Jacqueline A. Laing

This is a compact, nicely written book that provides a rejuvenating alternative to the utilitarian orthodoxy that dominates contemporary bioethics. There is currently a dearth of bioethical literature presenting what might be called a more traditional approach to medicine and health care. This contribution is a short and useful introduction to such an approach. The book announces itself as being written with “both the general reader and students and professionals in medicine, nursing, law, philosophy and related areas in mind”. Accordingly, it assumes no prior knowledge of ethics. It gives a neat introductory overview of some ethical concerns raised by reproduction, death, and dying. The issues considered include euthanasia and withdrawal of treatment, the persistent vegetative state, abortion, cloning, and in vitro fertilisation. By beginning the early chapters with a real-life case, Watt captures the interest of the reader. The case is introduced and discussed dispassionately. It is then employed as a springboard for a general discussion of principles often thought dry and difficult. Newcomers to the study of ethics will …

There is currently a dearth of bioethical literature presenting what might be called a more traditional approach to medicine and health care. Life and Death in Healthcare Ethics promises a reasoned and clear alternative. It considers ethical concerns raised by reproduction and death and dying. The issues considered include euthanasia and withdrawal of treatment, the persistent vegetative state, abortion, cloning and in vitro fertilization. Given its clarity and simplicity the book is likely to be read eagerly by students from a range of different disciplines. For those who want a basic text to introduce them to life and death issues in bioethics, this is a most welcome contribution.

This article challenges the view most recently expounded by Emily Jackson that ‘decisional privacy’ ought to be respected in the realm of artificial reproduction (AR). On this view, it is considered an unjust infringement of individual liberty for the state to interfere with individual or group freedom artificially to produce a child. It is our contention that a proper evaluation of AR and of the relevance of welfare will be sensitive not only to the rights of ‘commissioning parties’ to AR but also to public policy considerations. We argue that AR has implications for the common good, by involving matters of human reproduction, kinship, race, parenthood and identity. In this paper we challenge presuppositions concerning decisional privacy. We examine the essential commodification of human life implicit in AR and the systematicity that makes this possible. We address the objection that it is an ethically neutral way of having children and consider the problem of ‘existential debt’. After examining objections to the thesis that AR is illegitimate for reasons of public policy and the common good, we return to the issue of decisional privacy in the light of considerations concerning the legitimate role of the state in matters affecting human reproduction.

A critic of utilitarianism, in a paper entitled “Innocence and Consequentialism” Laing argues that Singer cannot without contradicting himself reject baby farming (a thought experiment that involves mass-producing deliberately brain damaged children for live birth for the greater good of organ harvesting) and at the same time hold on to his “personism” a term coined by Jenny Teichman to describe his fluctuating (and Laing says, discriminatory) theory of human moral value. His explanation that baby farming undermines attitudes of care and concern for the very young, can be applied to babies and the unborn (non-persons on his view) and contradicts positions that he adopts elsewhere in his work.

A consideration of the concept of authority. The term authority derives from the Latin 'auctoritas'. Although often regarded as synonymous with 'potestas' or power, authority is more properly considered power legitimately exercised. Whereas Stalin had the power to kill millions of innocents he did not have the authority to do so. Accordingly, it is often said that the supreme authority is God himself who is both omnipotent and all good. On this view God is the source of the eternal law which is observed both in the fullness of the physical universe and also in the moral universe that governs men and angels. Accordingly the book of Proverbs states that “By me kings reign and lawgivers decree just things” (Prov. 8:15).

There is a tendency in contemporary jurisprudence to regard political authority and, more particularly, legal intervention in human affairs as having no justification unless it can be defended by what Laing calls the principle of modern liberal autonomy (MLA). According to this principle, if consenting adults want to do something, unless it does specific harm to others here and now, the law has no business intervening. Harm to the self and general harm to society can constitute no justification for legal regulation or prohibition. So pervasive is this understanding of legal intervention in human affairs, that it is common now to encounter arguments in favour of permissive laws on, for example, private drug use, pornography, sexual and reproductive choice, based on the idea that to intervene in these areas would constitute a breach of the liberal ideal. The only alternative to modern liberal autonomy is assumed to be radical oppression, in which the State intervenes in the individual’s life to impose unwarranted measures designed to further its own ends. The legacy of Stalin, Hitler and other modern tyrants has undermined conceptual appeals to the common good. So widespread is this liberal assumption in the Western, English-speaking world that critics of the outlook embodied by MLA are customarily regarded with suspicion and charged with paternalism, narrow-mindedness and intolerance. Laing highlights contradictions inherent in the modern liberal tradition. She argues that there is a certain reliance on the notion of the common good within the natural law tradition that is instructive. According to this view, the common good constitutes a mean between two extremes: on the one hand, contemporary liberalism’s over-insistence on radical individual autonomy and, on the other hand, totalitarianism’s over-emphasis on collective social benefit. There is, I will argue, substantial terrain between the conceptual excesses of modern liberalism and oppressive tyranny that needs to be acknowledged and discussed.

This is a compact, nicely written book that provides a rejuvenating alternative to the utilitarian orthodoxy that dominates contemporary bioethics. There is currently a dearth of bioethical literature presenting what might be called a more traditional approach to medicine and health care. This contribution is a short and useful introduction to such an approach. The book announces itself as being written with “both the general reader and students and professionals in medicine, nursing, law, philosophy and related areas in mind”. Accordingly, it assumes no prior knowledge of ethics. It gives a neat introductory overview of some ethical concerns raised by reproduction, death, and dying. The issues considered include euthanasia and withdrawal of treatment, the persistent vegetative state, abortion, cloning, and in vitro fertilisation. By beginning the early chapters with a real-life case, Watt captures the interest of the reader. The case is introduced and discussed dispassionately. It is then employed as a springboard for a general discussion of principles often thought dry and difficult. Newcomers to the study of ethics will …

The Mental Incapacity Bill not only paves the way for euthanasia, but invites wholesale abuse and homicide, writes Jacqueline Laing. On 19 October 2004, when the Mental Capacity Bill was at its crucial committee stage, the Law Society issued a statement of ‘strong support’, claiming that it empowers patients and in no way introduces euthanasia. Laing argues that the Bill threatens the incapacitated by granting a raft of new third parties power to require that health professionals withhold ‘treatment’, which, after the controversial decision in Airedale NHS Trust v Bland [1993] AC 789, includes food and fluids delivered both by tube and, in certain cases, by spoon. The Bill further endangers the vulnerable, first, by allowing non-therapeutic research on the non-consenting mentally incapacitated, in breach of the Nuremberg Code and First Declaration of Helsinki, and secondly, by permitting new agents power to undertake on people with learning disabilities certain questionable procedures currently authorised by the High Court, such as non-voluntary sterilisation.

An analysis of moral theology, the study of how man must live in order to achieve his highest end, which, according to many theistic outlooks, is union with his maker. A species of theology, it involves the study of things divine, and is distinct from dogmatic theology by virtue of its focus. Whereas dogmatic theology concentrates upon doctrines and articles of faith, moral theology relates, more specifically to the actions of human beings and their relations to God. Moral theology naturally involves a discussion of ethics and the natural law, since this law is recognized also by divine revelation. It is not, however, co-extensive with moral philosophy, since its subject matter derives generally from revelation and theological sources.

Airedale NHS Trust v Bland establishes three principles among which is the controversial idea that people in a PVS, though not dying, have no best interests and no meaningful life. Accordingly, it is argued, they may have their food and fluids, whether delivered by tube or manually, removed, with the result that they die. Laing challenges this view arguing that not only is this bad medical science, it is unjustly discriminatory and at odds with our duties to the severely disabled. Laing highlights research by Keith Andrews et al and points out that Andrew Devine, in the same Hillsborough disaster, woke up some years after Tony Bland was decided.(Post script) Laing argues elsewhere that after the Mental Capacity Act 2005 the case has become a dangerous springboard for new third parties' to require the removal of food and fluids from the vulnerable incapacitated.

Despite the prevalence of human rights talk in Western jurisprudence, there has never been less belief in or acceptance of, any genuine form of objective morality. Academics reject the reality of moral objectivity and proclaim, as an objective truth, that morality is a mere “socio-historical construct”, illusory because always outweighed by worse consequences, expressions of subjective preference or mere evidence of culturally relative predilections. If morality is not that, then it is thought to be evidence of the power of the ruling elite in an essentially value-free universe. This article examines moral scepticism and moral relativism as a bedrock for human rights laws. It argues that if we are to retain any coherent and meaningful concept of human rights we will have to jettison our moral relativism.

By the mid-1960s the sexual revolution was in full swing. The persuasive rhythms of the Beatles and the Rolling Stones urged new personal freedoms, Carl Djerassi’s Pill was introduced to widespread acclaim, and feminists were setting their underwear ablaze. Most Christian denominations had long ago overturned their previous teaching on contraception. John Calvin, had at one time, called the act "condemned" and "doubly monstrous", while John Wesley had said contraception was "very displeasing to God", and the "evidence of vile affections." Those who used them he regarded as "logs", "stock" and "swine". But most Protestants had by now abandoned this instruction. Indeed, the Church of England had as far back as 1930 up-ended its once entrenched rejection of contraception as “demoralizing to character and hostile to national welfare.” Into this unlikely and tempting climate came the explosive Humanae Vitae. The Roman Catholic Church, alone among religions, publicly reaffirmed its traditional teaching prohibiting contraception. The encyclical warned of the need to maintain the connection between sex and babies – and this, despite the Rockefeller offer of cash for favourable encyclicals in the summer of ’65. Pope Paul VI warned that contraception would lead to promiscuity, loss of respect for life, marriage and the family, and breakdown of essential social structures. Laing suggests that there is reason to think this fear for the likely effects of separating sex from babies well founded.

The word monogamy derives from the Greek words μóνoδ meaning one and γάμoδ meaning marriage. When Christianity was founded, polygamy (the marriage of a man to many women) was, at that point in Judaic history, regarded as acceptable practice. The Gospel according to Matthew reports that Christ restored marriage to its original unity and indissolubility (Matt. 19:6). Monogamy is still deeply entrenched in the Christian tradition. It has long been held that polygamy and polyandry undermine the dignity due to man and woman as parties to the marriage contract. The command “What God has joined together let no man put asunder” (Mark 10:9) is still a central part of the marriage ceremony of many denominations notwithstanding widespread changes of attitude and practice.

Laing contends that the practice of eugenics has not disappeared. Conceptually related to the utilitarian and Social Darwinist worldview and historically evolving out of the practice of slavery, it led to some of the most spectacular human rights abuses in human history. The compulsory sterilization of and experimentation on those deemed “undesirable” and “unfit” in many technologically developed states like the US, Scandinavia, and Japan, led inexorably and most systematically to Nazi Germany with the elimination of countless millions of people for their race, class, political views, sexuality, religion or disability. Biometric databases exposing one’s medical data, DNA defects, IQ, political views, while in some ways appearing socially useful, demonstrates how vulnerable humans are, not just at the hands of political malfeasors and tyrants but insurance companies, government snoopers, false friends and determined social engineers.

The Liverpool Care Pathway is intended as a palliative care regime at the end of life. Even its critics agree that certain of its recommendations may be useful and appropriate. Additionally, critics are aware that there are occasions when death may be a foreseen side effect of perfectly licit palliation whose primary ends are not homicidal at all. It is evident that treatment may be over-expensive, over-burdensome or simply futile. There is no suggestion that critics of the Pathway adhere irrationally to what is known in medical ethics as the error of vitalism, the commitment to excessive, extraordinary or futile treatment, or over-burdensome care at the end of life. However, to ask whether treatment is futile, over-burdensome or over-expensive is very different to the discriminatory question about the futility, burden or expense of a frail and vulnerable patient. The sedation-dehydration aspect of the Pathway attracts much proper opposition. Doctors and families have found that those on the Pathway recovered when they intervened to take the patient off it. Senior medics have stepped forward, in the face of managerial opposition to argue that it is often impossible to know with certainty whether a person is imminently dying. One problem with the Pathway is that where a patient is misdiagnosed as terminal, the combination of morphine and dehydration has a self-fulfilling character and is likely to undermine a patient’s capacity. Persistent dehydration of even fit and healthy sedated patients will kill them. This was the difficulty highlighted by concerned medical professionals many years ago. The independent inquiry ordered in response to Freedom of Information Act requests performed in 2012 demonstrating a staggering increase in the number of people dying on the Pathway once it was financially incentivised needs to ensure certain investigations take place. What is needed, however, is not a whitewash but an independent inquiry with all interests declared and data sets interrogated and collated. These will cover a time-series medical history of each anonymised patient on the Pathway, duration until death, information about interventions provided during the period, monthly raw data from each trust, hospice or care home, medical histories, removals from the Pathway, information about journals that were corrected once a patient recovered, demographic data, location information and an audit trail of all data management.

The experience of the twentieth century bears witness to the abuse, mutilation and homicide of the vulnerable made possible by the power of the state, mass markets, and medical and financial interests. Suggestions for reform of the law regarding food and fluids typically take place in the context of utilitarian personistic “quality-of-life” presuppositions, and interests in shifting legal responsibility for life-and-death decisions, medical research, drug trials, organ harvesting as well as more mundane bureaucratic concerns like bed-clearing. With the Western world undergoing massive demographic change and a growing ageing and non-productive population, it cannot be assumed that these alterations to the positive law are problem-free. By allowing new agents power to require that food and fluids be withdrawn, non-therapeutic research and other procedures (like abortion and sterilisation) be performed on non-consenting patients, novel legislation such as that discussed cannot be regarded as autonomy enhancing so much as a threat to human rights. These laws although touted as progressive, more often than not invite routine abuse and destruction of the vulnerable, obscure accountability and create an inconsistent body of law, with conflicting obligations for health professionals.

John Harris criticises the European Parliament’s ‘waft in the direction of human rights and human dignity’ and rejects its suggestion that ‘human cloning violates the principle of equality since “it permits a eugenic and racist selection of the human race”’. He argues that, by parity of reasoning, so too do ‘pre-natal and pre-implantation screening, not to mention egg donation, sperm donation, surrogacy, abortion and human preference in choice of partner’. Conflating the techniques mentioned (ie, human cloning, egg donation, etc) with human preference in choice of a partner, he holds that reproductive liberty must be the operative principle in determining what ought to be prohibited by law in the realm of human reproduction. This article challenges his two problematic assumptions.

A useful case against voluntary euthanasia. This short article summarises at least ten reasons why voluntary euthanasia should not be legalised.On the subject of voluntary euthanasia she argues that institutionalizing medically assisted death - erodes respect for human life, underestimates human capacity for error and vice and is intrinsically discriminatory. She argues that it plays into the hands of illicit interests and trades on an improper understanding of human autonomy. She warns against dismissing “the army of corporate, financial, medical and political interests that there are in controlling death, euthanasia’s corrosive effects on public and professional attitudes, and the discrimination implicit in its implementation.”

An analysis of the concept of law, its source and connection with human positive law. The article begins by noting that “law” relates not only to prescriptions governing the behavior of human individuals. The term has a far wider sense. It can also refer to a standard or rule that binds things or events. This sense of the term covers the laws of the physical as well as the moral sciences. There is a distinction to be drawn between scientific laws of nature and moral laws. Regularities in natural occurrences are often regarded as laws of nature even though what we ordinarily think of as laws are those rules that govern human behavior. We speak, for example, of the “law” of gravity and of Newton's, Einstein's, and Kepler's laws. In so doing we emphasize the regularity and binding nature implicit in each of their formulas. The thought that there are laws of the natural sciences as well as moral laws has traditionally been seen as implying a creator and regulator of all things, and an eternal source of these laws. Equally it raises the disputed question of the place of miracles, or those suspensions of regularities, in the natural scheme of things. In the same way, sacred scripture speaks of Divine Wisdom as directing all actions and movements. This article considers the physical and moral laws more generally and considers human law and its connection with the natural law.

The Groningen Protocol and contemporary defences of the legalisation of infanticide are predicated on actualism and personism. According to these related ideas, human beings achieve their moral status in virtue of the degree to which they are capable of laying value upon their lives or exhibiting certain qualities, like not being in pain or being desirable to third party family members. This article challenges these notions suggesting that both ideas depend on arbitrary and discriminatory notions of human moral status. Our propensity to sleep, fall unconscious, pass out and so on, demonstrates that we very often exhibit our status as “potential persons.” Our abilities can and do fluctuate. The equal dignity principle, distinguished in turn from both the excesses of vitalism and consequentialism, is analyzed in the context of human rights logic and law. The normalization of non-voluntary euthanasia, via such ad hoc practices as the Groningen Protocol is considered. Substituted ‘consent’ to the euthanasia of infants or others, is scrutinized and the implications of institutionalizing non-voluntary euthanasia in the context of financial, research and political interests are considered. The impact on the medical and legal professions, carers, families and coroners, as well as public attitudes more generally, is discussed. It is suggested that eroding the value of human life carries with it significant destructive and hazardous long-term implications for societies. To elevate some long-term implications whilst ignoring others demonstrates the irrational nature of the effort to institutionalize euthanasia.

The article discusses questions on the significance of blood relatedness in the context of identity arguments about artificial reproduction (AR). Kinship, origins, and biological connections are significant to human beings. The author explains that family relationships bear on the identity of human beings. Moreover, she emphasizes that once these principles are neglected, it is possible to create people in ways that threaten significant human bonds and alienate people who are naturally related spelling loss, confusion and grief for them.