Medical ethics: Edexcel B grade notes

Edexcel
Ethics

AO1: Religious & secular views on the value of life (sanctity vs quality)

  • Religious views typically support the sanctity of life, the belief that life has intrinsic value because it is created by God.
  • The Bible supports this, for example Paul teaches that the body is a temple and humans “are not your own”, implying life belongs to God.
  • This means life should not be destroyed or treated merely as a means.
  • Natural Law, developed by Aquinas, strengthens this by grounding sanctity in reason.
  • The primary precept to preserve life and the concept of telos suggest all human life, including embryos, has a natural purpose and must be protected from conception.

  • However, Situation Ethics, proposed by Fletcher, offers a more flexible Christian approach.
  • Fletcher argues that agape (selfless love) is the only absolute, so the value of life depends on what is most loving in each situation.
  • He does not fully reject sanctity of life, but reinterprets it, denying that life is always inviolable and allowing it to be overridden where love requires.

  • Secular views reject divine authority and instead base morality on reason and human experience.
  • Utilitarianism, developed by Bentham and Mill, supports a quality of life view.
  • This judges life’s value by factors such as consciousness, the ability to feel pleasure or pain, and overall wellbeing, rather than simply being biologically human.

AO1: Application to the status of the embryo

  • Embryo research involves experimenting on embryos, usually leading to their destruction.
  • Natural Law rejects this because embryos are human life from conception, with a telos to develop, so destroying them violates the precept to preserve life.
  • Situation Ethics may allow embryo research if it produces the most agape, such as curing disease.
  • Utilitarianism would allow it where significant medical benefits outweigh harm, but oppose it if benefits are minimal or alternatives exist.

  • Pre-implantation genetic diagnosis (PGD) involves testing embryos for genetic conditions, often leading to selective abortion.
  • Natural Law opposes PGD as it treats embryos instrumentally and may lead to killing innocent life.
  • Situation Ethics may permit PGD to prevent serious suffering.
  • Utilitarianism would allow PGD if it reduces future suffering, but reject it where it encourages discrimination (e.g. gender selection).

  • Stem cells can become any cell type, while cord blood provides similar cells after birth.
  • Natural Law rejects embryonic stem cell use but accepts cord blood, as no life is destroyed.
  • Situation Ethics supports both if they maximise love.
  • Utilitarianism allows both where benefits are high, but may reject embryonic use if non-destructive alternatives are equally effective.

  • IVF enables conception but often results in unused embryos being destroyed.
  • Natural Law opposes IVF for separating reproduction from its natural purpose and risking life.
  • Situation Ethics may support IVF to help couples conceive.
  • Utilitarianism allows IVF where it increases happiness, but may criticise excessive embryo loss.

  • Abortion involves terminating a pregnancy.
  • Natural Law rejects it as the taking of innocent life.
  • Situation Ethics may allow it where it is the most loving outcome.
  • Utilitarianism permits abortion, especially early on, but may oppose it if it causes greater overall harm.

AO1: Application to assisted dying

  • Assisted dying involves helping a person to end their life, while euthanasia involves directly causing death, and palliative care focuses on relieving pain, even if this may hasten death.
  • Natural Law rejects assisted dying and euthanasia as they intentionally end innocent life, violating the precept to preserve life and the natural telos of human beings.
  • However, it may allow palliative care through the doctrine of double effect, where the intention is to relieve pain rather than cause death.
  • Situation Ethics may permit assisted dying or euthanasia if it is the most loving response to suffering, while supporting palliative care as agape.
  • Utilitarianism would allow assisted dying where it reduces suffering and increases wellbeing, but oppose it if it risks abuse or wider social harm.

  • The legal position varies, but in the UK assisted dying and euthanasia are illegal, reflecting concerns about protecting life and preventing misuse.
  • Natural Law supports this restriction, while Situation Ethics may criticise rigid laws that prevent compassionate choices.
  • Utilitarianism may support legalisation with safeguards if it maximises wellbeing, but reject it if risks outweigh benefits, such as pressure on vulnerable people.

  • Debates about rights and responsibilities focus on whether individuals have a right to die or a duty to preserve life.
  • Natural Law denies a right to die and emphasises duties to God and society, while Situation Ethics may support it in loving circumstances.
  • Utilitarianism supports rights where they promote wellbeing but limits them if they risk harm to others.

  • Personhood and human nature are also key.
  • Natural Law sees all human life as equally valuable, while Situation Ethics and utilitarianism place more weight on quality of life, including awareness and capacity to suffer.

  • Options and choices emphasise autonomy and control over death.
  • Natural Law limits individual choice to protect life, whereas Situation Ethics allows flexible decisions based on agape.
  • Utilitarianism values choice where it increases happiness, but may restrict it where it could create harmful social consequences or reduce trust in medical care.

AO2: Whether Situation Ethics gives the right level of autonomy in medical ethics

  • Barclay argues that Situation Ethics gives people too much freedom, which is dangerous in medical contexts.
  • Without clear rules, individuals may justify harmful actions as “loving.”
  • For example, in embryo ethics, parents or clinics could pressure decisions like abortion, PGD selection, or embryo destruction for financial, social, or convenience-based reasons, while claiming it benefits wellbeing.
  • Similarly, in assisted dying, vulnerable patients could be pressured by relatives seeking inheritance, or by subtle societal and economic pressures (e.g. reducing healthcare costs), leading to decisions that are not genuinely autonomous.
  • This supports the view that human judgement is often shaped by self-interest, making unrestricted autonomy risky.

Counter

  • However, J. A. T. Robinson argues that humanity has “come of age” and is capable of responsible moral decision-making.
  • In modern societies, greater emphasis on autonomy reflects respect for individuals as rational agents.
  • In medical ethics, this supports allowing people to make deeply personal decisions about abortion or assisted dying, even if risks exist.
  • Denying this freedom may itself be unloving, as it overrides individual circumstances and suffering.

Evaluation

  • Barclay’s argument remains more convincing in application.
  • Medical decisions often involve power imbalances and external pressures, meaning choices may not be fully free.
  • Evidence from wider society suggests behaviour can deteriorate without constraints, and autonomy alone does not eliminate self-interest.
  • Therefore, while autonomy is important, it requires legal and ethical safeguards to prevent abuse.
  • This suggests Situation Ethics is too optimistic about human nature if applied without clear guardrails in medical ethics.

AO2: Whether Natural Law is outdated in medical ethics

  • Natural Law may be outdated because it reflects medieval conditions rather than modern medical contexts.
  • Mill argued biblical morality suited a more “barbaric” time, and Aquinas’ precepts reflect this.
  • In a period with higher violence, limited medicine, and fragile social order, strict rules on killing and reproduction (e.g. absolute bans on abortion or euthanasia) helped preserve stability.
  • However, in modern societies with advanced healthcare, welfare systems, and greater education, these conditions have changed.
  • In issues like embryo research or assisted dying, absolute rules may now prevent beneficial outcomes, such as reducing suffering or advancing medicine.
  • So, the original reasoning behind Natural Law’s strict sanctity of life may no longer be relevant.

Counter

  • Aquinas would argue that Natural Law comes from God, so it cannot become outdated.
  • If society changes its views, then society is wrong, not the moral law.

Evaluation

  • The strongest critique is that Natural Law reflects the needs of Aquinas’ time rather than universal truths.
  • Strict precepts like preserving life would have been highly useful in maintaining order in a less stable society, which explains their development.
  • This suggests Aquinas did not discover divine law, but identified principles that worked for his context.
  • If so, the sanctity of life is not objectively grounded but historically conditioned, weakening its authority in modern medical ethics.

AO2: The slippery slope (applied to medical ethics)

  • The slippery slope argument claims that allowing practices like euthanasia or embryo destruction in limited cases can lead to wider, more harmful uses.
  • For example, allowing assisted dying for terminal illness could extend to non-terminal or mental illness, or create pressure on patients to reduce costs.
  • Similarly, in embryo ethics, allowing embryo research or PGD for serious conditions could expand to selecting traits like gender or intelligence.
  • This suggests that once we judge life by quality, it becomes difficult to draw clear limits, so sanctity of life provides a safer boundary.

Counter

  • Singer argues this risk is overstated.
  • He claims we can combine quality of life with autonomy to prevent abuse, so only voluntary decisions are allowed.
  • Evidence from places like Oregon shows euthanasia is rare and not targeted at vulnerable groups.
  • There is also no clear evidence of it becoming more widespread.
  • In embryo ethics, regulation can limit PGD to serious conditions, preventing misuse.

Evaluation

  • The slippery slope is less convincing when applied carefully.
  • The Nazi example is often used, but their approach to euthanasia was their starting point, not a gradual slide.
  • This suggests the real issue is having clear ethical principles and safeguards.
  • With strong regulation, autonomy and quality of life can be used without leading to morally troubling outcomes.

AO1: strengths and weaknesses of religious vs secular approaches to medical ethics

  • Weakness: Religious ethics can be too restrictive in medical decisions, limiting personal autonomy in cases like abortion or assisted dying.
  • Strength: Religious ethics provides clear moral limits that protect vulnerable people from pressure and misuse of freedom in medical contexts.

  • Weakness: Religious medical ethics may be based on outdated ideas about preserving life that do not fit modern society, healthcare or technology.
  • Strength: Religious ethics offers a consistent principle of the sanctity of life, preventing harmful decisions based on convenience or changing social views.

  • Weakness: Religious ethics can allow unnecessary suffering through its strict views on the status of the embryo and assisted dying.
  • Strength: Religious ethics avoids the risks of a slippery slope by setting firm boundaries on practices that could otherwise expand in harmful ways.