The word ‘morality’ seems to be used in both descriptive and normative meanings. More particularly, the term “morality” can be used either (Stanford Encyclopaedia of Philosophy https://plato.stanford.edu/entries/morality-definition
1. descriptively: referring to codes of conduct advocated by a society or a sub-group (e.g. a religion or social group), or adopted by an individual to justify their own beliefs,
or
2. normatively: describing codes of conduct that in specified conditions, should be accepted by all rational members of the group being considered.
Examination of ethical theories applied to Euthanasia
Thomas Aquinas’ natural law considered that morally beneficial actions and the goodness of those actions is assessed against eternal law as a reference point. Eternal law, in his view, is a higher authority and the process of reasoning defines the differences between right and wrong. Natural law thinking is not just concerned with focussed aspects, but considers the whole person and their infinite future. Aquinas would have linked this to God’s predetermined plan for that individual and heaven. The morality of Catholic belief is heavily influenced by natural law. Primary precepts should be considered when considering issues involving euthanasia particularly important key precepts to do good and oppose evil and to preserve life upholding the sanctity of life. Divine law set out in the Bible states that we are created in God’s image and held together by God from our time in the womb. The Catholic Church’s teachings on euthanasia maintain that euthanasia is wrong (Pastoral Constitution, Gaudium et Spes no. 27, 1965) as life is sacred and God-given. (Declaration on Euthanasia 1980). This view can be seen to be just as strongly held and applied today in the very recent case of Alfie Evans where papal intervention in the case was significant and public. Terminating life through euthanasia goes against divine law. Ending life and the possibility of that life bringing love into the world or love coming into the world in response to the person euthanised is wrong. To take a life by euthanasia, according to catholic belief, rejects God’s plan for that individual to live their life. Suicide or intentionally ending life is an equal wrong to murder and as such is to be considered rejection is God’s loving plan (Declaration on euthanasia, 1.3, 1980).
The Catholic Church interprets natural law to mean euthanasia is wrong and that those involved in it are committing a wrongful and sinful act. Whilst the objectives of euthanasia may appear to be good in that they seek to ease suffering and pain they are in fact failing to recognise the greater good of the sanctity of life within God is greater plan and include people other and the person suffering and eternal life in heaven
The conclusions of natural law consider the position of life in general and not just the ending of a single life. An example would be that if euthanasia is lawful older people could become fearful of admission to hospital in case they were drawn into euthanasia. It could also lead to people being attracted to euthanasia at times when they were depressed. This can be seen to attack the principles of living well together in society as good people could be hurt. It also makes some predictions on the slippery slope and floodgates type arguments about hypothetical situations. Euthanasia therefore clearly undermines some primary precepts.
Catholicism accepts the disproportionately onerous treatment is not appropriate towards the end of a person’s life and gives a moral obligation not to strenuously keep a person alive at all costs. An example of this would be the terminally ill cancer patient deciding not to accept further chemotherapy or radiotherapy which could extend their life, but at great cost to quality of that remaining life. Natural law does not seem to prevent them from making these kinds of choices.
There is a doctrine of double effect an example being palliative care with the relief of pain and distress as the objective might have a secondary effect of ending life earlier than if more active treatment options had been pursued. The motivation is not to kill, but rather to ease pain and distress. An example of this is when an individual doctor’s decision to increase opiate drug dosage to the point where respiratory arrest occurs almost inevitably but at all times the intended motivation is the easing of pain and distress. This has on various occasions been upheld as being legally and morally acceptable by the courts and medical watchdogs such as the GMC (General Medical Council).
The catechism of the Catholic Church accepts this and view such decisions as best made by the patient if competent and able and if not by those legally and professionally entitled to act for the individual concerned.
There are other circumstances when the person involved in the process might not be the same type of person as is assumed by natural law. For example, someone with severe brain damage and in a persistent coma or “brain-dead”. In these situations, they may not possess the defining characteristics of a person. This could form justification for euthanasia. The doctors or relatives caring for such a patient may have conflicts of conscience by being unable to show compassion to another and thereby prolong suffering, not only of the patient, but of those surrounding them.
In his book Morals and Medicine published in 1954, Fletcher, the president of the euthanasia Society of America argued that there were no absolute standards of morality in medical treatment and that good ethics demand consideration of patient’s condition and the situation surrounding it.
Fletcher Situation Ethics avoids legalistic consideration of moral decisions. It is anchored only actual situations and specifically in unconditional love for the care of others. When considering euthanasia with this approach it will always “depend upon the situation”.
From the view point of an absolutist, morality is innate from birth. It can be argued that natural law does not change as a result of personal opinions; remaining never changed. Natural law is a positive view with regard to morality as it can be seen to allow people from ranging backgrounds, classes and situations to have sustainable moral laws to follow.
Religious believers also follow the principles of Natural Law as the underlying theology of the law argues the idea that morality remains the same and never changes with an individual’s personal opinions or decisions. Christianity as a religion, has great support amongst its religious believers for there being a natural law of morality. Christian understanding behind this concept has been largely shown to have come as a result of Thomas Aquinas- following his teaching of the close connection of faith and reason being closely related arguments for there being a natural law of morality.
Natural Law has been shown over time to have compelling arguments, one of which being its all-inclusiveness and fixed stature- a contrast to the relative approach to morality. Natural law is objective and is consequently abiding and eternal. It is considered to be within us/innate and is seen to occur as a mixture of faith and reason to go on the form an intelligent and rational being who is faithful in belief of God. Natural law is a part of human nature, commencing from the beginning of our lives when we gain our sense of right and wrong.
However, there are also many disadvantages of natural law with regard to resolving moral problems. They can include, the fact that they are not always self-evident (proving). We are unable to confirm whether there is only one global purpose for humanity. It can be argued that even if humanity had a purpose for its existence, this purpose cannot be seen as self-evident. The perception of natural beings and things is forced to change over generations due to different perceptions, with forms of different times being more fitting with the present culture. It can therefore be argued that absolute morality is changed and altered by cultural beliefs of right and wrong. Some things later on in time being perceived as wrong, leading on to believe that defining what is natural is almost impossible as moral decisions are ever changing. The thought of actuality being better that potentiality, cannot easily transfer to practical ethics. The future holds many potential outcomes, however some of these potential outcomes are ‘wrong’. (Hodder Education, 2016)
Natural law being the best way to resolve moral problems holds a strong argument, however its strict formation means that there is some confusion as to what is right and wrong in certain situations. These views are instead formed by society- not always following the natural law of morality. Darwin’s Theory of Evolution put forward in On The Origin of the Species in 1859, challenged natural law as he put forward the notion that living things strive for survival (survival of the fittest) and supporting his theory of evolution by natural selection. It can be argued that moral problems being solved by natural law may be possible, but not necessarily the best solution.
For many years, euthanasia has been a controversial debate across the globe with different people taking opposing sides and arguing in support of their opinions. Ideally, it is the act of allowing an individual to die in a painless manner by suppressing their medication. Often, these are classified in different forms such as voluntary, involuntary and non-voluntary. However, the legal system has been actively involved in this debate. A major concern put forward is that legalizing any form of euthanasia may lead to slippery slope principle, which holds that permission of anything comparatively harmless today, may begin a trend that results in unacceptable practices. Although one of the popular stands argues voluntary euthanasia is morally acceptable while non-voluntary euthanasia is always wrong, the legal constitution has been split in their decisions in various instances. (Oxford for OCR Religious Studies, 2016)
Voluntary euthanasia is defined by the killing of an individual upon their approval through various ways. The arguments that voluntary euthanasia is morally acceptable are drawn from the expressed desires of a patient. As far as the respect for an individual’s decision does not harm other people, then it is morally correct. Since individuals have the right to make personal choices about their lives, their decisions on how they should die should also be respected. Most, importantly, at times, it remains the only option of assuring the well-being of the patient especially if they are suffering incessant and severe pain. Despite these claims, several cases have emerged, but the court has continued to refuse to uphold the morality of euthanasia irrespective of a victim’s consent. One of these is the case of Diane Pretty who suffered from motor neuron disease. Since she was afraid of dying by choking/aspiration, a common end of life event experienced by many motor neurone disease victims. She sought to have legal assurance that her husband would be free from the threat of prosecution if he assisted her to end her life. Her case went through the Court of Appeal, The House of Lords (the Supreme Court in today’s system) and the European Court of Human Rights. However, due to the concerns raised under the slippery slope principle, the judges denied her request, and she lost the case.
There have been many legal and legislative battles attempting to change the law to support voluntary Euthanasia in varying circumstances. Between 2002 and 2006 Lord Joel Joffe (a Patron of the Dignity in Dying organisation) fought to change the law in the UK to support assisted dying. His first Assisted Dying (Patient) Bill continued to the stage of a second reading (June 2003) however surpassed the time limit to progress to the committee stage. However, Joffe persisted and in 2004 restated his plight with the Assisted Dying for the Terminally Ill Bill which progressed further to the earlier bill to make it to the committee stage in 2006. The committee stated: “In the event that another bill of this nature should be introduced into Parliament, it should, following a formal Second Reading, be sent to a committee of the whole House for examination”. However, unfortunately in May 2006 an amendment at the Second reading lead to the collapse of the bill. This was a surprise to Joffe, with the majority of the select committee on board with the bill. In addition to this calls for a statute supporting voluntary euthanasia have increased and this can be evidenced by the significant numbers of people in recent years travelling to Switzerland where physician assisted suicide is legal under permitted circumstances. Lord Joffe expressed these thoughts in an article written for the campaign for Dignity In Dying cause in 2014 shortly before his death in 2017 in support of Lord Falconer’s Assisted Dying Bill which was a Bill which proposed to permit the “terminally ill, mentally competent adults to have an assisted death after being approved by doctors” (Falconer’s Assisted Dying Bill, Dignity in Dying, 2014). The journey of this bill was followed by the following referenced documentary.
The BBC documentary ‘How to Die: Simon’s Choice’ followed the decline of Simon Binner from motor neurone disease and his subsequent plight for an assisted death. The documentary followed his journey to Switzerland for a legal assisted death and documented the reactions of his surrounding family. During filming of the documentary, a legal bill was being debated in parliament proposing to legalise assisted dying in the United Kingdom. The bill proposed a new law (The Lord Falconers Assisted Dying Bill) which would allow a person to request a lethal injection if they had less that six months left to live, this raised a myriad of issues including precisely defining a life term whereby one has more or less that six months left to live. The Archbishop of Canterbury, Justin Welby urged MP’s to reject the bill stating that Britain would be crossing a ‘legal and ethical Rubicon’ if parliament were to vote to allow the terminally ill to actively be assisted to die at home in the UK under medical supervision. The leaders of the British Jewish, Muslim, Sikh and Christian religious communities wrote a joint open letter to all members of the British parliament urging them to oppose the bill to legalise assisted dying. (The Guardian, 2015). After announcing his death on LinkedIn, Simon Binner died at an assisted dying clinic in Switzerland. The passing of this bill may have been the only way of helping Simon Binner in his home country, although assisted dying was ruled to be unlawful. (Deacon, 2016)
The result of the private members bill, originally proposed by Rob Marris (a Labour MP from Wolverhampton) ended in defeat in 330 MPs against and 118 MPs in favour. (The Financial Times, 2015)
The 1961 Suicide Act (Legislation, 1961) decriminalised suicide, however it didn’t make it morally licit. It outlines that a person who aids, abets, counsels or procures suicide of another/attempt by another to commit suicide shall be liable to be sentenced to a prison term of up to 14 years. It also provided for the situation of a defendant on trial on indictment for murder/manslaughter it is proved that the accused aided, abetted, counselled or procured the suicide of the person in question, the jury could find them guilty of that offence as an alternative verdict.
Many took that the view that the law supports principle of autonomy, but the act was used to reinforce the sanctity of life principle by criminalising any form of assisted suicide. Although the act doesn’t hold the position that all life is equally valuable, there have been cases when allowing a person to die would be the better solution.
In the case of non-voluntary euthanasia, patients are often incapable of giving their approval for death to be induced. It mostly occurs if a patient is either very young, mentally retarded, has an extreme brain damage, or is in a coma. Opponents argue that human life should be respected and in this case, it is even worse because the victim’s wishes are not factored when making decisions to end their life. As a result, it becomes morally wrong irrespective of the conditions that they face. In such a case, all parties involved should wait for a natural death while at the same time according the patient the best palliative medical attention possible. The case of Terri Schiavo who was suffering from bulimia and with an extremely damaged brain falls under this argument. The ruling of the court allowing the request of her husband to have her life terminated triggered heated debates with some arguing that it was wrong while others saw it as a relief since she had spent more than half of her life unresponsive.
I completed primary research in order to support my findings as to whether it would be moral or not to legalise Euthanasia in the UK. With regard to the having an understanding of the correct definition of Euthanasia nine out of ten people who took part in the questionnaire selected the correct definition of physician-assisted suicide being “The voluntary termination of one’s life by administration of a lethal substance with the direct or indirect assistance of a physician” (Medicanet, 2017). The one person who selected the wrong definition believed it to be “The involuntary termination of one’s own life by administration of a lethal substance with the direct or indirect assistance of a physician. The third definition on the questionnaire stated that physician assisted suicide was “The voluntary termination of one’s own life by committing suicide without the help of others”- this definition is the ‘obvious’ incorrect answer and no participant in the questionnaire selected this answer.
The morality of the young should be followed. From the results of my primary research completed by a selected youth audience seventy percent were in agreement that people should have the right to choose when they die. However only twenty percent of this targeted audience were in agreement that they would assist a friend or family member in helping them die. This drop in support can be supported by the fear that prosecution brings of a possible fourteen year imprisonment for assisting in a person’s death.
The effect of the Debbie Purdy case (2009), was that guidelines were established by the Director of Public Prosecutions in England and Wales (Dying or assisted dying isn’t illegal in Scotland however there is no legal way to medically access it). These guidelines were established according to the Director of Public Prosecutions to “clarify what his position is as to the factors that he regards as relevant for and against prosecution” (DID Prosecution Policy, 2010). The guidance policy outlines ‘more likely’ factors as to when prosecution should take place; for prosecution of an assistor the policy outlined that if they had a history of violent behaviour, didn’t know the person, received a financial gain from the act or acted as a medical professional then they were more likely to face prosecution. However despite these factors the policy stated that police and prosecutors of the case should examine any financial gain with a ‘common sense’ approach as many financially benefit from the loss of a loved one, however the fact that they were a close relative being relieved of pain for example should be a larger factor behind assisting someone to die, to be considered in case of prosecution.
Arguments that state voluntary euthanasia is morally right while involuntary euthanasia is wrong, remains as being one of the most controversial issues even in the modern society. It is even more significant because even the legal systems remain split in their ruling in the various cases such as those cited. Based on the slippery slope argument, care should be taken when determining what is morally right and wrong because of the sanctity of human life. Many consider that the law has led to considerable confusion and that one way of developing the present situation is to create a new Act which permitting physician assisted dying, with the proposal stating that there should be a bill to “enable a competent adult who is suffering unbearably as a result of a terminal illness to receive medical assistance to die at his own considered/persistent request… to make provision for a person suffering from a terminal illness to receive pain relief medication” (Assisted Dying for the Terminally ill Bill, 2004).
There is a major moral objection to voluntary euthanasia under the reasoning of the “slippery slope” argument: the fear that what begins as legitimate reasons to assist in a person’s death will also permit death in other illegal circumstances.
In a Letter addressed to The Times newspaper (24/8/04), John Haldane and Alasdair MacIntyre along with other academics, lawyers and philosophers, suggested that any supporters of the Bill change from making the condition one of actual unbearable suffering from terminal illness to merely the fear, discomfort and loss of dignity which terminal illness might bring. In addition, there is an issue of if quality of life is grounds for euthanasia from those who request it therefore it must be open to those who don’t request it or are unable to request it therefore presenting the issue of a slippery slope. Also in the letter addressed to The Times, the esteemed academics referenced Euthanasia in the Netherlands where it is legal. The purpose of this was to infer that many people have dies against their desire due to safeguarding issues. (Hodder Education, 2016)
In conclusion, upon considering different morality arguments on both sides of the debate, I concluded that the two forms of morality (Natural Law and Situation Ethics) would give two opposing responses in relation to the question.
From the viewpoint of a deontologist who would be guided by natural law, duty and obligation arguably from a religion would lead a society to decide that it would be wrong to legalise Euthanasia. However, from the viewpoint of a situational ethicist whose viewpoint would be changeable depending on the independent situation could support the plight to legalise Voluntary Euthanasia in the UK under guidelines to account for differing situations.
After completing my Primary and Secondary Research, considering the passage of many unsuccessful bills put through parliament to legalise euthanasia and many case studies including the moving account of Simon Binner’s fight to die, my own view rests on the side of a situational ethicist who would believe that depending to the independent situation people should be able to have the right to die in their own country by legalising voluntary euthanasia, rather than being forced to travel abroad to access a legal form of voluntary euthanasia and risk their loved ones being prosecuted on their return to the UK for assisting them.
The slippery slope argument does not help those in particular individual situations and it must surely be wrong to shy away from making difficult decisions on the grounds that an individual should sustain prolonged suffering in order to protect society from the possible extended over use of any legalisation. In practice over the past half century some sort of euthanasia has been going on in the UK when doctors give obvious over-dosage of opiates in terminal cases, but have been shielded from the legal consequences by an almost fictional notion that as long as the motivation was to ease and control pain then the inevitable consequence of respiratory arrest (respiratory suppression is a side effect of morphine type drugs), then the action was lawful.
Discredited and now defunct Liverpool Care Pathway for the Dying Patient (LCP) was an administrative tool used as an attempt to assist UK healthcare professionals to manage the care pathway and deciding palliative care options for patients at the very end of life. As with many such tick the-box-exercises individual discretion is restricted in an attempt to standardise practice nationally (Wales was excluded from the LPA). The biggest problem with the LPA (which attracted much adverse media attention and public concern in 2012) was that most patients or their families were not consulted when they were placed on the pathway. It had options for withdrawing active treatment whilst managing distressing symptoms actively. However, removing intravenous hydration/feeding by regarding it as active treatment would inevitably lead to death in a relatively short period of time making the decision to place a patient on the LPA because they were at the end of life a self-fulfilling prophesy. (Liverpool Care Pathway)
There is a chilling consideration of cost of provision of “just in case” boxes at approximately £25 in the last part of this lengthy document should be part of the process of considering what to advise professionals may seem alarming to some. However there is a moral factor in the financial implications of unnecessarily prolonging human life. Should the greater good be considered when deciding to actively permit formal pathways to euthanasia or to take steps to prohibit it (the crimes of murder or assisting suicide). In the recent highly publicised case of Alfie Evans enormous financial resources were used to keep a child with a terminal degenerative neurological disease alive on a paediatric intensive care unit at Alder Hay hospital in Liverpool for around a year. In deciding to do this it is inevitable that those resources were unavailable to treat others who might have gone on to survive and live a life. Huge sums of money were spent both on medical resources and lawyers. The case became a highly media publicised circus resulting in ugly threats made against medical staff at the hospital concerned. There was international intervention in the case by the Vatican and Italy (granting of Italian nationality to the child). Whist the emotional turmoil of the parents was tragic and the case very sad was it moral that their own beliefs and lack of understanding of the medical issues involved should lead to such a diversion of resources and such terrible effects on those caring for the boy?
(NICE (National Institute of Clinical Excellence) guidelines, 2015)
The General Medical Council (GMC) governs the licensing and professional conduct of doctors in the UK. They have produced guidance for doctors regarding the medical role at the end of life Treatment and care towards the end of life: good practice in decision making. It gives comprehensive advice on some of the fundamental issues dealing with the end of life treatment and it covers issues such as living wills (where withdrawal of treatment requests can be set out in writing and in advance). These are binding both professionally, but as ever there are some caveats regarding withdrawal of life prolonging treatment.
It also sets out presumptions of a duty to prolong life and of a patient’s capacity to make decisions along established legal and ethical viewpoints. I particular it is stated that “decisions concerning life prolonging treatments must not be motivated by a desire to bring about a patient’s death” (Good Medical Practice, GMC Guidance to Doctors, 2014)
Formally the Hippocratic Oath was sworn by all doctors and set out a sound basis for moral decision making and professional conduct. In modern translation from the original ancient Greek it states with regard to medical treatment that a doctor should never treat “….. with a view to injury and wrong-doing. Neither will [a doctor] administer a poison to anybody when asked to do so, nor will [a doctor] suggest such a course. Doctors in the UK do not swear the oath today, but most of its principles are internationally accepted except perhaps in the controversial areas surrounding abortion and end of life care.
(Hippocratic Oath, Medicanet)
In conclusion, upon considering different morality arguments on both sides of the debate, I concluded that the two forms of morality (Natural Law and Situation Ethics) would give two opposing responses in relation to the question.
From the viewpoint of a deontologist who would be guided by natural law, duty and obligation arguably from a religion would lead a society to decide that it would be wrong to legalise Euthanasia. However, from the viewpoint of a situational ethicist whose viewpoint would be changeable depending on the independent situation could support the plight to legalise Voluntary Euthanasia in the UK under guidelines to account for differing situations.
After completing my Primary and Secondary Research, considering the passage of many unsuccessful bills put through parliament to legalise euthanasia and many case studies including the moving account of Simon Binner’s fight to die, my own view rests on the side of a situational ethicist who would believe that depending to the independent situation people should be able to have the right to die in their own country by legalising voluntary euthanasia, rather than being forced to travel abroad to access a legal form of voluntary euthanasia and risk their loved ones being prosecuted on their return to the UK for assisting them.
At the end of the day, much of the management of the end of life of patients is not determined by the stipulations laid out by committees in lengthy documents, but by the individual treatment decisions made by individual doctors and nurses who are almost always acting in the best interests of patients and their families. The methodology of accelerating the inevitable event by medication or withdrawal of treatment is almost impossible to standardise across a hospital or local community care setup, let alone a country. It may be a better way to continue the practice of centuries and let the morality and conscience of the treating professions determine what happens and keep the formal moral, religious and legal factors involved in such areas in the shadows.
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