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Ethics Essay: Euthanasia continued....
Speaking Medically
The medical question of 'euthanasia' covers two specific
areas, that of bioethics, the ethics of medical and biological research (The
Readers Digest Wordfinder Dictionary) and that of clinical practice.
Underpinning these is the etymological change that has
occurred in the use of the word 'euthanasia', which is why I have consistently
up to now shown the word in parenthesis. In the Middle Ages the dying could be
issued with a booklet called 'Ars Moriendi', or 'the art of dying well'. In the
seventeenth century the word 'euthanasia' came into use, encapsulating this
idea of 'dying well and happily' and meaning being prepared for death in the
most positive sense of the word. In the nineteenth century it's meaning changed
and it came to have overtones of 'putting someone to death before their natural
end'. (Ling, John.R, The Edge of Life, Day One Publications 2002, p79).
In addition to the above change we now have euthanasia
divided into different categories. There is 'active' or 'voluntary' euthanasia
where the person concerned has expressed a wish to be painlessly put to death.
This can be done by 'Advanced Directive' or 'Living Will', where the person
decides in advance of the terminal stage of an illness what they wish to have
happen at that time, which may include deliberate putting to death. The medical
practitioner with whom I spoke in my research, who is a practitioner in a
hospital serving the terminally ill, was unhappy about the introduction of such
a practice as the patient's opinion of the treatment they need varies very much
during the progression of their illness. What they might want six months in
advance of their impending death could be very different to how they see things
towards the end. Life can become very precious when there is little of it left.
There is also 'passive' euthanasia, which divides into
'non-voluntary' and 'involuntary' euthanasia. Non-voluntary euthanasia refers
to situations where the patient is either comatose, or incompetent in some way
and unable to communicate as in either senility or new-born. The best known of
such cases was that of Anthony Bland, the victim of the Hillsborough disaster,
who was left in a permanent vegetative state and who eventually was deemed by
court of law to be allowed to die by withholding 'treatment' ie food.
Involuntary euthanasia would be the situation where the
person would be killed against their will. One must call this murder, it has no
other name. This is where the 'professional' decides that they know what is
best for the patient and overrules their wishes. (Ling John R., The Edge of
Death, Day One Publications, p 84)
The foundation of medical ethics was the Hippocratic Oath (c
460-377BCE) taken by all doctors at the start of their clinical practice. This
divides into four principles of good medical practice. These are firstly that
doctors should be registered and follow a course of instruction that was common
to all, secondly the principle of 'first do no harm' in clinical practice,
thirdly the doctor must never 'take advantage of ' the patient and fourthly,
euthanasia, abortion and suicide were strictly forbidden. (Ling, John R., The
Edge of Death, Day One Publications, 2002, p47). This plus strong Christian
faith and practice in this country formed the basis for medical ethics until
the nineteenth century when the effects of the enlightenment spread to medical
thinking.
In more recent times the influence of secular humanism has
infiltrated the area of medical ethics. Thus Beauchamp and Childress
(Principles of Biomedical Ethics, Oxford University Press, 1994) have
identified eight criteria for the construction of an ethical theory within
modern bioethics. According to them such a theory should have clarity, be
coherent, be complete and comprehensive, be simple, have explanatory power,
justificatory power, that is it should justify the grounds for the ethic
professed, have output power, that is it should move some established practice
onward, and practicability, that is it should be accessible to a wide number of
people. Such an ethic does not include, or give credence to, any principle of
the sanctity of human life, though one might otherwise applaud the
comprehensiveness of the arena it seeks to embrace.
While there is no law that permits the deliberate killing
of a patient, whether for voluntary, involuntary or non-voluntary reasons,
nevertheless there is case law, which reveals that such killing does take place
in this country, and that the perpetrators receive relatively light sentences.
One cannot refer to the case of Harold Shipman as he was carrying out wholesale
murder for gain. But one can cite the case of Tony Bland. This was clearly a
painful situation for his relatives and no-one would wish to condemn them for
the action they took in the circumstances, but such cases do open the door to
changes in the law becoming more possible.
The key issue in these situations is the one of motive
and/or intention. Ling draws a distinction between the two, stating that motive
is concerned with the reason a particular outcome is desired, and intention is
concerned with the desired outcome itself. (Ling, John R., The Edge of Death
Day One Publications, 2002 p 82) In law the intention is taken into
consideration but the motive is not. So if the intention is to offer pain
relief, but early death ensues then deliberate killing has not taken place. On
the other hand, if the intention was to kill the patient then 'euthanasia', in
it's modern sense, has been committed.
Evidence of polls taken among health professionals has
apparently consistently shown that nurses are less in favour of euthanasia than
the public and more in favour than doctors. (Ling, John R., The Edge of Death,
Day One Publications, 2002, p 90) In Church circles again the laity are more in
favour than the clergy. (Gill, Robin, ed., Euthanasia and the Churches,
Cassell, 1998, Preface) This would suggest either that the effects of secular
humanism have spread very widely and infiltrated our church circles or that
many people have watched the painful death of someone dear to them and wanted
to foreshorten the pain.
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