. It will all depend on the patient’s wishes, since the expression of their
autonomy is paramount. However, Mill might also argue that in some cases, provided
adequate pain control was administered, there would be no need for euthanasia. If we
accept that many requests for euthanasia are really requests to be put out of pain, then
once out of pain, the patient’s quality of life will improve enabling them to prepare in
a more rational way for their death. Furthermore, making sure the patient is out of
pain will reveal the true intention of the patient and ensure respect for their autonomy.
● The next element of Mill’s theory to consider is his stress on the importance of
internal sanctions. Bentham believed people acted morally because of ‘external
sanctions’ which acted upon them as a restraining influence such as the law and
public opinion. Mill, however, understood that people acted morally independently of
such sanctions and instead acted out of conscience or guilt. Conscience and guilt have
both a restraining influence and an ability to set the individual free to act against
prevailing norms. In a simple way, euthanasia could be wrong if a person’s
conscience was against killing themselves – assisted suicide. A doctor who believes
their duty is always to preserve and save life and not seek to end life may decide also
not to participate in euthanasia on grounds of conscience. At the very least, a doctor,
on grounds of conscience, may make a distinction between ‘killing’ and ‘letting die’
and never participate in the former. Furthermore, the guilt felt by people involved in
euthanasia –healthcare professionals and family members – may become an influence
which prevents others from participating in euthanasia.