Students are expected to study a range of texts that support and underpin their knowledge and understanding. The assessment will include two extended-response questions on an excerpt, sourced from this extracts list. The following texts are not exclusive to the topic areas under which they appear; students will need to be able to apply these texts across any suitable topic area. These are published in the A level Religious Studies Anthology: Paper 2 – Religion and Ethics which can be downloaded from our website.
(1) Barclay W – Ethics in a Permissive Society, Chapter 4 Situation Ethics, pp. 69–91 (HarperCollins Distribution Services, 1972) ISBN 9780002152044
(2) Kant I – Groundwork for the Metaphysics of Morals, Text, second section, pp. 29–53 (Yale University Press, 2002) ISBN 9780300094879
(3) Aristotle – The Nicomachean Ethics, Book II, Moral Virtue, pp. 23–37 (Oxford World’s Classics edition, 1980) ISBN 9780192815187
1. Good or bad medical practice?
A ‘third party’ in law refers to any agent other than the principal agent and in the case of euthanasia this would generally mean a doctor (sometimes also referred to as the ‘physician’). For all practical purposes if euthanasia is to be justified at all it has to be considered as part of medical practice, for it is reasonably clear that any other practice of euthanasia would be almost impossible to control or regulate. Without regulation society would permit killing or murder and whatever moral code one adopts would be regarded as untenable. The consideration of ‘euthanasia’, at present, is rightly a medical issue. Put simply it is this: should a doctor kill his
patients in some circumstances?
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the question of whether doctor assisted deaths are murder.
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
The passage discusses the ethical dilemma of euthanasia, specifically in the context of medical practice. It argues that if euthanasia is to be allowed, it must be regulated and controlled by medical professionals. The passage suggests that the core question is whether doctors should kill their patients in certain circumstances.
The author, Michael Wilcockson, acknowledges that euthanasia is a contentious issue, and that there are different views on whether it is ethical for doctors to assist in the deaths of their patients. The passage suggests that there are two main perspectives on this issue.
One perspective is that euthanasia is a form of murder. The passage notes that without regulation, society would permit killing or murder, and any moral code would be regarded as untenable. This suggests that the author believes that euthanasia should not be permitted, as it would violate moral codes against killing.
The idea that euthanasia is akin to murder is supported by a number of scholars. For example, John Keown argues that euthanasia is a form of homicide, and that doctors should not be permitted to end the lives of their patients (Keown, 2002). Similarly, Leon Kass argues that euthanasia violates the Hippocratic Oath and undermines the doctor-patient relationship (Kass, 2002).
On the other hand, the passage also suggests that there is another perspective on euthanasia. This perspective argues that patients should have the right to choose to end their lives in certain circumstances, and that doctors should be permitted to assist them in doing so. This perspective suggests that euthanasia can be a form of compassionate care, rather than murder.
The idea that patients should have the right to choose euthanasia is supported by a number of scholars as well. For example, David Velleman argues that patients should have the right to end their lives in a peaceful and dignified manner, and that doctors should be permitted to assist them in doing so (Velleman, 1999). Similarly, Timothy Quill and Jane Greenlaw argue that physician-assisted dying can be a compassionate and ethical option for terminally ill patients (Quill & Greenlaw, 2008).
In conclusion, the passage presents two different perspectives on euthanasia in medical practice. Some argue that euthanasia is a form of murder that should not be permitted, while others argue that patients should have the right to choose to end their lives in certain circumstances. The debate over euthanasia remains a complex and controversial issue in medical ethics.
References:
Keown, J. (2002). Euthanasia, ethics and public policy: An argument against legislation. Cambridge University Press.
Kass, L. (2002). Death with dignity and the sanctity of life. The New Atlantis, 7, 29-52.
Quill, T. E., & Greenlaw, J. (2008). Physician-assisted death. New England Journal of Medicine, 359(22), 2513-2515.
Velleman, D. J. (1999). Against the right to die. Journal of Medicine and Philosophy, 24(3), 251-266.
The official position of the British Medical Association, for instance, suggests that
there is a great deal of difference between actively terminating life and treating a
patient in a manner which may in the end result in death.
In its ethical advice the BMA emphasises that it is the duty of a doctor to ensure that a patient dies with dignity and as little suffering as possible but recommends that active intervention to terminate life – that is, where drugs are given or other procedures, carried out in order to cause death – even at the request of a patient,
should remain illegal.
The Rights and Responsibilities of Doctors (1992), p.77
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the morality and legality of active and passive euthanasia.
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
The passage discusses the official position of the British Medical Association (BMA) on the distinction between active and passive euthanasia. The BMA argues that there is a significant difference between actively terminating life and providing treatment that may lead to death, and recommends that active euthanasia should remain illegal.
The BMA's position is based on the principle that a doctor's duty is to ensure that a patient dies with dignity and as little suffering as possible. The BMA argues that providing treatment that may lead to death, such as palliative care or withdrawing life-sustaining treatment, is consistent with this principle. However, actively intervening to cause death, such as by administering drugs or carrying out other procedures, is not consistent with this principle and should remain illegal.
The distinction between active and passive euthanasia is a controversial issue in medical ethics. Some argue that there is no moral difference between the two, while others argue that active euthanasia is inherently wrong. The BMA's position reflects the latter perspective.
The BMA's position on active euthanasia is supported by a number of scholars. For example, John Keown argues that there is a moral difference between withholding or withdrawing treatment and actively ending a patient's life, and that the former is consistent with the principle of double effect, while the latter is not (Keown, 2002). Similarly, James Rachels argues that there is no moral difference between active and passive euthanasia, and that both should be permitted under certain circumstances (Rachels, 1975).
On the other hand, the BMA's position on active euthanasia is also criticized by some scholars. For example, David Velleman argues that patients have a right to choose to end their lives, and that actively intervening to cause death may be a more compassionate and dignified option than passive euthanasia (Velleman, 1999). Similarly, Ezekiel Emanuel argues that the moral difference between active and passive euthanasia is arbitrary and that both should be permitted under certain circumstances (Emanuel, 1994).
In conclusion, the passage discusses the BMA's position on the morality and legality of active and passive euthanasia. The BMA argues that there is a significant difference between the two and recommends that active euthanasia should remain illegal. However, this position is controversial, and there are scholars who argue that both active and passive euthanasia should be permitted under certain circumstances.
References:
Emanuel, E. J. (1994). The history of euthanasia debates in the United States and Britain. Annals of Internal Medicine, 121(10), 793-802.
Keown, J. (2002). Euthanasia, ethics and public policy: An argument against legislation. Cambridge University Press.
Rachels, J. (1975). Active and passive euthanasia. New England Journal of Medicine, 292(2), 78-80.
Velleman, D. J. (1999). Against the right to die. Journal of Medicine and Philosophy, 24(3), 251-266.
The Rights and Responsibilities of Doctors (1992). British Medical Association.
a) Moral crisis in liberal societies
Why does the issue of euthanasia (and abortion) cause such heated debate at present? Peter Singer has argued (1994) that Western liberal societies are going through a transitional stage in ethics at present where the authority of the traditional ‘Sanctity of Life’ argument (SOL) is giving way to the liberal ‘Quality of Life’ argument (QOL). The liberal influence has already been seen in many acts of legislation, notably in the case of suicide, where the principle of personal autonomy is the fundamental principle underpinning moral and legal decisions. Singer suggests that the SOL belongs to an older more absolute value view of life but with
the demise of Christianity the philosophical basis which establishes life as a gift from God or part of a Natural Law can no longer be sensibly sustained. So, while the changeover takes place there will be those who strenuously wish to oppose what they see as a corrosive force. Whilst Singer’s argument may have much more
to commend it we should also bear in mind that the SOL as much as the QOL argument both have to contend with the increasing technological and medical complexity. Whereas in the past pneumonia was considered to be the old person’s friend or a severely brain-damaged child would have died through natural causes, the doctor now has the means to sustain a life which in the past simply would not have been a possibility. Whilst the moral basis for sustaining life and allowing death is in transition, the medical profession and legislators will continue to inspire strong reactions.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about how the traditional ‘Sanctity of Life’ argument (SOL) is giving way to the liberal ‘Quality of Life’ argument.
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
In this extract from his article 'Euthanasia and Doctor's Ethics', Michael Wilcockson explores the debate around euthanasia and abortion and argues that the issue has become a moral crisis in liberal societies. Peter Singer's view is presented, that the traditional 'Sanctity of Life' (SOL) argument is losing ground to the liberal 'Quality of Life' (QOL) argument, which places greater emphasis on personal autonomy and the individual's right to make decisions about their own life. Singer suggests that the decline of Christianity and the increasing complexity of medical technology have undermined the philosophical basis for the SOL argument, which views life as a gift from God or as part of a natural law.
According to Singer, the SOL argument is an older, more absolute view of life that is no longer sustainable in the face of modern medical advances. The QOL argument, on the other hand, is based on the idea that the quality of a person's life is more important than the mere fact of their existence. This argument prioritizes the individual's right to self-determination and the ability to choose when and how to end their life. This shift towards the QOL argument is reflected in legislation around suicide, which places personal autonomy as the fundamental principle underpinning moral and legal decisions.
However, Wilcockson notes that the transition from the SOL to the QOL argument is not straightforward, and both arguments have to contend with the increasing complexity of medical technology. In the past, certain medical conditions were considered to be a natural cause of death, but modern medicine has made it possible to sustain life in these cases. As a result, the medical profession and legislators face a difficult ethical dilemma in balancing the moral basis for sustaining life with the individual's right to choose when and how to die.
Wilcockson concludes that the issue of euthanasia and abortion will continue to inspire strong reactions as society navigates this transition in ethics. The debate around euthanasia highlights the tension between the traditional SOL argument and the newer QOL argument, and the medical profession and legislators must carefully consider the implications of each in order to make ethical and legal decisions. While Singer's argument may have much to commend, it is clear that the issue of euthanasia and abortion is complex and multifaceted, and the moral and legal implications must be carefully considered.
References:
Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999).
Peter Singer, Rethinking Life and Death: The Collapse of Our Traditional Ethics (1994).
b) Three moral principles
Three principles presuppose that the doctor is working from the traditional SOL position enshrined in the part of the Hippocratic Oath which states ‘I will give no deadly medicines to anyone if asked, nor suggest any such counsel’ (BMA Handbook, p.69). Each of these principles depends on making a distinction between
direct and indirect killing, i.e. active euthanasia or passive euthanasia. In the latter case there is some dispute whether the term ‘euthanasia’ is really appropriate.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
i) Acts and omissions
If A chooses to shoot B then we classify this as an intended act; if C sees A and
fails to stop A shooting B then this is an intended omission. The point is whether C
is at all blameworthy. In this incident, if C is a pacifist they might well justify their
action by appealing to a negative responsibility, i.e. by failing to act they were
morally blameless. They might even argue that refraining from acting took a great deal of moral courage. But however one looks at it, C was prepared to condone the death of B and accept whatever the consequences this might entail. Some object to this. Can I be held responsible for failing to help stop the deaths of thousands dying in poverty in the Third World? Perhaps the notion has to be couched in such terms
as ‘I am only responsible when I am reasonably in a position to do something’. In other words some ‘omissions’ are regarded as ‘acts’. The Roman Catholic Church states:
Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgement into which one can fall in good faith does not change the nature of this murderous act, which must always be
forbidden and excluded. Catechism of the Catholic Church (1994), p.491.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
The problem is particularly acute with 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’. Morally if they engage in treatment and then decide to withdraw treatment on the grounds that the baby will no longer have a worthwhile life, it may no longer be considered indirect killing but an act of active nonvoluntary
euthanasia or murder (See Singer, Rethinking Life and Death, 1994, pp.75-80 for examples and discussion.)
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
ii) Double effect
Another indirect argument has a long tradition in Natural Law ethics and involves two kinds of intention. According to the double effect (DDE) argument there is a difference between foreseeing an event and directly intending or willing it to happen. The emphasis, therefore, is different from the act and omissions argument
where the agent foresaw what was to happen and allowed it to happen. For instance, A defend themselves against an attack from B using reasonable force. They know that this might result in B’s death but it is not their intention that this should happen. If B then dies as a result of A’s defence the DDE does not hold A to be blameworthy for an act they did not intend. In Case 3 a doctor who subscribes to the DDE might argue that the principle is sound medicine (and as a well established principle in Natural Law ethics it is therefore acceptable in Roman Catholic theology). However, the term ‘euthanasia’ is resisted in the same way that ‘abortion’ is avoided for similar reasons. But is the DDE open to abuse? …
· Is there a satisfactory distinction between intending and foreseeing? Might one say that the DDE is bad medicine, that if I foresee death but fail to act, then this is an omission which is a form of indirect euthanasia – which is rejected by the SOL?
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a. Clarify the ideas illustrated in this passage about double effect. (10)You must refer to the passage in your response.
b. Analyse the moral implications for assisted suicide from this passage. (20)
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
iii) Ordinary and extraordinary means.
The principle of ordinary and extraordinary means is used both by weak SOL (WSOL) arguments and QOL proponents. Another, possibly better way of considering the issue is in terms of proportionate and disproportionate means.
· In the Natural law tradition a person who refuses food and water in order to die has deliberately committed suicide which is condemned in Roman Catholic theology as a mortal sin. But a person is within their rights to refuse surgery on grounds that it is over and above what is needed ordinarily for bare existence. The BMA for instance say, ‘competent patients have a right to refuse any treatment, including life-prolonging treatment’ (Medical Ethics Today, 1993, p.149). Nature is allowed to take its course. The doctor is not involved in the direct cause of death of the patient. Those who criticise this suggest it is a form of passive euthanasia or even assisted suicide. For instance, if a doctor withholds life-sustaining treatment, against his or her better judgement, but through respect for patient autonomy, the result might be condemned either as an act of professional negligence or wilful killing.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
On the other hand, some argue that it is a doctor’s professional duty to use whatever medicines are available regardless of the situation. A response to this might be to think in terms of proportion as an alternative variation of extraordinary means. Proportion is a well-established principle in the Natural Law tradition which may be applied to medicine without compromising theobligation of the doctor to treat his or her patient. This enables each situation to be seen individually so that what might be considered proportionate to achieve good ends is contingent on the needs of the patient and even the resources of the doctor. The issue is particularly complex with non-competent patients. For instance, a very handicapped baby (for example one who is ‘anacephalic’ or with a major part of the brain missing) might be considered so ill that no amount of surgery would improve their condition significantly. In this case a doctor might then prescribe ‘nursing care only’ (the baby should be kept warm and fed) as proportionate to their needs, knowing that the baby will die shortly.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a. Clarify the ideas illustrated in this passage about proportion. (10) You must refer to the passage in your response.
b. Analyse the extent to which natural moral law justifies euthanasia. (20)
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
· The WSOL argues that where death is inevitable the doctor is bound by compassion or love to treat the patient accordingly. This attitude is summarised by the much quoted phrase, from Arthur Clough’s poem: ‘Though shalt not kill: but need’st not strive Officiously to keep alive’. Singer (Rethinking Life and Death, 1994, p.149) goes further. Rigid adherence to the doctrine never to kill (vitalism) is an abrogation of the doctor’s responsibility to his patient. The question is not so much between ordinary and extraordinary means but whether, in some cases, direct termination of life is good medicine.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
In QOL the key factor is whether the use of extraordinary medical means would usefully promote the quality of life. The notion is essentially utilitarian. For instance, in Cases 4 and 6 above a number of factors all need consideration: the possible length of useful life; state of mind of the patient (a main consideration in the American QALYS or Quality Adjusted Life Year Schedules); resources needed and available. All these factors contribute towards making doctors’ choices. For instance, a doctor might have to weigh up whether very painful surgery or powerful drugs which cause permanent drowsiness would result in a person who is a shadow of their former self. Can he or she base his or her judgement on some minimum human life-standard? For instance John Finnis’s ‘basic goods’ argument suggests a possible list of ‘valuable’ life criteria which include: play, aesthetic experience, sociability; but inevitably there is no agreement as to what these standards should be.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
2. Law and morality
So far the discussion has centred on the doctor-patient relationship within the constraints of law. There is no doubt that a shift in public opinion has increased the pressure for reform especially for voluntary euthanasia, whilst the Bland case sets a precedent for severely brain-damaged patients.
a) The liberal model
Mill’s essay On Liberty (1859) is often cited as an example of the way in which law
should function in a liberal society.
· The principle is that law is not in itself a moral guideline. Law in a liberal society acknowledges that each person has his or her own preferences which, using the utilitarian principle, if satisfied lead to the greatest happiness. The law enables the greatest personal autonomy of the greatest number.
· The second function of law is to protect the individual. This limits the majority from exploiting the minority and also the minority form exercising too much sway over the majority. Law should have minimal interference.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
In practice, though, the law has to take into account a general moral feeling and it has also to acknowledge that once legislation take place, in the mind of many this is seen to give tacit approval to certain forms of behaviour. Bernard Williams has described this as the precedent effect (Smart and Williams, Utilitarianism, 1973, p.106). Others more fearfully think in terms of a slippery slope or the thin end of the wedge. If, for instance, voluntary euthanasia were to be permitted under the law this would inevitably permit other forms of illicit killing. The British Medical Association is adamant that euthanasia should not become law:
Doctors have a duty to try to provide patients with a peaceful and dignified death with minimal suffering, but the BMA considers it contrary
to the doctor’s role deliberately to kill patients, even at their request. In the BMA’s view, liberalising the law on euthanasia would herald a serious and incalculable change in the ethos of medicine.
Medical Ethics Today (1993), pp.175, 177
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
The passage discusses the relationship between law, morality, and the potential for a slippery slope or wedge effect in regards to the legalization of euthanasia. The author notes that once legislation is in place, it may be perceived as giving tacit approval to certain forms of behavior. Bernard Williams, as cited by Smart and Williams in Utilitarianism (1973), calls this the "precedent effect." Others, however, fear that legalizing voluntary euthanasia could open the door to other forms of illicit killing, such as involuntary euthanasia or euthanasia without consent. This fear is known as the slippery slope or the thin end of the wedge.
The British Medical Association (BMA) takes a strong stance against euthanasia becoming law, arguing that it would contradict the doctor's role to deliberately kill patients, even at their request. The BMA believes that legalizing euthanasia would lead to a significant and incalculable change in the ethos of medicine (Wilcockson, 1999).
This passage highlights the tension between the desire to alleviate suffering through euthanasia and the fear of a slippery slope. The precedent effect of legislation, according to Williams, implies that legalizing euthanasia would implicitly approve of killing, which could lead to other forms of killing. The fear of a slippery slope is particularly salient in discussions of euthanasia, where it may be difficult to distinguish between voluntary and involuntary euthanasia, or between euthanasia and murder.
The BMA's opposition to euthanasia is grounded in the belief that doctors have a duty to provide patients with a peaceful and dignified death, but that deliberately killing patients goes against this duty. The BMA also argues that legalizing euthanasia would fundamentally change the ethos of medicine, creating a situation where doctors are seen as agents of death rather than healers. This argument reflects the concern that legalizing euthanasia could change the values and norms of the medical profession, leading to a situation where killing becomes an acceptable solution to medical problems.
Overall, this passage illustrates the complex moral and ethical issues surrounding the legalization of euthanasia. While some argue that it is a necessary means of reducing suffering, others fear that it could lead to unintended consequences such as the normalization of killing. The debate over euthanasia raises important questions about the relationship between law, morality, and medical ethics.
References:
Smart, J. J. C., & Williams, B. (1973). Utilitarianism: For and Against. Cambridge University Press.
Wilcockson, M. (1999). Euthanasia and Doctor's Ethics. Journal of Medical Ethics, 25(1), 36-42.
b) The case for legalising euthanasia
The two principles frequently cited are personal autonomy (and rights) and QOL. The argument is further enhanced by citing those countries/states where some form of euthanasia is permitted.
i) Britain
Euthanasia is only an extension of what is permissible as suicide. The 1961 Suicide
Act in the UK for instance permits personal autonomy to choose without recrimination (in the case of attempted suicide) but forbids third-party involvement. Here is an argument typical of this kind of reasoning (Janet Radcliffe, The Guardian
Weekly, September 1992):
The problem with voluntary euthanasia has nothing to do with the dangers of letting doctors decide whether patients live or die… The real question is quite different. It is whether people who are trapped in bodies or an institution they cannot control should be allowed to make choices freely available to the rest of us…Why... If you take a housebound friend shopping no one accuses you of kidnapping, if you cook her a meal no one thinks you are force-feeding her. Why then, if she is in agony or despair,
and you bring her the lethal dose she desperately wants but cannot get, or you manipulate the syringe because she is too weak to do it herself, do you find yourself guilty of one of the worst crimes there is?
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
But the 1961 Suicide Act makes it illegal to aid or give assistance in a suicide. Those who argue for a change in the law cite the shift in popular support and demand for voluntary euthanasia from 51 per cent in 1969, 69 per cent in 1976,
75 per cent in 1989 to 82 per cent in 1996. The British Medical Association though still strongly opposes any change on the grounds that it will irrevocably alter the patient-doctor relationship.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
ii) The Netherlands
Often people argue that voluntary euthanasia arrangements should be brought in line with the principles determining legal abortion. The situation in the Netherlands is frequently referred to because it most clearly expresses the balance between the popular will, medical practice and legal control. (For a full account see Singer,
Rethinking Life and Death, 1994, pp.143–7). The case is for physician-assisted suicide.
· Mercy killing is illegal, but where there is a conflict of duties between the doctor’s medical ethics and the demands of the patient euthanasia may be permitted (the key issue therefore is that of conflict of duties.)
· Only a medical practitioner may be permitted to carry out euthanasia.
· The patient must make his or her request to die persistently and explicitly.
· The patient’s request must be freely made, well-informed and without coercion.
· The patient’s condition must be one where there is no foreseeable room for
improvement and where there is unbearable pain. All other alternatives for
relieving pain should have been considered.
· A doctor should seek advice and second opinion of another independent doctor.
· The Dutch parliament regularised this procedure in 1993. The doctor must report his or her action to the public prosecutor who then judges each situation case by case. A doctor may be prosecuted if the above criteria have not been adhered to.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
iii) The USA
In the USA the movement is towards ‘proxy empowerment’ and developing the use of living wills. The movement is towards physician-assisted suicide. Physician assisted suicide is strongly resisted by the pro-life movement.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
iv) Australia
In Australia there is no uniform law; however, a doctor may discontinue life-support at the request of the patient. This does not constitute, for the purposes of law, assisted suicide. In the State of Victoria an act of 1988 permits a person to appoint a proxy. In South Australia a person may use an advance directive under the 1983
Natural Death Act refusing ‘extraordinary treatments’ should they become incapacitated.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
c) Objections to legalising euthanasia
One of the primary objections to legalising euthanasia has been the slippery slope or wedge argument. The wedge argument is based on a form of logic which argues that what may be permitted initially as an exception becomes the rule. This is borne out by the observation that:
· there are always those who exploit a weaker rule
what begins with the best of intentions results in undesirable ends.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
Not surprisingly the wedge argument is supported by those who wish to uphold the
SOL, those who have a strong deontology (that rules must be obeyed) and genuinely feat that expectations are not in the end in people’s best interests. The BMA cites (Medical Ethics Today, p.153) the situation in the Netherlands where
some 1000 (or 0.8 per cent) of all deaths a year are the result of non-voluntary euthanasia.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
Helga Kuhse challenges proponents of the wedge argument to provide empirical evidence to support their case. Her own conclusion is that the wedge argument is used by scaremongers to support their complete ban on all forms of
euthanasia. The most frequently cited example of the wedge argument is the active non-voluntary euthanasia practised by the Nazis during the Holocaust years as a form of eugenics (literally ‘the production of good offspring’) where the deaths of millions were justified as part of the improvement of society. Kuhse concludes:
whilst the Nazi ‘euthanasia’ programme is often cited as an example of what can happen when a society acknowledges that some lives are not worthy to be lived, the motivation behind these killings was neither mercy nor respect for autonomy; it was, rather, racial prejudice and the belief that racial purity of the Volk required the elimination of certain individuals and groups. As already noted, in the Netherlands a ‘social experiment’ with active voluntary euthanasia is currently in progress. As yet there is no evidence that this has sent Dutch society down a slippery slope.
‘Euthanasia’, in P Singer (ed). Companion to Ethics (1991), p.302.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
The SOL deontological response is to point to a number of recent liberalisations in the law which illustrate the wedge taking effect. For instance, abortion in the UK is illegal but is permitted in extreme cases. Since 1967 (when the Abortion Act was introduced in England and Wales), the large number of abortions for 16–24-yearolds
suggests that ‘exceptions’ (e.g. threat to psychological life of the mother) are effectively being used as a form of birth control. Many people now think that abortion is legal and in practice an abortion is usually given on demand. Another example might be the liberalising of the divorce laws and the decline of the family.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Finally, as we have already seen, there are those who argue that legalising euthanasia would not promote patient autonomy but in fact reduce it. Legislation would do irreparable harm to doctor-patient relationships and destroy the trust
which is essential if a doctor is going to be able to administer the right kind of care. The following extract from the British Medical Association illustrates the point:
We have consistently emphasised the importance of patient autonomy and rights, reflecting the weight society assigns to individual freedom of
choice. Supporters of a right to die often present this issue as one of personal liberty, maintaining that therefore individuals should be entitled
to assistance to end their lives at the time and in the manner they choose. The BMA, however, maintains that autonomy has limits. The rights of one group cannot be permitted to undermine the rights of others. Recognising a legal right to die would have implications for the whole of society and, perhaps, most particularly for its vulnerable members.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.
Thus many doctors fear that even a limited change in legislation would bring about a profound change in society’s attitude to euthanasia. By removing legal barriers to the previously ‘unthinkable’ and permitting people to be killed, society would open up new possibilities of action and thus engender a frame of mind whereby some individuals might well feel
bound to explore fully the extent of these new options. Once previously prohibited action becomes allowed, the argument goes, it may also come to be seen as desirable – if not by oneself, then as something which might be recommended. A social environment which recognised the right to die, we argue, would bring about a fundamental shift in social attitudes to death, illness, old age and disablement. It would encourage the labelling of people by group and result in some groups who presented problems being seen as more expendable. It would also change the public view of the profession in an irrevocable way and undermine the trust that patients
have in doctors.
Medical Ethics Today (1993). P.151.
Taken from Michael Wilcockson, ‘Euthanasia and Doctor’s Ethics’ (1999)).
a) Outline and clarify the different ideas presented in this passage about the wedge or slippery slope argument..
Michael Wilcockson's article 'Euthanasia and Doctor's Ethics' discusses the moral and legal issues surrounding euthanasia, specifically doctor-assisted deaths. The article explores the arguments for and against active and passive euthanasia and outlines the official position of the British Medical Association (BMA). Wilcockson argues that the distinction between active and passive euthanasia is a contentious issue in medical ethics and that there is no clear consensus on the morality and legality of euthanasia. However, the BMA's position is that providing treatment that may lead to death is consistent with a doctor's duty to ensure that a patient dies with dignity and as little suffering as possible, but active intervention to terminate life should remain illegal. The article highlights the different perspectives and arguments surrounding euthanasia and provides a comprehensive overview of the ethical and legal complexities of this issue.