Medical and Environmental Ethics

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Defining Euthanasia

  • passive euthanasia - to allow a patient to die by withdrawing medical treatment or nourishment, for example turning off a life-support system to which a patient in a coma has been connected
  • active euthanasia - to take action deliberately to end a patient's life, for example giving someone a lethal injection or, in time of war, a mortally wounded soldier in great pain asking his comrade to 'finish him off' in order to shorten his suffering.
  • voluntary euthanasia - this means causing a patient's dealth, where consent has been given by the individual. I.e. euthanasia carried out at the specific request and consent of the dying person. those campaigning for voluntary euthanasia in the UK include the 'Dignity in Dying'
  • non-voluntary euthanasia - the killing of a patient who isn't able to express their wishes about whether they should be able to live or die (for example newborn babies; or a person severly brain-damaged and in a long-term coma with no answers of their surroundings - permanent vegetative state). A question linked to non-voluntary euthanasia is: 'at what point does someone cease to be a person and die?'

 


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The current legal position on euthanasia in the UK

  • deliberate or 'active' euthanasia will normally leave anyone assisting suicide or death liable for murder.
  • Euthanasia is outlawed by the Murder Act of 1965 and by the suicide act of 1971. The murder act states that intentional killing, even with the patient's consent for compassionate reasons, is a crime and the suicide act makes assisted suicide a crime.
  • The House of Lords ruled in 1994 that 'there should be no change in the law to permit euthanasia'
  • Euthanasia has been decriminalised in a number of European countries, such as the Netherlands and Belgium, in 2008 these countries were joined by Luxembourg.
  • In Luxembourg euthanasia is allowed only for the terminally ill, who have expressed their desire to die, and where the consent of two doctors and a panel of experts has been given
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Case study: Diane Pretty

  • Wanted a doctor or her husband to help her die
  • Motor neurone disease left her mind sharp but gradually destroyed her muscles, making it hard for her to communicate with her family. It left her in a wheelchair, catheterised and fed through a tube.
  • Rather than living with the fear of dying by choking or suffocation, she wanted her husband to help her die, although this would be classed as assisted suicide and is illegal in the UK
  • Pretty took her case to court, using the Human Rights Act to argue that the Director of Public Prosecutions should make a commitment not to prosecute anybody involved in helping her to die. British courts didnt accept Pretty's arguments, with the House of Lords eventually turning down her case.
  • The European Court of Human Rights refused to acknowledge that the European Convention on Human rights provided a right to die, and her appeal to that court also failed.
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Case Study: Antony Bland

  • 17 year old victim of the 1989 Hillsborough football stadium disaster. He was left in a persistent vegetative state.
  • His parents belived that Antony wouldn't want to be kept alive in such a condition
  • The hospital, with the support of his parents, applied for a court order allowing him to 'die with dignity'
  • As a result he became the first patient in English legal history to be allowed to die by courts through the withdrawl of life-prolonging treatment.
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Arugments for leagalising voluntary euthanasia

personal autonomy

  • The 'good medical practice' guide for doctors states that doctors should listen to patients and respond to their concerns and preferences. They should respect their patients' rights to reach decisions with their doctor about their treatment and care. It should be a patient's own choice whether they live or die: it's a basic human right.

the 'quality of life' principle

  • quality of life is a human condition in which a person enjoys a degree of physical, intellecutal and emotional well-being, the absence of which through severe illness is sometimes used as an argument in favour of euthanasia. A person's standard of life could be continually diminishing and this would prevent them from having a decent existence. For example they may lose their dignity by becominig incontinent or ending up reliant upon other people to care for them. Humans should be able to live their lives in a dignified manner until the end of their days
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Arugments for leagalising voluntary euthanasia 2

Euthanasia will end the person's suffering

  • death is often preceded by serious pain, which can be prevented only to a limited extent by drugs. Is it not more humane, therefore, to quickly end a person's suffering? Other arguments which support legalising voluntary euthanasia include the principle of compassion - that in some circumstances it is the most loving thing to do.

Not allowing euthanasia will put extra pressure on society

  • some argue that euthanasia is preferable to being left to die alone or putting pressure on the Health service. There arent enough hospice placements for everyone and there is a need for organ transpants, when those dying could know that they are helping others to live. Also people often state that they would prefer death to dementia.
 
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Arugments for leagalising voluntary euthanasia 3

It shortens the suffering caused to the patient's family

  • people find that the drawn-out process of a serious or terminal illness can have a massive impact upon the emotional, physical and psychological well-being of the patient's spouse/partner, family and friends. Allowing a patient to die quickly would reduce the length of the suffering they have to endure

allowing euthanasia would allow us to legalise and regulate what already happens

  • doctors can give their patients morphine to minimise pain, but they know that a side-effect of this is that it will hasten the patient's death. this is known as the principle of double effect. when a person performs an action in order to achieve a good primary effect they arent held responsible for any unintentional secondary effects. in this case the primary effect is to reduce the pain the patient is suffering, whereas the secondary and unintended consequence of this is that you also shorten the patient's life
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Arugments for leagalising voluntary euthanasia 4

what is the difference between withdrawing treatment (passive E - which is legal) and delivering a lethal injection (active E - which isnt)

  • this argument states that if you allow one form then you should allow the other. In fact, passive euthanasia could cause more suffering than active euthanasia, as the patient may live for longer in pain. Active euthanasia could allow people to die quicky, less painfully and with greater dignity

Voluntary euthanasia is already allowed in other European countries

  • the fact that people would have to travel to another country involves a financial cost for the family, but also adds further stress to what is already a distressing time. Legalising voluntary active euthanasia would allow people to spend their last few days in their own home environment.

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Arugments for leagalising voluntary euthanasia 5

It isn't right to use the limited resources of the NHS on expensive treatment merely to prolong the life of a dying person by a few days or weeks

  • A hospital has a limited financial budget and artifically prolonging the lilfe of someone who is going to die by keeping them on a life support machine isn't achieving the best value fo rmoney for the hospital's many patients. It would be a better use of resources to use this money to treat other patients and to improve their chances of survival or quality of life. The money could be spent on performing a heart transplant on a young child, whose quality of life could be dramatically improved and who could go on to live for many years.
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arguments against euthanasia

The principle of the 'sanctity of life'

  • This argument is often used by religious belivers. It's based on the belief that human life is sacred and that no person has the right to take his or her own life of the life of another person. If life is sacred and created by Him [God], then only He can end it. Therefore euthanasia challenges God's will.

people who are suffering a terminal illness are vulnerable

  • as a result of this, they shouldn't be asked to make a definite decision whilst suffering. their judgement might be coloured by pain. Patients might feel that they don't want to impose on their family by continuing to live and therefore feel pressurised into ending their own lives
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Arguments against euthanasia

Making doctors or nurses perform euthanasia will undermine people's confidence in these professions

  • 'dignity in dying' claim that there is no evidence that the patient's confidence in doctors and nurses would be jeopardised if their role were extended to include ending lives.

A mistaken diagnosis could lead to a request for euthanasia

  • E.g. recovery from brain injury takes place at different rates, and it's only after a period of twelve months that it's diagnosed as persistent. However there are documents of cases of recovery after this time. Not every illness diagnosed as terminal will necessarily end in death,

How can we know the motive for an act of euthanasia

  • any process would have to be establish the true intentions of the patient who is requesting euthanasia and that the patient is fully aware of the situation. the risk of misinformation or a failure to comprehend the situation leaves the patient vulnerable to a decision that they may not want.
     
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Arguments against euthanasia 3

The slippery slope argument

  • this states that once we accept euthanasia, the door is open for all sorts of other procedures and abuses, including infanticide. The argument is that euthanasia involves crossing a line and once this line is crossed the consequences are unforeseeable.there is the danger that voluntary euthanasia could lead to compulsory euthanasia.

Euthanasia is a decision which doesn't just affect the patient

  • it affects others and society as a whole - the doctor who assists, the nurse who is caring for the patient, the hospital in which it takes place and the wider community. The argument of an individual's right to die must be set against the community in which individuals exist. Acceptance of the practice of killing in hospitals could reduce the respect for life that civilzations uphold now more than ever in terms of human rights
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Arguments against euthanasia

Doctors have a duty to protect life

The good medical practice guide for doctors states that doctors are 'personally accountable for their professional practice and must always be prepared to justify their decisions and actions'. Prehaps the most enduring tradition in the history of medicine is the Hippocratic Oath.The oath includes several duties that a physician must perform, such as:

  • the duty to never harm a patient
  • the duty to work to the best of their ability for the good of the patient
  • the duty to remain free from all intentional injustice

death doesnt have to be painful - the hospice movement

the hospice movement exists to care for terminal patients and to educate the public and the medical profession in alternatives to the extremes of a painful death or euthanasia.

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Jewish arguments against

  • Many Jews support the sanctity of life argument against euthanasia. According to the Book of Genesis, God is the Creator of life. Human beings are made in God's image and so they deserve dignity and respect. All that God creates is good and he is the only one who should determine when it should end - life is a god-given gift
  • God also gave humans dominion over all creation, and so we have a responsibility to use God's gift to the full, including the gift of life
  • there is the religious duty in the Ten commandments to 'Honour your father and mother'. this is often interpreted as meaning that ending the life of an elderly relative would be wrong
  • Jews also refer to the prohibition of 'killing' in the ten commandments - 'you shall not kill'. by allowing euthanasia we are allowing the killing of another human being
  • the book of Job suggests that suffering is part of God's plan and taking a lfie is wrong. despite living through considerable suffering Job refuses to take his own life, arguing that we must accept suffering just as we accept happiness and joy. Many jews believe that Jewish law forbids active euthanasia and regards it as murder; for them there are no exceptions to this rule and it makes no difference if the person concerned wants to die
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Jews in favour of euthanasia

  • Rabbi Isserles - if something is an impediment to the natural process of death and the patient only survives because of it, it is permitted under Jewish law to withdraw that thing. So if a patient is certain to die, and is only being kept alive by a ventilator, it's permissible to switch off the ventilator since it's impending the natural process of life
  • Rabbi Moshe Feinstein and Rabbi Shlomo Zalman Auerbach have ruled that a dying patient should not be kept alive by artificial means where the treatment doesnt cure the illness but merely prolongs the patient's life temporarily and the patient is suffering great pain. Pain relief medicine can be given even though it may hasten death, as long as the dose isnt certain to kill, and the intention is not to kill but to relieve pain.
  • some may argue that they are fulfilling their religious duty in the 10 commandments to 'honour your father and mother' by respecting their wish to die
  • there is debate on whether the 6th commandment should be translated from the original hebrew texr as -'you shall not kill' or 'you shall not murder'. some jews argue that if the hebrew word 'ratsha' is translated as 'murder' this implies that you are intentionally wanting to cause harm to another person - which is wrong, whereas when performing euthanasia you are 'killing'.when you 'kill' in this instance you don't intentionally cause harm, but your intention is to end the suffering of another human being and therefore this is permissible
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Sikhism arguments against euthanasia

  • life is a god given gift. they believe that it is up to God to decide when to die: 'whatever God does, accept that with pleasure; in comfort and in suffering, meditate on him'
  • humans should accept that suffering occurs and try to make the best of it in order to improve their karma
  • a great deal of sikh teaching is devoted to the care of others and by providing such good care for those suffering they hope that the person will not want to end their life
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Sikhs in favour of euthanasia

  • however there isnt a single sikh approach to this issue. some believe that life is a gift from God, but Sikhism also teaches that we have a duty to use life in a responsible way. A number of Sikhs believe it is the quality of life that matters, not the length. Sikhs shouldnt be afraid of death - it isnt the end.
  • sikhs contemplating euthanasia for themselves or others should make the appropriate distinction between ending life, and not artificially prolonging a terminal state
  • voluntary euthanasia would be acceptable to some, so long as there were medical/legal safeguards in place
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Animal rights - do they have moral status?

  • humans in the western world have generally adopted the stance taken by Aristotle that animals existed simply to fulfil human desires and needs. He said that animals, unlike humans, did not have the ability to reason, and as a result animals had no moral status. This meant the had no value in themselves and that they didnt deserve to be given any 'rights'.
  • developments such as Darwin's theory of evolution have caused people to rethink the 'gap' between humans and animals. If we share a common link with other animals such as primates, this calls into question claims that we are superior to other species. Recent research has found that apes share almost 99% of their functional genes with humans, and even when differences in less significant DNA are taken into account they remain 96% identical.
  • Christians, in modern times, have stressed the need for us to demonstate responsible stewardship of the world. This is based on the idea that we have been given the responsibilty by God to care for the world, its environment and the other species found in it.
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animals have no moral rights

animals have no moral rights - we have no moral obligations to animals

  • animalsa have only an instrumental value - they have value only because they are useful to humans. E.g. humans need meat, therefore killing animals for meat is simply part of our biological existence. Animals have no moral status or rights, because they don't appear to have the ability to reason and don't possess free will or a conscience.
  • Animals don't appear to have the capacity to act 'morally'. for example they cannot think rationally about whether to kill or not, they simply act instinctively
  • some would argue that rights are appropriate only for beings that have self-awareness and a social system, and can express their desires and be held accountable for their actions - which animals cannot
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animals have a moral status

animals have a moral status - we should treat them with respect, but ultimately they are of less moral worth than humans

  • this implies that animals have an intristic value - they are worthy in themselves of a moral status. Animals arent equal to use: as full members of the moral community humans have rights and duties, whereas animals do not. E.g. if you have the right to live, then everyone has the right not to be killed. However animals are unable to understand this concept and so therefore don't deserve rights.
  • Another argument is that humans, as the most powerful and superior species, have a responsibilty to care for other species. The idea of animals having a moral status is often linked to the issue of animals experiencing pain and suffering. if they can experience pain and suffering then should they not be afforded rights? Do they not deserve the right to be treated with respect? We should also consider the fact that if we mistreat animals we cannot claim to have greater moral worth as human beings.
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animals have the same moral status as humans

animals have the same moral status as humans. They deserve the same respect as other species such as humans

  • this claims that animals have equal intrinsic value - all beings have equal value in themselves for what they are. Animals deserve the same rights as those given to humans. All beings have an inherent value and possess it equally. We are wrong to view animals as a resource to be killed for sport, experimented on or used for fashion.
  • The idea that animals have a significant moral status has been developed by philosophers such as Peter Singer and Richard Ryder: Ryder used the term 'speciesism' to describe 'the unjust belief that one species is superior to another'. This means that a member of one species has a clear prejudice against members of another species. Singer believes that, just like racism, this attitude is wrong. He believes that if animals have rights, then this must include the right to be regarded as just as valuable as any other species, even humans
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Issues involving the use of animals

  • animals as food
  • animal experimentation
  • bloodsports/hunting
  • culling
  • animals as pets/entertainment
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i. animals as food

  • 90-95% of the animals that suffer and die to human intervention do so because of the demand for animals as 'food'.
  • approx. 2.5 million animals are killed for food per day in the UK. Genetic modification of some of these animals can also lead to higher meat yields. this raises the further issue that even if it's acceptable to breed animals for food, is it also acceptable to deliberately genetically modify them in order to make money?
  • one form of factory farming involves battery hens. 93% of eggs in the EU come from battery hens and 70% of Britain's eggs. 24 million chickens are currently farmed in Britain, ensuring the low price of eggs and chicken products. On such farms five hens are packed into a cage of only 45xm X 50cm, where they cannot perform basic functions such as spreading their wings or even walking. They are then stacked into a shed with artificial light for 17 hours to promote egg laying. Slaughtered battery hens are processed into soups, baby food, stock cubes etc. In 1999 the EU passed a law banning battery cages from 2012, after which hens will have to be housed in bigger cages.
  • another factory farm form is artificial insemination of cattle. In order to produce commercial quantities of milk, dairy cows are routinely made pregnant by AI, as this increases the amount of milk they produce. they are seperated from their mothers before having milk from them which creates a bond making seperation harder
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arguments in favour of animals for food

for

  • as superior beings we have the right to do what we want with animals
  • using animals is necessary - we need food to live
  • many animals today are created for food: they wouldnt exist if we didn't create them
  • humans killing animals for food is part of the 'natural' order

against

  • if animals have rights then surely they deserve the most basic right - the right to life
  • humans dont need to eat meat to survive
  • many of the animals reared by factory farming live in poor conditions
  • animals killed for food are often killed in brutal ways
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II. animals in medical and non-medical experiments

  • more than 2 million animal experiments take place in the UK. E.g. OncoMouse is a genetically modified lab mouse used to carry a specific gene which increases the mouse's susceptibility to cancer; thus making the mouse suitable for cancer research
  • what is the reason for the experiment? experimenting on animals to save human lives brings greater benefit to us in the long term than testing cosmetics.Those who claim we have no moral obligation towards animals might disagree,however,and allow experimentation for any reason
  • which animals are being used? people tend to oppose experimentation on animals which we have the greatest emotional attachment, such as primates or popular pets. The majority of experiments are carried out on mice/rats. This raises another issue, however: should one animal receive a higher moral status than another?

 

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argu in fav of animal experiments

  • human life has greater intrinsic value than animal life
  • the information gained from such experiments could not be gained in other ways
  • the pain inflicted on the animals is minimised and controlled by legislation
  • useful medicines have been developed as a result of animal experimentation such as vaccines against rabies, polio, TB, etc.

 

arguments against animal experiments include:

  • animals have as much a right to life as human beings
  • the experiments cause unnecessary suffering to animals and degrade us as human beings
  • the benefits of such experiments could be gained in other ways e.g. computer modelling
  • the stress endured by animals in the laboratory can render the results meaningless
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arugs in fav/againt hunting

  • some animals are a nuisance to other animals, so they are hunted to prevent a loss of stock
  • hunting is a tradition, an ancient sport, and should therefore be maintained
  • skilled hunters ensure the animals dont suffer unnecessarily
  • people need to eat and in some parts of the world, hunting is the main source of food

arguements against

  • there must be more humane ways of killing the animals, if they do have to be killed
  • hunting one species can disrupt the food chain for other species
  • the 'tradition' argument is a poor one - slavery was also a tradition, but it doesnt mean it was right
  • organised hunts can do greater damage to the countryside than the animal being hunted
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Argus in fav/against culling

  • culling prevents potential damage to livestock or infections
  • it restores 'balance' if one species is killing off a native species
  • culling prevents the loss of food sources for other animals or humans
  • culling removes animals which pose a threat to human life

argus against culling

  • we often cull for financial reasons, which is a misuse of our dominion over animals
  • we have no right to interfere with nature
  • there is often an alternative to culling - using noise devices to deter seals from damaging fishermans nets
  • methods used to cull animals are often brutal
  • culling is not effective in the long term as the species will eventually repopulate the area
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Argus in fav/against keeping animals as pets

  • many animals receive better treatment as pets than they would do in the wild
  • we can learn about animal behaviour from spending time with our pets
  • having a pet may encourage people to behave responsibly towards other animals
  • such relationships allow expressions of emotion, companionship and shared enjoyment

arguments against keeping animals as pets

  • we have no right to keep an animal in captivity in order to learn from it
  • we often abandon pets when they cost us money or are no longer cute or fashionable
  • the animal fails to live in its natural environment so it lives in a 'false' way
  • if animals have rights do they not deserve the right to freedom?
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argus in fav/against animals in circuses

  • circuses help to preserve endangered species
  • they raise awareness of the animals
  • as the 'superior' species we can use animals in any way we see fit
  • the animals can live in a 'safe' environment

arguments against using animals for circuses

  • animals bred in captivity often cant be returned to the wild, as they arent able to survive
  • we have no right to remove animals from their natural habitat
  • animals are still kept in 'prison'-like environments
  • people are more likely to consider animals as inferior species if we allow their use for entertainment
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arguments for against zoos

for

  • zoos help to preserve endangered species - they help to increase the numbers of animals such as panadas, which help to prevent them from becoming extinct
  • most zoo animals are bred in captivity and not taken from the wild
  • some creatures bred in captivity are released back to the wild
  • zoos are replacing poor living conditions with spacious enclosures
  • we can learn about animals behaviour
  • zoos help to educate people about conservation

against

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