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(Please
note: These are rough notes for a lecture given in November 2003, mostly taken
from the relevant sections of Philosophy and Ethics and should not be
reproduced or otherwise used verbatim.)
In all
probability, you will have already considered the moral issues concerning
abortion and euthanasia at GCSE level, and will therefore be familiar with the
basic arguments for and against each of them. At AS level, the same information
will be relevant, but it is also important that you relate the arguments to the
various ethical theories that you have studied, and be able to present your own
views in the light of them.
Abortion
The abortion
debate has centred of the conflict between the right to life of the foetus and
the right of a woman to choose whether or not she will have a child, for
whatever reason. Hence the opposing camps have generally been labelled
‘pro-life’ and ‘pro-choice’.
When does
human life begins? At what point in the process that goes the tiny bundle of
cells that forms the early embryo, through the developing fetus, to the moment
of birth, should what is growing be regarded as a new human individual?
Note:
The term
‘embryo’ is used for the developing bundle of cells in the first 8 weeks
after fertilisation; the term ‘fetus’ is used from that point through until
birth.
In the UK,
The Abortion Act of 1967 allowed abortion up to 28 weeks gestation, provided
that the approval of two doctors was given, and if continuing the pregnancy
threatened the life, physical or mental health of the mother or the physical or
mental health of existing children, or if there was substantial risk that the
child would be born with serious physical or mental handicap. Prior to 1967,
abortion was illegal.
The Human
Fertilisation and Embryology Act, which came into force in 1991, reduced the
upper limit to 24 weeks, except if a mother’s life or health was in danger, or
if there was a serious risk of foetal handicap. This change came about because
it became possible for babies to survive from 24 weeks gestation.
The
principle behind this legislation therefore is that, whatever the validity of
reasons for an abortion, a foetus should be given legal protection if it is
possible for it to survive outside the womb. If that principle is adhered to,
then with the advance of technology and the resulting viability outside the womb
at an earlier stage, the legality of abortion will be progressively reduced.
Some arguments and
problems:
Key
Questions:
At what
point does the life of an autonomous human being, with rights as an
individual, begin? Is a fetus an individual? Do we become individuals with
rights only at birth?
One idea put
forward by Peter Singer and Deane Wells in The Reproductive Revolution,
1990, was an ectogenetic solution to this problem. Ectogenesis is the keeping
alive of a young foetus in an artificial womb. If that became possible, they
argued, then the issue of whether a woman should continue with her pregnancy
could be separated from the issue of killing the foetus – since it could simply
be transferred out into an artificial womb.
At the
moment, that solution to the problem is not technically viable, and it also
tends to follow the traditional line of weighing the rights of the mother over
those of the foetus. But what would be the moral situation of those in charge of
such an artificial womb? Would they not take on exactly the responsibility and
moral dilemmas of the mother? What if the foetus was shown to have abnormalities
at a later stage? Should it then be ‘aborted’ from its artificial womb? The
problems remain.
A rather
crude but vivid analogy in favour of the right of a woman to choose abortion was
presented in a controversial article by Judith Jarvis-Thomson entitled ‘A
Defence of Abortion’ (1971). She asked the reader to imagine the situation of a
woman who is kidnapped and wakes up in a hospital, finding that she has her
circulatory system plugged into that of a famous violinist, whose supporters
have kidnapped her for that very purpose. The hospital staff explain that she
has exactly the right blood for the violinist, and must remain attached to him.
On the other hand, she should not complain, because she could be unplugged in
nine months’ time.
Jarvis-Thompson argued that, in those circumstances, it would not be unjust for
the woman to request to be unplugged from the violinist, even if he were to die
as a result. On the other hand, if the violinist did in fact survive, the woman
would not have the right to kill him.
Notice how
crucial this is. Some people argue that the foetus has a right to life if it can
be shown to be an individual person (in other words, that its rights can be
separated from those of the mother). Jarvis-Thomson argued, however, that even
in the case of a separate adult human being, there was no absolute right to make
such a claim on the body of a woman.
However,
there are several problems with this argument:
First of
all, the violinist is a separate individual, who is imposed upon the kidnapped
woman, whereas the developing foetus may be considered to be part of her body.
Whatever the moral justification for doing so, the act of unplugging the
violinist is therefore very different from that of terminating a pregnancy.
Secondly,
the woman is effectively being used as a machine for supplying blood. Let us
suppose that a philanthropist had loaned to the hospital a life-support machine.
A desperately ill person is hooked up to it and is being kept alive. Then the
philanthropist returns and demands his machine back, unplugging the patient.
Would that be morally acceptable? Is there not an implied contract, if the
arrangement is freely entered into? Jarvis-Thompson’s argument could then only
support abortion in the case of rape (which would effectively be the situation
she describes, since the woman is kidnapped, and finds herself ‘pregnant’ with
the violinist against her will).
By saying
that unplugging the violinist is not the same as taking active steps to kill him
once he has recovered, she implies that abortion is not acceptable once the
foetus has reached the point of viability.
Some
books, for example The Abortion Myth, by Leslie Cannold (Allen and
Unwin, 1998) have argued that one should take into account the whole
experience of pregnancy and motherhood, and that women should be trusted to
make their own decisions over abortion. It also takes into account the
social and gender issues surrounding abortion.
If it is
argued that a new life exists and should be protected from the moment of
conception, there is a further problem: twins.
There are
possible stages at which the embryo may divide and produce two or more
individuals:
a)
It can happen on about the 4th or 5th day after the egg is fertilised. In this
case, each twin will go on to develop its own placenta.
b)
It can happen at about the time when the embryo becomes implanted in the womb.
In this case, the twins will have the same placenta, and may be identical.
c)
It may happen at about the 12th or 14th day, by which time the resulting twins
will have to share the same amniotic sac, and may be joined ('Siamese twins').
Until about
the 14th day, it is therefore not possible to say whether there will be a single
or multiple birth. It is therefore sensible to think of the embryo as a unique
human person before the time when it is possible that it will become twins?
Sometimes
twins are formed, but then re-combine to result in a single birth. If each is
an individual with rights from the moment of conception, is the surviving foetus
guilty of murder? This extreme situation highlights the problem of taking the
single genetic identity established at conception as the unquestioned basis of
human individuality.
Euthanasia
Fundamental
issues are similar to those of abortion. when life should be considered to have
ended? Does an individual have the right to take active steps to end his or her
life, or the life of another person.
-
The intentional killing of
another person is considered to be murder (unintentional killing is
manslaughter). In the case of the intentional killing of someone on
compassionate grounds, the penalty may be reduced to manslaughter, on what
is generally termed ‘diminished responsibility’ (a term which is used in a
variety of situations, where there are exceptional circumstances leading up
to the killing).
-
Hence, while suicide was
made legal in the UK in 1961, helping someone to kill themselves (assisted
suicide), killing them at their own request (voluntary euthanasia)
as well killing someone in order to save them further suffering even though
they have not requested it (involuntary euthanasia) all remain
illegal in the UK.
-
Further issues concern the
difference between actively taking steps to end the life of someone who is
seriously ill (active euthanasia) and simply discontinuing treatment
that keeps them alive (passive euthanasia).
-
Should a person whose life
is maintained on a machine, and who is in a ‘persistent vegetative state’,
unable to communicate or participate in the normal activities and
relationships that constitute human living, be considered to have a life
that is worth prolonging? Should a person who is conscious of being in such
a state have the right to ask for that life to be ended?
-
When should life be
considered to have ended? Is a person on a life support machine ‘alive’?
Normally, a person is considered to be dead if brain activity ceases.
Note: In
some countries (e.g. Holland; Australia) euthanasia has been allowed under
strictly controlled circumstances. Ethical debate here concerns whether or
not there are any circumstances in which it should be permitted, and
– if so – what controls should be put in place to ensure that it always
operates in a way that directly and obviously is n the best interest of the
person concerned.
This was
brought home to me recently because my partner’s mother, who is 83, decided to
join the Euthanasia Club, as she calls it. She has signed a form to the effect
that, if she finds herself in a situation where she is ill and unconscious, and
therefore unable to be consulted, she wants to be now just allowed to die, but
she wants to be ‘put down’. And that is what her doctor, after consultation with
the family and colleagues, will do. She, of course, lives in the north of
Holland. She now feels relieved that she does not have to worry about her life
dragging on in a way that would only be a burden to others but do her no good.
She is a very practical woman, and not religious.
Key
question:
For both
abortion and euthanasia, the key question is ‘What constitutes a human
life?’ Only once that is answered, can we sensibly decide when human life
should be considered to have started or stopped, and when it should have the
protection of the law and receive moral consideration.
Key to
doing well at A level is to appreciate and apply the various ethical theories to
these practical issues:
Utilitarianism
– especially 'preference utilitarianism' – is important in medical and nursing
ethics.
Autonomy of
the individual is a key consideration here. Doctors should not be allowed to
follow their own wishes, or research interests, in determining treatment.
Patients come first: that is basic to framing professional ethics of all sorts.
But can 'the
wishes of a patient' necessarily always be followed? What is the patient seeks
his or her own harm? The difficulty is in establishing criteria which all can
accept for what constitutes benefit of harm. Utilitarianism only works if one
can assess the results of an action, and decide whether or not, on balance, they
are to the advantage of all concerned.
Hence, a
utilitarian will consider the preferences of the mother, in the case of
abortion, along with the potential harm to other children in the family, for
example. In the case of euthanasia, the utilitarian balance is between the
advantages of life rather than death, both for the person concerned but also for
their relatives, friends and carers.
One of the
limitations of this process is that it requires careful and impartial judgement.
But can we be detached and objective enough to assess what should be done,
without acknowledging that our judgement is clouded by our own history and
experiences?
I may know,
for example, that it is in the best interests of an old or sick pet that it
should be put down. That might also correspond to my own interests at a
practical level. But that does not make the decision any easier; and in the end
it is generally taken because there is a prior and overwhelming desire to see an
end to the animal’s suffering.
In other
words, the utilitarian judgement may be used to justification an action that is
taken primarily on the basis of a strong emotional reaction to an intolerable
situation.
Pro-life
groups and others cannot accept a simple utilitarian judgement on such matters,
since they hold that human life has an absolute value. A value that must be
upheld, even if the result is additional suffering for those concerned. In other
words, that it is better for a natural course of events to take place, whatever
the consequences, rather than to take life.
Comment:
All
human life will eventually come to an end; so the sum total of all
advantages and disadvantages is Zero. What counts is not an end point - but
the value of the process that leads to that point - the quality of life, or
enjoyment etc, along the way.
Thus, the
fact that we cannot achieve a final or definitive assessment of happiness should
not, in itself, deflect us from using a utilitarian argument. – because
otherwise we’d never be able to use a utilitarian argument for any issue. But it
needs to be balanced against othe considerations.
Natural Law
claims that we should use reason to examine the place and purpose that
everything has within the universe, and we should act in a way that reflects
that understanding.
It makes the
benefits to those concerned a secondary matter, compared with the basic nature
of the act of euthanasia or abortion in itself. From this perspective, abortion
appears to go against Natural Law, since it frustrates the natural outcome and
purpose of conception. Euthanasia deliberately interferes with the natural
process of dying.
Hence it is
very different from a utilitarian argument in terms of what it takes into
account. That does not discount the benefit of those concerned, since Aquinas
argued that natural law should provide ‘an ordinance of reason for the common
good’, but it makes the benefits to those concerned a secondary matter, compared
with the fundamental nature of the act of euthanasia or abortion in itself.
So, in the
case of abortion or contraception, for example, Natural Law looks at the place
procreation has within our understanding of what it is to be human. What does it
mean to have conceived a child?
From this
perception, the act of abortion appears to go against Natural Law, since it
frustrates the natural outcome and purpose of conception.
Similarly,
it will be argued that the body grows old, or contracts disease, and we
naturally strive to keep alive in spite of that. To deliberately say ‘no’ to
life therefore goes against what ‘God’ offers – and remember that, for the vast
majority of those arguing from a natural law standpoint, the theory is linked to
belief in God, since it was promoted primarily by Aquinas, who sought to
reconcile philosophy and the Christian faith.
Issue:
A key
issue for the natural law approach concerns when an individual human life
can be said to begin. At conception? At birth? At some point in-between?
Science
gives only a general guide on this:
Something is generally defined as being alive if it is a complex system that
is self-replicating and self-determining.
It is
then said to be conscious if it responds to the environment, and appears to
do so in a way that implies choice.
E.g. a
wooden block responds to being pushed by toppling over. An animal similarly
pushed will turn, look at the personal pushing it, and will decide how to
respond. Hence the animal is conscious and the wood is not.
The
thing you have to decide, therefore, is whether you are going to consider an
embryo a ‘human life’, or whether it is just a potential to become a human
life. Similarly, you need to ask if the person who is unconscious and dying
slowly is still considered an individual human being.
If they
are, then they should be given all the rights of a human being, and not
treated as a ‘thing’ to be disposed of.
BUT,
that does not settle the matter – because, in the case of euthanasia, one
might argue that respect for that individual might mean following his or her
expressed wish to be allowed to die with dignity in such circumstances.
In the first
century, the philosopher Cicero said ‘True law is right reason, in agreement
with nature.’ – and that is the most clear statement of what a Natural Law
approach seeks to put into practice. (So it works quite well without any
religious backing.)
On the other
hand, there is always going to be a problem with an ethical theory that gives us
general principles, because it leaves us with the difficult task of knowing how
to apply it to particular cases. The old term for doing that was ‘casuistry’ –
and it got a bad name, simply because clever lawyers could argue for almost
anything, and bend the laws to fit the case they wanted to make.
Kant’s
ethical theory is very different, as you will know. It concerns the categorical
imperative. The first formulation of this is that you should act only in such a
way that you could will the maxim (or principle) of you action to become a
universal law. In other words, that you should be prepared to allow everyone to
do what you propose to do, if you are to consider your action moral.
Now that can
have some application to the issues of abortion and euthanasia – since you could
argue that everyone should have the right to decide to have an abortion, or to
have their life ended, in certain circumstances. As so often with Kant, his
ethical theory gives a general and abstract framework which does not easily get
translated into the particular situations in which people find themselves.
BUT far more
relevant is the second formulation of the categorical imperative, which states
that people should be treated as ends, never only as means.
If the
unborn child is considered to be an individual, then its life should not be
assessed on the basis of the benefit or otherwise that it offers to the mother
and others concerned, but should be treated as an end in itself. Similarly with
those who are seriously ill; their lives should be viewed as ends in themselves,
and the needs of other people should not be used to justify ending them. Hence,
abortion or euthanasia could only be justified if it were seen as being directly
of benefit to the person concerned – i.e. that continuing to live would, on
balance, be against their own interests on the grounds that it would involve
more suffering than that person (if able to make a rational decision) would find
acceptable.
Another
approach is that of Situation Ethics – as put forward by Fletcher in the 1960s.
A situationist view would be that it is unrealistic to try to legislate
on such matters, and that what counts is to do the most loving thing in each
situation. This would be very much in line with those who support ‘mercy
killing’ on the grounds that love demands that they no longer allow a situation
of intolerable suffering to continue. But who is to decide what is most loving?
Most loving for whom? For the mother who cannot cope with the thought of having
this child? For the relatives who cannot bear to watch their loved-one suffer?
For the foetus who may not get a chance to live? For the sick person who may or
may not get some further benefit from life?
Just as, for
Kant’s theory, we have a general principle that is not easily translated into
particular situations – so here too, we have a general wish to do that which is
most loving, but that does not actually tell us WHAT the most loving thing is.
A
religious response to any of these issues might argue that all life is
created by God and is therefore sacred. God alone has the right to decide what
should happen. However, religious people are seldom able to apply this
consistently across the whole range of ethical issues. They often want to take
direct action to change a situation (e.g. to feed those who are starving) – why
then should this not be applied to the situation of the unborn or the terminally
ill?
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