Euthanasia

OCR
Ethics

Theories on the value of life

Euthanasia being morally acceptable or not will depend on which view of the value of life is correct and, if relevant to the theory, on the particular type of euthanasia or situation in question.

The Sanctity of life

The conservative, sometimes also called the ‘strong’ sanctity of life view, claims that because God created human life, only God has the right to end it. Humans were created in God’s image, further suggesting that human life is especially valuable.

Both conservative catholics and protestants believe that the strong sanctity of life principle is justified by the Bible. Catholics would also think that Natural Law ethics provides justification for the conservative sanctity of life principle.

The sixth of the ten commandments is “thou shalt not murder”.

“Your body is a temple of the holy spirit, who lives in you and was given to you by God. You do not belong to yourself” (1 Corinthians 6:19).

“Whoever sheds human blood, by humans shall their blood be shed; for in the image of God has God made mankind.” Genesis 9:6

Fletcher’s liberal view of the Bible. Fletcher argued that the Bible is not a legalistic ‘rules book’ but an ‘editorial collection of scattered sayings’ which at most offers us ‘some paradigms or suggestions’. We can’t take the Bible literally, nor can we figure out which interpretation is correct. Fletcher’s liberal approach to the Bible allows him to reject the sanctity of life and claim that the central paradigm of the Bible is the promotion of agape, which he basis his situation ethics on.

Quality of life

Quality of life refers to how happy or unhappy a life is. Proponents of the quality of life in relation to euthanasia regard it as a valid ethical consideration because they think that life has to be of a certain quality in order for it to count as worth living.

Peter Singer believes the quality of life to be an important factor in euthanasia. He goes as far as recommending non-voluntary euthanasia for babies whose potential quality of life is low, such as due to being born with an incurable condition like spine abifida.

Peter Singer’s criteria for personhood are rationality and self-consciousness. He distinguishes between ‘humans’ (members of our species) and ‘persons’ (rational self-conscious beings). Not all humans are persons. Singer argued that belief in the sanctity of life of members of our species (humans) was based on ‘Christian domination of European thought’, especially belief in an afterlife and that God had ownership of us, his creation. He proposes that since Christian theological tenants are no longer accepted, we should re-evaluate Christian ethical precepts too.

Singer argues that if we think about what we find wrong with killing someone, it is that it deprives them of the life they want to continue live. A consequence is that if euthanasia is voluntarily asked for by a competent adult, then it would not be wrong because they don’t want to continue living their life. In the case of non-voluntary euthanasia for babies or patients in a vegetative state, they have no sense or conception of their life, let alone their life continuing. So, it’s not morally wrong to kill them because it doesn’t deprive them of anything that they are able to have a preference to not be deprived of.

Autonomy

Autonomy is the freedom of people to make their own choices. This isn’t directly a view on the value of life, but it is the view that the decision about whether a life is valuable ought morally to be up to the individual whose life it is.

Those who think euthanasia can be justified on these grounds either think autonomy has intrinsic ethical value, or they think that it has consequentialist value (Mill & Singer). If autonomy is a valid ethical principle for euthanasia then it must supersede the consideration of the sanctity of life.

J. S. Mill played a vital role in shaping political liberalism which defines all western democracies. Before the enlightenment, religion told people what to think, say and do. Mill, however, thought that society would be happier and make more progress if the underlying ethos of civilisation radically shifted to one based on individuality. Mill thought that society should not try to enforce a certain way of life on its citizens but merely stop people from harming each other. People should be the ultimate sovereign authority over their own life. Mill gave a number of arguments for this, including that individual people are in the best position to judge what is best for them and have the greatest motivation to ensure they live the best lives possible. People have different personalities and temperaments. If left free, people will run experiments in living which will result in a wealth of public knowledge about the better or worse ways to live, which future free people will be able to draw on in their own free choices and experiments, thus progressing the well-being of society at a greater rate than if that autonomy were not granted.

Mill’s arguments suggest that euthanasia should be left to the autonomy of a competent adult.

Peter Singer says he is not an absolutist about autonomy as he doesn’t want to make it easy for people to end their lives when they have a treatable condition or when they might easily recover. Singer also gives the example of a young person who is suicidality depressed due to relationship issues as an exception to the autonomy principle as we can ‘safely predict’ that they will come to view their life as worth living again and the value of that ‘overrides’ the temporary violation of their autonomy to deny them euthanasia. Singer agrees with Mill’s argument that 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. The young love-sick person is clearly not making that rational calculation however. An autonomous choice therefore has to be not only sane but also rational.

Situation ethics

Fletcher argued that the ‘indicators of humanhood’ are self-awareness, self-control, a sense of the future and past, the capacity to relate to others, have concern for others, communication and curiosity.

Situation ethics would be in favor of euthanasia in situations where it has a loving outcome and against it in situations where it does not have a loving outcome.

Natural law

Euthanasia violates the primary precept to protect and preserve human life. 

However, the Catholic Church uses the double effect to suggest that sometimes doctors can stop or withdraw treatment 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.

The Catechism of the Catholic Church on euthanasia:

“Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable.

Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate … Here one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.

Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable. Palliative care is a special form of disinterested charity. As such it should be encouraged. “

Peter Singer criticises the way that the sanctity of life principle is applied by the Catholic Church – claiming that “they do not really act as if they believe it”. He points out that the Catholic Church allows for passive euthanasia – the withdrawal of life support machines from patients who are in a coma or vegetative state. The Church claim that this is because they have no obligation to provide “burdsonsome or disproportionate treatment”. However, there are cases of patients in comas who the Church have allowed passive euthanasia for (e.g. Karen Ann Quinlan). Singer points out that since such patients are in a coma, it’s impossible to see how keeping them alive on life-support machines could have imposed a ‘burden’, since unconscious people cannot experience burden. Singer concludes that the only logical way to think it good to remove treatment is if you believe that life must have some “positive quality” in order to be valuable, i.e. the quality of life view.

The Natural law social order argument for sanctity of life. This Catholic argument is based on Aquinas’ natural law, which is the idea that God designed all things, including humans, to have the potential to act in harmony if they follow God’s natural laws, which involves preserving human life. If we go against that natural harmony then then our society will break down because living contrary to God’s design is unnatural and leads to immorality and social disorder. It is dangerous for human beings to give themselves the right to decide who gets to live and who doesn’t because we are unworthy of that power and would be corrupted by it. We need to believe that life is sacred otherwise we will treat it as less valuable. 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?” The idea is, if we stop treating life as sacred and having intrinsic value, that will reduce the value we place on life and be dangerous for the order of society.

Another way to put this argument is: are humans really worthy of the power to decide who it’s ok to kill? Isn’t it arrogant and dangerous to imagine we are good enough to wield that power responsibly?

Mother Theresa’s argument doesn’t seem to be true. Northern Europe has the most atheistic countries where quality of life is acted on instead of sanctity of life, but those countries are nonetheless some of the most stable and happy in the world. So, it just doesn’t look like it’s true that sanctity of life is a requirement for social order.

General critiques of euthanasia

The slippery slope

The slippery slope is an argument which suggests that if we allow something in an extreme case, it won’t be long until we allow it in a less extreme case and so on until it’s allowed in many or all cases. If we allow euthanasia for the reason of quality of life for terminally ill people then we are committed to the view that euthanasia is about reducing suffering, but then we have no basis for resisting extending this principle to young people with incurable mental or physical illnesses or even babies and small children who have conditions that will cause them suffering. We could even suggest a further case, where adults who are suffering are killed without their permission to increase the happiness of society.

Allowing euthanasia for the reason of autonomy is also vulnerable to the slippery slope issue as there is no way to reasonable restrict the principle of “freedom to die” to the hard cases. If we grant that people have the autonomous freedom to die, how can we then deny it in all cases where someone wishes to die, no matter how short-sighted their reason?

Archbishop Anthony Fisher makes the slippery slope argument against euthanasia, arguing that wherever it is legalised, it is extended to more and more people as that is where the logic of autonomy or quality of life arguments lead. E.g. in Holland, euthanasia was legalised for the terminally ill but 10 year later was legalised for babies in cases of severe illness where both parents consented.

Singer responds by pointing out that 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 20010.

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.

The negative effect on the vulnerable of allowing euthanasia

If Euthanasia is allowed, then some elderly or otherwise vulnerable people might be tempted to die because they feel like a burden. Some might even be pressured or manipulated into it by their family who want their inheritance, or simply to be rid of them.

This pressure is not limited to interpersonal relationships, but could occur at the societal level too. Our culture values success, self-sufficiency, productivity and beauty. Those who are unable to attain any of these markers of social status can feel miserable as a result. If we allow euthanasia, such people might feel encouraged to die because they feel like failures.

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”.

The idea that helping marginalised vulnerable people to die as a ‘solution’ is horrific. The obviously ethical solution is changing the goal of culture away from success and towards more fulfilling things like love. Those who believe in euthanasia think they are doing so out of love and kindness, not realising they are acting as the executioners for our merciless success-driven society.

Singer responds that people who receive euthanasia in Oregon are disproportionately white, educated and not particularly elderly, so euthanasia does not especially target vulnerable people.

Furthermore, these criticisms are arguably 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.

Types of euthanasia which the theories on the valid of life will have judgements on:

Terminal illness

Terminal illness is the most common reason for euthanasia as the person is going to die anyway often after a period of suffering.

Incurable physical illness

incurable physical illness such as cluster headaches are simply extremely painful and have no cure, reducing quality of life. Other incurable physical illness such as locked in syndrome almost completely paralyse a person which make them incapable of committing suicide even if they wanted to.

Incurable mental illness

incurable mental illness raises the issue of whether there is a kind and degree of mental illness which sufficiently impinges on the mind such that a rational choice to die cannot be made. Someone might be suffering considerable from an incurable mental illness, but if their ability to make informed rational choices is undermined by their illness, pro-autonomists would argue they shouldn’t be given euthanasia, while quality of life advocates might decide they should be.

In Belgium euthanasia is legal for people who don’t have a terminal illness but have an incurable and severe mental illness. Even young people in their 20s have been euthanized for this reason. If they have tried everything including every medication available, euthanasia is seen as a last resort.

Active & passive

Active euthanasia is when the person is killed by some positive action such as lethal injection, usually by a Doctor. Passive euthanasia is when no one performs an action which results in the death of the person but they are left to die by natural means, either by the result of their illness if they have one or simply by removing life-support machine equipment or even stopping giving them food. The death takes longer and unless they are unconscious in a coma or braindead, is more painful. However, the moral difference is that no one performed an action of killing them.

Voluntary & non-voluntary

Voluntary euthanasia is when a person has the mental capacity to want to be euthanized. Non-voluntary euthanasia is when someone does not have that mental capacity. If they are in a coma for example, or braindead, or are a baby.