Jacqueline A. Laing

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.

A consideration of monotheism. The term ordinarily suggests belief in one God and derives from the Greek monos meaning “one” and theos meaning “god.” In the Abrahamic religions, Judaism, Christianity, and Islam, the one god is regarded as supreme lord and creator of the universe, almighty, all-knowing, and all-good. Traditionally, Christianity has taught that God revealed himself to our first parents, Adam and Eve, as the one true God in Genesis. The Old Testament reveals a jealous God who forbids the worship of strange and multifarious gods. God's chosen people, the Jews, are destined to prepare the way for the coming of the universal religion available not just to a privileged few.

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.

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.

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).

On the sixtieth anniversary of the Universal Declaration of Human Rights, 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. She argues that the new eugenics collapses into the old variety because of its fixation on producing “the better” or even more implausibly, “the best”. It was this very idea that drove much of the injustice of the twentieth century. Ethically questionable strategies were at the time viewed as progressive and socially evolutionary. The new eugenics, she thinks, fares no better and spells disaster for people regarded as deficient in some way. She rejects the idea that autonomous efforts to choose “better” or the “best” children are less problematic for being freely chosen. The fact that one freely chooses to give one’s children away into slavery or medical experimentation or to end one’s life, is no bar to the action’s being part of a eugenic agenda and independently at odds with intergenerational justice and the common good. She points out that misinformation, propaganda and behaviour modification techniques, subliminal or otherwise, are celebrated ways of getting people to act in a way that destroys their own interests. Laing regards eugenics as an ongoing threat to the defenceless in particular, but the ‘deficient’ classes more generally.

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.

The Mental Capacity Bill endangers the vulnerable by inviting human rights abuse. It is perhaps these grave deficiencies that prompted the warnings of the 23rd Report of the Joint Committee on Human Rights highlighting the failure of the legislation to supply adequate safeguards against Articles 2, 3 and 8 incompatibilities. Further, the fact that it is the mentally incapacitated as a class that are thought ripe for these and other kinds of intervention, highlights the Article 14 discrimination inherent in this and related legislation. The financial, medical and research interests that underpin the legislation highlight how the legilsation endangers the ulnerable. It appears to be both a responsibility shifting exercise. Most alarmingly of all, efforts to permit non-therapeutic research on the non-consenting vulnerable as well as sterilisation and abortion on those who do not consent suggest that the legislation heralds a new era o gross human rights abuse in instutions around the UK.

Helga Kuhse suggested in 1985 at a session of the World Federation of Right to Die Societies in Nice, that once dehydration to death became legal and routine in hospitals, people would, on seeing the horror of it, seek the lethal injection. The strategy of legalising passive euthanasia is itself flawed. Laing argues that the Mental Capacity Bill threatens the vulnerable by inviting breaches of arts 2,3,5,8, and 14 of the European Convention on Human Rights. Most at risk are the disabled and incapacitated. Sections permitting non-therapeutic research and non consensual sterilisation are at odds with the Nuremberg Code. New third party powers to dehydrate the vulnerable permit new systemic human rights abuse of a clinical though not historically unfamiliar variety.

Wars have been entered into as a means of gaining property, taking slaves and dominating and controlling peoples. The pacifist claims that no form of war can ever be justified. By contrast, just war theory holds that it is possible for a war to be morally justified, an idea that underlies much international law, as can be seen in the Geneva Conventions. Teichman introduces us to such thinkers as Aristotle, Cicero, Augustine, Aquinas, Hugo Grotius, John Rawls and Elizabeth Anscombe on the very idea of a just war.

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.

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.

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 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.

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.

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.