This page contains A*/A grade level summary revision notes for the Euthanasia topic.

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Into:

There are five theories you need to know on the ‘value’ of life, on what determines/gives life its value:

Sanctity of life
Quality of life
Autonomy
Situation ethics
Natural law

There are four types of euthanasia you need to know:

Voluntary
Non-voluntary
Active
Passive

You need to be able to explain what each of the 5 theories would say about each variant of euthanasia.

AO1: The sanctity of life

The traditional Christian view. Sometimes now called the ‘strong’ sanctity of life.
Traditionally based on the bible:
God created human life, it is a gift from God, only God has a right to end it.
Biblical evidence:
We are created in God’s image. Genesis says that is why it is wrong to kill people.
The 10 commandments say thou shalt not murder.
1 Corinthians says that our body is a ‘temple of the holy spirit’ and ‘you do not belong to yourself’.
This clearly denies autonomy and self-ownership over one’s life, and links the reason for that being the sacredness of life by likening the body to the sacred space of a temple.
It straightforwardly implies that we belong to God.

AO2: strong vs weak sanctity of life

The weak sanctity of life view argues that although life is sacred, sanctity of life is not the only biblical theme.
Other themes include compassion, love and mercy, all emphasised by Jesus.
This view treats biblical ethics as involving several moral principles which may need to be weighed against each other.
In extreme cases, sanctity of life may be outweighed by compassion.
For example, if someone is in unbearable suffering with no hope of recovery, it might be more loving to allow death than preserve biological life at all costs.

Counter

However, defenders of the strong sanctity of life view argue that compassion does not justify overruling God’s law.
That misunderstands biblical commands, which are presented as absolute moral rules, not flexible themes to be balanced against each other.
“Do not murder” is not merely one value among others, but a clear divine command.
So, the most faithful approach is to show compassion within the limits of God’s absolute prohibition on intentionally ending innocent life.

Evaluation

However, the strong sanctity of life view seems less convincing in the modern medical context.
We now have the technology to keep people alive far beyond what was possible when the Bible was written.
This makes the strong view seem outdated, because it can collapse into preserving biological life artificially, even when no recovery is possible.
The case of Tony Bland illustrates this: after being left in a persistent vegetative state, the courts allowed artificial nutrition and hydration to be withdrawn because continued treatment was not in his interests.
A DNR order shows the same principle: refusing resuscitation need not reject sanctity of life, but may recognise that prolonging dying is not always required.
So, the weak view is better because it respects life while allowing compassion to guide extreme cases.

AO1: The Quality of life

This claims that what makes life valuable is the quality that it has in terms of the balance of happiness over suffering.
This view grew out of the enlightenment rejection of religion and re-centering of ethics around human interests, flourishing and happiness.
Utilitarianism represents this view, claiming that what remains to value in life without sanctity, are things like happiness or the satisfaction of pleasure.
Peter Singer argues that the sanctity of life is based on outdated Christian views and thus should be re-evaluated.
Singer argues that the reason killing is wrong is that it violates the preferences or interests of a being to continue living.
That reason killing is normally wrong does not apply in cases where quality of life is low or non-existent and the person has a preference to die.
Then, voluntary euthanasia is justified.
Non-voluntary euthanasia is also justified for those in a vegetative state and for babies born with terrible medical conditions.
They cannot have or express a preference, but they do have an interest in not suffering unnecessarily.
Singer justifies this with claims about personhood: that it requires rationality and self-consciousness. He concludes not all humans are persons, and therefore can lack moral status.

AO2: The issue of marginalisation of the vulnerable

Archbishop Fisher argues that if Euthanasia is allowed for quality of life, then some elderly or otherwise vulnerable people might be tempted to die because they feel like a burden.
Western culture values success, self-sufficiency and beauty. Those who fall short can feel miserable as a result.
If we allow euthanasia, such people might feel encouraged to die because they feel like failures.
Adding to Fisher’s argument, In 2022 in Canada there was a controversy over two high profile cases of people with medical conditions for which they received insufficient financial support applying for euthanasia.
One called Denise saying they have applied for euthanasia “because of abject poverty”.
Pope Francis criticised Canada’s system as part of a tragic culture of treating the elderly and disabled as disposable, “patients who, in place of affection, are administered death”.

Counter

Canada did make the mistake of allowing doctors and nurses to raise euthanasia to patients as a possibility, even without having explored all other options.
Other places like Belgium have not allowed that.

Evaluation

We can conclude that Fisher’s points are not criticisms of euthanasia per se.
They highlight the problem with allowing euthanasia in a society which lacks proper support for those who need it.
It also highlights the issue of perverse incentives for health services, who will be incentivised to recommend euthanasia if it saves them money from treating a patient.
So, this does raise an important point, but at most suggests that euthanasia must be regulated carefully and combined with proper support for the vulnerable.
This critique does not show that euthanasia cannot be justified.

AO2: The slippery slope

The slippery slope argument claims that allowing euthanasia in clear terminal cases risks eventually allowing more controversial cases too.
E.g., moving from terminal illness to incurable illness, mental illness, NHS cost-saving, and eventually involuntary euthanasia, approaching Nazi logic.
Anthropologically this questions whether we are virtuous enough to safely wield the power to decide who should die.
Logically, it asks what theoretical resources pro-euthanasia theories have to non-arbitrarily draw the line, to prevent extension to further cases.
Fisher argues only sanctity of life can resist this.

Counter

Following Mill, Singer argues we can prevent slippage by linking quality of life with autonomy.
Singer claims the slippery slope argument only made sense in the 1970s, before we had real data.
In Oregon, recipients are disproportionately white, educated and not especially elderly, so vulnerable people are not especially targeted.
Nor is there obvious “creep”: only around one in three thousand Oregon deaths are by euthanasia.
Post-birth non-voluntary euthanasia even fell after genetic screening made some conditions detectable before birth.

Evaluation:

Nazism is often used to illustrate the slippery slope.
However, Nazis did not slip from compassionate voluntary euthanasia into involuntary killing.
Dehumanisation was their starting point.
Nazism only shows the importance of having the right ethical starting point: autonomy and compassion, rather than racial purity and social Darwinism.
This highlights the deeper issue with the slippery slope.
It assumes natural law’s logic: human nature requires strict laws to preserve flourishing, and breaking them spirals into chaos.
Singer’s data contradicts this: where euthanasia is regulated by autonomy and quality of life, it does not appear to slide towards ethical degeneracy.
This critiques the whole natural law framework: its laws are not absolute requirements of flourishing.
At best they may merely have been useful in earlier socio-economic conditions.
This suggests enlightenment movements like humanism and utilitarianism rightly identify quality of life and autonomy as the true grounds for human flourishing.

AO2: Autonomy

Nozick took a deontological/absolutist view of autonomy.
He argued for the principle of ‘self-ownership’, that each person owns their body and can do what they want with it.
If someone wants euthanasia then that is up to them, no matter the reason.
If a doctor then wants to help them die, there is nothing ethically wrong with that.
Voluntary euthanasia is therefore always morally acceptable.

Counter

There are ethical downsides to allowing anyone to die who wants to.
Singer points to the example of a love-sick teenager who wants to die for short-sighted reasons.
Mill and Singer take a consequentialist view of autonomy to solve this issue.
Singer claims we can ‘safely predict’ they will get over their issues.
Allowing autonomy in euthanasia for absolutely any reason would lead to many people dying when they themselves would have ended up regretting that. That doesn’t seem like it actually enables autonomy.
Being allowed to do something you’d regret due to temporary short-sighted emotions is not autonomy. Humans can have lapses in judgement where they act uncharacteristically. It’s not autonomy to allow people to die due to such desires.
Philosophers argue we should understand autonomy in terms of a person’s ‘ideal’ desires, meaning what they would want will full knowledge and without any non-rational distractions like intense emotion.
Thinking of autonomy as being free to act on literally any desire we might have, ignores the fact that humans are often irrational. When acting based on intense emotions, we aren’t acting autonomously, we’re acting animalistically.
Singer concludes we need to make sure that autonomy is rational.

Evaluation:

The slippery slope
Allowing consequentialist autonomy will result in a slippery slope towards absolutist autonomy.
Fisher argues that once you accept that people have the right to die, you have no way to prevent slipping down the slope to allowing it in all cases where people want it.
In that case, autonomy cannot avoid the issues faced by Nozick’s version.
However, there is a way to coherently adopt a consequentialist view of autonomy, which is to pair it with rationality.
Following Singer and Mill’s arguments, the individual who is in the best position to judge what is best for them and whether the potential value of their future life is of sufficient worth to make continuing to live the best choice for them. However, sometimes people can make irrational choices, not taking their actual long term self-interest into account.
To ensure that autonomy avoids ethical issues, we can therefore add the condition of rationality. The young love-sick person is clearly not making a rational calculation, for example. This also involves quality of life, since a low quality of life would usually be a requirement for a wish for euthanasia to be rational.
This position is not susceptible to the slippery slope argument. It would not allow euthanasia for short-sighted unthinking reasons since that would not be rational. This is a logically coherent way of avoiding extending autonomy absolutely.

AO1: Situation ethics application to Euthanasia

Fletcher was president of the euthanasia society of america.
Situation ethics would judge that euthanasia can be morally good, in situation where it maximises agape.
In situations where it would maximise agape to avoid euthanasia, it would be wrong, however.
For example, if someone has a very low quality of life and an autonomous wish to die, it seems that Fletcher would accept euthanasia.
However if someone is pressured into euthanasia by their family who are greedy for inheritance or by society making them feel like a failure or a burden, or if they have a short-term issue like Singer’s example of a lovesick teenager, Fletcher would think it wrong to allow euthanasia in such cases.

AO2: Whether situation ethics grants the right level of autonomy (applied to euthanasia)

William Barclay argues that situation ethics grants people a dangerous level of autonomy.
He denies humanity has progressed beyond needing the protection of strict laws.
Under situation ethics, people will not reliably choose the loving action, but may act selfishly or cruelly.
This reflects the view that human moral judgement is often distorted by self-interest and rationalisation, rooted in a sinful or flawed human nature.

Application:

Someone might find it loving to manipulate/pressure someone into or out of euthanasia, perhaps if they will get inheritance to pay for their children’s food or something.
Some might find it loving to end their life because they feel like a burden.

Counter

J. A. T. Robinson defends situation ethics, claiming that humanity has ‘come of age’ (influenced by Bonhoeffer concept of the ‘world come of age’).
This means that humanity has become more mature since medieval times.
In the past, people were less educated and self-controlling. They needed fixed, clear rules to follow.
However, now people are more civilised and can be trusted to think for themselves more.
Giving them more autonomy (a person’s ability to act on his or her own values and interests) will increase love without risking stability of society.

Evaluation

Robinson’s defence is unsuccessful against Barclay, because of the evidence for the corrupting influence of power.
People are more civilised, but only because of the careful legalistic system of rules built around them to ensure being civilised is in their self-interest.
When we take away laws, people behave terribly.
This can be seen during failed states when governments collapse, or when police go on strike as seen in Canada in 1969.
Zimbardo’s stanford prison experiment also shows how power can corrupt people.
‘The lord of the flies’ is literature which powerfully represents the decline in civilised behaviour once laws are taken away.
So, without external supervision of legalistic morality, humans become corrupt.
Fletcher’s theory would lead to antinomianism if implemented.

Application:

So, Fletcher’s situation ethics cannot safely adjudicate euthanasia.
If Euthanasia can be justified, individuals being trusted to apply agape correctly is very far from the institutional safeguards and legal regulations required to deploy it morally.
What we need is still a quasi-legalistic system, just to improve the actual laws, not replace them with unbridaled autonomy.

AO1: Natural law application to euthanasia

Natural law ethics claims that we should follow the Bible teachings, which Aquinas calls the ‘divine law’. It claims there is also another law, the ‘natural law’ which also comes from God.
God has given reason to human nature and designed it to be able to intuitively know the primary precepts of natural law.
Application to Euthanasia. Euthanasia violates the primary precept to protect and preserve human life.
Violating the sanctity of life, such as by allowing euthanasia, also violates the primary precept of maintaining an orderly society.
Natural law is the idea that God designed all things, including humans, with the potential to be in harmony if they follow God’s natural law, such as the preservation of human life. Failure to follow this will therefore cause disharmony. Our society will break down because living contrary to God’s design is unnatural and thus leads to immorality and social disorder.
Mother Theresa summed up this kind of argument well during her speech upon receiving the noble peace prize. She claimed “the greatest threat to world peace is abortion. If a mother can kill her own child in her own womb, what is left to stop us from killing one another?”
Euthanasia might seem right in extreme cases, but the natural law view is that if we allow killing, that disorders our being in relation to God. It blackens our soul. Humans are unworthy of wielding the responsibility of deciding who lives and who dies. It’s arrogant to think that we could make decisions like that without being corrupted.
The Catholic Church uses the double effect to claim that sometimes doctors can stop or withdraw treatment (passive euthanasia) or even administer pain medication which could speed up death. So long as the intention is not to kill, the double effect would suggest such actions can be morally acceptable.

AO2: Whether Natural law is outdated (applied to euthanasia)

J S Mill claims the divine law of the bible, especially the old testament, was only relevant in an ancient more barbaric time.
We can also apply this critique to Natural law ethics:
Its precepts reflect the medieval socio-economic conditions it was created in.
The murder rate was around 60-70 times today’s, showing a need for strict rules against killing.

Application:

This shows that the precept to protect human life might have reflected the needs of medieval chaotic society for strict laws to control the population.
This made sense, to stop society from falling apart.
Today, these conditions are significantly changed as we have much lower crime.
Aquinas’ precepts made sense in his time but are now outdated.

Counter

However, philosophically speaking, outdated doesn’t mean incorrect, just that popular opinion has shifted.
Aquinas would say the precepts come from God, so can’t be outdated.
If society thinks they are outdated, Aquinas would say society has gone wrong.

Evaluation:

However, the fact that Aquinas’ precepts are so neatly aligned with the needs of his time is unlikely to be a coinscidence.
It’s a simpler explanation that Aquinas was simply figuring out what would have been good for people in his time period & socio-economic condition.
His notion that the precepts came from God was only in his imagination.

Application:

The catholic Church (followers of natural law) allow passive euthanasia, prompting Singer to proclaim that they don’t act as if they really believe in the sanctity of life.
The Church claims this is to avoid burdensome treatment, but they allow passive euthanasia of patients who are comatose and thus impossible to burden.
That can only be justified if the value of life depends on it having a positive quality.
The precept to preserve life was formed before modern technology started keeping people alive long past the point of well-being and dignity.
Aquinas’ precepts were not intuited taking this into account.
Society can now afford to gradually relax the inflexibility of its rules and think about how they might be reinterpreted along quality of life grounds.

Question preparation

Revision paragraphs:

AO1: The sanctity of life
AO2: strong vs weak sanctity of life
AO1: The Quality of life
AO2: The issue of marginalisation of the vulnerable
AO2: The slippery slope
AO2: Autonomy
AO1: Situation ethics application to Euthanasia
AO2: Whether situation ethics grants the right level of autonomy (applied to euthanasia)
AO1: Natural law application to euthanasia
AO2: Whether Natural law is outdated (applied to euthanasia)

Question types:

Questions could focus on the application of these theories to euthanasia:

Sanctity of life
Quality of life
Autonomy
Situation ethics
Natural law

Questions could focus on these types of euthanasia, or on a theory applied to one of these particular types:

Voluntary euthanasia
Non-voluntary euthanasia (unconscious – coma – vegetative state – babies)
Active euthanasia (medical intervention to end a patient’s life)
Passive euthanasia (medical non-intervention to end a patient’s life)
Euthanasia for terminal illness
Euthanasia for incurable illness (locked-in syndrome – patients who are paralyzed & babies born with incurable illness e.g. Spina bifida. Singer thinks even down syndrome is a justifiable basis for non-voluntary euthanasia)

(It’s good to have a case study of all these types of euthanasia – in case the AO1 question focuses on it. Some case studies will efficiently cover multiple types!).

“Non-voluntary euthanasia can never be justified” – Discuss [40]
Focused Q: non-voluntary euthanasia

AO1: for non-voluntary euthanasia – including a case study would be ideal for this AO1.
AO1: Natural law application to euthanasia (minimal AO1 – don’t describe the theory in massive detail, just emphasise its view on non-voluntary euthanasia, including how non-voluntary passive euthanasia could be justified by the double effect).
AO2: Whether Natural law is outdated (applied to euthanasia)
AO1: Situation ethics application to Euthanasia (minimal AO1 – mostly application)
AO2: Whether situation ethics grants the right level of autonomy (applied to euthanasia)
AO1: The Quality of life (minimal AO1 – application)
Then either:
AO2: The slippery slope
- Helps evaluate the quality view answer to this question; includes some good discussion of non-voluntary euthanasia of babies (the stuff about autonomy would have to be linked to the consent of relatives, since non-voluntary people can’t give consent).

Evaluate the application of Natural law to voluntary euthanasia [40]
Split focused Q: natural law’s application to voluntary euthanasia

AO1: Natural law application to euthanasia
AO2: Whether Natural law is outdated (applied to euthanasia)
AO1: The Quality of life (minimal AO1 – highlight rejection of natural law and sanctity of life)
AO2: The slippery slope
This involves a critique of the specifically natural law assumptions behind the slippery slope.
AO2: Autonomy
- Natural law would be opposed to autonomy for the reasons discussed in the paragraph.
Or instead of Autonomy, could do:
AO2: The issue of marginalisation of the vulnerable

Does situation ethics provide the best approach to dealing with terminal conditions? [40]
Split focused question: situation ethics’ application to euthanasia for terminal conditions.

AO1: terminal conditions – explain, include case study.
AO1: Situation ethics application to Euthanasia
AO2: Whether situation ethics grants the right level of autonomy (applied to euthanasia)
AO1: The Quality of life (minimal AO1 – showing how situation ethics is a religious version of secular utilitarian well-being accounts of the value of life).
AO2: The slippery slope
- This criticises all attempts to justify euthanasia – including situation ethics’ attempts.
- Especially relevant here as it argues terminal conditions are the first step on a slippery slope.
- It ends with thinking it’s more quality of life and autonomy that prevents the slippery slope, though you could consider whether Agape might instead/also help there.
- I’d probably here conclude quality of life and autonomy is looking more stable than agape as a ground for euthanasia.
AO2: The issue of marginalisation of the vulnerable
This would target situation ethics and quality of life, and both can be defended.

You could do natural law here if you wanted to, (minimal AO1 – since Q is focused on situation ethics).

Should a person have complete autonomy over the decision to receive euthanasia? [40]

Focused question: on the place of autonomy in the ethics of euthanasia

AO1: The Quality of life (minimal AO1 – emphasise intellectual background of the development of autonomy as ethically relevant).
AO2: Autonomy
AO1: The sanctity of life (minimal AO1 – emphasise rejection of autonomy)
AO2: The slippery slope
- A criticism which backs up the sanctity of life rejection of autonomy, and the counter/eval involves autonomy heavily – as the solution to the slippery slope.
AO1: Situation ethics application to Euthanasia (minimal AO1 – emphasise support of autonomy
AO2: Whether situation ethics grants the right level of autonomy (applied to euthanasia)
- Situation ethics might go too far in the end, so you could side with Singer’s utilitarian approach to autonomy instead.

Weirdly worded questions:

Is there is a moral difference between medical intervention to end a patient’s life and medical non-intervention to end a patient’s life? [40]

This question is asking you to judge whether active & passive euthanasia are equally good, equally bad, or whether one is better than the other.

AO1: Natural law application to euthanasia
- It claims there is a moral difference: passive justifiable, active unjustifiable.
AO2: Whether Natural law is outdated (applied to euthanasia)
AO1: Situation ethics application to Euthanasia
- Would say there’s no significant moral difference – both potentially justifiable if agape is maximised. Maybe active is slightly better more often, as it’s quicker.
AO2: Whether situation ethics grants the right level of autonomy (applied to euthanasia)
AO1: The Quality of life
- Would say there’s no moral difference, except perhaps similar to Fletcher, that active is quicker which might be better sometimes.
AO2: The slippery slope
- Challenges the quality of life – and therefore challenges its judgement that both active and passive are equally justifiable, arguing instead neither might be justifiable – (certainly not active, which is most susceptible to the slippery slope).

Conclusion: there’s no significant moral difference – both can be justified on quality of life grounds when combined with rational autonomy.

“Euthanasia is easier to justify for terminal conditions compared to incurable conditions” – Discuss [40]
Focused Q: on euthanasia for terminal and incurable conditions

AO1: terminal and incurable conditions – case studies
AO1: The sanctity of life (minimal AO1 – mostly its judgement on terminal and incurable conditions (neither acceptable)
AO2: strong vs weak sanctity of life
AO1: Situation ethics application to Euthanasia (minimal AO1 – mostly its judgement on terminal and incurable conditions – both equally justifiable when agape is maximised)
AO2: Whether situation ethics grants the right level of autonomy (applied to euthanasia)
AO2: The slippery slope
- Attempts to show that justifying terminal conditions leads to incurable conditions – and then slips even further than that, suggesting we can’t allow euthanasia of any type (all types equally unjustifiable).