Ethical issues at the end of life

Defining the terms

Definition: Euthanasia is the intentional killing by act
or omission of a person whose life is considered not
to be worth living

Euthanasia (Greek) = good death

 Voluntary and involuntary euthanasia

Voluntary: at the patients explicit request
Involuntary: someone elses decision

Passive and active euthanasia

Active: mercy killing The direct, intentional
effort to aid a dying patient in suicide
Passive: withdrawing or withholding treatment
and allowing the patient to die

 Ordinary and extraordinary methods of treatment

Ordinary: morally obligatory treatment that offers
a reasonable hope of benefit
Extraordinary: morally optional treatment that
does not offer such hope

Biographical and biological life

Biographical: A persons goals, dreams,
accomplishments and relationships
Biological: Existence as a body when biographical
life has been lost

 Living will
Patients decide what
kind of treatments
they want or do not
want if there is no
reasonable hope of
recovery

 The law of double effect

An unintended but foreseen
negative consequence of a
specific action that does
not necessarily make that
action immoral

4 categories of euthanasia
Voluntary, passive euthanasia

At the patients request, nature is allowed to take its

course
Voluntary, active euthanasia
At the patients request, the medical personnel
hastens death by some active means
Involuntary, passive euthanasia
Regardless of the patients wishes, the medical
personnel do not go to extraordinary measures to
save the patient and may also withhold food,
antibiotics or life-support systems
Involuntary, active euthanasia
Regardless of the patients wishes, the medical
personnel does something active to hasten death

Three examples of euthanasia practice

Northern Territory, Australia 1996/7
Germany 1930-45; 2010

 The Netherlands 1984

onwards; 2002

Other countries include

USA (Washington 2008; Oregon 1994;

Montana 2008; Texas
Futile Care Law
1999); Colombia
(1997);Belgium (2002);
Luxemburg (2009);
Switzerland (specific
situations); Mexico
(2008 passive
euthanasia)

The Remmelink Report

Euthanasia Results in the Netherlands
Number of Cases in 1990

Arguments for active euthanasia

The argument from mercy
The argument from utility
The bare difference argument
The distinction between biographical and biological life
The argument from free will (autonomy)

Arguments against active euthanasia

It violates the prohibition on taking innocent life
It removes the chance of a cure or a miracle
There is a slippery slope from voluntary to
involuntary euthanasia
Logical slope
Psychological slope
Empirical slope

It diminishes the standard of care for the elderly and

terminally ill

It puts a great burden on doctors whose purpose is

to save life not end it

Passive euthanasia:
Debate over withdrawing food and hydration
Arguments against:

Starving a patient is cruel

Nutrition and hydration fall into the ordinary
category of treatment

Criteria for deciding to withdraw food and hydration:

If the patient cannot absorb nutrients

If feeding causes more of a burden than a benefit
If there is no hope of regaining consciousness (PVS)
If the patient has left a written directive or someone
to act as a proxy to that effect

A biblical perspective on death

Creation
No death

Fall
Sin brought death

Redemption
Gods reign: a new perspective on death

Consummation
The end of death

 Basic-conviction level
Gods nature is one of love and justice
The gospel brings life
God is the giver and taker of life

Principles
Respect for human life and dignity
Justice and love that includes knowing when to
let someone go

Rules
Do not kill

Particular/immediate judgment level

Exceptions may include specific cases of
passive euthanasia

Applying a Christian ethic

The Church needs to

communicate a godly
perspective
The value of a human
life
The limits of freedom
Alternative ways to
deal with fear

 The Church needs to act with

compassion
Treat people with dignity
and compassion
Promote palliative care
and good pain
management
Help people to find faith
and to end their lives well
Oppose euthanasia

 We need to work out

What is a mutual love ethic?
What might a retrieval ethic look like?
You matter because you are you.
You matter to the last moment of your life,
and we will do all we can,
not only to help you die peacefully,
but also to live until you die
Dame Cicely Saunders, founder of Hospice