Transcript PeterVardy Euthanasia

EUTHANASIA
Powerpoints prepared by Dr. Peter Vardy, Vice-principal, Heythrop College, University of London
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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.
Dr. Jack Kavorkian
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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.
Dr. Jack Kavorkian
with the Mercitron
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
Qu’ran;
Natural Law;
Proportionalism;
Situation Ethics or
Utilitarianism
The Bible
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It is not possible to absolutise the sixth
commandment (‘Thou shalt not kill’).
This is put forward in Exodus Ch. 20:13 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. 31:4); Anthithopel (2 Sam. 17: 23);
Samuel (Judges 16:30); Judas (Matt. 27:5)
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 Qu’ran
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.
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THE STATUS OF SACRED TEXTS
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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.
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.
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FOUR ETHICAL THEORIES
(Very briefly!)
Natural
Law
Situation Ethics
Proportionalism
Utilitarianism
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 Aristotle’s
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.
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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.
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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.
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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.
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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.
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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
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.
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 byproduct of a good action.
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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 person’s life to an end. Its 1988
statement on Euthanasia maintained that
the deliberate bringing to an end of life
should remain a crime.
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.)
ORDINARY MEANS
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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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CATHOLIC
DECLARATION ON
EUTHANASIA
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
Magisterium’s 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.
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.
II.
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
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)
IV.
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.
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.“
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)..
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 wellbeing.
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.
JOSEPH FLETCHER
Fletcher is an advocate of SITUATION ETHICS and
he is a consequentialist (a position specifically
rejected by the Vatican’s ‘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.
 PROPORTIONALISM
 IN
 EUTHANASIA
DANIEL C MAGUIRE
Maguire is a Catholic moral philosopher and he puts
forward which is effectively a proportionist’s 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.
Maguire’s 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’.
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 God’s 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".
Maguire’s 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.
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 person’s achievements,
possessions or capacities which contemporary society often
counts as essential to the value of human life.
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.
UTILITARIANISM
EUTHANASIA AND UTILITARIANISM
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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.
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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.