Applied Ethics: Medical Ethics — WJEC A-Level Study Guide

 ## Overview Component 3: Religion and Ethics requires a rigorous application of ethical theories to the contentious issues of Abortion and Euthanasia. This guide will navigate the tension between the Sanctity of Life and Quality of Life arguments, integrating legal precedents and religious concepts with scholarly critique. Examiners expect candidates to move beyond descriptive accounts and construct evaluative arguments, weighing the strengths and weaknesses of Natural Law, Situation Ethics, and Utilitarianism. A high-level response will demonstrate a nuanced understanding of meta-ethical terminology and the practical application of theoretical frameworks to real-world medical dilemmas, such as the case of Tony Bland or the legal status of abortion in the UK. This topic is not just about what thinkers believe, but *how* their theories function under pressure.  ## Key Concepts & Debates ### The Sanctity of Life vs. Quality of Life **What is it**: This is the central philosophical clash in medical ethics. The **Sanctity of Life** principle, often rooted in religious doctrine (e.g., Catholicism), holds that life is intrinsically sacred and God-given. The concept of *Imago Dei* (made in the image of God) is fundamental here, suggesting that all innocent human life has an absolute value from conception to natural death. In contrast, the **Quality of Life** principle, often argued from a secular or utilitarian perspective, maintains that the value of life depends on its quality. Thinkers like Peter Singer argue that factors like self-awareness, rationality, and the capacity for relationships determine whether a life is worth living. **Why it matters**: Examiners expect you to frame your essays around this core tension. You must be able to explain *why* Natural Law champions the Sanctity of Life and *why* Preference Utilitarianism prioritizes the Quality of Life. High-level marks are awarded for showing how 'Weak' Sanctity of Life positions (e.g., allowing the withdrawal of treatment) try to find a middle ground.  ### Personhood **What is it**: The debate over what constitutes a 'person' with a right to life. Joseph Fletcher and Peter Singer have proposed criteria for personhood, such as self-consciousness, rationality, and a sense of the future. Under these definitions, a foetus, an anencephalic infant, or a patient in a Persistent Vegetative State (PVS) may not be considered a 'person'. **Why it matters**: This concept is crucial for AO2 evaluation. You can use it to critique the absolutism of Natural Law or to build a utilitarian argument for abortion or euthanasia. For example, if a foetus is not a 'person', then from a utilitarian perspective, the preferences of the actual persons involved (e.g., the mother) take precedence. Examiners credit the use of scholarly views on personhood to challenge assumptions. ## Key Ethical Theories in Application  ### Natural Law **Key Principles**: Associated with Thomas Aquinas, this is an absolutist, deontological theory. It posits that our God-given reason can discern the 'natural law'. The purpose of humanity is to flourish and achieve fellowship with God. This is achieved by following the **Five Primary Precepts**, including the 'Preservation of Life' and 'Living in an Ordered Society'. **Application**: Natural Law forbids actions that directly violate a primary precept. Therefore, abortion and euthanasia are seen as intrinsically wrong because they intentionally end an innocent human life. However, top-band responses MUST discuss the **Doctrine of Double Effect**. This principle allows for an action that has a bad consequence (e.g., death) if the primary intention was good. For instance, administering pain-killing drugs to a terminally ill patient to alleviate suffering is permissible, even if the drugs foreseeably shorten the patient's life. The intention is to relieve pain, not to kill. ### Situation Ethics **Key Principles**: Developed by Joseph Fletcher, this is a teleological and relativistic theory. It rejects legalistic rules and argues that the only absolute is *Agape* (selfless, unconditional love). The right action in any situation is the one that produces the most loving outcome. **Application**: A situationist would ask, “What is the most loving thing to do in this specific medical scenario?” There are no fixed answers. For a woman whose pregnancy is the result of rape, or for a patient suffering unbearably from a terminal illness, a situationist might argue that abortion or euthanasia, respectively, could be the most compassionate and loving course of action. To earn high marks, candidates must apply Fletcher’s **Four Working Principles**: Pragmatism (the proposed action must work in practice), Relativism (no fixed rules), Positivism (faith in God and love), and Personalism (people come before rules). ### Utilitarianism **Key Principles**: A teleological theory focused on consequences. **Act Utilitarianism** (Bentham) focuses on the specific act and uses the Hedonic Calculus to measure the greatest good for the greatest number. **Rule Utilitarianism** (Mill) considers the consequences if a particular action were to become a universal rule. For medical ethics, **Preference Utilitarianism** (Peter Singer) is the most sophisticated tool. It argues we should seek to maximize the satisfaction of the preferences of all involved. **Application**: A utilitarian approach weighs the different interests at stake. In the case of abortion, a preference utilitarian would weigh the preferences of the woman against the foetus. Since the foetus (according to Singer) is not a person and has no preferences, the woman's preference to not continue the pregnancy would likely prevail. In the case of euthanasia, if a person has a clear and settled preference to end their life due to extreme suffering, a preference utilitarian would likely support it. The case of **Airedale NHS Trust v Bland (1993)** is a key example where the courts, using utilitarian-style reasoning, decided it was in the best interests of the PVS patient Tony Bland to have his life-sustaining treatment withdrawn as he had no preferences or interests to satisfy.