Medical Ethics

  • Created by: MattyLew
  • Created on: 13-05-18 14:13

Sanctity of Life

the view that human life is intrinsically valuable because it was created specifically and uniquely by God

"Let us make man in our image, in our likeness, and let them rule...over all the earth" - Genesis - sanctity of life is absolute and based on biological status, we hold sovereign over animals 

"All the days ordained for me were written in your book before one of them came to be" - OT

"Thou shalt not commit murder" Ten Commandments 

Natural Moral Law: 2 of the 5 primary precepts - Preserve all human life and Pro-create based upon the sanctity of life 

Roman Catholic Church

  • "Man's life comes from God; it is his gift, his image and imprint, a sharing in his breath of life" - Imago Dei, our life is sacred as we are created in God's image
  • Believe life begins at the moment of conception so the foetus must be treated as a person with rights 
  • Believe no human has the right or power, like god, to take away or destory another life 
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Why do Christians reject the Quality of Life?

  • 1. Permits too much group pressure power - people may be forced into decisions to end lives to protect or satisfy a group
  • 2. Leads to a slippery slope, people may start with good reason but over time the law may allow less good reasons because an absolute law is no longer there to keep things stable.
  • 3. Reduces a peron's autonomy - as doctors may make decisions without consent
  • 4. Fails to treat humans with dignity as human life is only valued on quality, rather than because we are simply human

But why might SOL no longer be relevant in today's society?

  • Modern religious approaches, like Situation Ethics, undermines SOL
  • Scientific and medical advances render Biblical teachings irrelevant as there is no direct teaching when considering modern medical issues, leading to hermeneutical issues. 
  • Developments in medicine mean we have created states where people are neither alive or dead, such as permanent vegetative states.
  • Bibilical teachings were created in a time with much less medical capability, considering possibilites now is it really Christian to keep alive a baby who is suffering greatly just because it's human? 
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Criticisms of Sanctity of Life

Albert Schweitzer, 20th Century: suggested 'Reverence for life' meangs holding high value for life because all forms of life have a desire to carry on living and this is justification for revering their life. We should therefore avoid killing any living thing including grass, insects, lions + humans. Won a Nobel Peace Prize for this idea.

  • Mary Anne Warren: argued against reverence for life suggesting 'will' is based upon the capacity to think, which many life forms do not have. We are genetically built to promote our own survival; this does not deserve reverence. Instead, we should protect things for their own sake. + using reverence for life we cannot conclude abortion is wrong because abortion can be defended under the 'compulsion of necessity' (necessary to kill in some situations even though in most situations we revere life)

Peter Singer: Argues against Speciesism seen in SOL; compares it so racism. Furthermore, feels Christian attitudes are out of date and we need to reassess our beliefs in our more secular society. values personhood, not species (rational + self-awareness). Argues it is worse to kill a fully grown chimpanzee than a human being who has a profound intellectual disability. For Singer, that human is not a person. 

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Criticisms of Sanctity of Life

  • Jonathon Glover

in Utilitarianism killing is indirectly wrong because it is a teleological theory - the consequences make killing unnaceptable not the act itself. SOL says killing is directly wrong + it is intrinsically wrong. --> Glover argues killing is directly wrong, but not intrinsically wrong. 

Asks about the value of life - SOL suggest life is valuably no matter what, values only conciousness but this does not distinguish us from apes - what makes human life valuable? = Suggests a better concept would be a 'life worth living' 

What makes life worth living? If someone wants to, but this may raise issues for someone suffering from severe depression and suicidal thoughts. This is not conclusive, though will to live is important to consider. 1) Self-Awareness + desire to live 2) Longer life is more valuable than a shorter one (always better to have more of a good thing). SO if life is worth-while it makes sense to preserve that life, ending that worth-while life is directly wrong as it cuts short your conciousness's ability to have a life worth living. But killing therefore is not intrinsically wrong. 

Rejecting SOL does not make us cruel, it just means we sometimes end lives which do not have value, rather than not having any value for life at all. 

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assessing certain charactersitics that make an individual valuable

  • Jack Mahoney: 'Bioethics & Belief' argues a person holds rationality, sentience (have experience, emotions, free-will and continuity (sense of past/present/future) 
  • Peter Singer: essential distinction between persons, human beings and potential human beings. A person show's rationality + conciousness, a human is simply a life form and a potential human is a cluster of cells that will eventually develop into a human. 
  • Personhood: rationality (autonomy, the ability to make choices) + self-awareness (the baby can see itself existing over time). There is no clear line when these characteristics manifest! Therefore, in some situations infanticide should be acceptable for up to 1 month of birth (if the baby is profoundly sick/deformed). 
  • Common argument the foetus becomes a person at the point of birth - but it has not changed in any way itself; only the environment it is in. If we argue the foetus is a person at birth, it is difficult to argue it is not a person a day earlier, inside the womb. Singer rejects sanctity of life saying it is speciest!
  • Problems: lead to legal issues, may lead to de-valuing the life of a baby because it is less 'desirable', for the sake of the law murder should count after birth. Singer Admits this should not be generally accepted even though his moral argument is consistent, because the legal impact could be problematic. 
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meaning the foetus can survive outside of the mother's womb 

UK Law: prohibits abortion after 24 weeks because the foetus is viable after this point.

Problem: the dividing line on viability depends on the medical assistance available. 50 years ago it was not possible for a baby to sruvive after 24 weeks (28 weeks before 1990) + depends on the country, some countries with less medical advancements a premature baby could not support. So does that mean what counts as killing depends on the country and era? Surely this is problematic. 

Also, the argument that because a feotus relies on it's mother it has no rights for it's own wishes. Does this mean it is moral to kill elderly people who are reliant on others too?

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Ensoulment/ The Quickening

in certain religions, refers to the placing of a soul within a human being 

This means the embryo holds personhood, as once it has recieved a soul it has the essence of human individuality. 

  • Pope Gregory: abortion is only immoral after the foetus had 'quickened' (moved inside the mother's womb
  • Aquinas: ensoulment occured 40 days after birth; Augustine said 46
  • Modern Catholics: unique individuality (ensoulment) occurs the moment of conception - creates a problem with twins, who develop after 14 days. Does the soul split into two also? 
  • Islamic: 120 days is when the feotus becomes fully human as life is breathed into it. But this traditional cut off now has less support because the foetus can be seen to move before this time


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the medical process of terminating a pregnancy so it doesn't result in the birth of a baby

Issues of Abortion:

  • When does personhood begin? is an embryo/foetus a person? If they are, what point does the personhood begin. e.g. at conception (sol approach), 3 weeks when the heart starts to beat or when all the organs are formed (8 weeks), when it can survive by itself outside of the womb 23/24 weeks (law), or when it is when it's born, or after then (singer) 
  • Do they have the right to life the way persons do? what is the relationship between the right of the woman and the foetus? - right of the women is more important than the right of an unborn child (pro-choice) 

SOL/ religious view does not support abortion! View it as murder. 

Reverence for Life: a foetus has no in built desire to go on living as it is not even conscience.

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Arguments for Abortion


  • Abortion has been legal since 1968 - limited to 24 weeks. Before this people were having illegal abortion, often dangerous to the life of the mother - key argument in making it legal.
  • Double Effect principle - NML 
  • Kantian Ethics - people as means in themselves, issue of personhood. Issue of universalisation - if abortion was a universal law, no one would be born. Abortion is currently a hypothetical imperative, and would not work as a categorical one. 
  • Vital for gender equality, important for women's rights because it affects women more than men (pro-choice movement). Pregnancy affects: employment, education, relationships with other people - her body, her choice. Banning abortion puts women at risk. 
  • Situation Ethics: Fletcher - "no unwanted and unintended baby should ever be born" SE rejects any absolute law, a situational relatavistic apprioch as in some situations abortion may be the most loving thing to do. Four Presuppositions would support A. Gave specific examples in 'Situation Ethics' 1966 (it is a more relevant/contemporary religious approach) e.g. Lady learnt she may have a defective baby because she had taken thalidomide, a doctor refused an abortion so the court refused as she had to have a medical practitioners approval. Her husband then took her to sweden, where she could safely have the procedure.  
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Evaluating Abortion: Utilitarianism

Bentham: Principle of utility - "actions are right in so far as they promote happiness or pleasure, wrong as they produce unhappiness or pain" If Abortion is for the safeguard of the mothers health, Bentham would support. Foetuses can only feel pain after 18 weeks. Problems - the hedonic calculus is subjective, some may argue against abortion using this. The foetus may develop into a human who brings pleasure to many in their lifetime, teleological nature is uncertain. Undermines the value of life? Undermines egalitarian approach as the foetus is the minority. Too relative? Described Natural Rights  as "nonsense upon stilts" as they may get in the way of the principle of utility

Mill: The Harm Principle - if the foetus is being harmed then abortion would be wrong. Would not support abortion if it were vanity reason, a lower pleasure, such as a mother not wanting to ruin her appearance. A baby brings more chance of achieving higher pleausres; however if the mothers chance to achieve higher pleasures is compromised by having the child he would not support. "The Individual is sovereign" - mother or feotus? 

Peter Singer: 'Practical Ethics' - Preference: Case Study of Peggy Stinson - 24 weeks premature labour, doctors knew the baby would die just unsure when. The parents did not want to keep the baby alive as it was in pain every time it took a breath (cost $104,000 to keep the baby alive for 6 months. --> argues its curel and inhumane to keep the baby alive; quality of life is so poor. It is more compassionate to kill the baby, therefore murder would be acceptable in this case.

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IVF - In Vitro Fertilisation

technique to help people with fertility problems have a baby - an egg is removed from the woman's ovaries, and fertilised with sperm in a laboratory. The embryo is then returned to the woman's womb to grow. 

  • First child born through IVF was 1978, Louise brown 
  • 2006 - oldest woman to give birth using IVF, aged 62
  • 2008 - same-sex IVF treatment allowed (use a donor sperm/egg)
  • Issues: only 20% effective, high costs - means these costs aren't spent on saving lives, allows pre-implantation genetic diagnosis (bias to fitter/more intelligent children, is this elitist and immoral?), issues of consent: can sperm be taken from a dead partner to produce a child + what happens if sperm is frozen then the husband changes his mind, Rights of the child: should the child know who the sperm donor is? What happens if embryos get lost, stolen or accidently destroyed? Risk of commercialisation where eggs/sperm are sold on the internet, is this immoral? Is this unnatural? There are other options for childlessness; children who need families (adoption) 
  • Arguments For: childlessness can cause great distress for couples, IVF allows them to have their own children. Arguably adopting a child is not the same as having your own genetics. Spare embryos can be used to add to the family later or used for life saving research, such as fertility issues. Allows same-sex couples to have a child with their own genetics, more equality. 
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Evaluating IVF - Religious Perspectives

  • Roman Catholic Church opposes: argues IVF goes against the right of every person to be conceived and be born within marriage from marriage. IVF can be viewed as adultery as it undermines marriage. 
  • "Life, once conceived must be protected with the utmost care; abortion and infanticide are abominable crimes" would rjeect desturction of spare embryos as ensoulment happens at conception - goes against the sanctity of life
  • Feels IVF revokes the dignity of the child as pro-creation (NML) should result through marital sex, as this is God's will, seen in Genesis (adam and eve) 
  • IVF arguably does not maintain order in society, as it is not what God intended e.g. same sex couples, unmarried couples having children, donor sperm/egg = unnatural and adulterous 
  • Protestant: Pro-creation outside of a marriage between a man and wife goes against god's clear design and purpose seen in Adam and Eve
  • "All the days ordained for me were written in your book before one of them came to be" not having children may be planned for by God, going against this is going against God + those embryo's have a plan from god. 

OR - less conservative "Be fruitful and multiply" perhaps modern science allows us to fulfil God's commands and promotes Jesus' agape love, to give the joy of children for everyone. 

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Secular Approaches to IVF

The embryo that is still in a test tube, is not yet a person but a potential person. This is before it is put inside a mother's womb. This means it would be acceptable to destroy them as they are only potential life. Singer asks why there are no pro-life movements for sperm or eggs as they are also potential life? 

Right's Ethics Issues : Donor: has the right to remain anonymous/ right to know the child. Child: right to know the donor/ who their bioligical parents are. Parents: right to IVF, infertility is like an illness which should be treated, right to access modern scientific advancements, right to donor's family history, Embryo: may be rejected for abnomalities or if they are the 'wrong' gender, religious groups would argue they hold SOL and are not a choice

Util: unused embryo's do not experience any meaningful suffering - consequentialist theory not absolute. Suffering from lots of failed IVF may result in loss of happiness, especially considering how low success rates are currently. This may change.

Kant: would not be interested in the agony of childlessness as 'good will' is the will to do the right thing regardless of outcome. Use Categorical Imperatives: universal law, desturction of spare embryos would be a contradicton because if it was a universal law you would not want to be destroyed as an embryo. Sperm/eggs should not be used as a mean to an ends, especially if the donor is being paid. 

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IVF continued

Virtue Ethics: one of Aristotle's virtues is justice, and this may result in arguing infertility treatments are fair. Furthermore childlessness may prevent parents from reaching eudaimonia. But the question is whether a child would bring them closer or do they need to come to terms with their childlessness. 

Religious Support: Situation Ethics: in some situations, infertility treatments fulfill the wishes of many couples therefore is the most loving thing to do. But is it the most pragmatic, if IVF only works for every fourth or fifth couple. Argues IVF humanises medical science as it shows the potential for human creativity to bring about compassionate outcomes. "laboratory reproduction is radically human" Joseph Fletcher

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The painless killing of a person who is painfully and terminally ill

  • Passive euthanasia: you have to be kept alive through medical intervention. You take away things that keep them alive. 
  • Active euthanasia: you purposely kill someone. They can still survive without medical intervention. 
  • Non-voluntary euthanasia: where a person who is unable to consent is killed to end their suffering
  • Voluntary euthanasia: where a person in great pain is killed on their request by someone else to end their suffering 

In the UK, all forms of euthanasia are against the law. Some cases where passive e has been allowed. Attempts to change the law so far have proved unsuccessful, the fact a patient wants to die is not a valid defense in court - assisting euthanasia can lead to prosecution.

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Issues with Euthanasia

  • Hermeneutical issue: "There is a time for everything...a time to be born and a time to die" either your death is decided by God, but this may include euthanasia - killing is acceptable in some situations? 
  • "All the days ordained for me were written in your book before one of them came to be" suggests God has a plan for us, and if we authorised euthanasia we would be usurping his role
  • "You are not your own...Therefore, honour God with your body" OT - God decides when you die, not you 
  • NML - precept to preserve all human life 
  • Belief that killing is wrong - humanist/sanctity of life view
  • Sanctity of Life -Christian morality - "Thou Shalt not commit murder" Ten commandments, deontological, absolute, no exceptions
  • Humanae Vitae: Pope Paul VI, 1968: reaffirmed orthodox teachings of the Catholic Church. In it he argued that if you give power of life and death to the government they may not honour it well. "Danger of this power passing into the hands of those public authorities who care little for the precepts of moral law"
  • People that are being cared for by family, may feel obligated to be euthanised to not be a burden due to guilt. Opens up legal issues, how should it be regulated?
  • Puts a huge responsibility on medical practitioners; they may not want this. In Switzerland, you have to have two doctors agreeing to it. 
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Arguments for Euthanasia

  • It is possible to regulate euthanasia, as seen in countires where it is legal e.g. switzerland
  • Dignity in death - giving people the right to die before they become to ailed or life is too unbearable/painful. Rather die when they have autonomy.
  • A person's choice, if there is no harm to others, the state has no right to interfere. Family member could be a risk of arrest if they help them to die. 
  • Jonathon Glover: Great Ormond Street motto "the child first and always" feels uneasy about, because we have to think about other people's interests such as family members. Moral status in modern society has risen, showing them the same respect as adults is relatively rnew - believes this is right. But there needs should not go above anyone elses.

1) scarce medical resources, if we always put the child first i means paediatrics has priority over all parts of medicine.

2) NHS's Job is give to the greatest need and not have an age bias 3) is it justifiable to keep a baby alive who is incredibly debilitated, knowing this will cost a lot of medical resources and continue their suffering

3) interest's of family members that differ from the interest's of the child 


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Euthanasia Continued 1

e.g. Imogen: permanent brain damage, never be able to walk/talk, needs feeding, in/out of hospital her life and cannot communicate except crying. Expectation of life = 20 years. Special needs school cost £135,000 a year, mother spoke about how difficult the situation was, feels overwhelmed "nurse this baby in a horrible cloud of non-communication for 20 years". Consequences for family members should be taken into consideration. DANGERS OF THIS: parents wanting to abort down syndrome children who can have a quality of life.. coudl argue they would not want the stress of bringing up a disabled child.

  • Personhood - memory (people with dementia/amnesia) Peter Singer's own mother suffered from dementia, felt she wasn't a person at this time. People who sleep walk and commit crimes: can they be held responsible for their actions? Conciousness (people who are in a persistant vegetative state would not be considered people). If you argue you can be a person without conciousness, this would mean robots would be considered persons/ Koko the Gorilla. 
  • Quality of Life - people who have a low quality of life wish to end their life.
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Euthanasia Continued 2

Palliative Care: Alternative to euthanasia: it is the omission of treatments and therapies to those are terminally ill and possibly psychologically distressed by the issue. Aims to improve quality of life, as it doesn't quicken death nor postpone it; suggesting it brings an equally graceful death as E. Some may prefer euthanasia as they want full control over their death as this is less distressing than anticipating it. SOL - would support it as an alternative to euthanasia. 

  • Glover: euthanasia is moral as long as there is no small doubt over whether the person wants to die or not. 
  • Util: negative, would reduce suffering so would support. It may bring happiness to the greatest number, if the family supported the decision. Gives power to the individual and family - but difficult to instigate in legal terms. 
  • Situation Ethics: depends on the situation, if it was the most loving thing to do then yes. Ignores sanctity of life
  • Kantian Ethics: would not support as using a person to the end of reducing their suffering goes agains the second categorical imperative. Furthermore, if everyone was able to die when they wanted there would be no one to follow the rule - suggesting it is a contradiction of nature. - doesn't respect a persons dignity and right to die BUT values human life and rights, and avoids people beings used. 
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Sanah Iqbal


Amazing. Thanks. Do you have the Wilcockson anthology of medical ethics?

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