RMPS Medical Ethics Euthanasia

Transcription

1 RMPS Medical Ethics Euthanasia

2 In this section we will study: The 4 categories of euthanasia- Dangers and benefits of euthanasia The reasons people choose euthanasia The law and euthanasia in the UK and Netherlands The BMA guidelines Viewpoints on euthanasia Religious and Secular views When I m lying on my bed and life for me is done I hope you ll help me at that time by bringing me a gun You see I don't want to end my life all twisted and in pain With all my life, my hopes and fears, all muddled in my brain. Or maybe some nice pills would more cleanly end it all A kindly doctor with a needle and plenty of gall To take his duties seriously and spare me my death throes And save my family from guilt and spare me my death throes

3 To kill or cure s the subject of the Hippocratic Oath Is it either / or more likely both He ll send me swiftly to a peaceful gentle kindly death my eyes will close, my pain will go, then finally my breath. So even if in those last days without even my voice Remember that as it was in life in death it is my choice And once my life is over my untimely death pronounced I ll make my way to heaven albeit unannounced. So let me die with dignity at my own time and place Let me choose when I last look with love upon your face If I'm aware or if I'm not I hope you ll clearly see If I could speak I'd surely say this life belongs to me! Does your life belong to anyone or anything?

4 Euthanasia literally means gentle or easy death, it is sometimes also referred to as a mercy-killing. This is where a person is either aided in a quick death or helped to die through withdrawal of treatment. Euthanasia can be divided into many categories and headings depending on the situation it applies to. They are not necessarily independent of each other and vary from case to case. For the purpose of this topic we will stick to 4 main headings. The first 2 are ACTIVE Actively killing someone. You are given something on purpose which will bring your life to an end. A person may be given drugs by a doctor, which kill them, or they may be able to take them themselves with a doctor s help or the patient could be suffocated.

5 PASSIVE This is where treatment to save you from death may be withheld. This may be turning off a life support machine or system that is keeping the person connected to it in a life state. In some countries a do not resuscitate order can be requested by a person which would mean that in the event the person needs life saving treatment this would not be given at their request, resulting in death. These are very important distinctions because for many people there is a very great difference between killing and allowing to die for many this is the crucial issue in the whole topic of euthanasia. Do you think there is any real difference between a doctor actively killing a patient or allowing their patient to die through withdrawing treatment or being inactive in some other way?

6 Voluntary Euthanasia: A person only comes under this category if they have previously stated that they wish euthanasia. This could occur in a number of situations the person knows they are terminally ill and does not wish to suffer, a person who is very ill may state that if their heart stops or they stop breathing they should not be resuscitated or a person has a degenerative disease (like Alzheimer's) and want to die before they stop recognising family and friends. Or maybe it is just that a person has decided there is no point in living anymore. It differs from straight suicide in that it usually involves you seeking professional medical help to end your own life rather than just doing your own DIY job.

7 When might voluntary euthanasia be a potential option? In a situation where you are terminally ill ( no hope of recovery and which will end in your death), some people believe that it is a better option to choose the time and place of your dying rather than wait for the inevitable, possibly prolonged and possibly painful process of death. In a situation where your terminal illness is likely to lead to some deterioration in what you see as the quality of your life. This of course could be physical pain which you want to avoid but it could also be mental suffering or the fear of losing touch with what you see as yourself through, memory loss or brain deterioration leading you to be unable to live as you. You might also choose euthanasia in a situation where medical opinion tells you that you are likely to lapse into a Persistent Vegetative State (PVS) from which you would never recover. Some might wish the option of voluntary euthanasia where they feel for some reason the quality of their life is no longer worth living even though they are not terminally ill. This would vary widely between people.

8 Imagine that you are a professional sportsperson and through an accident you become quadriplegic you might consider your life not worth living because the things that matter most to you in life are no longer possible. So you might want the option of voluntary euthanasia. Watch an excerpt from the film Million Dollar Baby Write a brief description of what you saw in this scene. Do you think Maggie s decision was the right one? Do you think it was fair of her to ask Frankie for his assistance? Do you think Frankie did the right thing? Always explain your answers!!

9 Some people might want this option as they do not want to burden their family with looking after them through a long and difficult illness. They also don't want to give their family the awful responsibility of ending their life and so they turn to their doctors to do this. Doctors have the medical skill to help end your life painlessly. Some people believe that life and death is something you should have individual control over. If you have a headache you take a pill. Some argue that taking your own life with a doctors help is just the same your getting rid of the headache which is your life. Your life is yours and you should be able to rationally choose when you no longer want it. Some argue that euthanasia is about the quality of life. As a human being perhaps it is your decision when you think it is no longer worth living. Why should anyone have the right to deny you this choice? Supporters argue that ending your life is a personal choice which affects no one but you. Do people have the right to die?

10 Supporters say it allows us to die with dignity. It stops people from taking their own lives without medical help. Physician assisted suicide is a far more humane way of ending human life. It means that vital healthcare resources don't need to be used up on people who don't actually want to live. If its all done legally and controlled then no one risks prosecution by assisting you to die. It allows everyone to make their own choices about this important part of life. This respects the rights of all people. It gives us control over our lives. Why shouldn t we have freedom over our deaths?

11 Is it ever right to put doctors in this position? Do we have the moral right to ask them to do this? Is everyone who decides that they want to end their life in the same mental state when they choose to do so? If you choose long before your ill then you assume you will think the same way later. Doesn t society have a duty to protect people maybe even from themselves? You d have to be of sound mind to decide you might want voluntary euthanasia. Who decides when someone is of sound mind? Isn t voluntary euthanasia the first step on a slippery moral slope? Wouldn t it just mean that we deal with many of society s problems poverty, care for the elderly, support for the sick and dying by getting rid of them? If voluntary euthanasia becomes commonplace, what does this say about quality of life? Is society upholding this idea or making it worthless? Isn t life valuable no matter what?

12 Do you think legalising euthanasia is a slippery moral slope? 1. What other words / phrases are used to describe euthanasia? 2. Describe ONE situation where voluntary euthanasia might be considered an option? 3. Why might someone think voluntary euthanasia is unnatural and why might someone think the opposite? 4. Do you think a person has the right to choose when to end their own life? 5. Explain ONE possible benefit of voluntary euthanasia. 6. Explain ONE possible danger of voluntary euthanasia. 7. Should voluntary euthanasia be made legal in the UK?

13 Arguments FOR euthanasia There are many arguments put forward in support of euthanasia 1.We should be able to choose how we die. 2. Euthanasia lessens pain for the patient. 3. People should not have to live if they have no chance of getting better. 4. It stops the suffering of relatives watching the patient die a slow and painful death. 5. It is cheaper to let dying patients die quickly than to keep them alive with expensive care and drugs. 6. The health you have in your life is far more important than the length of your life. 7. It stops doctors breaking the law when they let someone die on purpose. 8. It helps to take away the fear of a painful and prolonged death. 9.A life of pain and suffering can be as bad as dying. 10. It gets rid of people who are no longer useful. 11. It allows money to be spent on people who could get better. 12. It makes death gentle, peaceful and easy. In your opinion, which of the above arguments are GOOD reason for supporting euthanasia? In your opinion, which of the twelve arguments are POOR reasons

14 Perhaps carrying out non-voluntary euthanasia is the last act of kindness can that anyone can perform ending someone s suffering when curing is impossible If it was legal it would take away the fear that this act of kindness might result in your prosecution. It might help us to know that we would never die in great agony, especially if we couldn t express our wishes. Such medically controlled euthanasia avoids relatives trying to do it themselves and resulting in a botched job. It would be much better for our relatives to see us slip away in a peaceful controlled manner than in obvious distress. It does mean, like it or nor, we could free up much needed resources for people who have a chance of recovery from illness.

15 Would doctors always make the right decision? They might feel pressurised about the money it costs to keep someone in PVS or they might be persuaded by greedy relatives. Doctors might also make mistakes with their diagnosis. It wouldn t be the first time that someone in a PVS with no hope of recovery amazingly comes out of it and goes on to have a long and happy life. Maybe its not an act of kindness but one of hopelessness. Modern medicine should prevent pain and suffering until death comes naturally so why the need to hurry it along? The process of the dying of a relative is an important time for those they leave behind. Maybe being too hasty with the non-voluntary euthanasia doesn t give them time to adjust and wondering if they had done the right thing. Also in situations like this people s emotions run high and maybe they re not thinking straight. Maybe it makes society a less caring place. We would know that if we were ever in a situation where non-voluntary euthanasia was an option that it might be rushed into it without much thought this might not give us much confidence in our doctors or our relatives.

16 Arguments AGAINST euthanasia There are many arguments put forward in opposition to euthanasia 1. Mistakes can happen. 2. It is unnecessary when there are painkilling drugs. The dying patient might not be able to think properly when deciding that he/she wants to die quickly. 4. It could be used on people who were normal rather than those who were dying (for example, insane people). 5. If doctors could put fatally ill people to sleep their patients might not trust them anymore. 6. Places called hospices now look after the terminally ill. These places allow people to die peacefully and without pain. Hospices also help relatives cope with the death of their loved ones. 7. Patients could be talked into euthanasia by the doctor or by their relatives for the wrong reasons. 8. Euthanasia is no better than murder. 9. The doctor s job is to keep people alive, to keep their pain down and to care for people. 10. It is not fair to expect doctors and nurses to give drugs which will kill a patient. 11. If the patient is unable to choose to die, then who makes the choice? 12. It could make the old and the very ill feel that they are a burden on their families. They want to die to get out of the way. In your opinion, which of the above arguments are the best reasons for opposing euthanasia? In your opinion, which are STRONGER the arguments FOR euthanasia or the arguments AGAINST euthanasia?

17 Non-Voluntary Euthanasia: This is where the choice is not made by you but by others. This is generally in cases of terminal illness with no hope of recovery, and where you are unable to make the decision for yourself usually due to PVS. However, relatives do sometimes refuse and hospitals may well go to court asking for permission to override the relatives decisions. The courts have to decide what the person would have wanted if they had been able to choose for themselves. This is often difficult and also if the patient is a newborn child should the parents beliefs and values override the medical circumstances? When might non-voluntary euthanasia be a potential option? Where a person is in a persistent vegetative state (PVS) with no predicted hope of recovery. Where a person is terminally ill and suffering greatly but unable to communicate their wishes.

18 Do we ever have the right to make decisions about whether someone should die or not? 1. Explain the difference between voluntary and nonvoluntary euthanasia. 2. Who might have to make a decision about non-voluntary euthanasia? 3. What is a PVS? 4. What is meant by the phrase doctors are always making life and death decisions and how does this relate to euthanasia? 5. Explain ONE possible benefit of non-voluntary euthanasia. 6. In your opinion, do the dangers of non-voluntary euthanasia outweigh the benefits? Explain your answer fully. 7. Does a person have the right to choose when to die?

19 The Meaning of Life: When is a life worth living? Some people argue that quality of life is what matters. There comes a point where what you are experiencing can not be thought of as living in a proper sense. You may no longer be a conscious, thinking being even though your heart is beating. Supporters of euthanasia often argue that it should be an option where a persons quality of life is so poor that there is no point in them going on living. Others argue that what is important is the sanctity of life. That life is valuable as long as you are alive, no matter the quality. Life is sacred (special) and should always be preserved as long as possible by whatever means possible. No one has the right to make judgments about quality of life and so end your life. Do you think life is sacred? What for you would be a good/poor quality of life?

20 The questions Euthanasia asks: Euthanasia raises agonizing moral questions like these: Is it ever right for another person to end the life of a terminally ill patient who is in severe pain or enduring other suffering? If euthanasia is sometimes right, under what circumstances is it right? Is there any moral difference between killing someone and letting them die? Task: In discussion with a small group, see if you can answer these questions, write your answer down and bring them to a class discussion.

21 Personal freedom is the issue here. Should everyone have the right to choose when and how they die? Supporters of euthanasia usually argue that we should, though there should be safeguards to protect people who don't agree. If you choose to end your life or have it ended then that should be up to you it doesn t mean that the same thing should apply to everyone in the same situation just to you. So there are no dangers to anyone else from your choice. People who argue this way point out that human beings have freedom over everything else in life. Why not this? Supporters of the sanctity of life often argue that our life is not our own it belongs to God, and isn t ours to do with as we please. God will decide when our life is at an end, not us. There are limits to our freedom from ourselves. This means that no one has the right to end a life in an unnatural way, such decisions should be left to God.

22 Some argue that the morality of euthanasia comes down to its likely consequences. If it led to a society which is more caring then it is right but if it leads to a society more thoughtless about the value of life then its wrong. Its really to do with the balance of benefits and dangers. Is it morally correct to make a doctor use his skill to end a life or to force him to watch helplessly while his patient suffers an unnecessarily painful death? Is there any real moral difference between killing (when its an expressed wish) and allowing to die? Euthanasia and the Law: For these complex reasons UK law covers the issue of Euthanasia. There have been many high profile cases where people have tried to use their own situation to force the government to change it views on euthanasia. Active euthanasia in this country is ILLEGAL. Helping someone to die by administering an overdose of drugs or by smothering them is illegal and could result in a person being charged with MURDER. There are certain circumstances where euthanasia is legal and accepted when do you think this might be?

23 When there is no doubt that a person on life support will not recover a decision will be made to withdraw treatment by turning off a life-support machine. Where someone is in a permanent vegetative state treatment may be withdrawn Where a seriously ill person is not resuscitated if their heart stops or their breathing ceases

24 The Law on Euthanasia in Britain: The House of Lords has blocked a bill that would allow terminally ill people to be helped to die. Lord Joffe, in May 2006 proposed that after signing a legal declaration that they wanted to die, a patients' doctor could prescribe a lethal dose of medication that the patient could take themselves. A person would have to meet all of these criteria to be able to end their life under Lord Joffe's proposal: * Only people with less than six months to live * Who are suffering unbearably * Deemed to be of sound mind * Not depressed There was also a big debate on whether or not it was right to allow a person who was terminally ill to be given drugs they could then use to end their own life. Lord Joffe said: "We must find a solution to the unbearable suffering of patients whose needs cannot be met by palliative care."

25 Peers backed an amendment to delay the bill for six months by 48 votes. (148 were in favour and 100 opposed.) Lord Joffe said the move was intended to end the debate, but pledged to reintroduce his bill at a later date. The debate highlighted divisions between supporters of the right to die and those who want better palliative care. Amongst those Lords against the bill was the Archbishop of Canterbury Dr Rowan Williams, Lady Finlay, a professor in palliative care and Cardinal Cormac Murphy O'Connor, Archbishop of Westminster. They urged more to be done instead to improve palliative care for terminally ill patients. These Lords were also supported by disability campaigners. Opponents to the bill demonstrated outside Parliament and submitted a petition to Downing Street which was signed by 100,000 people.

26 The bill's supporters said doctors should be able to prescribe drugs so a terminally ill person suffering terrible pain could choose to end his or her life. These included Labour's Baroness David aged 92. She said: If I were terminally ill, I believe I would be the only person with the right to decide how I died, and whether I preferred palliative care to assisted dying. It would provide me with an additional option on how to end my life, which I would find tremendously reassuring. Mark Slattery, of the charity Dignity in Dying, formerly the Voluntary Euthanasia Society, said the campaign to introduce an assisted dying bill would continue. Julia Millington of the ProLife Alliance welcomed the Lords' decision and stated they would continue to resist any change in the law.

27 Questions: Answer these questions, and explain why. These are the types of questions parliament would have to consider when they debate the issue of Euthanasia. Would euthanasia give the doctors too much power and responsibility? Would sick people be pressurised by relatives into euthanasia? Would the choice of euthanasia lead to involuntary euthanasia for the old or handicapped? Is it not our duty to care for those in our society who are ill? Is life always precious no matter what sort of life it is? Can we really tell when it is hopeless as new cures are being discovered all the time? Why is it difficult to change your mind?

28 Assisted dying British Medical Association: Up to 2005, the British Medical Association had always spoken out against the legalisation of euthanasia or physician assisted suicide for a number of reasons: It would involve breaking the Hippocratic Oath, a promise which doctors make never to do any harm to their patients. It would lead to a change in the patient-doctor relationship where the patient may lose trust in the doctor. Doctors may find it difficult to balance their traditional role as healer with any new powers to carry out euthanasia or assisted suicide. In June 2005, however, the BMA decided by a narrow majority to with draw its active opposition to assisted dying legislation and voted to take a neutral stance in relation to legislation on assisted dying. This did not mean support for legal change but rather the belief that the question of the criminal law is primarily a matter for society and for Parliament. The narrowness of the vote indicated, however, that a wide spectrum of medical opinion still persists within the BMA.

29 Indeed, in 2006, the BMA voted to return to its previous position against euthanasia and assisted suicide. Numerous issues were raised by the BMA, including the following: Vulnerable people must be protected from any pressures to end their lives prematurely. Some patients have distressing symptoms at the end of life that cannot be completely alleviated by medical skills. Good effective palliative care must be more widely available. Emotional and spiritual support must be available for patients wanting it. Any future move to legalise physician assisted dying should involve close consultation with doctors, including palliative care doctors. Assisted suicide need not necessarily involve doctors. The law should be respected. If, however, carers or others assist a terminally ill person to end his or her life, courts should consider the circumstances of the case and provide a penalty proportional to those circumstances, rather than a mandatory prison term.

30 Another Option: Palliative Care Opinion: Proper palliative care makes euthanasia unnecessary? Palliative care is physical, emotional and spiritual care for a dying person when cure is not possible. It includes compassion and support for family and friends and may well be enough to prevent a person feeling any need to contemplate euthanasia. The key to successful palliative care is to treat the patient as a person, not as a set of symptoms, or medical problems. The World Health Organisation states that palliative care affirms life and regards dying as a normal process; it neither hastens nor postpones death; it provides relief from pain and suffering; it integrates the psychological and spiritual aspects of the patient. Making things better for patient, family and friends The patient's family and friends will need care too. Palliative care aims to enhance the quality of life for the family as well as the patient. Effective palliative care gives the patient and their loved ones a chance to spend quality time together, with as much distress removed as possible.

31 They can (if they want to) use this time to bring any unfinished business in their lives to a proper closure and to say their last goodbyes. Palliative care should aim to make it easier and more attractive for family and friends to visit the dying person. Palliative care and euthanasia Good palliative care is the alternative to euthanasia. If it was available to every patient, it would certainly reduce the desire for death to be brought about sooner. But providing palliative care can be very hard work, both physically and psychologically. Ending a patient's life by injection is quicker and easier and cheaper. This may tempt people away from palliative care. Some fear that the introduction of euthanasia will reduce the availability of palliative care in the community, because health systems will want to choose the most cost effective ways of dealing with dying patients. Making euthanasia easier would be cheaper, pushing people towards euthanasia who may not otherwise choose it.

32 When palliative care is not enough: Palliative care will not always be an adequate solution Pain: Some doctors estimate that about 5% of patients don't have their pain properly relieved during the terminal phase of their illness, despite good palliative and hospice care. Dependency: Some patients may prefer death to dependency, because they hate relying on other people for all their bodily functions, and the consequent loss of privacy and dignity. Lack of home care: Other patients will not wish to have palliative care if that means that they have to die in a hospital and not at home. Loss of alertness: Some people would prefer to die while they are fully alert and able to say goodbye to their family; they fear that palliative care would involve a level of painkilling drugs that would leave them semi-anaesthetised. Not in the final stages: Other people are grateful for palliative care to a certain point in their disease, but after that would prefer to die rather than live in a state of helplessness and distress, regardless of what is available in terms of pain-killing and comfort.

33 Many people say, there should be no law or morality that would limit a doctor from administering the frequent dosages of pain medication that are necessary to free people's minds from the pain that shrivels the spirit and leaves no time for speaking when, at times, there are very few hours or days left for such communication. Tasks: In your opinion is palliative care a better solution to the pain and indignity that a terminally ill person may be feeling? What are the benefits of palliative care, and what are the drawbacks? Make a list of both and present them as a table. Which action seems to be in the interest of the patients? What do you think is the best thing to do? Explain your answer clearly.

34 The Netherlands was the first country in the world to legalise euthanasia in It was being carried out by doctors long before it was legalised, and sometimes quite openly. However, even though it is now legal there are very careful safeguards around it to make sure that it is not abused. The patient must be terminally ill with no hope of recovery The patient must personally request euthanasia and this must be in the context of a professional relationship with a doctor who is aware of the case history and therefore the patients mental state Euthanasia must be the last resort -every form of treatment must be exhausted It must be greed by two doctors that this is the best option for the specific patient. If euthanasia were made legal in the UK, at what age should be able to opt for it?

35 One other interesting feature of debate here is that in the Netherlands terminally ill children aged between 12 and 15 can also obtain euthanasia with parental permission. (beyond 16 it is entirely your choice) some argue that this is far too young to fully understand the issues. Some of the factors that make the Netherlands different: There is a high standard of medical care - amongst the highest in the world. The majority (over 95%) of people are covered by private medical insurance, guaranteeing a large core of basic healthcare, including long-term care Palliative care is very advanced. Pain and palliation centres are attached to all hospitals. Other countries, by comparison, have costly but relatively few such centres (normally known as "hospices") During the Nazi occupation, Dutch doctors went to concentration camps rather than divulge the names of their patients. This is one of the factors that increase the relationship of trust between doctors and patients, to a much higher level than in most other countries. Moreover, most patients know their doctor well, and over a considerable time period.

36 Christians are divided on the issue of euthanasia. Some argue that all forms of euthanasia, active or passive go against the will of God. God gives life and god is the only one who will Decide when it should end. Some Christians distinguish between ordinary and extraordinary medical treatment, drawing a difference between killing and allowing to die. For some Christians there does come a point where extraordinary measures should not be taken to preserve life. Instead it should be allowed to follow its natural course. And so allow Gods will to be done. Euthanasia - the Christian view Christians are mostly against euthanasia. The arguments are usually based on the beliefs that life is given by God, and that human beings are made in God's image. Some churches also emphasise the importance of not interfering with the natural process of death 1. Life is a gift from God all life is God-given birth and death are part of the life processes which God has created, so we should respect them therefore no human being has the authority to take the life of any innocent

37 2. Human beings are valuable because they are made in God's image Human life possesses an intrinsic dignity and value because it is created by God in his own image for the distinctive destiny of sharing in God's own life.saying that God created human kind in his own image doesn't meant that people actually look like God, but that people have a unique capacity for rational existence that enables them to see what is good and to want what is good as people develop these abilities they live a life that is as close as possible to God's life of love. This is a good thing, and life should be preserved so that people can go on doing this. To propose euthanasia for an individual is to judge that the current life of that individual is not worthwhile such a judgement is incompatible with recognising the worth and dignity of the person to be killed. Therefore arguments based on the quality of life are completely irrelevant nor should anyone ask for euthanasia for themselves because no-one has the right to value anyone, even themselves, as worthless.

38 3. The process of dying is spiritually important, and should not be disrupted Many churches believe that the period just before death is a profoundly spiritual time. They think it is wrong to interfere with the process of dying, as this would interrupt the process of the spirit moving towards God 4. All human lives are equally valuable Christians believe that the basic dignity and value of human lives means that the value of each human life is identical. They don't think that human dignity and value are measured by mobility, intelligence, or any achievements in life. Valuing human beings as equal just because they are human beings has clear implications for thinking about euthanasia patients in a persistent vegetative state, although seriously damaged, remain living human beings, and so their intrinsic value remains the same as anyone else's so it would be wrong to treat their lives as worthless and to conclude that they 'would be better off dead' patients who are old or sick, and who are near the end of earthly life have the same value as any other human being people who have mental or physical handicaps have the same value as any other human being

39 Euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. The Roman Catholic Church regards euthanasia as morally wrong. It has always taught the absolute and unchanging value of the commandment "You shall not kill". The church has said that: Nothing and no one can in any way permit the killing of an innocent human being, whether a foetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. Pope John Paul II spoke out against what he calls a 'culture of death' in modern society, and said that human beings should always prefer the way of life to the way of death. The church regards any law permitting euthanasia as basically an unjust law.

40 The value of life Life is a thing of value in itself; its value doesn't depend on the extent that it brings pleasure and well-being. This means that suffering and pain do not stop life being valuable, and are not a reason for ending life. The Roman Catholic Church believes that each person should enter the dying process with all its mysteries with trust in God and in solidarity with their fellow human beings; they should die with the dignity of letting themselves be loved unconditionally. Catholic leaders and moral teachers believe that life is the most basic gift of a loving God--a gift over which we have stewardship but not absolute dominion. The right to die The Roman Catholic Church does not accept that human beings have a right to die. Human beings are free agents, but their freedom does not extend to the ending of their own lives. Euthanasia and suicide are both a rejection of God's absolute sovereignty over life and death.

41 The Roman Catholic Church believes that each human life is a manifestation of God in the world, a sign of his presence, a trace of his glory. "The life which God offers to man is a gift by which God shares something of himself with his creature." A human being who insists that they have the 'right to die' is denying the truth of their fundamental relationship with God Refusing aggressive medical treatment The Roman Catholic Church says it is morally acceptable to refuse extraordinary and aggressive medical means to preserve life. Refusing such treatment is not euthanasia but a proper acceptance of the human condition in the face of death. True compassion leads to sharing another's pain; it does not kill the person whose suffering we cannot bear.

42 Questions on Roman Catholic views on Euthanasia What is the Roman Catholic view on the Right to Die? Explain your answer. Which basic rule do Roman Catholic s use when looking at the issue of euthanasia? What did Pope John Paul II say about any laws permitting euthanasia? What is the Roman Catholic view on refusing medication. The Biblical View "What is the Biblical view of euthanasia? - Christian Beliefs from bible authority. Physical death is inevitable (Psalm 89:48; Hebrews 9:27). However, God alone is sovereign over when and how a person's death occurs. Job testifies in Job 30:23, "For I know that You (God) will bring me to death and to the house of meeting for all living."

43 Ecclesiastes 8:8a declares, "No man has authority to restrain the wind with the wind, or authority over the day of death..." God has the final say over death Euthanasia is man's way of trying to usurp that authority from God. Death is a natural occurrence. Christians believe that sometimes God allows a person to suffer long before death is realized; other times, the person's suffering is cut short. No one likes to suffer, but that does not make it right for us to determine that a person is ready to die. Often God's purposes are made known through a person's suffering: Romans 5:3, teaches that tribulations bring about perseverance. God cares about those who are crying out for death to end their suffering. God gives purpose to life even until the end. Only God knows what is best, and His timing even in one's death is perfect. Why is the Bible seen as an authority? What does Ecclesiastes say about humans power over death? Some Christians believe suffering is intended. Why is this the case? What does Romans 5.3 teach about God s purpose?

44 Muslims are against euthanasia. They believe that all human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this. Most of the teaching on Euthanasia comes from the Qur an which is seen as the words of Allah himself. The Sunnah of course has some teaching from the life of Muhammad and can also be seen as an authority when it comes to making moral decisions. If a Muslim goes to the mosque to ask advice from the Imam he should offer teachings according to the teachings in the Qur an and Sharia will follow these too. To get a clear picture of Islamic teaching on Euthanasia, the value of life and beliefs on killing must be looked at. Life is sacred: Euthanasia is not included among the reasons allowed for killing in Islam. Do not take life, which Allah made sacred, other than in the course of justice. If anyone kills a person - unless it is for murder or spreading mischief in the land - it would be as if he killed the whole people.

45 Allah decides how long each of us will live: When their time comes they cannot delay it for a single hour nor can they bring it forward by a single hour. And no person can ever die except by Allah's Euthanasia is explicitly forbidden: Destroy not yourselves. Surely Allah is ever merciful to you. The Prophet said: "Amongst the nations before you there was a man who got a wound and growing impatient (with its pain), he took a knife and cut his hand with it and the blood did not stop till he died. Allah said, 'My Slave hurried to bring death upon himself so I have forbidden him (to enter) Paradise.' " Islamic attitudes towards euthanasia: Islam is totally opposed to euthanasia. The Qur'an says that Allah created all life and everything belongs to him: To Allah belongs the kingdom of the heavens and the earth. He creates what He pleases. Surah 42:49 Life is sacred and people are forbidden to kill themselves: Destroy not yourselves. Surely Allah is ever merciful to you. Surah 4:29 If people are suffering badly they should ask Allah for help: O ye who believe, seek help with patient perseverance and Prayer; surely Allah is with those who patiently persevere. Surah 2:153

46 We will surely test you with something of fear and hunger, some loss of wealth and lives and the fruits of your work; but give glad tidings to those who patiently persevere, who, when a misfortune overtakes them do not lose heart, but say: To Allah we belong and to Him is our return. Surah 2: No one has the right to decide when they will die: When their time arrives they cannot tarry for a single hour nor can they go ahead. Surah 16:61 Nor can a soul die except by Allah's leave, which is a decree with a fixed term. Surah 3: What is the Holy book in Islam and why is it considered to be the ultimate authority? 2. Why should Humans not interfere with Life according to Islamic teaching? 3. What example is given from the Qur an to show that euthanasia is forbidden, explain the story in your own words? 4. What should a Muslim do when they are suffering? Explain your answer. 5. Explain the Islamic teaching on when a person should die.

47 The Humanist View What Humanists believe: Humanists are non-religious people who live by moral principles based on reason and respect for others, not obedience to rules as they say religion does. They promote happiness and fulfilment in this life because they believe it is the only one we have. Humanist concern for quality of life and respect for personal independence lead to the view that in many circumstances voluntary euthanasia is the morally right course. They say people should have the right to choose a painless and dignified end, either at the time or beforehand, perhaps in a "living will". The right circumstances might include: extreme pain and suffering; helplessness and loss of personal dignity; permanent loss of those things which have made life worth living for this individual. Humanists say that to postpone the inevitable with no intervening benefit is not a moral act. Individuals should be allowed to decide on such personal matters for themselves

48 So humanists generally support voluntary euthanasia, they do however say that people must uphold the need for safeguards to prevent involuntary euthanasia. There is no rational moral distinction between allowing someone to die and actively assisting them to die in these circumstances: the intention and the outcome (the death of the patient) are the same in both cases, but the more active means is probably the more compassionate one. The British Humanists Association supports attempts to reform the current law on voluntary euthanasia. Safeguards If someone in possession of full information and sound judgement decides that her continued life has no value, her wishes should be respected. Of course there should be safeguards: counselling; the prevention of pressure on patients; clear witnessed instructions from the patient; the involvement of several doctors; no reasonable hope of recovery. People often argue that it is not for doctors "to play God" and that it's for God to decide when people die. But it could be said that all medical interventions are "playing God" (even your childhood vaccinations may have kept you alive longer than "God" planned) so we have to decide for ourselves how we use medical powers. Arguments which invoke God are unconvincing to those who do not believe in gods, and laws should not be based on claims which rely on religious faith.

49 Tasks: 1. What is the basic belief of a Humanist? 2. Do Humanists support voluntary euthanasia? 3. What do Humanists believe there must be safeguards against? What safeguards do they suggest? 4. What do Humanists mean when they say that people are playing God? 5. How can it be said that medical care has been playing God all of The modern Utilitarian, Peter Singer is well known for his views about Euthanasia. He stresses the importance of quality of life, arguing that there are times when a persons life is no longer worth living and so euthanasia should be an option to them or to society on there behalf. He makes no specific distinction between killing and allowing to die, because for him, once euthanasia seems appropriate the patient can no longer be considered a person in the proper sense.

50 We often use person as if it meant the same as human being. In recent discussions in bioethics, however, person is often now used to mean a being with certain characteristics such as rationality and self awareness. Rethinking Life and Death, Singer P, OUP 1994 p180 Singers view is that without the qualities of rationality and selfawareness we cant describe someone as a person and therefore they aren't necessarily entitled to the same moral rights as a persons. Singer argues that the sanctity of life argument is weak because there are many cases, war for example, where those who uphold the sanctity of life seem quite able to ignore the idea for what they see as the greater good. He does not therefore see that suspending the notion of the sanctity of life is any different in the case of euthanasia. He argues that the slippery slope argument is weak as it doesn t seem to have resulted in wide scale abuse in the Netherlands, nor in other countries where euthanasia is carried out by the doctors illegally. Singer also cites the decisions in the case of Tony Bland which seem to support his own view of the quality of life argument. He rejects the idea that all human life is of equal value, instead suggesting that: We should recognise that the worth of human life varies... When we reject the idea [that all human life is of equal worth] we will instead focus on ethically relevant characteristics like the capacity for enjoyable experiences, for interacting with others, or for having preferences about continued life.

51 Without consciousness none of these are possible: therefore, once we are certain that consciousness has been irrevocably lost, it is not relevant that there is still some hormonal brain function because without consciousness it cannot benefit a patient...so our decision about how to treat such a patient should not depend upon lofty rhetoric about the equal worth of all human life, but on the views of families and partners. If a patient in a PVS has previously expressed wishes about what should happen to her or him in such circumstances.. At the same time..we cannot ignore the limits set by the finite nature of our medical resources... Rethinking Life and Death, Singer P; OUP 1994 p192 This is classic preference utilitarianism making the moral decision based on the interests of those directly involved, but it is also a more classic form of utilitarianism at the same time. The greatest good for the greatest number cannot, in Singers view, be served by keeping alive someone who is no longer a human person, even if they remain a human being. Also if when you are a person, you might make a rational choice to opt for euthanasia should you ever cease to be a person., then that wish should be respected.

52 Exam Questions 1. Why do some people believe that Euthanasia is morally wrong? 6AE 2. Outline two different forms of euthanasia. 6KU 3. Euthanasia is allowed in certain circumstances in the Netherlands. Describe the law concerning Euthanasia in Holland. KU 4. People should have the right to make decisions about ending their own lives. Explain the religious and moral implications of the view point. 8AE

53 German philosopher Immanuel Kant argued that all moral judgments should be based on Duty & Reason. An action performed from a sense of duty is a morally good UNIVERSALISABLE an action is right if you would will for everyone in the universe to abide by this law THE CATGEGORICAL IMPERATIVE we should act as if the principle of our action was to become a law for everyone HUMAN REASON we should reason when deciding our moral principles. Evaluate the argument that Kant s moral theory could not support the idea of voluntary euthanasia. - two possible answers over the page

54 Evaluate the argument that Kant s moral theory could not support the idea of voluntary euthanasia Kant s theory says that there are moral absolutes which we ought to follow, which can be worked out by reason. They are categorical imperatives. To work out where an action is right or wrong, you need to universalise the maxim and see if it is self contradictory or a contradiction of the will. For example, Thomas Hyde had ALS, a disease that attacked his body while leaving his mind active. He asked Dr Jack Kevorkian to help him to die. If we universalise the maxim Anyone with ALS should be helped to die, we get a contradiction of the will we couldn t want to live in a society where people were killed because they were disabled. This does show up a weakness of Kant s theory, however, as someone Another statement of the Categorical Imperative says that we should act in such a way that our maxims become universal laws of nature. This is more helpful how would it be if people with ALS just died? We would be deprived of Stephen Hawking s brilliance, among others. Thomas Hyde would not have wanted to condemn everyone with ALS to death he was merely asking for it in his circumstances. Kant s theory doesn t allow us to consider the individual s situation, however. This may be seen as a criticism of Kant, because the suffering of an individual seems morally relevant. Kant would also argue against a compassionate response, as he believed it was possible to do the wrong thing if led by our emotions.

55 Evaluate the argument that Kant s moral theory could not support the idea of voluntary euthanasia Kant s theory could be used to argue against voluntary euthanasia. Firstly, Kant would dismiss arguments concerning the suffering of the patient or the cost of treatment these are not morally relevant factors for Kant. He is concerned with the act itself, not the consequences. Most justifications for voluntary euthanasia can therefore be dismissed. Kant would consider the maxim It is right to kill Dianne Pretty, suffering from Motor Neurone Disease, who has asked to die. He would then universalise it, forming a Categorical Imperative: It is always right to kill people suffering from Motor Neurone Disease. Kant would ask Is this a self contradiction? It doesn t appear to be. Is it a contradiction of the will? The answer seems to be Yes! We couldn t want to make a rule that meant everyone with MND had to be killed. For Kant, the universal rule is important, and individual circumstances should not be taken into consideration. However, Kantians can put more thought into their Categorical Imperatives, and might easily form a different universal rule. For example, we might be more comfortable making a rule that said Anyone suffering from MND who has lost the will to live, and has asked to die, should be Killed. Put another way, we might accept a law of nature that ended life when pain became unbearable. Kant s theory says that people should never be merely a means to an end. You should never kill someone in order to reduce suffering, or save money. However, Kant held respect for persons in such high esteem that allowing someone to suffer and die without dignity may seem to go against his theory. The concept of human rights does not contradict Kant s theory, which could be used to argue for the right to die with dignity.

56 Explain how Utilitarianism might be applied to the issue of euthanasia. Classical Utilitarianism is teleological, and says that the outcome of an action determines whether the action is right or wrong. In the case of Dianne Pretty, who had motor neurone disease, they would be concerned with the suffering that would result from the decision not to let her die. Bentham developed a hedonic calculus to work out factors like the duration of the pain, it s intensity, how remote it was etc. He was also concerned with the extent of the suffering in Dianne s case, her husband would have suffered greatly watching her die in agony. As an Act utilitarian, Bentham would have considered Dianne Pretty s case individually, and would not have been concerned with the precedent it might set. Mill adapted the theory to include the quality as well as the quantity of the pleasure and pain that would result. While he may have supported euthanasia in the case of an Alzheimer sufferer who would lose their mental capacities, he may have thought differently about Thomas Hyde, who suffered from ALS. In Hyde s case, he could still have lived a long life (like Stephen Hawking who has the same condition), and would have been able to enjoy the higher pleasures like reading, watching plays, listening to opera etc. However, Mill placed a high value on individual freedom, saying that one should have sovereignty over the things that didn t affect other people, whether or not it led to the