GROUP PROJECT REPORT:

ABORTION AND EUTHANASIA

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PREFACE

This report has been prepared by students of Section D for the subject of “Business Ethics” taught
by Dr. Akshay Bhat. The purpose of this report is to learn, understand and apply concepts of our
coursework into the topic posed in front of us. The report is an attempt to analyze the the ethical
aspects related to abortion and euthanasia.

Members
NAME ROLL NO.
Aachman Anand 2021187
Aprajita Kapoor 2021199
Avnika Chhikara 2021205
Ishan Rekhi 2021213
Kanika Gupta 2021216

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CONTENT

1. Ethics related to Abortion........................................................................ 4

2. Ethics related to Euthanasia................................................................... 8

3 More Ethical Perspectives...................................................................... 11

4. Abortion vs Euthanasia ......................................................................... 13

5. References..............................................................................................17

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ETHICS RELATED TO ABORTION

Since time immemorial, the role of women has been subsequently reduced to child-bearing and
childcare. With the advent of a technological and cultural change, we have seen some shift in the
prospects of women, but this thought still fragments the world into believing and belittling the role
of women in society. "Representation of the world, like the world itself, is the work of men; they
describe it from their own point of view, which they confuse with absolute truth."1 Due to highly
unrealistic standards set by society, one of the key tasks given to a woman is to bear a child and
have a family. No matter how accomplished she becomes in her life, the absence of children from
her vicinity indentures her identity.

Moral rights of a human person: Human beings are commonly thought to be persons; thus, we can
refer to them as human persons. Human beings are regarded to have ‘human rights’, which are
moral rights, or entitlements to be treated in specific ways, in addition to having recognized legal
rights conferred by governments. A human being has the right to life and liberty, as well as the
right not to be injured and the freedom to live one's own life as long as it does not infringe on the
liberty of others.

Abortion is the medical procedure through which the fetus is removed from the womb. This is as
simple as the definition to the term seems to be. This paper wants to highlight the ongoing battle
from both sides of the schools of thought: the pro-life activists and the pro-choice activists. In
recent years, polarisation has increased globally and the topic has become exceptionally politically
partisan, with the personal and political aspects increasingly difficult to separate.

The morality of abortion is influenced to some extent by how the embryo or fetus is treated: if it
is a moral patient, whether it has the moral right not to be injured and to live, and what kind of
moral care it is entitled. We appear to believe that a being's moral standing is determined by its
metaphysical or physical status. For example, we believe that humans and rocks should be treated
differently since they are metaphysically and physically distinct- so it's possible that an embryo's
or fetus' moral status is determined by its metaphysical or physical status: whether it's a person,
conscious, or has a soul, for example. Although moral status alone may not determine whether
abortion is morally allowed, some thinkers feel that other elements may overrule the fetus' moral
status.

A couple of years ago, the significant US Supreme Court decision in Roe v Wade, which held that
a woman's right to terminate her pregnancy fell under the category of freedom of personal choice
in family affairs and was protected by the 14th Amendment of the US Constitution, backed such

1
Excerpt from Simone de Beauvoir 'The Second Sex' published in 1949 talks about feminist
issues and the need for women to have a voice in a world that inherently casts us aside as the
second (inferior) sex.
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perspective to some extent. As a result, some argue that banning abortion is unethical since it
denies women their right to choose and forces the "unwilling to carry the unwanted."

Abortion is allowed medically and legally only on the terms that the pregnancy should be
terminated only in causes of medical necessity i.e., if the child is underdeveloped or prone to
develop major issues post-birth and if there is good chance that the child would suffer from
physical or mental abnormalities which would leave him or her seriously handicapped, or if the
womb cannot support the child for the duration of the pregnancy, thereby affecting the life of the
expectant mother.

Most opposition to abortion relies on the premise that the fetus is a human being, a person, from
the moment of conception.2 The idea is valid but there exists a logical fallacy. We are asked to
notice that a human being's development from conception to birth and childhood is continuous;
then it is said that to draw a line, to choose a point in this development and say "before this point
the thing is not a person, after this point the thing is a person" is to make an arbitrary choice, a
choice for which no good reason can be given in the nature of things.

One of the more incendiary arguments against abortion is the claim that the fetus may feel pain
and thus that abortion is a ‘cruel procedure’. This is quite unlikely to be the case. A fetus in its
early stages of development does not have a fully formed nervous system or brain to experience
pain or even be aware of its surroundings. Until about 26 weeks into pregnancy, the
neuroanatomical apparatus essential for pain and sensation is complete. The subject of fetal
discomfort is a complete red herring because the global upper limit for termination is 24 weeks,
and the great majority of pregnancies are ended much before this.

Pregnancy is undoubtedly one of the most defining aspects of a woman's life. It wreaks havoc on
her body. It causes her studies to be disrupted. It causes her job to be disrupted. And it frequently
causes havoc in her entire family's lives and, because of the implications for the woman, this is a
subject of such fundamental and basic concern to her that she should be permitted to choose
whether to continue or terminate her pregnancy.

Judith Jarvis argues that if abortion rights are denied, women's freedom to act in ways that are
important to them is limited, both for their own sake and for the sake of achieving equality.

If the restraint is imposed on the basis that the fetus has a right to life from conception, it is imposed
on a basis that neither reason nor the rest of morality requires women to accept, much alone give
any weight to. The freedom to manage one's own body is regarded by many as a fundamental
moral right. Women lose their choice to terminate an unwanted fetus if they are not allowed to do
so.

2
Excerpt from A Defense of Abortion by Judith Jarvis Thomson
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Hence, the bigger question arises: how ethical is an abortion?

Abortion, in general, is considered highly unethical in almost every nook and corner of the earth.
Women (and often couples) are looked at when they go to a clinic or hospital for the procedure. It
comes down to a decision on the side of the going-to-be parents and the doctor who will perform
the surgery. This ethical decision can come under a branch called Bioethics.

The study of ethical, social, and legal concerns in biomedicine and biomedical research is referred
to as bioethics. Medical ethics, which focuses on issues in health care; research ethics, which
focuses on issues in the conduct of research; environmental ethics, which focuses on issues relating
to human activities and the environment; and public health ethics, which addresses ethical issues
in public health, are all examples of bioethics.

The decisions based on bioethics are based on the four commonly accepted principles stated in
research conducted by Beauchamp and Childress in 2008. These four principles are respect for
autonomy, nonmaleficence, beneficence, and justice. While the principle of respect for autonomy
deals with the decision-making power of the patient (here, going to be a mother), nonmaleficence
deals with the decision of us not intentionally creating harm or injuring the patient. The principle
of nonmaleficence is generally based on the duty framework. Considering the mentioned
principles, choosing to go for abortion is highly based on the duty-based framework.

We know that the debate on abortions starts about with the status of the fetus where the defenders,
i.e., those who are for the concept of abortion, do not consider the fetus as a human being, i.e.,
those who are opponents think it otherwise.

As per the study conducted by Ionuţ Ştefan in 2014, the concept of abortion should be restricted
to the fetus and the mother and should consider the nature in which the pregnancy has occurred.
According to the study, they have categorized the nature of pregnancies into two ethical theories.
The theories are named Teleological and Deontological theories.

The teleological ethics theory looks into the consequentialist perspective and considers the
accidental nature of the termination of those pregnancies. The idea deals with the ethical choices
a woman (or, in one case, a couple) has about when they are about to terminate a pregnancy based
on how the child was conceived. Teleological ethics looks into the ways such as unwanted
pregnancies occurring even after taking necessary precautions, cases that are "therapeutic," where
the fetus has some medical issues, and traumatic situations, where pregnancies occur without the
will of the mother.

The deontological ethics theory looks more into the duty-based perspective and considers some
non-accidental based reasons for termination of the pregnancy. The theory deals with the choices

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one has to make because the abortion is done because the girl got pregnant as they did not have
proper education about the protection techniques, where there are some misdiagnoses of the
pregnant woman that leads to the termination of the pregnancy, or, cases where the woman is
avoiding abortion as some infertile couple wants the conceived child.

Both the theories give rationales the getting an abortion is ethically correct or not. But the theories
that attempt to analyze these mentioned situations are not reducible and cannot unilaterally
encompass all existential circumstances. There are instances when a consequentialist appears to
be looking for a good balance, just as there are moments when a deontological approach works
extremely well.

It is critical to avoid absolutization, which might lead to a blond alley or an impossible, ludicrous
scenario. We can't work just on teleology or comply with rigid, non-transformable deontology all
of the time. We must also recognize that we may always deceive the argument; no one should
pretend to be infallible. Such a claim cannot be considered philosophically legitimate. We may
apply a severe and critical analysis, including our reasons, prejudices, beliefs, and so on, if we
have a critical mindset and real philosophy.

Freedom of choice is one of the most significant ideals of civilized society in the twenty-first
century. Individual autonomy and actional responsibility are built on the freedom to make
decisions. From a democratic standpoint, it is desirable to maintain unrestricted decision-making
freedom rather than constraining it, especially in existential crises.

The question still remains whether it is ethical to abort a child or not. The answer to this question
also comes out to be quite ambiguous. Both duty-based or the virtue-based approach are correct in
each of their places. Each of these approaches provide one with a perspective but it should be noted
that these are just ideas. The final decision should always look into the health of the woman. There
will always be a debate about the topic, but the one who is making this decision should always
consider the facts in the case of why the abortion is being conducted. The decision-maker should
look into the condition of the expecting mother and whether the pregnancy is harming her or not.
It is well established now that no single rule can determine whether one should abort a child or
not. Thus, the final decision should belong to the female person facing such a momentous situation,
barring some specific circumstances.

Abortion is a huge step in a woman's life. Be it the first, second, or in sporadic cases, the third
trimester, the idea of separation from the fetus is the most devastating for their mental health as
well. But if decision-making power is given to her, she'll be the one who would be the best judge
for herself. No doctor or man should deny her this decision. One should not consider these the
multiple ethical frameworks here, as it will never justify whether the abortion should be done or
not. The most important answer would be whether the mother is safe or not

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EHICS RELATED TO EUTHANASIA

What is euthanasia and why does it remain a debate across the world?
Throughout history, humanity has faced many challenges and topics of discussion, but none
remains a debate across the globe, like the right to a dignified death. Euthanasia which comes from
the Greek words meaning “a good death” refers to the practice where an individual intentionally
ends their life. Euthanasia in many cases is also known as mercy killing.
Advocates demanding autonomy for patients regarding how and when they will die have been
increasingly vocal during recent years. These cases have centered on the plight of dying patients
with terminal illnesses. What has often been overlooked however is the importance of medical,
social, and psychological factors like depression, and schizophrenia, that may contribute to suicidal
ideation or desire for hastened death. Euthanasia is the act of deliberately ending a person’s life,
usually to alleviate suffering. It’s a complex process that involves many factors like local laws, a
person’s physical and mental health, and personal beliefs.

There are several types of euthanasia:

Now that we have a basic understanding of what Euthanasia is, let’s look at it from a different
aspect.
Euthanasia is primarily considered an ethical and moral dilemma. The Hippocratic oath- or the
doctor’s oath, clearly condemned euthanasia or euthanasia-like practices. The Medical Council of
India also considers Euthanasia as unethical conduct, however, on specific occasions, the question
of withdrawing supporting devices shall be decided only by a team of doctors and not by the
treating physician alone.

The counter-argument of the Hippocratic oath is based on the interpretation that the basic idea of
the oath is to not harm. What constitutes “harm” can be different for everyone. When a patient is
in intense pain or suffering severe mental anguish, our society could be doing more harm by
keeping them alive than allowing them to die.40 Physician-assisted suicide came up as a solution
that argued to be following the primacy of personal autonomy, promoting human dignity, and may
represent a deeply humanizing act.

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Philosophically, pro-euthanasia arguments are centered on patients’ experiences and rights. They
argue that if a patient is suffering from a terminal illness and all available life-prolonging measures
had been exhausted, then euthanasia is morally permissible. The right to life also includes the right
to die. People should have the right to shorten the process of death and therefore, reduce the
unpleasantness. By refusing a terminally ill patient’s request to die, the state is, in some way,
violating that person’s fundamental rights. The state does not tell us how to live our personal lives
as long as we live by the law. Death is a somewhat uncomfortable aspect of our lives that we may
not want to consider until it is necessary. But, when we are ready to face death, whether it is our
own or that of a family member, it should be an entirely private matter. It should be left up to us
and our loved ones.

For many terminally ill patients, it is a matter of concern to die with dignity. They want to be
remembered as a person who lived life with pride and died with dignity and not being slowly
deteriorated by disease. Dr. Kevorkian, later famous as “Dr. Death” euthanized 130 patients to end
the suffering of terminally ill patients who wished to die. Arguably, he not only offered his patients
a source of relief but also allowed them to keep their dignity. Later, Dr. Kevorkian got convicted
of second-degree murder and spent 8 years in prison.

In India, active euthanasia is illegal and a crime under Section 302 or 304 of the IPC. Physician-
assisted suicide is a crime under Section 306 IPC (abetment to suicide), but passive euthanasia has
been legalized since March 9, 2018.33 The legalization of passive euthanasia was a landmark
judgment in the history of India. The judgment was a result of a criminal writ petition filed on
behalf of Aruna Ramchandra Shanbaug in 2009. The Supreme Court laid a provision for caregivers
of cognitively incapacitated persons to request non-voluntary and passive euthanasia to the High
Court. Till the legislation from the Parliament is in place, Judgment has cited the powers of article
226 of the constitution. On receipt of any application for passive euthanasia, the High Court would
appoint a board of doctors comprising a physician, a psychiatrist, and a neurologist to examine the
patient based on which the court would decide on life-supporting treatment.

During the renaissance and early modern periods, there was a paradigm shift; the sacred human
body became a natural scientific object; for instance, dissecting cadavers became common. By the
early modern period, some dared to suggest that perhaps euthanasia was not such a grievous sin
after all. Physicians throughout Europe and North America started advocating euthanasia openly.

The human-rights philosophy allied with the rise of technological prowess available through
science produced many zealous movements to legitimize medical suicide or euthanasia. After
looking at pro-euthanasia arguments from various aspects, let us now explore it in deep from the
perspective of the physicians, be it nurses or doctors. We shall explore the duty and virtue
perspectives of the same.

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Practitioners are often torn between acting from virtue and acting from duty. Appraising active
euthanasia from a virtue perspective can offer a more compassionate approach to the predicament
of practitioners and clients. The tensions arising from the virtue versus rules debate generate
irreconcilable difficulties for nurses. A shift towards virtue would help to resolve this problem and
support the call for a change in the law.

Virtue ethics denies the claims that the moral person is necessarily governed by a concept of duty,
and that good conduct is necessarily presented to us in the form of general rules and principles.
Instead, virtue ethics emphasizes the Aristotelian and Thomistic belief that morality and the self
are inseparable, or intertwined.

Stuart Horner, chairman of the British Medical Association’s Medical Ethics Committee said of
VAE: ‘It is effectively an execution. Doctors are supposed to be relieving pain, not putting patients
out of their misery.’ To those who do not consider it to be morally wrong for doctors to ‘put patients
out of their misery (if this is the wish of an autonomous adult and it is the decision of an
autonomous doctor) this is a disturbing statement.

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EUTHANASIA AND ABORTION: MORE PERSPECTIVES

Euthanasia, frequently known as mercy killing, is the act or process of putting to death individuals
who are struggling from a terrible and incurable sickness or a physically incapacitating disorder
without pain or enabling them to die sans treatment or artificial life-support measures.

Now the question comes of whether it is ethical or not. It seems to be made the right choice to
release someone of the pain if that person is in for a very long time. But, we should think in
hindsight too that people can make it an avenue for committing suicide leaving their friends,
family, and well-wishers in misery and in curiosity as to what happened.

Assisted suicide or medical aid in dying also comes under Euthanasia. Even if the purpose is to
"alleviate the pain," and even if the person has a terminal condition, killing another person is
considered murder in most nations. It Is absolutely difficult to follow legal interpretations and
outcomes to whom Euthanasia is prescribed. There are 8 out of 10 chances that there is going to
be the misuse of the legal prescription of mercy killing. It is not just about the patient that suffers
through Euthanasia, it is the doctor who performs mercy killing who goes through personal
consequences. The whole act of killing someone, even though it is to release their pain, is not
peaceful and can cause mental trauma keeping them scarred for a very long time.

Moreover, at many levels, it does not sound ethical as if a person is being granted Euthanasia, it
someway or the other way proves that that particular person’s life is not as worthy as others. It is
suggestive of the fact that these people are better dead than being sick or handicapped, it shows
our law’s inability to help these people with their sufferings.

Access to euthanasia could lead to an internal struggle for the patient, who is split between the
desire to continue living rich moments with his family and loved ones and the fear of agony. Thus,
in a society where euthanasia is legal, the patient who is struggling to cope with a serious illness
would be burdened even more.

Furthermore, the patient's vulnerability is heightened by the fact that she is dealing with a doctor
who can both heal and kill. The goal of our society is to lower the suicide rate. Quebec even has a
national Suicide Prevention Week, which some would like to see emulated across the country. It's
worth noting that in states where aided suicide is legal, the rate of non-assisted suicide has
increased.

Though it comes at a cost of duty to a doctor who has to perform Euthanasia, here comes a fight
and a conflict between the duty and the virtue of the doctor whether as a part of his duty, he should
kill and alleviate the person of his pain or suffering or be a virtuous person and not mercy kill the
person as his/her life is equally important as to others.

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As states throughout the country debate whether or not to authorize doctor-assisted suicide, a long-
standing but little-known group of Christian healthcare experts is stepping up its opposition by
filing a lawsuit against proponents of the practice. On July 19, the Christian Medical and Dental
Associations filed a federal lawsuit against the Vermont Board of Medical Practice, alleging that
the government is forcing physicians to violate their conscience and professional ethics by
requiring them to either inform patients about end-of-life care or refer them to a doctor who will.
Many French doctors want euthanasia to be legalised. This opinion is more common among
general practitioners and neurologists than among oncologists. The support shown for euthanasia
may be due to a lack of professional knowledge on end-of-life care in France, our study suggests.
Previous research found similar trends, but French general practitioners and oncologists were more
supportive of euthanasia than their Italian counterparts. The findings refute the claim that
euthanasia attitudes are influenced by cultural differences in English-speaking nations;
comparative research is needed. The support for euthanasia in France could be attributed to a lack
of professional awareness about palliative care. Improving this understanding would improve end-
of-life care while also clarifying the euthanasia issue.

Grief is a normal reaction to the death of a loved one and normally does not require professional
help. Unnatural death, such as suicide, can cause severe grief reactions in family members.
Physician-assisted suicide should be expected to resemble euthanasia on this point because it will
also usually be announced.

There have been unfortunate incidents of persons who are dying of a terminal illness and desire
others to assist them in ending their lives. It is critical, however, that we do not overlook the
enormous number of terminally ill people who, despite the agony and sorrow, have found meaning
and purpose in life.

According to a 2011 poll published in the British Medical Journal, the majority of patients who
are nearly completely paralyzed but fully awake claim they are happy and do not wish to die. A
total of 168 members of the French Association for Locked-in Syndrome were polled. Matthew
Hampson was a promising teenage rugby player until he was paralyzed from the neck down and
had a ventilator to breathe due to a collapsing scrum. Matt spends his time raising money for Spinal
Research in the United Kingdom, coaching kids at local schools, and writing essays for rugby
magazines. He's also the author of an autobiography. The Matt Hampson Foundation gives
assistance, advice, and support to young people who have been gravely injured as a result of their
participation in sports.

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EUTHANAISA VS ABORTION: THE LESSER EVIL

Doctors’ attitudes on the ethical issues pertinent to the beginning and end-of-life are associated to
values, beliefs and the philosophy of life prevalent in all societies but can vary from country to
country. To illustrate this, there is a difference between German and Israeli perspectives of end-
of-life care. The German accentuates the doctor’s duty to respect the patient’s autonomy and right
to self-determination, while the Israeli concentrate on the doctor’s duty to respect the sanctity of
life. Acceptance of euthanasia among doctors working under different circumstances and socio-
cultural settings also varies significantly. The rates of acceptance for euthanasia internationally
range from 1% in Japan, 9% in Nepal, 9.8% in Hawaii, 15% in Sudan, 30–39% in the UK, and
over 40% in France, Switzerland and Canada. A survey among physicians in nine European
countries and Australia showed that 70–99% would be willing to withdraw chemotherapy and
intensify symptomatic treatment at patients’ requests. About half would be willing to deeply sedate
patients to alleviate suffering until the patient’s death. Generally, doctors are considered to be less
inclined to undertake active steps leading to patient death.

The first argument is that doctors must inevitably harm patients to provide them with a benefit.
Good effects in medicine do result from evil effects. A doctor does not do wrong to a patient, when
she harms him to benefit him, with his consent. These actions would usually be wrong but they
are made right by the end in view. But the doctrine specifically forbids the achievement of good
ends by bad means. I will argue that euthanasia is no different from these other practices. Surgery
provides common examples of harming to confer benefit. Nobody sees any immorality when a
surgeon makes a large cut in an abdomen to remove a cancer. Two objections are made to the
application of the doctrine to surgery.

It is claimed that the operation is a single action, in which the good predominates. But the incision
must be performed at a prior point in time and it only facilitates the surgeon performing a separate
act—the excision of the cancer. They are different acts in space and time. The opening of the
abdomen by itself does not have good effects. It merely sets the stage for another act, which itself
has the good effect—excision of the cancer. According to the double effect doctrine, opening the
abdomen should be impermissible, because it is a harmful act. But it is obviously permissible.

One might still argue that the excision of the tumour is somehow a good effect of the abdominal
incision. But pain relief follows a fatal injection more surely and more quickly than tumour
removal follows an abdominal incision. So by that argument, both pain relief and killing are also
effects of the same action and euthanasia is as permissible as removal of the cancer. In reality, in
both cases the good can only be achieved by first doing the harm. Another way of defending double
effect is to argue that a physical harm is not always a moral evil. A robber may make a similar cut
to the surgeon and that is both a physical and a moral evil, because he wants to steal money. But
the surgeon wants to save life. Therefore it is the reason why harm is inflicted which determines

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whether it is a moral evil. But the doctrine does not permit actions which would usually be wrong,
because they are a means to a good end, in a particular situation. Opposition to euthanasia cannot
be based on an objection to achieving good effects through bad effects.
The second argument against the doctrine is that the patient's own ethical evaluation of a method
or an outcome should determine whether it is good or bad.
Patients reluctantly agree to mutilation by the removal of normal tissue. Thus someone might be
in imminent danger of death from fire, because a viable limb was trapped by fallen masonry. He
would allow a doctor to amputate his healthy limb to save his life. Patients with a genetic
predisposition to breast cancer may choose to have their normal breasts amputated. It is argued
that the doctrine should not apply when a part is excised to save life, even if the part is healthy.
But it is the patient who decides that amputation is justified. Conversely, a patient with a cancerous
limb may prefer to keep it and die, rather than lose it and live. Surgeons also perform mutilations,
not necessarily to save life. They sew up the normal stomachs of patients with severe obesity. The
colon is sometimes removed in laxative addicts, because nothing else can terminate the addiction.
Surgeons cut off normal genitals in sex change operations for patients with gender dysphoria. In
other circumstances, that would be horrific torture. Normal limbs are occasionally removed to
benefit patients with unusual mental disorders, in which they regard the normal limb as
supernumerary. The mutilation makes that particular patient feel better. The doctrine does not
allow doctors to kill a patient, even if he has reasons for wishing to die quickly with which we can
all sympathise. It does allow them to perform terrible mutilations because a particular patient sees
them as a benefit to him, although they would horrify other people. The doctrine is applied in a
selective and arbitrary way.
The prohibition of euthanasia must derive from a belief that direct killing of the innocent is
supremely and always wrong, in a way that dreadful mutilations are not. That belief may or may
not be true. The patient should decide for himself. The doctrine makes no sense in the context of
the treatment of a single patient capable of making his own value judgments.
A third argument against the doctrine is that there is little intuitive moral difference between
indirect killing, permitted by the doctrine, and direct killing, forbidden by it. Confusion arises,
because good analgaesia may lengthen, not shorten, the life of a dying patient. A thought
experiment simplifies and clarifies the situation. Suppose the only drug able to relieve the distress
of a particular dying patient inevitably caused death an hour later. Would using this drug be
morally different from killing the patient to relieve distress? One intuitive answer is that patients
should be treated as they wish, provided the law, which protects us all, allows it. For these three
reasons the doctrine is irrelevant to euthanasia.
A doctor does not do wrong to a patient when she harms him or kills him to benefit him, if the
patient judges that the benefit outweighs the harm. At first sight, the doctrine seems to stand on
more reasonable ground when it forbids killing one human to benefit another. The sole issue,
however, is the moral difference between killing the fetus as a means of treating the mother, and
killing it as a side effect of treating her. The contention is that reasons adequate to justify indirect

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killing, will also justify direct killing. The first argument is that making a moral distinction between
direct and indirect killing gives obviously counterintuitive results. Consider a woman who will die
with her fetus from eclampsia or malignant hypertension within hours, unless the fetus is aborted.
An abortion will save the mother and deprive the fetus of just a few hours of intrauterine life. This,
the doctrine forbids. It is hard to justify a principle which demands an avoidable extra death.
In contrast, the doctrine allows a doctor to remove a cancerous uterus containing a fetus, because
the death of the fetus is just a side effect of the hysterectomy. If the hysterectomy was delayed,
however, until the fetus was viable, a life might be saved. A doctrine which allows the fetus to be
killed in this case but not in the previous case, is implausible. Consider ectopic pregnancy. The
doctrine permits the removal of the fetus with the fallopian tube. But it is sometimes possible to
spare the woman surgery by giving her an intramuscular injection of methotrexate to kill the fetus.
The doctrine does not allow this. It insists on the surgery.
A principle which makes the mother suffer extra harm without any advantage to the fetus, is
unreasonable. Some followers of the doctrine concede this last point. A principle is weak if it is
frequently abandoned because it gives counterintuitive results. The second argument is that
intuitive responses to causing death as a means and causing it as a side effect, are similar, when
the total effect on the mother and the fetus is the same. Another thought experiment examines these
responses.
A dangerous disease is sometimes triggered by pregnancy. It can be cured only by abortion. A
new drug specific for the disease is introduced. It is quite safe outside pregnancy but it always
promptly aborts a fetus. Some might feel more comfortable using the new drug than with
abortion. It would nevertheless be illogical to refuse an abortion, if one were prepared to kill the
fetus just as surely with the new drug.
COMPARING EUTHANASIA TO ABORTION

It is strange that abortion is more widely permitted than euthanasia. A woman can choose to have
her fetus killed but not herself. The euthanasia patient is already dying and requests death in his
own interest. The doctor kills a healthy fetus in the interest of a third person. The paradox is partly
explained by the lower value which society puts on prenatal—as opposed to postnatal—life.
However, that may not fully justify killing one human (the fetus) to help another (the mother).
Pragmatic reasons may be important. It can be difficult to solve some problems of pregnancy
without abortion but good palliative care can usually manage the distress of the dying.
THE MEDICAL PERSPECTIVE

The double effect distinction may be psychologically relevant to the doctor. When she kills as a
means, she must ensure that death occurs. When she kills as a side effect, she can occasionally
hope that it will not follow. She might also feel more comfortable with indirect killing. It could
not, however, be an overriding moral principle.

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A fundamental flaw is its failure to recognise that the person affected by an action is the one who
must evaluate the harm and benefit arising from it. Doctors and lawyers, when thinking they are
applying the doctrine, may really be following three pragmatic rules, not the doctrine. Two are
restrictive and one is permissive. Firstly, many societies do not permit treatments which hasten
death, even though they relieve symptoms. Thus, the drug flosequinan relieved the symptoms of
heart failure but was withdrawn because it shortened life. Secondly, an exception is made to that
rule, when a patient is dying. We then accept treatments which relieve symptoms but shorten life.
Thirdly, we forbid doctors to kill as a tool of treatment. It is not less moral than mutilating a patient
or killing him as an inevitable side effect. It is just against the general interest to accept killing as
a treatment method, even if that deprives a few patients of benefit. This alternative explanation of
current practices around the end of life has practical relevance. We cannot easily change practices
if they are based on moral principle. We might do so, in the light of experience, if they are just
based on pragmatic rules. I suggest that our practices regarding euthanasia are based on such
pragmatism, not on ethics.The logic of abortion demands euthanasia. The logic of euthanasia
demands abortion.
Ethically, abortion and euthanasia are inseparable twins, pagan gods engraved on either side of the
same evil coin, for both of them directly attack the same value - the inherent worth of every human
being.

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4684-2223-8_5

• Beauvoir, S. . (1989). The second sex. New York: Vintage Books.

• Grimes, D. R. (2015, August 12). A scientist weighs up the five main anti-abortion
arguments. The Guardian. Retrieved March 5, 2022, from
https://www.theguardian.com/science/blog/2015/aug/12/five-main-anti-abortion-
arguments-examined Henshaw, S. K., Singh, S., & Haas, T. (1999). The Incidence of
Abortion Worldwide. International Family Planning Perspectives, 25, S30–S38.
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• Begley, A. M. (n.d.). Guilty But Good: Defending Voluntary Active Euthanasia From a
Virtue Perspective. Sage Pub. Retrieved from
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• Patel, M. (2022, January 17). Euthanasia: Why the right to die remains a debate across the
world. The Indian Express. Retrieved April 9, 2022, from
https://indianexpress.com/article/research/euthanasia-why-the-right-to-die-remains-a-
debate-across-the-world-7727575/'

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