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Before getting to the topic of euthanasia. However, let me briefly talk about religious secular exchange more generally.

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And for those of you that were at that event last night, I hope you're not too annoyed to hear this again because as you probably know,

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in America we have both robust religious and robust secular discourses and we both try to work things out in our public spheres.

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I come to these discussions specifically as a Christian ethicists, Catholic ethicist,

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who wants to speak on some of the most controversial issues in bioethics and ethics more generally.

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Some of my colleagues are very pessimistic about the possibility of such interaction.

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And with good reason, we are now more polarised in the United States than at any time since our civil war.

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And divides between secular and religious folks play a large part in this polarisation.

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But I'm actually more hopeful than many about this, especially given my recent interactions with Peter Singer, who helped teach Julian.

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Though Julian is moving away from Singer's news at the moment, I think I've debated Peter and lectured in his classes at Princeton.

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Last year he came to my own doctoral bioethics seminar at Fordham and came to dinner with some of us afterwards.

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We planned a major international conference together at Princeton, trying to find new ways to think and speak about abortion.

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And next month, he will join a panel a panel at Fordham that I'm putting together,

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which puts him in conversation with a diverse group of Christian theologians to think

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differently about non-human animals on the basis of these and other experiences.

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I want to argue that religious and secular discourse, something that is the overview of these two debates,

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can go much, much better if the following three things can happen.

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First, religious folks need to acknowledge the critique that often comes from secular folks,

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that our arguments rest on first principles for which we do not have arguments.

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They simply grab or claim us by some kind of authority.

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They're based on faith. Second, secular folks need to acknowledge the critique that often comes from theologians,

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that their arguments also rest on first principles for which they do not have arguments.

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They also simply grab or claim them by some sort of authority, whether it is the utilitarian dogma that one counts as one and none more than one,

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or the supreme libertarian doctrine of personal freedom and autonomy,

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or even general claims about our capacity to recognise flourishing and well-being.

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These ideas come from a fundamental understanding of the good for which there simply cannot be arguments.

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They come from a narrative, a story, an intuition or other, a play or a commitment.

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In short, they are also based on faith.

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Third, armed with the knowledge that both religious and secular folks have faith based understandings of the good,

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we need to take the time in intellectual solidarity with each other to map all the places where we agree and where we disagree.

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We will often find, I believe, that the agreement is quite substantial,

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in particular because even in the secular West I would argue that our understandings of the good are totally,

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totally free, strong, significantly indebted to the Abrahamic religions.

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This is especially promising methodology in my view anyway, when we can work to find similar ways to talk about flourishing and well-being.

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And Julie and I are working on a paper they were trying to write together at the moment.

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We're going to get together on Monday to talk about to try to do precisely this.

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At any rate,

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I found precisely the kind of substantial agreement I just talked about in my systematic exploration of Peter Singer and Christian ethics.

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In some ways, it is sad that the series will be focusing only on abortion and euthanasia,

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because even though there is broad overlap in the premises of arguments with regard to these issues,

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and the ultimate conclusions are of course quite different. But on ethical issues like concern for non-human animals and poverty, for instance,

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the striking overlap is both with regard to premises and with regard to conclusions.

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But let's turn to euthanasia. We have people that study US bioethics have a saying which only a few of you will get here about the use anyway.

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Abortion is the bowling ball on the mattress of bioethics.

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This American idiom is difficult to understand unless you watch American television commercials for mattresses.

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But the basic idea is that our abortion discourse is a muddled mess that prohibits productive discussion against other of other bioethical issues.

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This, I would argue, is especially true of euthanasia and of end of life issues in several ways.

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People on multiple sides of the abortion debate, some of which we talked about last night,

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bring their more fundamental views about abortion into the euthanasia debate.

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And what is actually going on often is a sort of proxy battle in the war over abortion, but fight on the terrain of the issue of euthanasia.

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And though there is some overlap and we'll talk about that today, I find that this causes tremendous confusion in the debate over euthanasia.

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And I hope I can use my remarks to help unpack some of that confusion or what I see to be that confusion.

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In my bioethics courses, I divide the readings that I give my students into three different families of issues general issues,

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moral status and value for one to killing and treatment.

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And three, moving from moral claims to prudential judgement judgements about public policy.

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My experience is that many, if not most, of the problems that are euthanasia discourse come from confusion about which

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of these three issues has priority or even which is under discussion at all.

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Often we talk past each other, talking about one but not the other.

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So I will divide my remarks on euthanasia such that I can treat each of these issues separately and hopefully avoid at least some of this confusion.

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So moral status and value. That's the foundational set of claims that sets up everything else, it seems to me.

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If the patient we are considering is not a person of being with intrinsic value and a right to life,

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then discussions about reasons why we may or may not aim at her death will be very

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different from discussions in which we claim that she is considered to be a person.

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Right. And here the discussion from last night about abortion does loom large.

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And part of the reason why the abortion debate has infected the euthanasia debate in my own view.

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Again, building off the discussion last night,

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all beings which have a rational nature count as persons and accidental traits which limit their ability to express their rational nature.

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Do not change this moral status at all. Examples of such such accidental traits include immaturity.

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In the case of embryos, foetuses and infants intoxication, temporary unconsciousness, mental illness, disability or injury.

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Such states of affairs do not change the kinds of things that persons are, not change their persistence through time or personal identity.

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They are not what I referred to last night. These are not what I referred to last night as nature changing events.

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Therefore, when we consider classic cases at the end of life like persistent vegetative state or persistent unconscious state,

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I prefer deep and long term coma and even brain death.

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These patients should all count as persons since they have rational natures.

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They remain living though damaged beings who have all the inherent active potential to be rational and relational.

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Rational and relational are coterminous in a lot of Catholic tradition, and it is merely first, they are merely frustrated.

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This potential is merely frustrated by an injury or a disease.

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If we think that non-rational human beings like those who are asleep, temporarily comatose,

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etc. count as persons, then we should consider these individuals, these patients to be persons as well.

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And for the same reason.

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In my book on Peter Singer and Christian Ethics, I point out that one of the interesting agreements that I have with Peter and Julian,

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I think that we'll hear is a judgement against the current medical consensus around brain death.

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We tell ourselves, in my view, and I think Julian's view though again I'll let him speak for himself,

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that we tell ourselves a medical fiction, that a living, breathing, pulsing, human being with homeostasis is dead.

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But what we really mean is that there is a difference between a living, pulsating, breathing, human being and a person.

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So actually, in switching, as we did our view to brain death, we have adopted an important aspect of Singer's and Julian's thought.

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Perhaps even without realising it, in my view. So I think both Julian,

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I can agree that we need a more honest appraisal of what we are claiming when we say that a living human organism with homeostasis is dead.

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Okay, more of that is too quick, but we can come back to some of that stuff. Let's move on to killing and treatment.

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But even if one thinks that all these patients are persons,

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there are still really interesting and important questions to ask about whether it would ever be legitimate to aim at their death.

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After all, we allow killing of persons for all sorts of reasons, including in certain circumstances, without their consent.

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Now I come out of a tradition, the Catholic tradition, which brings a pretty solid, decent,

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logical principle to this debate, namely that it is always wrong to aim at the death of an innocent person.

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This comes directly from the claim that the lives of persons have intrinsic non instrumental value,

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such that it is never accepted to radically reduce that value to some other end, especially the killing.

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Though this might seem like a conversation stopper when it comes to dialogue, for those who do not share this principle,

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there are two important possible areas of overlap to mention and possibly explore in greater depth.

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First, to pay attention to the language I'm using aiming at death.

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Julian and Peter Singer often point out that it is incoherent to object to killing via an action, but not to object to killing via omission.

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Here, of course, we have broad agreement. The Catholic prohibition is against aiming at death of an innocent person.

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This explicitly includes both acts and omissions. The example I do use of my students is my bathtub example.

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So imagine a scenario where this really bad husband wants to kill his wife for the life insurance money and.

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She's taking a bath, right? And he walks in with the toaster ready to drop it in the water.

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But to his horrific delight, he realises that she's drowning already in the bathtub.

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Right. And just he could easily save her, but he lets her die because he wants her dead right for the life insurance money.

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Is that any different than if you actually drop a toaster of water?

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From the Catholic perspective and I think from doing respect that there's no difference at all is aiming at death in both circumstances.

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Whether it happens by action or omission is not of consequence morally.

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So the second area of overlap. But so once again, as with brain death, we agree, I think with the logical incoherence of our culture on this issue,

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that we make this distinction, but we then we disagree about which way to resolve it, which way to reason to resolve it.

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So I think Gillian's going to want to say that whether we aim at death actively or whether we aim at that passively,

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there are circumstances where that should be done, even if it's an innocent person.

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I'm going to say we should refrain from both, whether it's active or passive.

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That would. But at least we agree on the coherency, which is no small thing.

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The second area of overlap involves the church's tradition on refusing life sustaining treatment.

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As many of you know, the church did a lot of thinking about this in the Middle Ages, especially with regard to battlefield medicine,

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and eventually came up with a distinction between ordinary and extraordinary treatment,

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which I think is still operative in our secular medicine today in the West.

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We can talk about that if you like, but one of the first questions that was asked was, well, suicide is always wrong.

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Killing innocent person, including suicide is always wrong.

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What about battlefield soldiers who don't want their legs cut off in order to save their life if they refuse the amputation?

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Are they in fact committing suicide or they're aiming at their own death?

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And the answer from Catholic moral theology was not that they did not that they did not,

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because as long as they were aiming at death and death was merely a foreseen but unintended consequence,

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and they had a proportionate reason, like the really intense pain of having your leg cut off without pain medicine,

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that that would have been acceptable. And over the centuries,

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lots of different kinds of proportionate reasons have been given as reasons that would be acceptable for refusing life sustaining treatment.

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Pain was obviously one given that example, but even the expense and burden on family or affected others is in the tradition,

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which I think explicitly includes distributive justice. That was what my first book was on,

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and I think that might be an interesting area that Julian I could talk about in terms of the kinds of views that he holds about this.

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And interestingly, at least to me, I think we could also largely agree that in certain circumstances,

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giving someone a very large dose of pain medication, one that we knew would lead to their death being radically sped up would be acceptable.

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I would just insist that the reason the pain medication would be given would be with the intention to control pain.

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And the death was merely foreseen but not intended.

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While Julian would, of course, I think, just not insist on that,

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but at least at the very level of public policy, we would admit that this is a legitimate thing to do.

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I would just insist on different intentions and divining intention and public policy is a very complicated thing.

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But anyway, I think that's another thing we could talk about might be interesting.

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But let me lastly talk about public policy and think about public policy specifically.

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So even if one objects to the claim that every living human being is a person with a right to life,

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and even if one rejects the claim that it is always wrong to aim at the death of an innocent person,

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there are still questions to ask about the unintended consequences of putting any of this into a public policy.

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As was mentioned last night, Julie and I are trying and just now I guess I put it in here.

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Julie and I are trying to write a paper together on how a common focus on a focus on flourishing and well-being

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might bridge gaps between us and between second and religious discussions or general discourses more generally.

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So let me propose an important question, which I think is important.

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Question What does a culture look like that has euthanasia as a broadly available option?

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Is this a flourishing culture? We could ask this about the medical culture specifically, which is the whole set of questions in itself.

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Or we could ask it about R and or we could ask it about our culture at large.

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My friends who are social ethicists are generally sceptical of merely focusing on the autonomous choice of individuals

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in which to dig deeper and think harder about the social structures underneath that might coerce such choices.

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We saw last night with the proposition of pro-life feminists that they are sceptical of a focus on autonomous choice for abortion,

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arguing that given the social structures that still work against women,

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abortion choice actually ends up coercing and harming women in powerful ways, many social ethicists reasoned in a similar way about euthanasia.

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We have social. Structures in the West,

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driven by a vigorous market economy and pushed several kinds of vulnerable populations to the margins as a result of these social structures.

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This is especially true of those who are old or injured or disabled,

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such they can no longer contribute capital and youth to our culture in the proper ways.

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Given that these vulnerable populations are already pushed to the margins and feel unwelcome in our culture,

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what unintended consequences might there be in giving them the right to kill themselves?

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Some answers to this question would involve something like reasonable speculation about what might happen, but some answers are just simply empirical.

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The Netherlands, for instance, has been considering a measure to allow euthanasia for those who are simply tired of life.

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No pretence about medical need at all.

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Switzerland, as you may know, has a group called Dignitas that is now charging a fee for what is essentially euthanasia, euthanasia, tourism.

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Here, the market is directly involved with no pretences about that. I gave a talk in Belgium this past spring and after the talk we had,

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I had dinner with a few of the people who were players in the euthanasia debate there.

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It was legalised in 2002, but despite warnings from some of the people I was talking with,

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it took only six years for euthanasia to be connected to organ donation and given organ shortages.

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The practice gives Belgian society an explicit stake in the deaths of people with seriously disabling, disabling or terminal conditions.

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And if we consider that these people are often the most expensive for whom to care,

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especially in light of the acute medical resource shortages we face,

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there is the potential for a perfect storm of considerations which demonstrate that the supposed free choice to kill oneself is

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actually manipulated and even coerced by a host of social factors operating beneath the surface of so-called patient autonomy.

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So I've talked enough. I'm just going to conclude here and turn this over to Julian so we can get some some exchange.

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But in concluding, let me make two broad points and sort of back up.

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So while we may not get broad agreement on some of the principles involved in these debates,

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even simply cutting through the confusion to see where we disagree, I think is of significant value for the discourse and just in general.

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But then I think we can even push our culture to be more together.

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We can push our culture to be more consistent where we both see in coherency, even if we disagree about which way to push to make it coherent.

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I think this is especially true when it comes to brain death and aiming at death by action or omission.

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Another opening for conversation again involves the effects of various euthanasia public policies on the flourishing of our communities.

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Last night I asked the question, Whatever you think of abortion as an individual moral issue in itself,

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what do you think of a culture that has, you know, millions of abortions done for any reason at all?

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Can we have a productive argument about whether this is good for the flourishing of women in our broader culture?

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Today, I want to ask a similar question about euthanasia. Whatever you think of euthanasia as an individual moral issue in itself.

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What do you think of a culture that gives the free choice for marginalised populations to kill themselves?

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Can we have a productive arguing about whether this is good for the flourishing of the sick and elderly in our broader culture?

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Thanks, Charlie. So just in answer to that, I quite like Holland in Switzerland.

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I think they're quite good places. So. So I think they're quite, quite civilised societies in fact are more civilised than many other societies.

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But that's not my main point.

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I want to start by saying what I said last night is many of my best friends are Christians and actually practising Christians.

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So so I am actually deeply committed to this project of engagement.

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And I want to thank Charlie for, for taking a positive step towards this and having an open and honest dialogue and not trying any shenanigans,

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which I've seen a lot of in in the years in this sort of area.

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And so in that spirit, I've actually written a new paper,

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and this is in the paper I would give defending euthanasia, because I'm not going to talk about moral status.

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The traditional arguments that are given for for euthanasia are two fold.

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One is based on personal autonomy that we have the right to determine our own lives, including when we die.

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And and so this grounds voluntary euthanasia and an an argument based on beneficence that some lives involve

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such degrees of suffering or such poor quality that it's better to no longer go on and live on these grounds,

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on voluntary euthanasia. And I'm not going to give either of those arguments and I'm not going to challenge

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Charlie's claims about or directly challenge all these kinds of moral states.

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I take the spirit of this debate to be to find common premises that we can agree on.

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So there are going to be things that we just can't agree on.

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And I made some comments about Charlie's reference to both secular and religious ethics being based on faith,

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which I'm not going to repeat, and we can talk about that later, but I don't quite agree with what how he phrased that.

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So I'm not going to talk about moral sites. For what it's worth.

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I think that people with advanced brain damage, there's dementia, permanent unconsciousness, lack moral status.

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But my argument isn't going to depend on that. And I agree with Charlie that I think brain death is a fiction.

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It's a fiction invented to to harvest organs.

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And the more relevant moral point is some serious loss of of sophisticated or rich consciousness that separates humans rather than non-human animals.

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But leave aside all that.

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What he did draw attention to is this very important agreement about the moral equivalence of what's called active and passive euthanasia.

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Active euthanasia is the administration of or the direct lethal act that that kills a person, typically a lethal injection.

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Passive euthanasia is the withdrawal, the withholding of medical treatment, life prolonging medical treatment that keeps somebody alive.

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The omission to do something to to to keep somebody alive.

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Now,

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there is an interesting category of medical treatment that is routinely employed that falls between these two cases of active and passive euthanasia.

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And that's the act of withdrawing life, prolonging medical treatment.

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Now, here we face the first hypocrisy.

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If society, if I snuck into the John Ratcliffe Hospital now and disconnected somebody's ventilator,

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I would be guilty of murder because the act that I did stopping the ventilator killed the patient.

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If I snuck into the neonatal intensive care unit and withdrew the feeding tube and substituted some inert substance for the feed,

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and that baby died of starvation. I would be guilty of murder.

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If a mother failed to feed her child, that would, if not be murder, a serious criminal offence.

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But when doctors do that, it's not classified as murder.

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Now, how can that be? Well, this was most clearly articulated in the case of Tony Bland, a man who was crushed in the Hillsborough soccer disaster.

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And I think around 1996, after he'd been unconscious for many years, his brain had turned to mush.

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There was no hope. It was sad of any sort of meaningful recovery.

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His family wanted his artificial feeding to stop, and doctors were concerned that by actively stopping his feeding, they would be charged with murder.

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So they they took it to the to the to the highest court in the land.

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And inevitably, eventually,

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the decision was that Tony Bland had no interests and it was not against his interests to stop feeding in this circumstance.

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And on the question of whether this would. Constitute murder. The judge has said that the act of stopping the the the treatment was not an act.

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It was no mission to act because if it was an act, it would be murder.

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So that's why doctors are not guilty of murder. And I would be if I did the very same act, if we fight it, it would be called an act.

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If I do it. It's called the mission, which is an absolute tribute to the to the hypocrisy, the moral hypocrisy of people.

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So I completely agree with Charlie. Those those acts or omissions are morally equivalent.

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So it's important to recognise that already a form of euthanasia, withdrawal of treatment, withdrawal of feeding in neonates,

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withdrawal of feeding for people with dementia, withdrawal of insulation from people in intensive care is routinely practice.

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It is part of routine medical practice.

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So euthanasia, what I would actually classify as active euthanasia is already a part of accepted medical practice.

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As Charlie mentioned, there's one see here if you want. As Shelley also mentioned, we do sanction the killing of innocent people.

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And I mentioned this case last night, but I mention it again,

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the case of conjoined twins such as the Jodie and Mary pair in Manchester a few years ago.

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One of them, Mary, the so-called weaker twin who was inevitably going to die but could threaten the life of the healthy twin.

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Jodie was killed. And in fact, one of the justices said this was murder, but it was judged to be justifiable murder.

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So the first point I'll make is that the society that we live in, the medical practices and the law,

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are already based only on an acceptance of certain kinds of intentional killing.

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Okay, now, now I want to sort of soften you up a bit.

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I want to move on to the more productive part. Now, Charlie and I both agree that active and passive euthanasia are morally equivalent.

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So now I'm going to start with some things that I think we can agree on,

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a very well trodden principle that you, in fact articulated with this battle battlefield example.

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People have the right to refuse medical treatment, even lifesaving medical treatment.

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Jehovah's Witnesses can refuse a blood transfusion because they believe if they refuse a blood transfusion, they'll go to heaven.

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And if they accept somebody else's but or even their own blood, when it's left their body,

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they'll turn to dust that's well regarded as a right that people have.

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So people had to refuse treatment now and in advance.

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A Jehovah's Witness can write an advance directive or a living will saying I refuse a blood transfusion,

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whatever the circumstances, if I'm going to die. And that has the force of law.

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People have the right to refuse medical treatment in advance with the implication that they'll die.

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Now, if they're going to die, they're inevitably going to die because they're refused medical treatment.

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But surely it's compassionate or benevolent to make that dying as easy as possible.

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So surely, if they're going to die, we should provide them, at least with what I call anaesthetic palliative care.

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That is anaesthetise them with propofol until they die.

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Or in fact, Charlie even opened an even better door. Since our intention is not to kill them because they're going to die anyway,

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because they refuse, we can give them a lethal dose of morphine because and that's been,

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again, well accepted in the courts, the duty to give pain relief for seeing that you'll kill the patient when your intention is truly suffering.

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So if people can refuse medical treatment and I think Charlie should agree with that,

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because otherwise he's really radically rewriting medical ethics,

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then those people are entitled to at least anaesthetic sedation and I would argue active euthanasia to facilitate their death.

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So here we have we've started with an uncontroversial premise what refuse medical treatment, and we've already accepted one class of euthanasia.

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In fact, he raised this spectre of tying organ donation to euthanasia.

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There's one seat in front of me. In fact, I've embraced this with the paper with Dominique Wilkins.

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We argue for this proposal called organ retrieval euthanasia.

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We argue that people in advance should be entitled to express express a preference that

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if their treatment will be withdrawn on the grounds of futility or poor prognosis.

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Instead of them being allowed to die over a period of time, that ruins their organs.

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They should be allowed to say, I want to be taken to theatre and my organs be taken while I'm still alive.

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And those organs can be used so in advance they could express the wish for what's called what we call organ retrieval euthanasia.

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So the timing of organs to to euthanasia is not necessarily something that we should feel.

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Okay. Now, I try to argue that people who believe in the right to refuse medical treatment should and should accept certain instances of euthanasia.

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I'm going to say that that's even broader.

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It's a recent case of Tony Nicklinson, a man who suffered a stroke at the age of 51 and was left in locked in syndrome.

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He was fully conscious but unable to move any part of his body, except I think he could blink.

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He died at the age of 58, having refused nutrition and hydration and antibiotics,

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having lost a court battle to give his doctor immunity if the doctor assisted suicide.

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So this went to court and the court said, this is not something we can decide.

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This is something for parliament to decide. Very soon after he died, what did he die of?

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He died because he had refused to eat any further medical treatment, but he had refused to eat.

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Now everyone has the basic human right to refuse to eat.

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I don't think Charlie is going to say that we should be force feeding people who

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refuse to eat and they should have the right to refuse to eat in the future.

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So if somebody says, you know, if this happens to me, why don't I refuse to be fed?

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In fact, in the bland case, the feeding was judged to be a medical treatment.

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But we don't need to go that far because we can simply base the argument on everyone's common human right to refuse to eat or drink.

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Now, if somebody is refused to eat, they will inevitably die.

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And if they will inevitably die in this manner, they will inevitably suffer.

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So they have an intolerable on the grounds of beneficence or compassion to alleviate that suffering as they're dying again.

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They're entitled to at least anaesthetic, palliative care to be anaesthetise during the dying process of their starvation.

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And I'm sure Tony Nicklinson wasn't allowed to remain fully conscious as he died.

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He died very quickly after the court case. Or, in fact, we can employ his wonderful intention, foresight, distinction,

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and say our intention is to give him a high dose of morphine for saying that [INAUDIBLE] die.

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But our intention is to relieve pain.

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So, in fact, all of us have a de facto right to a certain kind of euthanasia in virtue of being able to make decisions about what goes in our mouth.

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So unless you are prepared to say that Nicklinson should have been force fed against his will,

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then all of us can in fact accept a form of euthanasia through our right to refuse medical, through our right to refuse food and thoughts.

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So, for example, I can say now, if in the future I'm incontinent or if in the future I can't recognise the people around me,

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or if in the future I don't know who who I am, I refused permission for you to feed me in those circumstances.

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Okay. I also refuse antibiotics and artificial ventilation CPR, but I refuse to be fed.

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In my view, that should be a legally binding directive.

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And at that point, people should be given either, as I said, anaesthetic,

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palliative care or a lethal injection under the intention feels like distinction.

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Okay. So, so I think starting from very simple premises other about the right to refuse medical treatment or the right to refuse food,

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we can go quite a long way to allowing people to access control over their dying.

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The third point, and then I'll finish, is I share what I suspect.

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Charlie has over a vast range of scepticism, over a vast range of medical decisions, decisions that are made about quality of life.

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Now, in many cases, medical treatment is stopped or withheld on one of two grounds.

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Not that the person's refused it because they didn't express any desires in their unconscious now,

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but on the grounds of futility, that is, it won't work.

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There's no chance of survival, but not in Tony Bland's case.

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He could have been kept alive for another ten years or.

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On the grounds of quality of life, that the quality of life is so poor that their life is no longer worth living.

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But now that won't apply to Tony Blair either, because he had no quality of life.

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He didn't have a negative quality of life. And the claim was not that continued living was against his interests.

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It was it wasn't it wasn't a violation of his interests to stop treatment.

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So both of these grounds are often, I think, spuriously employed and he's he's a good example of it.

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There was a famous case, I'm not sure if I mentioned this last night, so cut me off.

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If I'm going round in circles of Jamie Bone in the 1990s, a young girl who had leukaemia that was treated with bone marrow transplant it.

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The bone marrow transplant failed,

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the leukaemia returned and her father went to Cambridge Health Authority in Huntington in the Health Authority and said,

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I want you to try another bone marrow transplant. And the authorities said it's not in her interests to have another transplant.

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You often hear this and it's not in her interests. It will cause pain and suffering, you know, infection.

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And it's only got I can't remember when it was five or 10% chance of inducing a remission.

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And he said, well, I disagree. I think it is in our interests.

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I said, No, no, no, it's not in their interest, so I'm taking you to court.

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So he went to court and as soon as he got to court, the health authorities argument shifted.

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They didn't say it was against her interests any longer. They said it's not a fair distribution of scarce health care resources.

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Okay. And in fact, the first judge said you can't just say that.

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You have to show why it is you can't afford this treatment. But in fact, when it went to the highest court,

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the judgement was effectively in a utilitarian judgement that said scarce health care

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resources have to be distributed to bring the greatest good to the greatest number.

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And they endorsed the health authority's decision to not provide her care.

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But again, MAXINE and I were involved in this discussion about people who request treatment to continue for their children in intensive care,

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Great Ormond Street, while they wait for a miracle. And the doctors believe it's not in the interests of the child to continue treatment.

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Okay. Now, Steve Clarke made the point that it's bizarre to claim that they should know when a miracle is going to occur.

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That child could be brought back from the dead years later if God really wanted to perform a miracle.

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So that that doesn't seem to be a strong ground. But it's also true, I think, that in many of these cases, it's not at all clear,

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having worked in the in this area for many years, that it is against the child's interest to die at that point.

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What is really going on is, Charlie said, is the elephant in the room of distributive justice that people are making decisions that to

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continue to to spend large amounts of resources on this person where the quality of life will be.

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If positive, very minimally positive, and the life will be very poor, then those resources should be spent elsewhere.

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And I think that's a very valid judgement to make. But it's a distributive justice judgement.

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It's not a judgement about futility, it's not a judgement about quality of life.

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And we're Charlie and I, I think would disagree is I think you have to make those judgements on value of life grounds.

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It's not as if everyone is equal in this regard.

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Some lives are better than others and that's how we should distribute our resources.

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So the reason that it's legitimate to withdraw medical treatment from severely disabled neonates or severely

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disabled adults is because those lives are going to be so bad now that I think we will disagree about it.

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But both of us are united on the ground that distributive justice can be can be a reasonable ground for euthanasia.

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So we can agree, first of all,

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that competent people should have access to either euthanasia or anaesthetic palliative care if they refuse to wait in advance or contemporaneously.

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And we can agree that incompetent people can have treatment withdrawn or that euthanasia administered on distributive justice grounds.

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So in fact, there's much more agreement than you would think initially between Charlie and I,

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at least on the premises, as I understand it now, he raises many objections and these are familiar objections.

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I don't want to turn this into a standard debate around nutrition, but I would say something about the vulnerable.

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Okay. You often hear this this concern about, you know, the vulnerable will will suffer.

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And that's a reason for for not allowing euthanasia.

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But as Charlie just said, active euthanasia is equivalent to passive euthanasia.

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And passive euthanasia is vastly more common even in the Netherlands and Switzerland in active euthanasia.

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So if your concern was exploitation of the vulnerable,

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then you better be concerned already about exploitation of the vulnerable in terms of people's not have.

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Not having the medical care or having the medical care withdrawn inappropriately.

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And as I said, there's no evidence from the Holland, a very civilised country of any of the predicted abuses and so on of euthanasia.

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And the fact that people people request to die when they're tired of life hardly seems to me to be an overwhelming objection.

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There was a there was a a famous philosopher called Michael Bailes, who who always said,

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I'm going to commit suicide at 50 and I don't want to live any longer than 50.

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I'm 40, nearly 49. I find this prospect shocking.

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But he started to wind up all these projects and in all his writing and commitments to inactive decay committed suicide.

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Now people live their lives differently. I wouldn't do that.

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But it hardly seems to me this is the reductio ad absurdum of allowing people to control over their dying God.

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Let me finish there and I wish this.