EUTHANASIA

1
EUTHANASIA
Powerpoints prepared by Dr. Peter Vardy,
Vice-principal, Heythrop College, University of
London
2

• If a person had a favourite dog or cat which was
  in great pain they might want to put it out of
  its misery and, indeed, it might be considered
  wrong if the person failed to do this.
• If, when someone are old, are in great pain,
  cannot feed yourself, have a colostomy bag,
  cannot sleep without drugs, cannot walk and have
  made their peace with their friends and children,
  their may feel that a peaceful death is a
  reasonable choice to make.
• One danger, however, is that old people may be
  made to feel that they are a nuisance and quietly
  pressurised to choose to die.
• In order to understand the different perspectives
  on this issue, it is essential to understand the
  ethical assumptions underlying different
  positions.
• Often people are not aware of the assumptions
  underlying the arguments and sometimes rhetoric
  is substituted for careful analysis.

3
Dr. Jack Kavorkian

• Kavorkian helped a number of people to die in the
  U.S. using the Mercitron machine. There are
  various types but the idea behind them is that
  the person wishing to die not only takes the
  decision but actually performs the action that
  brings about death hence Kavorkian helped to
  put people in a position where they could take
  their own life. It was not, he therefore argued,
  murder and was bringing release to people from a
  life of great pain and suffering.
• However he was nicknamed Dr. Death and was
  sentenced to a prison term
• The devices he used are shown on the following
  slides.

4
Dr. Jack Kavorkian with the Mercitron
5
DIFFERENT ETHICAL THEORIES

• IN CONSIDERING EUTHANASIA, OR ANY OTHER ETHICAL
  ISSUE, IT IS FIRST ESSENTIAL TO DECIDE ON THE
  THEORETICAL ETHICAL FRAMEWORK TO BE ADOPTED.
• THE POSSIBILITIES INCLUDE
• The Bible or Holy Book such as the Quran
• Natural Law
• Proportionalism
• Situation Ethics or
• Utilitarianism

6
The Bible

• It is not possible to absolutise the sixth
  commandment (Thou shalt not kill).
• This is put forward in Exodus Ch. 2013 but the
  very next chapter (Ex. 21 12 - 16) gives four
  reasons for killing a human being
• 1) if you strike your parents,
• 2) if you kidnap someone,
• 3) if you murder someone or
• 4) if you curse your parents.
• The Bible has no universal prohibition against
  killing - it endorses war and provides for
  capital punishment.
• It does not even condemn the four cases which it
  records of suicide Saul (1 Sam. 314)
  Anthithopel (2 Sam. 17 23) Samuel (Judges
  1630) Judas (Matt. 275)

7
APPEAL TO REVELATION IN SACRED TEXTS

• Revelation is claimed by various religious
• Jews will appeal to the Torah and Talmud
• Christians to the Christian scriptures
• Muslims to the Quran
• BUT differences immediately arise as to how these
  texts are to be interpreted. None of them deal
  unequivocally with modern ethical dilemmas
  whether in the field of genetics, abortion,
  homosexuality, just war, crime and punishment or
  other issues.
• Much will depend on how the text is interpreted
  and there will be considerable disagreements.

8
THE STATUS OF SACRED TEXTS

• There are considerable differences within all
  religions as to the status of their sacred texts,
  as to the role of reason, individual conscience
  and the teaching authority of any central body.
• Within Christianity
• The Catholic Church attaches great importance to
  the teaching authority of the Magisterium in
  Rome,
• In the Protestant tradition more emphasis is
  placed on the Bible and
• Anglicans value the early Church Councils
  Tradition the Bible and personal experience.
  More recently the Lambeth conference and
  decisions of local synods have become influential.

9

• Because so many issues are raised by appeal to
  sacred texts, most arguments about euthanasia are
  based on philosophic grounds as reason is held to
  provide a common meeting point for those from
  different traditions.
• If someone simply says My sacred texts asserts X
  and I am not willing to discuss this further
  then it becomes difficult to engage in debate
  with those who do not accept the status of these
  texts or who interpret them differently.

10
FOUR ETHICAL THEORIES(Very briefly!)

• Natural Law
• Situation Ethics
• Proportionalism
• Utilitarianism

11
NATURAL LAW

• The Natural Law approach to ethics has its
  origins in the philosophy of Aristotle.
• St. Thomas Aquinas writing between 1265 and 1274
  c.e. used Aristotles philosophy to provide an
  intellectual grounding for Christian moral claims
  and also for NATURAL THEOLOGY.
• Natural Theology claims that reason can arrive at
  the existence of God. NATURAL LAW claims that
  human reason can be used to arrive at what is
  morally right or wrong.
• Nothing in revelation contradicts reason so
  reason and revelation go hand in hand.

12
ARISTOTLE AND AQUINAS

• Aquinas followed Aristotle in claiming that all
  human beings (and all animals and plants of the
  same genus or species) share a COMMON NATURE.
• To be morally evil is to freely choose to FALL
  SHORT OF THE HUMAN NATURE WHICH ALL HUMAN BEINGS
  SHARE.
• If, therefore, one can work out what it is to be
  human, one can then arrive at which acts are
  morally evil.
• Acts which go against what it is to be human are
  intrinsically evil. They are evil in and of
  themselves.

13
Situation Ethics

• Situation Ethics was put forward in its most
  developed form by the Anglican Joseph Fletcher in
  1965.
• It is a CONTEXTUAL and SITUATIONAL approach it
  therefore rejects the DEONTOLOGICAL approach of
  Natural Law.
• It has been condemned by the present Pope and the
  Catholic Magisterium as a position that no
  Catholic may hold. Some consider that it may not,
  therefore, be taught in Catholic institutions.

14
Situation Ethics.

• Fletcher claims that Jesus came to reject the Law
  i.e. the Jewish Torah. It was too inflexible
  and attempted to transform the spirit that lay
  behind the law into fixed rules.
• Fletcher said there is no ethical system that can
  be said to be Christian.
• Jesus two commands to love (God and neighbour)
  are the foundation and heart of all Christian
  morality.
• There are no moral absolutes except love
  everything depends on what is the loving thing to
  do in the particular situation.

15
PROPORTIONALISM

• This is based on the Natural Law approach and
  stems from the Catholic tradition. Many Catholic
  moral theologians maintain that it is more
  faithful to this tradition than a strict Natural
  Law approach.
• It holds that there ARE firm moral rules BUT
  THERE CAN BE EXCEPTIONS if there is a
  proportionate reason which would justify this.
• It maintains that an action maybe objectively
  WRONG but morally RIGHT and that another action
  may be objectively RIGHT but morally WRONG

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Proportionalism contd.

• A distinction has to be made between acts which
  are good and acts which are right - and this
  distinction, proportionalists maintain, is often
  not made.
• A person may have a good intention but may be
  able to achieve that intention only through an
  act which is considered to be, in itself, evil.
• The proportionalists hold that it is possible for
  an action, in itself, to be wrong, whilst based
  on the actual situation in which the action is
  done the action may be morally right.

17
UTILITARIANISM

• This aims for the greatest happiness or the
  greatest good for the greatest number of
  people. It was put forward by Jeremy Bentham but
  modified by John Stuart Mill.
• Bentham considered pleasure was a single thing no
  matter what its source, but Mill considered that
  there were higher and lower pleasures for
  instance listening to music and writing poetry
  were higher pleasures than piggy pleasures
  such as food, drink and sex because these are
  shared with animals.
• Once one differentiates between higher and lower
  pleasures, however, a criteria is being
  introduced that goes beyond mere happiness.

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Central to the debate about euthanasia are

• 1) Does God exist and do human beings have a duty
  to God in considering how to behave?
• 2) Is the maintenance of life an absolute value
  which no other good can outweigh?
• 3) Does one hold that an act is morally right or
  wrong because of the very nature of the act or,
  by contrast, does one hold that it is the
  consequences of the act which make it right or
  wrong?
• 4) Is euthanasia the start of a slippery slope
  that may justify the killing of handicapped
  people and others?

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Key distinctions in the debate about Euthanasia
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DIRECT AIM OR A BY PRODUCT?

• It is important to separate
• Acts whose direct aim and intention is the
  bringing about of death (euthanasia falls under
  this heading) and
• Acts such as providing pain relief whose main
  purpose is not to bring death but may cause death
  as a side-effect. There is generally considered
  to be no moral problem with the second of these
  positions.

21
The principle of double effect

• This is a long established principle in ethics
  that an action may have more than one effect. If
  the side effect is regrettable but inevitable,
  then it is still permitted.
• For instance, the removal of the cancerous womb
  in a woman is a good action and is permitted even
  if, as a by-product, the life of a foetus may be
  destroyed.
• In the case of euthanasia, the giving of drugs to
  relieve pain is permitted even if, as a
  by-product, the death of the person is hastened.
  The early death is then a by-product of a good
  action.

22
ACTS OF OMISSION AND COMMISSION

• Acts of Omission involve not doing something (for
  instance not giving a blood transfusion) whilst
• Acts of Commission involve a positive action
  (administering an injection or giving tablets).
• Leaving someone to die (subject to certain
  caveats) would fall under the first heading and
  would not be classified as euthanasia.
• The British Medical Association recognises a
  distinction between withholding treatment that
  may be burdensome and deliberately bringing a
  persons life to an end. Its 1988 statement on
  Euthanasia maintained that the deliberate
  bringing to an end of life should remain a crime.

23
ORDINARY AND EXTRAORDINARY MEANS

• A distinction needs to be drawn between
  ordinary and extraordinary means - this was
  particularly important in the days of warfare
  before anaesthetics when a decision could be made
  to forego amputation even if this meant the death
  of the individual.
• Extraordinary means effectively means
  disproportionate means - in other words means
  of attempting to save life which are out of
  proportion, in terms of the pain and degradation
  suffered, to the possibility of prolonging life.
• A major problem is what is decided to be
  extraordinary means and in relation to what is
  this to be measured (e.g. length of subsequent
  life quality of life pain during the procedure,
  etc.)

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ORDINARY MEANS

• Ordinary means has been taken to include air,
  water and food. If this is accepted, then it can
  never be permissible to deprive someone of these
  even if they are in a permanent coma and even if
  these have to be administered in ways that are
  highly invasive.

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• THE CATHOLIC DECLARATION ON EUTHANASIA

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CATHOLIC DECLARATION ON EUTHANASIA 1980

• The document represents the official moral
  position on euthanasia of the Roman Catholic
  Magisterium (the teaching authority in Rome)
• Even though this is not an 'infallible' teaching,
  it is still normative for the Catholic community.
  As 'normative' this moral position calls for the
  presumption of truth on the part of the faithful
  who ought to attend carefully to this teaching.
• Since 1990, all Catholic priests prior to
  ordination (except for members of a few religious
  orders) have to sign an oath giving religious
  assent of will and intellect to all teachings of
  the Magisterium). This means that the
  Magisteriums teaching is effectively binding on
  priests and, Cardinal Ratzinger, the Head of the
  Holy Office, has said that this teaching must be
  accepted by the laity as well.

27
Key Principles in the Catholic declaration

• 1) The Value of Human Life
• This recognises that most people regard life 'as
  something sacred'. There are three norms
• 1)The Universal prohibition against attempts on
  the life of an innocent person.
• 2) The Universal duty to live one's life in
  accord with God's plan that human life be
  fruitful and find its full perfection in eternal
  life.
• 3) The Prohibition of suicide on the grounds that
  suicide rejects God's sovereignty and plan.

28
Euthanasia

• The document recognises that the word has
  different means for different people. It defines
  euthanasia as "an act or an omission which of
  itself or by intention causes death, in order
  that all suffering may in this way be
  eliminated."
• It is not permissible for one person to do this
  to another or to ask for it for oneself even when
  this request comes from the experience of
  prolonged and barely tolerable pain.
• The document holds that the pleas of gravely ill
  people who ask for death should be seen as an
  anguished plea for help and love, not only in
  terms of medical care, but also for human and
  supernatural support and comfort.
• THIS LAST POINT CAN BE DEBATED

29
III. The Meaning of Suffering for Christians and
the Use of Painkillers

• Whilst seeing that some things e.g. prolonged
  illness, advanced old age, bring about
  psychological conditions that facilitate the
  acceptance of death, nevertheless, death is
  something which naturally causes people anguish.
• Suffering may so exceed its biological and
  psychological usefulness that it can cause the
  desire to remove it in any way and at whatever
  price. It accepts that only a very few who can
  limit the dosage of pain killers to associate in
  a conscious way with the sufferings of Christ.
• Most people will want to use pain killers and may
  do so even though the drugs will reduce
  consciousness and shorten life. Death is then a
  by-product to pain relief (principle of double
  effect)

30
Due proportion in the use of remedies

• The document says that it is "Important to
  protect, at the moment of death, both the dignity
  of the human person and the Christian concept of
  life against a technological attitude that
  threatens to become an abuse."
• The document interprets the phrase 'the right to
  die' as "rather the right to die peacefully with
  human and Christian dignity."
• Decisions about how the ill will live whilst
  dying should be taken by the sick person.
• The documents cites with approval an alternative
  distinction between 'proportionate' and
  disproportionate' means. Disproportionate means
  to preserve life occur when the gains of
  continuing life outweigh the costs to the patient.

31
Proportionalism in Euthanasia

• Proportionalism is the Declaration's basic
  approach to applying the traditional principle of
  ordinary/extraordinary means when solving
  dilemmas affecting the duration of life.
• It advocates weighing of relative values (such as
  risk, cost, burden to patient and benefit) and
  recognises that some means are disproportionate
  to the result sought.
• When death is imminent, an individual may in good
  conscience "refuse forms of treatment that would
  only secure a precarious and burdensome
  prolongation of life, so long as the normal care
  due the sick person in similar cases is not
  interrupted.

32
GERMAIN GRISEZ JOSEPH M BOYLE jr. Life and
Death with Liberty and Justice Notre Dame Press
(1979) p336-439

• These authors challenge what they see as two
  basic assumptions of a pro-euthanasia position.
• 1) The assumption that there is a distinction
  between bodily life and personal life. In other
  words they reject the view that one can cease to
  be a person and yet still be bodily alive.
• 2) They also reject the consequentialist position
  that consequences determine the rightness or
  wrongness of human actions.
• Their basic premise is that there are certain
  basic human goods constitutive of human
  well-being. The fundamental human goods which are
  inherently worthwhile and give meaning to one's
  life and serve as motives for human action
  include play and recreation knowledge of truth
  and appreciation of beauty, life and health,
  friendship and self-integration (NOTE the
  inclusion of life in this list)..

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Grisez and Boyle - 2

• These goods cannot be measured against one
  another in order to establish any form of
  hierarchy.
• These basic human goods provide motives for moral
  action and are the source of the moral obligation
  to promote human well-being.
• Once this is accepted, then it can never be right
  to act against one of these basic goods.
• If this is accepted, then euthanasia would be
  absolutely prohibited because it intends to
  realise some good (such as freedom or dignity) by
  directly turning against one or more basic goods
  (life or health).Euthanasia wrongly assumes that
  the choice for death over life can be morally
  right because it serves the higher goods of
  freedom, integrity or dignity.

34
JOSEPH FLETCHER

• Fletcher is an advocate of SITUATION ETHICS and
  he is a consequentialist (a position specifically
  rejected by the Vaticans Veritatis Splendour)
  - in other words Fletcher believes that the
  rightness or wrongness of actions are to be
  judged not according to something intrinsic to
  the action but in terms of the consequences of
  the action.
• This is directly opposed, therefore, to the
  position taken by Grisez and Boyle.
• Fletcher rejects any absolutes and believes that
  the situation has to be taken into account and a
  decision has to be made as to the most loving
  thing to do in the circumstances.
• Fletcher maintains that there is more to being
  human than just being alive and that the key
  feature of humanity is rationality - this
  rationality may, in certain circumstances, be
  used to make a free choice to die.

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• PROPORTIONALISM
• IN
• EUTHANASIA

36
DANIEL C MAGUIRE

• Maguire is a Catholic moral philosopher and he
  puts forward which is effectively a
  proportionists position. It holds that
• 1) Life is a BASIC but not an absolute good
• 2) ONE IS BOUND TO RESPECT LIFE, BUT NOONE IS
  BOUND TO PROLONG IT IN ALL CIRCUMSTANCES
• Maguire argues that issues such as euthanasia can
  only be handled adequately within the broad
  context of a complete ethical theory. The special
  task of ethics is to bring sensitivity,
  reflection and method to the way people decide
  the sort of persons they ought to be and the sort
  of actions they ought to perform.
• The first step is to discover the moral
  objective. This is done by asking
  reality-revealing questions such as what, why,
  how, who, where, when, what if and what else.
  Only when this is done can evaluations, using
  rational analysis, feelings, creative
  imagination, group experience be undertaken.

37
Maguires Central Questions

• 1) Can it be moral and should it be legal to
  take direct action to terminate life in certain
  circumstances?. Maguire answers Yes.
• (2) Must we in all cases await the good pleasure
  of biochemical and organic factors and allow
  these to determine the time and manner of death?
  Answer No
• (3) Can the will of God regarding a person's
  death be manifested only through the collapse of
  sick or wounded organs? Answer No
• (4) Can the will of God be discovered through
  human sensitivity and reasoning? Answer Yes.
• (5) Could there be circumstances when it would
  be reasonable and therefore moral to terminate
  life through either positive action or calculated
  benign neglect? Answer Yes.

38
Deciding on death

• Maguire rejects the idea of a kind of fatalistic
  theism which forbids expanding the human dominion
  over dying because the time of death is organised
  by God alone - this implies that human beings are
  Gods property.
• If we should not intervene in nature then all
  medicine would be immoral, there is no essential
  difference between ending life and preserving
  life. Maguire maintains that we have
  underestimated our dominion over life and death -
  we have been given the responsibility to discover
  the good and choose it, even when the good in
  question is death.
• Terminating a life under certain circumstances
  may be good so long as a greater good than
  physical life is being served. Maguire therefore
  challenges the 'absolute' and 'exceptionless'
  character often given to the principle "Thou
  shall not kill".

39
Maguires defence against attack!

• Maguire defends his position of death by choice
  against the objections of the "no direct killing
  of innocent life" principle on the basis of his
  understanding of the source, function and limits
  of moral principles. The principle that there
  should be "No direct killing of innocent life" is
  valid most of the time, but in the specific
  circumstances of the patient's moral situation,
  the principle may not apply and would have to
  yield to the principle of achieving a good death.
• Unless someone holds that continued living in any
  condition is always preferable, (s)he will have
  to enter into the weighing of proportional
  values. He accepts that making the judgement
  between conflicting values is not easy and it may
  be mistaken, but he maintains that the whole
  purpose of ethical reflection is to achieve a
  finer sensitivity to the values in conflict and
  make possible options less arbitrary. Therefore
  euthanasia can sometimes be a legitimate moral
  choice.

40
CHARLES E CURRAN

• Curran accepts life as a primordial value he
  accepts the sanctity of life as a basic principle
  and respect for life as a moral imperative BUT he
  does not see euthanasia as the taking of full
  control if it only happens once the dying process
  has begun.
• Curran emphasises relationships between persons
  and also responsibility so that direct taking of
  life may be allowed when the process of dying has
  begun. He therefore gives a qualified acceptance
  to euthanasia in limited circumstances. His is a
  more limited position than Maguire's.
• The sanctity of life, the dignity of life, or the
  value of life, comes from "the special relation
  of the human being to the life-giving act of God
  and from the destiny of each person." The value
  of life is more than a persons achievements,
  possessions or capacities which contemporary
  society often counts as essential to the value of
  human life.

41
Life is not just a gift

• Curran warns against too great a stress on life
  as a gift as this can play down the role and
  place of human responsibility in exercising
  self-determination and stewardship in a
  reasonable way.
• 1. exercising stewardship does not exclude
  weighing the value of life against other values,
  such as cost, physical and mental suffering or
  freedom, and
• 2. already implied in the Christian traditions
  acceptance of the distinction between ordinary
  and extraordinary means of treatment see
  separate paper on ordinary and extraordinary
  means.

42

• UTILITARIANISM

43
EUTHANASIA AND UTILITARIANISM

• Today utilitarianism is the ethical theory most
  often applied in practice if happiness is
  maximised, then an action is right.
• On this basis, to help an old person to die when
  they are in great pain and terminally ill and
  they want their life to be brought to an end
  might be argued to be right as happiness is being
  increased and pain is being minimised.
• The most common arguments in favour of euthanasia
  tend, therefore, to be utilitarian ones. However
  utilitarianism fails to make a distinctions
  between actions that are absolutely RIGHT or
  WRONG and if this distinction is accepted then it
  may be challenged as an ethical theory.

44

• Underlying, therefore, different positions on
  euthanasia are different ethical frameworks and
  unless these framework assumptions are identified
  and the pre-suppositions on which they rest are
  analysed and questioned, the debate is not likely
  to make significant progress except at a level
  that may owe more to rhetoric than careful
  argument.