What Are Some Key Bioethical Principles Involved in Euthanasia Debates?

Article ID: DE197-1 | By: J.P. Moreland

The following is an excerpt from article DE197-1 from the Christian Research Journal. The full article can be read by following the link below the excerpt.


Key Bioethical Principles

There are a number of ethical principles that are deontological in nature, are part of the natural moral law, and relevant to the kinds of dilemmas that occur in euthanasia cases.6 Four of them are as follows: 1. The Principle of Autonomy. A competent person has the right to determine his or her own course of medical action in accordance with a plan he or she chooses. We have a duty to respect the wishes and desires expressed by a competent decision maker. 2. The Principle of Beneficence. One should act to further the welfare and benefits of another and to prevent evil or harm to that person. Beneficence requires me to do something for someone. 3. The Principle of Nonmaleficence. One should refrain from inflicting harm (or unduly risking the infliction of harm) on another. Nonmaleficence requires me to refrain from doing something to someone. 4. The Principle of Life Preservation. We have a moral duty to protect and preserve human life whenever possible. The burden of proof is always on taking human life, not on sustaining it.

Moral dilemmas arise when duties such as these come into conflict. For example, if a competent renal dialysis patient wishes to forego treatments and die, then the principle of autonomy comes into conflict with, say, the principles of beneficence and nonmaleficence. Cases such as these bring out the importance of seeing absolutes as coming in grades of importance or weight. In Matthew 23:23 Jesus claimed that there are greater and lesser matters of the law. Now, all matters of the law are absolute in the sense that (1) they are objectively true whether anyone believes them or not; and (2) they apply universally to all cases similar in a morally relevant way. But some moral absolutes can be more weighty than others. A distinction may be helpful. A prima facie duty is an absolute in the sense that it is defined as an objectively true moral duty that can be overridden by a more stringent duty. When two duties conflict and one duty overrides another, the less stringent duty does not disappear completely, but is still present in a morally relevant way. These are examples of exemptions of duties, not exceptions of duties. An exception would be a case where a duty should apply (say the duty to tell the truth), but for some reason it “goes on holiday,” so to speak, and it no longer applies to the case in question in any way. An exemption, on the other hand, is a case where a duty is overridden by a weightier duty, much the same way that a King can trump a Jack in a game of cards, but the prima facie duty still makes its presence felt and does not disappear. An illustration may help to clarify how a moral absolute can function as a prima facie duty. An ambulance nurse told me of a case where a 35-year-old man had suffered a sudden heart attack and they were taking him to the hospital. The patient asked her if he had suffered a heart attack. In this case she knew that she had a duty to disclose information to him because he had a right to informed consent and to know what was happening to him. But she also had a duty to benefit and not harm the patient. And she knew that he was very nervous and vulnerable and the information could easily precipitate a second, perhaps lethal attack. In this case, arguably, the duty to disclose information was overridden by the duty to benefit and not harm. But this does not mean that the duty to disclose information, seen as a prima facie duty here, evaporates entirely. Its presence is still felt and should be overridden as gently as possible so as to honor the weightier duty. First, she tried to change the subject. He pressed her further. Then, she told him a half truth, assuring him that he was just fine at the moment. He pressed her further, claiming that if she continued to be evasive he would conclude that he had had a heart attack. Finally, she told him a falsehood so as to benefit and not harm him. The point here is not whether one agrees with her decision. The point is to illustrate that if a duty is prima facie, it still makes its presence felt and must be respected. It does not disappear. It is still objectively true, and it is applicable to the case at hand, even if it is overridden.