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.

The sanctity of life

The traditional Christian view. Sometimes now called the ‘strong’ sanctity of life.
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’.

Application to:

Voluntary euthanasia
Non-voluntary euthanasia (permanent vegetative state OR babies)
Active euthanasia
Passive euthanasia

Counter:

The weak sanctity of life view.
There are many themes found in the Bible, the sanctity of life is only one.
Other themes include compassion and love, both emphasised by Jesus.
This view considers the ethical precepts in the bible as things that need to be weighed against each other.
All these factors must be taken into account and in some extreme cases the sanctity of life may be outweighed by the others. In some cases, it might be compassionate to end a life.
Furthermore – the strong sanctity of life view no longer seems so relevant in our modern situation where we have the technology to keep people alive far past the point we could in the past when the Bible was written. This makes the ‘strong’ sanctity of life view seem outdated, because it was designed for a previous time.
Example of DNR

evaluation:

Compassion being recommended in the bible does not justify overruling the sanctity of life view. That is a misunderstanding of the biblical laws. They are presented as absolute rules, not themes or guidelines to be taken into account or weighed against other themes.

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.
Peter Singer says that the sanctity of life is based on outdated Christian views and thus should be re-evaluated. He takes a utilitarian view, that what remains to value in life without sanctity, are things like happiness or the satisfaction of pleasure.
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.
If someone has a low quality of life and 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 these views with claims about personhood.

Application to:

Voluntary euthanasia
Non-voluntary euthanasia (permanent vegetative state OR babies)
Active euthanasia
Passive euthanasia

Counter

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”.

Optional further evaluation:

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.
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. Arguably it at most suggests that euthanasia must be combined with proper support for the vulnerable, not that euthanasia cannot be justified.

The slippery slope

The slippery slope argument applies to any justification of euthanasia, whether autonomy, quality, or agape.
The slippery slope argues: if we allow euthanasia for low quality of life in clear cases of terminal illness – we are in danger of slowly starting to allow it in more controversial cases too.
We start with terminal illness, then we’ll allow it for incurable illness. Then incurable mental illness. Then, we might start encouraging people to be euthanised to save money for the NHS. Then, we might start involuntary euthanasia of homeless people – and then disabled people and then we’re in danger of becoming like the Nazis.
The danger is – once we start judging whose life is worth living based on its quality – how are we going to draw the line about which cases we will accept – Fisher argues the only way to resist that is to view human life as sacred.
This argument is logically coherent. It is right to worry whether we are virtuous enough to safely wield the power to decide who should die.
Singer’s response
Must combine quality with autonomy – this will prevent slipping down the slope to ‘involuntary euthanasia’
Singer says the slippery slope made sense to worry about back in the 70s, before we had real data.
People who receive euthanasia in Oregon are disproportionately white, educated and not particularly elderly, so euthanasia does not especially target vulnerable people.
Singer adds that there is no creep of euthanasia becoming more widespread. He points out how in Oregon only one in three thousand deaths are by euthanasia. Genetic screening allowing mothers to know if their baby has a condition before its born and aborting it meant the post-birth non-voluntary euthanasia numbers dropped from 15 in 2005 to 2 in 2010.

Adding to Singer: the Nazis are often brought up as an example of a situation we could slip down the slope towards. However the Nazis had very different motivations when creating their euthanasia program. Ultimately – the Nazis did not themselves slip down the slope to end up in their ideology regarding euthanasia. Their attitude to euthanasia was their starting point. So they are actually not a good example of slipping down the slope. They only illustrate the importance of having an ethical starting point when approaching euthanasia. If we do, we won’t betray that ethical starting point.

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.

Application to:

Voluntary euthanasia
Non-voluntary euthanasia (permanent vegetative state OR babies)
Active euthanasia
Passive euthanasia

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.

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.

Application to:

Voluntary euthanasia
Non-voluntary euthanasia (permanent vegetative state OR babies)
Active euthanasia
Passive euthanasia

Counter

W. Barclay’s critique.

People are not perfectly loving so if given the power to judge what is good or bad, people will do selfish or even cruel things.
People’s loving nature can be corrupted by power.
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.

Further evaluation:

Defence of Fletcher: humanity has progressed since mediaeval times.
Fletcher and Robinson argue (influenced by Bonhoeffer) that humanity has ‘come of age’, however. This means that humanity has become more mature.
In medieval and ancient time, when humanity had not come of age, people in general were less educated and less self-controlling.
This meant that they needed fixed ridged clear rules to follow, because they could not be trusted to understand and act on the nuances and complexities in how a rule could justifiably be bent or broken if the situation called for it.
However, now people are more civilised, to the point that granting them more autonomy will increase love without risking the stability of society.

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.

Application to:

Voluntary euthanasia
Non-voluntary euthanasia (permanent vegetative state OR babies)
Active euthanasia
Passive euthanasia

Evaluation:

Whether Natural law ethics and the sanctity of life is outdated

Aquinas’ Natural law ethics and the sanctity of life principle are increasingly seen as outdated. Sociologically, we could claim these ethical principles were created to be useful in the socio-economic conditions of their time. Ancient and Medieval society was more chaotic, strict rules were important to hold society together and because people were not educated nor civilised enough to be trusted with the freedom to interpret their application. It made sense to create strict absolutist ethical principles to prevent society from falling apart. This would explain the primary precepts. They served a useful function in medieval society.
Applied to euthanasia, we can argue it was useful to simply ban all killing in medieval times, because violence and killing was much more common and therefore needed to be strongly restricted. People were less self-controlling and less educated, so they needed clear simple rules to follow.
The issue clearly is that all of these socio-economic conditions have changed. So, the primary precepts are no longer useful. They were designed for a different time and are now increasingly outdated. Society can now afford to gradually relax the inflexibility of its rules and think about how they might be reinterpreted to better fit modern society.

Question preparation

Key paragraphs:

Sanctity of life
Quality of life
Autonomy
Situation ethics on euthanasia
Natural law on euthanasia
The slippery slope (attacks theories that argue for euthanasia, defends theories that argue against it – relevant to most questions).

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.)

(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 cover multiple types).

Autonomy question – e.g., should a person have complete autonomy regarding choices over life and death? [40]

Autonomy
Natural law – would say the human law must be based on the natural and divine law – so, euthanasia is wrong and should be illegal. We should not have the autonomy to decide it. In fact, autonomy is a misguided ethic – the ultimate good is to fulfil our telos of following God’s moral laws.
Slippery slope argument/debate

Weirdly worded questions:

Whether or not there is a moral difference between medical intervention to end a patient’s life (active euthanasia) and medical non-intervention to end a patient’s life (passive euthanasia).

This question is asking whether active & passive euthanasia are equally good, equally bad, or whether one is better than the other.
Natural law – there is a moral difference – passive can be justified through the double effect, but active cannot ever be justified.
Sanctity of life – equally bad
Fletcher – both potentially equally good (though one might be preferable depending on the situation – e.g. active could be quicker which would be more loving).