The Sanctity of Life and Euthanasia
Title: Introduction to Euthanasia
L.O. What are the main issues?
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80 year old doctor
12year old boy
40 year old army sgt.
Pregnant woman
Stephen Hawking
Cheryl Cole
Barack Obama
28 year old AIDS sufferer
Buddhist Monk
Why are these principles being challenged today?
• Human life is said to be intrinsically valuable (the
Latin word ‘sanctus’ means ‘sacred’, ‘inviolable’, ‘holy’):
1. It
is wrong intentionally to take an innocent human life.
2. All human lives are of equal value, irrespective of age
or condition.
3. In medical ethics, a moral distinction is made between
intentional killing, which is regarded as morally wrong,
and allowing a patient to die when further treatment is
seen as futile.
• These principles may be based on Biblical
perspectives (for example, the doctrine of Imago Dei
– human beings as created ‘in the image of God’).
Challenges to the Sanctity of Life Ethic
• The decline of religious authority and belief in
divine creation
• The belief that human beings should have
autonomy – the right of self-government (the
right to choose between life and death).
• Since Darwin, we have become more aware of
our kinship with other animals.
• It is possible to prolong life without
guaranteeing quality of life
• Advanced medical technology has blurred the
boundaries between life and death.
• Some philosophers argue that we should
distinguish between the biological category
‘human being’ and the psychological category
of ‘person’. They argue that ‘person’ rather
than ‘human being’ is the morally significant
category.
Peter Singer: Practical Ethics
• ‘The fact that a being is a human being, in
the sense of a member of the species Homo
sapiens, is not relevant to the wrongness of
killing it; it is, rather, characteristics like
rationality, autonomy and selfconsciousness that make a difference’
• In Re-thinking Life and Death, Singer
argues that the re-definition of death
actually involves a ‘quality of life’
judgement.
• He believes the same is true of the decision
to remove artificial feeding from Anthony
Bland.
Singer’s ‘Five New
Commandments’
Five old commandments
1. Treat all human life as
of equal worth.
2. Never intentionally
take human life.
3. Never take your own
life, and always try to
prevent others taking
theirs.
4. Be fruitful and
multiply.
5. Treat all human life as
always more precious
than any non-human
life.
Five new commandments
1. Recognise that the
worth of human life
varies.
2. Take responsibility for
the consequences of
your decisions.
3. Respect a person’s
desire to live or die.
4. Bring children into the
world only if they are
wanted.
5. Do not discriminate on
the basis of species.
Immanuel Kant
• Kant believed that human beings
deserve absolute respect
because they have rational
autonomy. This is what makes
human beings Godlike.
• Unlike rocks and thunderstorms,
human beings have the ability to
think and decide for themselves
what they will do.
• Treating someone no differently
than we would an object (as a
means to an end) is to act
immorally and irrationally.
Jeremy Bentham (1748-1832)
• “The question is not, Can they reason?
Nor, Can they talk? But, Can they
suffer?”
• Bentham denies the Kantian view that
rational autonomy is the basis of our
moral standing. He argues that what
matters is the ability to experience
pleasure and pain. On his view,
pleasure is intrinsically good and pain is
intrinsically bad. The world is better
when there is additional pleasure and
worse when there is more pain, and it
doesn’t matter who or what is having
that experience.
Dr Jack Kervorkian
Dr Jack Kervorkian is well known in the
United States for his practice of
assisted suicide. In 1990 he assisted
Janet Adkins to die. Since then he
claims to have assisted in over 100
deaths. He has been tried three times
by the US courts and acquitted in all
three cases by juries.
However, recently he escalated his practice
from assisted suicide to direct mercy killing in
the case of Thomas Youk, who suffered from
amyotrophic lateral sclerosis. He prepared a
video showing his every action and the exact
moment of Youk’s death, and appeared with the
video on a national television news programme,
daring the authorities to prosecute him. He was
brought to trial and convicted on charges of
second-degree murder.
• Did Dr Kevorkian do the right thing?
• Give your opinions with reasons.
Euthanasia and the Law in the UK
Euthanasia
“When life is taken deliberately, the appropriate charge is murder. Thus, if a doctor
responds to a request from a patient to end his life and administers a lethal injection,
the doctor will have acted with the necessary mens rea for murder (mens rea is the
mental element required for conviction of a crime. It makes no difference from the
legal point of view that the patient gave their consent. Consent is no defence to a
charge of murder, or indeed to the infliction of any substantial physical injury on
another. Nor does the doctor’s motive make any difference; the fact that this was a
case of ‘mercy killing’ does not affect the status of the act as one of murder …”
Withdrawing treatment
“The criminal law does not require doctors to persist in the treatment of a patient
when no medical purpose is served by such persistence”
Assisted Suicide
In England, suicide was a crime until the passage of the Suicide Act 1961. This
legislation decriminalised suicide (which could obviously only be prosecuted as an
attempted crime), but retained the criminal prohibition of aiding and abetting suicide.
This means that a doctor who responds to a direct request of a patient to prescibe
drugs which he knows the patient intends to use to take his life will be committing an
offence under this statute … It is certainly the case that suicide has not been a crime
in Scotland – at least in modern times – and, therefore, it is difficult to see how there
could be a conviction for being art and part guilty (the Scottish term for accomplice
liability) to a non-existent crime. This does not preclude, however, charging a person
who assists suicide with a common law crime, such as that of recklessly endangering
life.
(Alexander McCall Smith, British Medical Bulletin, 1996)
Around the world
• The only four places that today openly and legally authorize
active assistance in dying for patients, are:
• Oregon (since l997, physician-assisted suicide);
• Switzerland (1941, physician and non-physician assisted suicide);
• Belgium (2002, permits 'euthanasia’);
• Netherlands (voluntary euthanasia and physician-assisted suicide
lawful since April 2002 but permitted by the courts since l984).
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Each of the following conditions must be fulfilled:
The patient’s suffering is unbearable with no prospect of improvement.
The patient’s request for euthanasia must be voluntary and persist over
time (the request cannot be granted when under the influence of
others, psychological illness or drugs)
The patient must be fully aware of his/her condition, prospects and
options.
There must be consultation with at least one other independent doctor
who needs to confirm the conditions mentioned above.
The death must be carried out in a medically appropriate fashion by the
doctor.
The patient is at least 12 years old (patients between 12 and 16 years of
age require the consent of their parents)
This is
Terri
Schiavo.
She died in
2005 after
a long legal
battle
between
her
husband
and her
parents.
This photo was
taken in 1990,
shortly after a
chemical
imbalance
caused Terri's
heart to stop
beating, cut
off oxygen to
her brain and
left her
severely braindamaged.
Terri was in
a vegetative
state for 15
years.
In this photo
she gets a
kiss from
her mother,
Mary
Schindler.
Terri's husband,
Michael Schiavo,
says she told him
once that she
would not want to
be kept alive
artificially.
He attempted to get Terri's feeding tube
removed for seven years, after he came to
believe that she would never recover.
Under
American
law Terri’s
husband
was her
legal
guardian.
Bob and Mary Schindler, Terri's parents,
went to court to try to fight Michael’s
efforts to let her die.
Demonstrators cover their mouths with
tape, which they say represents the
silencing of Terri Schiavo, in a protest
outside the hospice where Terri was a
patient.
Terri’s
feeding
tube was
removed on
18th March
2005.
She died
13 days
later.
During this time her parents continued to try
to get the legal decision to remove her
feeding tube overturned.
Terri Schiavo 1963 – 2005
Terri spent the last 15 years of her life
connected to a feeding tube in what doctors
described as a persistent vegetative state.
Paired Task Part 1
• In pairs discuss these points. Write the
answers in your jotter
1. Why did her husband want to remove the
feeding tube?
2. Why did her parents not want it removed?
3. “You saw a murder, all who denied her right
to live are accomplices.” what does this
statement mean?
4. Do you agree with it?, explain your answer.
Individual Task
•
Put a title “Case Study: Terri Schiavo” and then answer
these questions as fully as you can.
1. Apart from Terri herself, who else was affected by this
case? Make a list. How far do you think that the views of
the people on your list should have be taken into account?
Explain.
2. Do you think that the decision that was finally made
(withdrawing Terri’s feeding tube) was the right decision?
Give reasons.
3. Think about how the decision was made. Do you think that
the courts should decide cases like this? Give reasons.
BMA Guidelines
• In 2006, BMA members voting at the annual meeting made clear that
the majority oppose euthanasia legislation.
• The BMA’s policy is that assisting patients to die prematurely is not
part of the moral ethos or the primary goal of medicine and, if
allowed, could impact detrimentally on how doctors relate to their
own role and to their patients.
• Although the BMA respects the concept of individual autonomy, it
argues that there are limits to what patients can choose if their
choice will inevitably impact on other people.
• If assisted dying were an option, patients might feel obliged to
choose it for the wrong reasons, such as if they were worried about
being a burden or concerned about the financial implications of a
long terminal illness.
• The concept of assisted dying could weaken society’s prohibition on
intentional killing and undermine safeguards against non-voluntary
euthanasia of people who are both seriously ill and mentally impaired.
• An urgent and continuing matter of concern remains the uneven
availability of good quality palliative care. In 2005, the House of
Lords Select Committee on the Assisted Dying for the Terminally Ill
Bill was critical of the gaps in palliative care provision.
The Principle of Double Effect
• The principle of double effect makes a distinction
between deaths that are directly intended and
deaths that are merely foreseen.
• It is not permissible for a doctor to administer a
large dose of morphine with the intention of
hastening death.
• It is permissible for a doctor to administer a large
dose of morphine with the intention of relieving pain
(if that is the only way to relieve pain), even if they
foresee the hastening of the patient’s death.
• If safer drugs were available, they would be used:
pain would be controlled and life would not be
shortened.
Peter Singer
‘… membership of the species Homo
sapiens is not a reason for giving a
being worse treatment than a
member of a different species
…We do not doubt that it is right to
shoot badly injured or sick animals
if they are in pain and their chances
of recovery are neglible.
To ‘allow nature to take its course’,
withholding treatment but refusing
to kill, would obviously be wrong. It
is only our misplaced respect for
the doctrine of the sanctity of
human life that prevents us from
seeing that what is obviously wrong
to do to a horse, it is equally wrong
to do to a disabled infant.’
‘Slippery Slope’ Arguments
• In its logical version, the ‘slippery slope’
argument is unconvincing. As Helga Kuhse
argues, there are no logical grounds why the
arguments for euthanasia – mercy and respect
for autonomy – should also justify killings that
are neither merciful nor show respect for
autonomy.
• However, as a reflection on human nature it
may be more plausible – e.g., once people have
one thing, they will always demand more.