David Jones

Between November 2017 and June 2024 eight jurisdictions in Australia and New Zealand passed laws to legalise some form of euthanasia and/or assisted suicide. Like the United States, Australia has a federal constitution and ‘voluntary assisted dying’ (VAD) in Australia has been legalised at the state level. However, unlike the United States, Australia and New Zealand both permit practitioner administration of the lethal drug (euthanasia) as well as self-administration (assisted suicide). Another difference is that physician-assisted suicide, at first, spread very slowly in the United States, and new laws were based closely on the requirements of the original legislation in Oregon. In contrast, in Australia and New Zealand, the spread of VAD has been rapid from the outset, and there is a discernible pattern of successive weakening of safeguards in more recent legislation. The Australian model has increasingly come to resemble that of Canada.

The determination of death by neurological criteria—colloquially known as “brain death ” —is accepted in some form in law and medical practice throughout the world, and has been endorsed in principle by the Roman Catholic Church. However, the rationale for this acceptance has been challenged by the accumulation of evidence of integrated vital activity in bodies determined to be dead by neurological criteria. This paper examines one response to the current crisis of confidence in the received justification. A number of Catholic philosophers and theologians have argued that the criteria for human death should be related, not to bodily integration, but to the potential for responsiveness, sensation, or rationality. The present paper criticizes such moves as unwarranted and morally dangerous. According to Pope John Paul II, neurological criteria for determining death are valid insofar as they provide evidence that “the individual organism has lost its integrative capacity.” On the other hand, the meaning of “integrative” in this context is not univocal or mechanical, but is analogical and substantial. According to Thomas Aquinas, “everything has unity in the same way that it has being”; thus, the unity that is relevant to the determination of human death is the substantial unity of a human organism. Nevertheless, while it may still be possible to provide a defence of neurological criteria for death, this does not imply that current practice provides moral certainty of death. In practice, the Catholic acceptance of neurological criteria for death remains in crisis.

In the last 20 years ‘assisted dying’ (and/or its variants ‘assisted death’, ‘assistance in dying’, ‘aid in dying’) has become increasingly prevalent as a term to denote the intentional ending of the life of a patient by or with the assistance of a doctor. However, there is no agreed definition. This paper focuses on the debate over the definition of this term in the UK. It notes that, broadly speaking, there are two ways in which ‘assisted dying’ has been defined. There are generic definitions, which cover a variety of practices, including self-administration of a lethal drug (assisted suicide) and administration by a healthcare professional (euthanasia) with or without specific eligibility criteria. In contrast, there are stipulative definitions which limit the term to a particular practice, for example, assisted suicide (not euthanasia) of adults (not minors) who are terminally ill (not those with chronic conditions). Examples of the former kind of definition are provided by the British Medical Association in its 2020 members’ survey and the POSTbrief on Assisted dying. Examples of the latter are provided by the British Medical Journal and the British Broadcasting Corporation. This paper argues that stipulative definitions are problematic in that they exclude practices that are widely referred to as ‘assisted dying’. The attempt to restrict the definition leads to the term being used inconsistently. Stipulative definitions can be used consistently if it is acknowledged that they are secondary to the generic sense. This matters because clarity of terminology is a prerequisite of rational debate.

Abstract‘Assisted dying’ (an umbrella term for euthanasia and/or assisted suicide) is frequently defended as an act of autonomous self-determination in death but, given a choice, between 93.3% and 100% of patients are reluctant to self-administer (median 99.5%). If required to self-administer, fewer patients request assisted death and, of these, a sizable proportion do not self-administer but die of natural causes. This manifest avoidance runs counter to the concept of autonomous self-determination, even on the supposition that suicide could truly be autonomous. The avoidance of self-administration does not show that self-administration, when it occurs, is necessarily autonomous. It suggests, rather, that there are other frames by which assisted dying is being understood. One such is desire for medical control, a desire shared by patients and doctors. Such a frame is not directed towards an exacting autonomy (self-directed action by the patient) but towards a comforting heteronomy (letting the doctor take control).

There is an apparent gap between public policy on embryo research in the United Kingdom and its ostensible justification. The rationale is respect for the “special status” of the embryo, but the policy actively promotes research in which embryos are destroyed. Richard Harries argues that this is consistent because, the “special status” of the human embryo is less than the absolute status of persons. However, this intermediate moral status does no evident work in decisions relating to the human embryo. Rather, public policy seems to be based on a different account of “special status”: that developed by Mary Warnock. According to this, the embryo has no inherent status and the language of “special status” serves rather to accommodate the feelings of those who object to embryo research. This “emotivist” account is highly problematic, not so much for its attitude to the embryo as for its subversion of public moral reasoning

The British Parliament has recently approved regulations to allow techniques ‘to prevent the transmission of serious mitochondrial disease from a mother to her child’. The regulations term these techniques ‘mitochondrial donation’, but in the popular media, the issue has been discussed under the heading of ‘three parent’ babies or ‘three parent’ embryos. This paper examines the language of the debate, with particular reference to one of the techniques approved. It concludes that the terminology of ‘mitochondrial donation’ is scientifically inaccurate and ethically misleading, while the popular media description of ‘three parent’ embryos is broadly accurate, at least for one technique. This latter phrase also has the great merit, from an ethical perspective, of drawing attention to the ‘other woman’, the egg donor. She takes risks with her health in order to provide the egg which supplies the body of the embryo. Without her, this embryo simply would not exist.

Rev. Kevin Flannery, SJ, has helpfully drawn attention to some key sources for magisterial teaching on “vital conflicts,” where interventions to save a mother’s life would involve or lead to the death of her unborn child. However, former responsa by the Holy Office on this topic from 1884 to 1902 need to be interpreted carefully and understood in relation to the context of the time. Recent teaching has indeed clarified that the condemnation of direct abortion is de fide. Nevertheless, in the last forty years, the magisterium has, de facto, tolerated debate among faithful Catholic scholars over the ethics of craniotomy. Appeal to former magisterial teaching is not sufficient to settle this contemporary debate over what constitutes direct abortion. National Catholic Bioethics Quarterly 14.1 : 81–104.

Slippery slope arguments have been important in the euthanasia debate for at least half a century. In 1957 the Cambridge legal scholar Glanville Williams wrote a controversial book, The Sanctity of Life and the Criminal Law, in which he presented the decriminalizing of euthanasia as a modern liberal proposal taking its rightful place alongside proposals to decriminalize contraception, sterilization, abortion, and attempted suicide (all of which the book also advocated).1 Opposition to these reforms was in turn presented as exclusively religious and particularly Roman Catholic. Thus Williams asserted that "euthanasia can be condemned only according to religious opinion" (1957, p. 312).The following year, in ..

The term ‘dignity’ is used in a variety of ways but always to attribute or recognize some status in the person. The present paper concerns not the status itself but the virtue of acknowledging that status. This virtue, which Thomas Aquinas calls ‘observantia’, concerns how dignity is honoured, respected, or observed. By analogy with justice observantia can be thought of both as a general virtue and as a special virtue. As a general virtue observantia refers to that respect for human dignity that is implicit in all acts of justice. As a special virtue it concerns the specific way we show esteem for people. Healthcare represents a challenge to observantia because those in need of healthcare are doubly restricted in expressing their dignity in action: in the first place by their ill health, and in the second place by the conditions required by healthcare. To be understood properly, especially in the context of healthcare, the..

There has been little considered reflection by Catholic theologians on the concepts of gender identity, gender dysphoria and gender transition. Seeking inspiration in the Scriptures, some Catholic thinkers have interpreted the first three chapters of Genesis and especially the text ‘male and female he created them’ (Gen. 1:27) as requiring all human beings to live in the gender role congruent with their biological sex, and have viewed the biology of sex as self-evident. This article argues that these chapters constitute an appropriate locus for reflection on theological anthropology but that they need to be taken together with other texts and especially with the explicit teaching of Jesus Christ. In the Gospel according to Matthew, the one occasion in which Jesus invokes this passage from Genesis is when he draws attention to exceptional examples in nature and, in a striking phrase, states that some ‘have made themselves eunuchs for the sake of the kingdom of heaven’ (Matt. 19:12). If the Genesis text is interpreted in the light of the words of Christ, the binary division of the sexes, while ordained by God and the basis for a vocation to marry and procreate, admits of exceptions both natural and supernatural.

Two conferences on genome editing held in December 2015 offer a lens through which to contrast bioethics policies in the United Kingdom and the United States. The Progress Educational Trust, which has no parallel in the United States, hosted the London conference and illustrates the close collaboration between government departments, scientific bodies, funding organizations, and lobby groups in the United Kingdom. The rhetoric of responsible regulation used in the United Kingdom protects not the embryo, but the practice of embryo destruction, and advocates of embryo experimentation are eager to guide the debate about genome editing. It would be perilous for the international community to allow the United Kingdom to frame the debate in this way.

A recent online article in the Journal of Medical Ethics, which received wide media coverage, raised the possibility that children are being ‘subjected to torture’ due to the ‘fervent or fundamentalist views’ of their parents. However, the quality of argument in that article was inadequate to sustain such a radical thesis. There was no engagement with the perspectives of different religious traditions about end-of-life care. Instead the authors invoked practices such as male infant circumcision which are wholly irrelevant to the end-of-life theme. There were serious failings in relation to core principles of social and epidemiological research practice: the study based its conclusion on a sample of only six cases and failed to consider even the more obvious confounding features. Rather than demonizing the religious beliefs of parents there should be recognition of the need for mutual respect, dialogue based on an ‘expert–expert relationship’ and collaboration based on ‘shared understanding’