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“The notion that human life is

sacred just because it is human


is simply medieval.”
Peter Singer

Medical Ethics: “Euthanasia is a crime against


human life, incurable does not
mean end of care.”

Euthanasia
TEXTBOOK PP 91-99
ANTHOLOGY EXTRACT 4

To know the different religious and secular approaches to medical ethics


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To be able to evaluate each approach and form a credible conclusion Medical Ethics
Learning Objectives
To know the different religious and secular
approaches to medical ethics
To understand the fundamental principles that
underpin approaches to medical ethics
To be able to evaluate each approach and form a
credible conclusion

To know the different religious and secular approaches to medical ethics


To understand the fundamental principles that underpin approaches to medical ethics EDEXCEL A Level Ethics
To be able to evaluate each approach and form a credible conclusion Medical Ethics
GCSE
Do Now: Definitions THROWBACK

Secular Without reference/recourse to religion

The belief that human life is made by God,


Sanctity of Life and that only God can take it away.
The belief that a life should have certain
Quality of Life qualities to make it worth living.
When death results from removing life-
Passive Euthanasia sustaining treatment.
When death results from the actions of
Active Euthanasia another (with their consent of the person).

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Specificatiopn

You covered
this last year

We will focus
on this

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Learning Checklist
Key Concepts Key Concepts Key Scholars
Personhood Double Effect  Peter Singer
 Catholic Teaching
Quality of Life Autonomy  Michael Wilcockson
Sanctity of Life The Slippery Slope  J.S. Mill
Active/Passive Argument  Jonathon Glover
Euthanasia The Wedge Argument Case Studies
Act vs Omission  Dianne Pretty
The Harm Principle
 Tony Nicklinson
Ordinary/
 Charlie Gard
Extraordinary Means
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Retrieval Hinge Question
Explain the Within the field of medical ethics, a human being is
classed as a biological/scientific definition separate

difference between from any other species, whereas a 'person' relates to


the moral status – whether or not the individual has

a human being and


value.

a person, within
the field of medical Biological Status
Moral Status

ethics.
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The 2nd Key
Principle:
Sanctity of
Life vs
Quality of Life

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Retrieval Hinge Question
Explain, with Catholic doctrine teaches that...
ALL life is intrinsically sacred as we are made

reference to the IMAGO DEI (Genesis 1:27).


All life is of equal value, from the moment of

doctrine of the conception to the grave.


This is a MORAL ABSOLUTE.

Sanctity of Life, the


Catholic approach Intrinsically Sacred; Equal Value; Conception; Death;
to the issue of Imago Dei

personhood.
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He deals with the first question by quoting
Schopenheur:
Glover’s Challenge to “We feel this destruction [of the body] only in the

the Sanctity of Life view evils of illness or old age… for the subject, death
itself consists merely in the moment when
consciousness vanishes.”
Jonathon Glover examines the SofL view and
questions what exactly it is that is of value: In this he sides with Singer’s ‘Speciesism’ argument
 Being alive (as opposed to being dead)? – that simply being a member of a particular species
is not in itself a reason to confer a value on
 Being human (as opposed to being a something to say that ‘human life is precious
member of another species)? because it is human’ is simply a tautology.
 Being Conscious?
Although he is careful not to offer a definitive
This has 2 implications: answer himself, Glover points out that the things we
1. If it is being conscious that is of intrinsic value, most value are linked in one way or another to
then human life is simply of instrumental value. being conscious – he asks us to consider whether
2. The Quality of Life becomes more important than being in a permanent coma is preferable to being
simply being alive. dead.

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Peter Singer: Quality of Life
 Has strongly argued that it is now time to abandon the sanctity of life principle
in favour of a secular, quality of life argument.
 Singer develops Locke’s notion that life is to be valued due to a person’s ability
to have desires and preferences – human life is not automatically given priority
over other species.
 Natural law, as practiced by the Roman Catholic Church in the area of sexual
ethics, is too biological and denies women in particular procreative autonomy.
 Singer argues that there should be a rejection of Aristotelian natural law which
holds an outdated, dualistic, biological approach to ethics.

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The Anthology: M. Wilcockson
Read p 50 of the Wilcockson article:
Summarise Singer's views on the Sanctity
of Life principle
Now read p53 on “The Liberal Model”:
What is the function of the law in a
liberal society?
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Preference utilitarianism
 Singer would define his ethical position as preference utilitarianism.
 Preference Utilitarians claim that the most moral action is that which produces the best
consequences, and they define the best consequences in terms of preference satisfaction.
 Quality of Life (and therefore personhood) are to be judged against whatever people
consider to be the most preferential – which may equally include wanting to live as to die.
 Singer's notoriety stems mainly from his conclusions concerning abortion, euthanasia
and infanticide:
 He argues that, although they can suffer, the unborn, infants and severely disabled
people lack the ability to plan and anticipate their future; it's therefore morally
permissible under certain circumstances, to end their lives.

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The Wrongness of Killing
Simply being a member of the species Homo sapiens, i.e. being a human being,
is not relevant to the wrongness of killing it. Rather, this wrongness must
depend on some morally relevant characteristics that the being has.
Sentience, or the capacity to feel pleasure or pain, seems to be a minimal
characteristic, and so the killing of plants is not wrong in itself.
Additionally, characteristics like rationality, autonomy, and self-consciousness
that make a difference.
Infants may be sentient beings but they are neither rational nor self- conscious.
Killing them, therefore, cannot be equated with killing normal human beings, or
any other self-conscious beings.
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Autonomy
In addition to sentience, however, Singer gives an important place to the
being's capacity for autonomy, for making his or her own decisions (including a
decision about whether or not to continue living).
Killing an autonomous being against that being's will is the most drastic
possible violation of autonomy, and this makes it more seriously wrong than the
killing of a sentient being not capable of autonomy.
However, should an individual exercise their autonomy and express a
preference not to go on living (in the case of Euthanasia), Singer argues that
their wishes should be respected.

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The End of the Sanctity of Life?
“During the next 35 years, the traditional view of the
sanctity of human life will collapse under pressure from
scientific, technological, and demographic developments. By
2040, it may be that only a rump of hard-core, know-
nothing religious fundamentalists will defend the view that
every human life, from conception to death, is sacrosanct
(sacred).”
Foreign Policy, 1995
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Write up
Explain, in your own words, Peter Singer’s views on:
Personhood
Autonomy
The morality of killing
Sanctity of Life arguments
With reference to preference utilitarianism.

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Learning Checklist
Key Concepts Key Concepts Key Scholars
Personhood Double Effect  Peter Singer
 Catholic Teaching
Quality of Life Autonomy  Michael Wilcockson
Sanctity of Life The Slippery Slope  J.S. Mill
Active/Passive Argument  Jonathon Glover
Euthanasia The Wedge Argument Case Studies
Act vs Omission  Dianne Pretty
The Harm Principle
 Tony Nicklinson
Ordinary/Extraord-
 Charlie Gard
inary Means
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Part 2:
Euthanasia and
the Law

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Explain the following
Retrieval concepts

Personhood The moral status of an individual

The belief that human life is made by God,


Sanctity of Life and that only God can take it away.

Quality of Life The belief that a life should have certain


qualities to make it worth living.

Preference Utilitarianism A form of utilitarianism that defines a moral


outcome in terms of preference satisfaction.

Autonomy The ability of an individual to make/enact


choices for themselves

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Starting Point: Definitions
From the video, write a definition
of the following:
o Euthanasia
o Assisted Suicide
o Active Euthanasia
o Passive Euthanasia
Explain what the organisation
Dignitas do, and how you would
classify it.
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Euthanasia in the UK

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Active/Passive Euthanasia

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Changing Attitudes?
2004 2014
‘Assisted Dying for ‘Assisted Dying Bill’
Suicide Act the Terminally Ill’ (Commission on
1961 (Lord Joffe) Assisted Dying)
Defeated in Lords Defeated in Commons

2002 2012
1993 2020:
Dianne Pretty Case Tony Nicklinson Case
65% Public Tony Bland Case 9% Public Against
Sought assurance her Sought assurance
Against Removal of life- some reform of
husband would not that doctors would
Legalisation of saving care not illegal Euthanasia Law
be prosecuted. not be prosecuted.
Euthanasia Successful Source:
Unsuccessful Unsuccessful www.politics.co.uk/
reference/euthanasia

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Around
the World

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The Case for Legalisation
BBC One - Morning Live, Should the law on assisted dying change in the UK?

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The Case for Legalisation
Read p54 of the Wilcockson Anthology article and answer “The law is an absolute mess and
the following: totally lacks compassion. It is so
urgently time for a change.”
1. What are the two main principles put forward in Lord Falconer, chair of Commission
arguments for legalisation? Briefly explain what each on Assisted Dying, 2020
one means.
2. What is Janet Radcliffe’s argument for assisted suicide?
“The right to die can so easily
3. What has happened to social attitudes towards become the duty to die.”
legalisation in the UK? Peter Saunders, Care Not Killing
4. What do you think are the THREE most important Alliance, 2016
conditions for Euthanasia in the Netherlands?

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Check your understanding
Explain the current UK legal position on:
Active Euthanasia
Passive Euthanasia
Identify one country where each kind of
Euthanasia is legal.

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Learning Checklist
Key Concepts Key Concepts Key Scholars
Personhood Double Effect  Peter Singer
 Catholic Teaching
Quality of Life Autonomy  Michael Wilcockson
Sanctity of Life The Slippery Slope  J.S. Mill
Active/Passive Argument  Jonathon Glover
Euthanasia The Wedge Argument Case Studies
Act vs Omission  Dianne Pretty
The Harm Principle
 Tony Nicklinson
Ordinary/Extraord-
 Charlie Gard
inary Means
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Part 3: 3 Moral Principles
- Act vs Omissions
- Double Effect
- Ordinary &
Extraordinary Means

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Arguments
Do Now: Retrieval
Outline one argument from a secular perspective,
and one from a religious perspective, that:
◦ Supports reforming the law on Assisted Dying
◦ Argues to maintain the legal ban on Assisted Dying

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Do Now: Retrieval
Secular Arguments

Maintain the ban


Reform the Law

Religious Arguments

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Active & Passive Euthanasia
“I will give no deadly medicines to anyone if asked, nor
suggest any such counsel.” (Hippocratic Oath)
This has often formed the basis for the British Medical Association’s (BMA) opposition
to euthanasia.
The BMA also emphasises the difference between active euthanasia (direct killing) and
passive euthanasia (indirect killing), preferring to talk of withholding or withdrawing
treatment, rather than ‘passive euthanasia.’
Since the landmark Tony Bland ruling in 1993, it has been accepted that withholding
treatment does not break the law.
According to Wilcockson, there are 3 moral principles that underpin this thinking.
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1. Acts vs Omissions
Is there a moral difference between acting in a way that causes a negative
outcome, and failing to act to prevent a negative outcome?
Is there a moral difference between the following:
Pushing someone into traffic and failing to shout a warning to someone about to
step in front of a car?
Extorting money from a younger student and failing to report someone you
know is extorting money?
Sexually abusing someone and failing to report someone accused of abuse?
Agreeing to volunteer to support a charity event and then not turning up, and
refusing to support in the first place?
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1. Acts vs Omissions - Extract
In this example, note the use of the phrase
intended omission. Wilcockson implies that
moral culpability stems from intention.
To what extent does it depend on having
knowledge of the consequences of not
acting?

If we are in the position to prevent a negative


outcome, and we don’t, we are as culpable as
the one who causes it.
Do you agree?

The CCC states that failure to prevent death is


morally equivalent to murder.
What are the implications of this?

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1. Acts vs Omissions
Within medical ethics, it is less straightforward.
It may well be that not attempting to save a patient in certain circumstances may be
regarded as ethically acceptable, if it was to be foreseen that their quality of life would be too
low or that saving them was beyond a reasonable request.
Wilcockson uses the example of premature babies:
If a baby is born very prematurely a doctor might have to consider whether they have a duty to save
the baby. Some argue that morally they may withhold treatment either as a form of passive
euthanasia (a form of non-voluntary euthanasia) or simply ‘letting nature take its course’.

However, Wilcockson then points out that if there was an attempt to save the baby’s life, and
then withdraw treatment, this could now be classified as active, non-voluntary euthanasia.

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Retrieval:
Where have we
2. Double Effect encountered the
principle of double effect
This is a long-standing principle which is often invoked before?
by the Catholic Church:
Natural Moral Law
A morally good action can be performed even if it has a also
negative side effect, so long as the side-effect is not The Just War Theory
intended. (it can be morally acceptable
to kill in war, if the intention
This applies even if the side-effect is foreseen.
is:
As such, this principle is often used to justify Self defence
administrating high doses of pain-relieving drugs, which Defence of innocent lives
may have the side-effect of hastening someone’s death. Service to the country in
which you are a citizen)

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Double Effect vs Omission
Scenario A Scenario B
A patient is at the end stages of Cancer A patient is in a persistent vegetative state
(advanced stage 4). A doctor continues to (PVS). Scans show there is minimal brain
prescriber morphine in increasing doses, activity. A doctor removes the feeding tube
despite knowing that death will come quicker. after consultation with the family.

For each scenario:


1. Is the doctor doing anything morally wrong?
2. How would you justify each action from a moral
perspective (using what we have learned)
3. What would the Catholic Church say about each
action?

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2. Double Effect
However, Wilcockson points out that this can be open to abuse – how can we
truly know what a person’s intentions are?
Furthermore, he questions the distinction between intention and foresight – a
good doctor should know the effects of what they prescribe. Giving such a high
dose of painkillers that is shortens someone’s lifespan could actually count as a
failure to treat someone properly, i.e. an omission:

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3. Ordinary & Extraordinary Means
This principle concerns the lengths that one is obliged to go to when preserving life.
This issue connects to the idea of patient autonomy, which we will cover next lesson.
The BMA allows competent patients the right to refuse treatment, including that
which will prolong their life. This can in effect be seen as ‘letting nature take its
course’.
However, this argument places the idea of a doctor’s intervention as purely artificial
means and might deny a doctor the autonomy to save a patient.
If a doctor withholds treatment from someone with cancer because it is their wish,
couldn’t this be regarded as a willful omission, or even medical negligence?
Some argue it is a doctor’s duty to treat patients in the best way possible, but
proportionately.
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3. Ordinary & Extraordinary Means

The question overall is whether to accept


that allowing the end of life in some Discuss:
circumstances is good and proportionate In your view, would the above
medicine. decision constitute as:
While there are great difficulties in  An act or an omission?
determining what would form a basis for a  A form of passive Euthanasia?
minimally good quality of life, there can
often be a general consensus as to when a  Moral?
life requires too much to save for too little.
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3. Ordinary & Extraordinary Means
A key problem with this is establishing a criteria Finnis’ Seven Basic Goods:
for what constitutes an acceptable quality of life. • Life
Wilcockson refers in the article to John Finnis’
“Seven Basic Goods” as a possibility. • Knowledge (for its own sake)
• Friendship and Sociability
(John Finnis is an Australian Legal Scholar and • Play (for its own sake)
practising Catholic. In 1980 he published “Natural
• Aesthetic Experience
Law and Natural Rights” which restated the
fundamentals of Natural Moral Law.) • Practical Reasonableness, i.e. the ability to
reason correctly about what is best for yourself,
Challenge: and to act on those decisions.
Does Finnis’ criteria constitute an acceptable QofL? • Religion i.e. a connection with, and
If not, can you propose a better criteria? participation with, the orders that transcend
individual humanity
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Check your understanding
Write 3 short paragraphs explaining how each
moral principle can be used to justify passive
euthanasia:
• Act vs Omissions
• Double Effect
• Ordinary & Extraordinary Means
Ensure you include the challenges/problems
encountered within each one.

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Independent
Work: Case
Study
Research the case of Charlie Gard, from
2017, using the following sites:
Charlie Gard case – Wikipedia
Charlie Gard: A case that changed everyt
hing? - BBC News
Written response:
https://youtu.be/ZqAmU-WYVCM
In your view, where did the Charlie Gard
case fall in terms of:
NB: This was a highly controversial case – • Ordinary/Extraordinary Means
you will find many, many other sites • (Parental) Patient Autonomy
covering the case. Very few – if any – will
be objective. • Doctor – Patient relationship
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Learning Checklist
Key Concepts Key Concepts Key Scholars
Personhood Double Effect  Peter Singer
 Catholic Teaching
Quality of Life Autonomy  Michael Wilcockson
Sanctity of Life The Slippery Slope  J.S. Mill
Active/Passive Argument  Jonathon Glover
Euthanasia The Wedge Argument Case Studies
Act vs Omission  Dianne Pretty
The Harm Principle
 Tony Nicklinson
Ordinary/Extra-
 Charlie Gard
ordinary Means
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Part 4: Arguments For &
Against
- Sanctity of Life
- Autonomy
- The Wedge Argument
- The Harm Principle

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Concepts
Do Now: Retrieval
Explain in no more than 2 sentences each, what is
meant by:
◦ Act vs Omission
◦ Double Effect
◦ Ordinary & Extraordinary means

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AO2: What is your evaluation of these particular
arguments?
1. Sanctity of Life
“Strong” SofL: “Weak” SofL:
This is the view maintained by the Catholic Church, which has This view places compassion for the person
repeatedly rejected any form of Euthanasia: suffering at the centre:
Whatever its motives and means, direct euthanasia consists in Killing an innocent person out of love is
putting an end to the lives of handicapped, sick, or dying
persons. It is morally unacceptable. (CCC2277) not morally equal to murder. there is no
evil motive. In exceptional circumstances, it is
The Church maintains that high-quality Palliative Care negates an act of love.
the need for Euthanasia.
No one has a duty to endure extreme pain
The use of painkillers to alleviate the sufferings of the dying,
even at the risk of shortening their days, can be morally in Life is a gift, not a burden: if we are given a gift,
conformity with human dignity if death is not willed as either we should use it responsibly and dispose of it as
an end or a means, but only foreseen and tolerated as
we have free will to do. we are stewards of this
inevitable Palliative care is a special form of disinterested
charity. As such it should be encouraged. (CCC 2279) life, so we are in control of ending it if we wish.

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AO2: What is your evaluation of this particular
argument?
2. Patient Autonomy
The Argument: Counter-Argument:
The 1961 Suicide Act permits people to choose to The BMA is very resistant to this due to their belief that
die without legal recrimination but forbids others it would cause widespread damage to the relationships
from helping them. between doctors and patients and destroy the trust
that is required for hospitals to administer care
Critics argue that this creates a disparity between effectively.
those who have the means to end their lives and
This argument effectively puts forward that maintaining
those who don’t. Why should a person in control of
the autonomy and liberty of all people is more morally
their body get to have the personal right to suicide important than the case-by-case issues of pain and
but a person physically incapable of committing the discomfort that some terminally ill people face
act find themselves unable to have help performing
the same act? While legalisation might help a few, it presents a
greater danger for everyone else, especially vulnerable
If the law was consistent, then every person would individuals such as the elderly who may no longer trust
have the right to die, with help or not, without doctors to have their best interests in care at their
recrimination from the law. hearts.
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AO2: What is your evaluation of this
particular argument?
3. The Wedge Argument
The Argument: Counter-Argument:
Were assisted suicide or voluntary euthanasia to be This argument makes an empirical, inductive claim, that because things
allowed, it would lead in practice to widespread have gone badly in the past with some laws, things will on probability go
abuse and numerous negative consequences badly in the future. This logical jump for many people is unwarranted,
beyond the original intentions of the law. especially when there is little evidence of widespread abuse of modern
euthanasia practices where it is legal.
As Wilcockson notes this can be seen to be based
on a form of logic which argues that something Some supporters of the wedge argument have used the Nazi euthanasia
‘permitted initially as an exception becomes the and eugenics programme as an example against legalisation, but as Helga
Kuhse points out the issues with this were less to do with euthanasia itself
rule’, and relies on a number of premises, such as: and rather the racial prejudices behind it.
· There are always those who exploit a weaker rule What the wedge argument seems to warn against really is the slipping of
· What begins with the best of intentions results in morality, which arguably is not beholden to any law. An equal argument
undesirable ends could be made that we should not imprison people because people with
power might abuse it and imprison whomever they desire.

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AO2: What is your evaluation of this
particular argument?
4. The Harm Principle
John Stuart Mill’s On Liberty outlines the function of There is also the question of how the general
law to both exist as a moral guideline and to in turn population feels about a particular issue.
protect the rights and existence of individuals, in
order that the majority section of a society might not Some point towards a shift in popular supporting the
exploit minority sections. UK towards legalising voluntary euthanasia; but as
Bernard Williams notes, in what he describes as the
Law in this way is minimal and non-interfering, but precedent effect, legalisation for something can be
this is difficult in practice. seen to give tacit approval towards certain
behaviours.
In one way it is important that the law does not affect
those suffering and wishing to end their lives, yet at
Challenge:
the same time, if legalising euthanasia threatens the
autonomy of those most vulnerable, then it may have Does legalising something effectively
to prioritise the protection of minorities and legislate psychologically or socially permit it?
against it. Think, for example, of the impact of changing
COVID rules – masks, etc

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To be able to evaluate each approach and form a credible conclusion Medical Ethics
Check your knowledge
1. Why do some people say that the 1961 Suicide Act is inconsistent?
2. What is the BMA’s response?
3. According to Wilcockson, what are 2 premises that the Wedge
argument is based upon?
4. For what reason does Helga Kuhse reject this?
5. According to J.S. Mill, what are the 2 functions of the Law?
6. What did Bernard Williams describe as the precedent effect?

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Final Arguments

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Jonathon Glover
“Causing Death and Saving Lives” (1977)
Glover focuses on the concept of autonomy. He also criticises the doctrine of double effect
in these circumstances from a consequentialist
He argues that when the rational reasons a position.
person might have to end their life are
considered and judged sound, then if that Whether or not one intends or foresees a
person has a right to end their life, society death, if it is predicted and allowed to occur,
equally has a responsibility to facilitate that if the results are still the same regardless of
the person is incapable of doing it themselves. whether someone has actively made it
happen.
Challenge:
In the case of euthanasia, therefore, a doctor
Should patient autonomy – which includes the right
engaging in passive euthanasia is committing
to refuse life-saving treatment – extend to the right
the same act as if it were active, with double
to take their own life?
effect simply being a guilt-avoiding
Should this include someone who is depressed?
rationalisation of his actions.
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Daniel Callahan
“When Self-Determination Runs Amok” (1992)
He argues from a purely rational and secular point of view:
1. He contends that Active Voluntary Euthanasia (AVE) is morally wrong because it is
"counselling adult killing" that create a new category of killing. It is not suicide as more than
one person is involved.
2. Allowing AVE could harm the common good. He argues that self-determination should be
limited in the name of the common good of the community.
3. He claims that we "should not waive our right to life, and then give it to another to take that
life.“
4. Since the value of life is not directly linked to suffering, Doctors and relatives cannot find an
objective way of judging whether or not a patient’s life is worth living.

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James Rachels
“Active and Passive Euthanasia” (1975)
Argues there is no moral difference between
Active and Passive Euthanasia:
Passive Euthanasia is more painful for patient,
takes longer, and causes unnecessary suffering.
It also has a greater impact on family, yet has
the same outcome as Active Euthanasia.
Many cases of "letting die" are WORSE (for the
patient) than killing them - the refusal of
treatment to some "defective" newborns, and Challenge:
their subsequent death by dehydration. Is this a valid argument?
What implication does it have on arguments
for/against legalisation?

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Match the Scholar to the Argument
Allowing Active Voluntary
Euthanasia will harm the
common good.

James Rachels
Daniel Callahan

Passive Euthanasia is just as Patient autonomy includes


morally wrong as Active the right to take your own life
Euthanasia

Jonathon Glover
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Learning Checklist
Key Concepts Key Concepts Key Scholars
Personhood Double Effect  Peter Singer
 Catholic Teaching
Quality of Life Autonomy  Michael Wilcockson
Sanctity of Life The Slippery Slope  J.S. Mill
Active/Passive Argument  Jonathon Glover
Euthanasia The Wedge Argument Case Studies
Act vs Omission  Dianne Pretty
The Harm Principle
 Tony Nicklinson
Ordinary/Extra-
 Charlie Gard
ordinary Means
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Types of Euthanasia

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Exam Practice:

a) Outline and clarify the different ideas presented in this passage about the wedge
or slippery slope argument (10).
b) Analyse the different implications of this passage for quality of life arguments for
the legalisation of voluntary euthanasia. (20)
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To be able to evaluate each approach and form a credible conclusion Medical Ethics
Indicative Content (Part a)

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To be able to evaluate each approach and form a credible conclusion Medical Ethics
Indicative Content (Part b)

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To understand the fundamental principles that underpin approaches to medical ethics EDEXCEL A Level Ethics
To be able to evaluate each approach and form a credible conclusion Medical Ethics

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