Before getting to the topic of euthanasia. However, let me briefly talk about religious secular exchange more generally.
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,
in America we have both robust religious and robust secular discourses and we both try to work things out in our public spheres.
I come to these discussions specifically as a Christian ethicists, Catholic ethicist,
who wants to speak on some of the most controversial issues in bioethics and ethics more generally.
Some of my colleagues are very pessimistic about the possibility of such interaction.
And with good reason, we are now more polarised in the United States than at any time since our civil war.
And divides between secular and religious folks play a large part in this polarisation.
But I'm actually more hopeful than many about this, especially given my recent interactions with Peter Singer, who helped teach Julian.
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.
Last year he came to my own doctoral bioethics seminar at Fordham and came to dinner with some of us afterwards.
We planned a major international conference together at Princeton, trying to find new ways to think and speak about abortion.
And next month, he will join a panel a panel at Fordham that I'm putting together,
which puts him in conversation with a diverse group of Christian theologians to think
differently about non-human animals on the basis of these and other experiences.
I want to argue that religious and secular discourse, something that is the overview of these two debates,
can go much, much better if the following three things can happen.
First, religious folks need to acknowledge the critique that often comes from secular folks,
that our arguments rest on first principles for which we do not have arguments.
They simply grab or claim us by some kind of authority.
They're based on faith. Second, secular folks need to acknowledge the critique that often comes from theologians,
that their arguments also rest on first principles for which they do not have arguments.
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,
or the supreme libertarian doctrine of personal freedom and autonomy,
or even general claims about our capacity to recognise flourishing and well-being.
These ideas come from a fundamental understanding of the good for which there simply cannot be arguments.
They come from a narrative, a story, an intuition or other, a play or a commitment.
In short, they are also based on faith.
Third, armed with the knowledge that both religious and secular folks have faith based understandings of the good,
we need to take the time in intellectual solidarity with each other to map all the places where we agree and where we disagree.
We will often find, I believe, that the agreement is quite substantial,
in particular because even in the secular West I would argue that our understandings of the good are totally,
totally free, strong, significantly indebted to the Abrahamic religions.
This is especially promising methodology in my view anyway, when we can work to find similar ways to talk about flourishing and well-being.
And Julie and I are working on a paper they were trying to write together at the moment.
We're going to get together on Monday to talk about to try to do precisely this.
At any rate,
I found precisely the kind of substantial agreement I just talked about in my systematic exploration of Peter Singer and Christian ethics.
In some ways, it is sad that the series will be focusing only on abortion and euthanasia,
because even though there is broad overlap in the premises of arguments with regard to these issues,
and the ultimate conclusions are of course quite different. But on ethical issues like concern for non-human animals and poverty, for instance,
the striking overlap is both with regard to premises and with regard to conclusions.
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.
Abortion is the bowling ball on the mattress of bioethics.
This American idiom is difficult to understand unless you watch American television commercials for mattresses.
But the basic idea is that our abortion discourse is a muddled mess that prohibits productive discussion against other of other bioethical issues.
This, I would argue, is especially true of euthanasia and of end of life issues in several ways.
People on multiple sides of the abortion debate, some of which we talked about last night,
bring their more fundamental views about abortion into the euthanasia debate.
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.
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.
And I hope I can use my remarks to help unpack some of that confusion or what I see to be that confusion.
In my bioethics courses, I divide the readings that I give my students into three different families of issues general issues,
moral status and value for one to killing and treatment.
And three, moving from moral claims to prudential judgement judgements about public policy.
My experience is that many, if not most, of the problems that are euthanasia discourse come from confusion about which
of these three issues has priority or even which is under discussion at all.
Often we talk past each other, talking about one but not the other.
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.
So moral status and value. That's the foundational set of claims that sets up everything else, it seems to me.
If the patient we are considering is not a person of being with intrinsic value and a right to life,
then discussions about reasons why we may or may not aim at her death will be very
different from discussions in which we claim that she is considered to be a person.
Right. And here the discussion from last night about abortion does loom large.
And part of the reason why the abortion debate has infected the euthanasia debate in my own view.
Again, building off the discussion last night,
all beings which have a rational nature count as persons and accidental traits which limit their ability to express their rational nature.
Do not change this moral status at all. Examples of such such accidental traits include immaturity.
In the case of embryos, foetuses and infants intoxication, temporary unconsciousness, mental illness, disability or injury.
Such states of affairs do not change the kinds of things that persons are, not change their persistence through time or personal identity.
They are not what I referred to last night. These are not what I referred to last night as nature changing events.
Therefore, when we consider classic cases at the end of life like persistent vegetative state or persistent unconscious state,
I prefer deep and long term coma and even brain death.
These patients should all count as persons since they have rational natures.
They remain living though damaged beings who have all the inherent active potential to be rational and relational.
Rational and relational are coterminous in a lot of Catholic tradition, and it is merely first, they are merely frustrated.
This potential is merely frustrated by an injury or a disease.
If we think that non-rational human beings like those who are asleep, temporarily comatose,
etc. count as persons, then we should consider these individuals, these patients to be persons as well.
And for the same reason.
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,
I think that we'll hear is a judgement against the current medical consensus around brain death.
We tell ourselves, in my view, and I think Julian's view though again I'll let him speak for himself,
that we tell ourselves a medical fiction, that a living, breathing, pulsing, human being with homeostasis is dead.
But what we really mean is that there is a difference between a living, pulsating, breathing, human being and a person.
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.
Perhaps even without realising it, in my view. So I think both Julian,
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.
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.
But even if one thinks that all these patients are persons,
there are still really interesting and important questions to ask about whether it would ever be legitimate to aim at their death.
After all, we allow killing of persons for all sorts of reasons, including in certain circumstances, without their consent.
Now I come out of a tradition, the Catholic tradition, which brings a pretty solid, decent,
logical principle to this debate, namely that it is always wrong to aim at the death of an innocent person.
This comes directly from the claim that the lives of persons have intrinsic non instrumental value,
such that it is never accepted to radically reduce that value to some other end, especially the killing.
Though this might seem like a conversation stopper when it comes to dialogue, for those who do not share this principle,
there are two important possible areas of overlap to mention and possibly explore in greater depth.
First, to pay attention to the language I'm using aiming at death.
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.
Here, of course, we have broad agreement. The Catholic prohibition is against aiming at death of an innocent person.
This explicitly includes both acts and omissions. The example I do use of my students is my bathtub example.
So imagine a scenario where this really bad husband wants to kill his wife for the life insurance money and.
She's taking a bath, right? And he walks in with the toaster ready to drop it in the water.
But to his horrific delight, he realises that she's drowning already in the bathtub.
Right. And just he could easily save her, but he lets her die because he wants her dead right for the life insurance money.
Is that any different than if you actually drop a toaster of water?
From the Catholic perspective and I think from doing respect that there's no difference at all is aiming at death in both circumstances.
Whether it happens by action or omission is not of consequence morally.
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,
that we make this distinction, but we then we disagree about which way to resolve it, which way to reason to resolve it.
So I think Gillian's going to want to say that whether we aim at death actively or whether we aim at that passively,
there are circumstances where that should be done, even if it's an innocent person.
I'm going to say we should refrain from both, whether it's active or passive.
That would. But at least we agree on the coherency, which is no small thing.
The second area of overlap involves the church's tradition on refusing life sustaining treatment.
As many of you know, the church did a lot of thinking about this in the Middle Ages, especially with regard to battlefield medicine,
and eventually came up with a distinction between ordinary and extraordinary treatment,
which I think is still operative in our secular medicine today in the West.
We can talk about that if you like, but one of the first questions that was asked was, well, suicide is always wrong.
Killing innocent person, including suicide is always wrong.
What about battlefield soldiers who don't want their legs cut off in order to save their life if they refuse the amputation?
Are they in fact committing suicide or they're aiming at their own death?
And the answer from Catholic moral theology was not that they did not that they did not,
because as long as they were aiming at death and death was merely a foreseen but unintended consequence,
and they had a proportionate reason, like the really intense pain of having your leg cut off without pain medicine,
that that would have been acceptable. And over the centuries,
lots of different kinds of proportionate reasons have been given as reasons that would be acceptable for refusing life sustaining treatment.
Pain was obviously one given that example, but even the expense and burden on family or affected others is in the tradition,
which I think explicitly includes distributive justice. That was what my first book was on,
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.
And interestingly, at least to me, I think we could also largely agree that in certain circumstances,
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.
I would just insist that the reason the pain medication would be given would be with the intention to control pain.
And the death was merely foreseen but not intended.
While Julian would, of course, I think, just not insist on that,
but at least at the very level of public policy, we would admit that this is a legitimate thing to do.
I would just insist on different intentions and divining intention and public policy is a very complicated thing.
But anyway, I think that's another thing we could talk about might be interesting.
But let me lastly talk about public policy and think about public policy specifically.
So even if one objects to the claim that every living human being is a person with a right to life,
and even if one rejects the claim that it is always wrong to aim at the death of an innocent person,
there are still questions to ask about the unintended consequences of putting any of this into a public policy.
As was mentioned last night, Julie and I are trying and just now I guess I put it in here.
Julie and I are trying to write a paper together on how a common focus on a focus on flourishing and well-being
might bridge gaps between us and between second and religious discussions or general discourses more generally.
So let me propose an important question, which I think is important.
Question What does a culture look like that has euthanasia as a broadly available option?
Is this a flourishing culture? We could ask this about the medical culture specifically, which is the whole set of questions in itself.
Or we could ask it about R and or we could ask it about our culture at large.
My friends who are social ethicists are generally sceptical of merely focusing on the autonomous choice of individuals
in which to dig deeper and think harder about the social structures underneath that might coerce such choices.
We saw last night with the proposition of pro-life feminists that they are sceptical of a focus on autonomous choice for abortion,
arguing that given the social structures that still work against women,
abortion choice actually ends up coercing and harming women in powerful ways, many social ethicists reasoned in a similar way about euthanasia.
We have social. Structures in the West,
driven by a vigorous market economy and pushed several kinds of vulnerable populations to the margins as a result of these social structures.
This is especially true of those who are old or injured or disabled,
such they can no longer contribute capital and youth to our culture in the proper ways.
Given that these vulnerable populations are already pushed to the margins and feel unwelcome in our culture,
what unintended consequences might there be in giving them the right to kill themselves?
Some answers to this question would involve something like reasonable speculation about what might happen, but some answers are just simply empirical.
The Netherlands, for instance, has been considering a measure to allow euthanasia for those who are simply tired of life.
No pretence about medical need at all.
Switzerland, as you may know, has a group called Dignitas that is now charging a fee for what is essentially euthanasia, euthanasia, tourism.
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,
I had dinner with a few of the people who were players in the euthanasia debate there.
It was legalised in 2002, but despite warnings from some of the people I was talking with,
it took only six years for euthanasia to be connected to organ donation and given organ shortages.
The practice gives Belgian society an explicit stake in the deaths of people with seriously disabling, disabling or terminal conditions.
And if we consider that these people are often the most expensive for whom to care,
especially in light of the acute medical resource shortages we face,
there is the potential for a perfect storm of considerations which demonstrate that the supposed free choice to kill oneself is
actually manipulated and even coerced by a host of social factors operating beneath the surface of so-called patient autonomy.
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.
But in concluding, let me make two broad points and sort of back up.
So while we may not get broad agreement on some of the principles involved in these debates,
even simply cutting through the confusion to see where we disagree, I think is of significant value for the discourse and just in general.
But then I think we can even push our culture to be more together.
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.
I think this is especially true when it comes to brain death and aiming at death by action or omission.
Another opening for conversation again involves the effects of various euthanasia public policies on the flourishing of our communities.
Last night I asked the question, Whatever you think of abortion as an individual moral issue in itself,
what do you think of a culture that has, you know, millions of abortions done for any reason at all?
Can we have a productive argument about whether this is good for the flourishing of women in our broader culture?
Today, I want to ask a similar question about euthanasia. Whatever you think of euthanasia as an individual moral issue in itself.
What do you think of a culture that gives the free choice for marginalised populations to kill themselves?
Can we have a productive arguing about whether this is good for the flourishing of the sick and elderly in our broader culture?
Thanks, Charlie. So just in answer to that, I quite like Holland in Switzerland.
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.
But that's not my main point.
I want to start by saying what I said last night is many of my best friends are Christians and actually practising Christians.
So so I am actually deeply committed to this project of engagement.
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,
which I've seen a lot of in in the years in this sort of area.
And so in that spirit, I've actually written a new paper,
and this is in the paper I would give defending euthanasia, because I'm not going to talk about moral status.
The traditional arguments that are given for for euthanasia are two fold.
One is based on personal autonomy that we have the right to determine our own lives, including when we die.
And and so this grounds voluntary euthanasia and an an argument based on beneficence that some lives involve
such degrees of suffering or such poor quality that it's better to no longer go on and live on these grounds,
on voluntary euthanasia. And I'm not going to give either of those arguments and I'm not going to challenge
Charlie's claims about or directly challenge all these kinds of moral states.
I take the spirit of this debate to be to find common premises that we can agree on.
So there are going to be things that we just can't agree on.
And I made some comments about Charlie's reference to both secular and religious ethics being based on faith,
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.
So I'm not going to talk about moral sites. For what it's worth.
I think that people with advanced brain damage, there's dementia, permanent unconsciousness, lack moral status.
But my argument isn't going to depend on that. And I agree with Charlie that I think brain death is a fiction.
It's a fiction invented to to harvest organs.
And the more relevant moral point is some serious loss of of sophisticated or rich consciousness that separates humans rather than non-human animals.
But leave aside all that.
What he did draw attention to is this very important agreement about the moral equivalence of what's called active and passive euthanasia.
Active euthanasia is the administration of or the direct lethal act that that kills a person, typically a lethal injection.
Passive euthanasia is the withdrawal, the withholding of medical treatment, life prolonging medical treatment that keeps somebody alive.
The omission to do something to to to keep somebody alive.
Now,
there is an interesting category of medical treatment that is routinely employed that falls between these two cases of active and passive euthanasia.
And that's the act of withdrawing life, prolonging medical treatment.
Now, here we face the first hypocrisy.
If society, if I snuck into the John Ratcliffe Hospital now and disconnected somebody's ventilator,
I would be guilty of murder because the act that I did stopping the ventilator killed the patient.
If I snuck into the neonatal intensive care unit and withdrew the feeding tube and substituted some inert substance for the feed,
and that baby died of starvation. I would be guilty of murder.
If a mother failed to feed her child, that would, if not be murder, a serious criminal offence.
But when doctors do that, it's not classified as murder.
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.
And I think around 1996, after he'd been unconscious for many years, his brain had turned to mush.
There was no hope. It was sad of any sort of meaningful recovery.
His family wanted his artificial feeding to stop, and doctors were concerned that by actively stopping his feeding, they would be charged with murder.
So they they took it to the to the to the highest court in the land.
And inevitably, eventually,
the decision was that Tony Bland had no interests and it was not against his interests to stop feeding in this circumstance.
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.
It was no mission to act because if it was an act, it would be murder.
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.
If I do it. It's called the mission, which is an absolute tribute to the to the hypocrisy, the moral hypocrisy of people.
So I completely agree with Charlie. Those those acts or omissions are morally equivalent.
So it's important to recognise that already a form of euthanasia, withdrawal of treatment, withdrawal of feeding in neonates,
withdrawal of feeding for people with dementia, withdrawal of insulation from people in intensive care is routinely practice.
It is part of routine medical practice.
So euthanasia, what I would actually classify as active euthanasia is already a part of accepted medical practice.
As Charlie mentioned, there's one see here if you want. As Shelley also mentioned, we do sanction the killing of innocent people.
And I mentioned this case last night, but I mention it again,
the case of conjoined twins such as the Jodie and Mary pair in Manchester a few years ago.
One of them, Mary, the so-called weaker twin who was inevitably going to die but could threaten the life of the healthy twin.
Jodie was killed. And in fact, one of the justices said this was murder, but it was judged to be justifiable murder.
So the first point I'll make is that the society that we live in, the medical practices and the law,
are already based only on an acceptance of certain kinds of intentional killing.
Okay, now, now I want to sort of soften you up a bit.
I want to move on to the more productive part. Now, Charlie and I both agree that active and passive euthanasia are morally equivalent.
So now I'm going to start with some things that I think we can agree on,
a very well trodden principle that you, in fact articulated with this battle battlefield example.
People have the right to refuse medical treatment, even lifesaving medical treatment.
Jehovah's Witnesses can refuse a blood transfusion because they believe if they refuse a blood transfusion, they'll go to heaven.
And if they accept somebody else's but or even their own blood, when it's left their body,
they'll turn to dust that's well regarded as a right that people have.
So people had to refuse treatment now and in advance.
A Jehovah's Witness can write an advance directive or a living will saying I refuse a blood transfusion,
whatever the circumstances, if I'm going to die. And that has the force of law.
People have the right to refuse medical treatment in advance with the implication that they'll die.
Now, if they're going to die, they're inevitably going to die because they're refused medical treatment.
But surely it's compassionate or benevolent to make that dying as easy as possible.
So surely, if they're going to die, we should provide them, at least with what I call anaesthetic palliative care.
That is anaesthetise them with propofol until they die.
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,
because they refuse, we can give them a lethal dose of morphine because and that's been,
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.
So if people can refuse medical treatment and I think Charlie should agree with that,
because otherwise he's really radically rewriting medical ethics,
then those people are entitled to at least anaesthetic sedation and I would argue active euthanasia to facilitate their death.
So here we have we've started with an uncontroversial premise what refuse medical treatment, and we've already accepted one class of euthanasia.
In fact, he raised this spectre of tying organ donation to euthanasia.
There's one seat in front of me. In fact, I've embraced this with the paper with Dominique Wilkins.
We argue for this proposal called organ retrieval euthanasia.
We argue that people in advance should be entitled to express express a preference that
if their treatment will be withdrawn on the grounds of futility or poor prognosis.
Instead of them being allowed to die over a period of time, that ruins their organs.
They should be allowed to say, I want to be taken to theatre and my organs be taken while I'm still alive.
And those organs can be used so in advance they could express the wish for what's called what we call organ retrieval euthanasia.
So the timing of organs to to euthanasia is not necessarily something that we should feel.
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.
I'm going to say that that's even broader.
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.
He was fully conscious but unable to move any part of his body, except I think he could blink.
He died at the age of 58, having refused nutrition and hydration and antibiotics,
having lost a court battle to give his doctor immunity if the doctor assisted suicide.
So this went to court and the court said, this is not something we can decide.
This is something for parliament to decide. Very soon after he died, what did he die of?
He died because he had refused to eat any further medical treatment, but he had refused to eat.
Now everyone has the basic human right to refuse to eat.
I don't think Charlie is going to say that we should be force feeding people who
refuse to eat and they should have the right to refuse to eat in the future.
So if somebody says, you know, if this happens to me, why don't I refuse to be fed?
In fact, in the bland case, the feeding was judged to be a medical treatment.
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.
Now, if somebody is refused to eat, they will inevitably die.
And if they will inevitably die in this manner, they will inevitably suffer.
So they have an intolerable on the grounds of beneficence or compassion to alleviate that suffering as they're dying again.
They're entitled to at least anaesthetic, palliative care to be anaesthetise during the dying process of their starvation.
And I'm sure Tony Nicklinson wasn't allowed to remain fully conscious as he died.
He died very quickly after the court case. Or, in fact, we can employ his wonderful intention, foresight, distinction,
and say our intention is to give him a high dose of morphine for saying that [INAUDIBLE] die.
But our intention is to relieve pain.
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.
So unless you are prepared to say that Nicklinson should have been force fed against his will,
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.
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,
or if in the future I don't know who who I am, I refused permission for you to feed me in those circumstances.
Okay. I also refuse antibiotics and artificial ventilation CPR, but I refuse to be fed.
In my view, that should be a legally binding directive.
And at that point, people should be given either, as I said, anaesthetic,
palliative care or a lethal injection under the intention feels like distinction.
Okay. So, so I think starting from very simple premises other about the right to refuse medical treatment or the right to refuse food,
we can go quite a long way to allowing people to access control over their dying.
The third point, and then I'll finish, is I share what I suspect.
Charlie has over a vast range of scepticism, over a vast range of medical decisions, decisions that are made about quality of life.
Now, in many cases, medical treatment is stopped or withheld on one of two grounds.
Not that the person's refused it because they didn't express any desires in their unconscious now,
but on the grounds of futility, that is, it won't work.
There's no chance of survival, but not in Tony Bland's case.
He could have been kept alive for another ten years or.
On the grounds of quality of life, that the quality of life is so poor that their life is no longer worth living.
But now that won't apply to Tony Blair either, because he had no quality of life.
He didn't have a negative quality of life. And the claim was not that continued living was against his interests.
It was it wasn't it wasn't a violation of his interests to stop treatment.
So both of these grounds are often, I think, spuriously employed and he's he's a good example of it.
There was a famous case, I'm not sure if I mentioned this last night, so cut me off.
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.
The bone marrow transplant failed,
the leukaemia returned and her father went to Cambridge Health Authority in Huntington in the Health Authority and said,
I want you to try another bone marrow transplant. And the authorities said it's not in her interests to have another transplant.
You often hear this and it's not in her interests. It will cause pain and suffering, you know, infection.
And it's only got I can't remember when it was five or 10% chance of inducing a remission.
And he said, well, I disagree. I think it is in our interests.
I said, No, no, no, it's not in their interest, so I'm taking you to court.
So he went to court and as soon as he got to court, the health authorities argument shifted.
They didn't say it was against her interests any longer. They said it's not a fair distribution of scarce health care resources.
Okay. And in fact, the first judge said you can't just say that.
You have to show why it is you can't afford this treatment. But in fact, when it went to the highest court,
the judgement was effectively in a utilitarian judgement that said scarce health care
resources have to be distributed to bring the greatest good to the greatest number.
And they endorsed the health authority's decision to not provide her care.
But again, MAXINE and I were involved in this discussion about people who request treatment to continue for their children in intensive care,
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.
Okay. Now, Steve Clarke made the point that it's bizarre to claim that they should know when a miracle is going to occur.
That child could be brought back from the dead years later if God really wanted to perform a miracle.
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,
having worked in the in this area for many years, that it is against the child's interest to die at that point.
What is really going on is, Charlie said, is the elephant in the room of distributive justice that people are making decisions that to
continue to to spend large amounts of resources on this person where the quality of life will be.
If positive, very minimally positive, and the life will be very poor, then those resources should be spent elsewhere.
And I think that's a very valid judgement to make. But it's a distributive justice judgement.
It's not a judgement about futility, it's not a judgement about quality of life.
And we're Charlie and I, I think would disagree is I think you have to make those judgements on value of life grounds.
It's not as if everyone is equal in this regard.
Some lives are better than others and that's how we should distribute our resources.
So the reason that it's legitimate to withdraw medical treatment from severely disabled neonates or severely
disabled adults is because those lives are going to be so bad now that I think we will disagree about it.
But both of us are united on the ground that distributive justice can be can be a reasonable ground for euthanasia.
So we can agree, first of all,
that competent people should have access to either euthanasia or anaesthetic palliative care if they refuse to wait in advance or contemporaneously.
And we can agree that incompetent people can have treatment withdrawn or that euthanasia administered on distributive justice grounds.
So in fact, there's much more agreement than you would think initially between Charlie and I,
at least on the premises, as I understand it now, he raises many objections and these are familiar objections.
I don't want to turn this into a standard debate around nutrition, but I would say something about the vulnerable.
Okay. You often hear this this concern about, you know, the vulnerable will will suffer.
And that's a reason for for not allowing euthanasia.
But as Charlie just said, active euthanasia is equivalent to passive euthanasia.
And passive euthanasia is vastly more common even in the Netherlands and Switzerland in active euthanasia.
So if your concern was exploitation of the vulnerable,
then you better be concerned already about exploitation of the vulnerable in terms of people's not have.
Not having the medical care or having the medical care withdrawn inappropriately.
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.
And the fact that people people request to die when they're tired of life hardly seems to me to be an overwhelming objection.
There was a there was a a famous philosopher called Michael Bailes, who who always said,
I'm going to commit suicide at 50 and I don't want to live any longer than 50.
I'm 40, nearly 49. I find this prospect shocking.
But he started to wind up all these projects and in all his writing and commitments to inactive decay committed suicide.
Now people live their lives differently. I wouldn't do that.
But it hardly seems to me this is the reductio ad absurdum of allowing people to control over their dying God.
Let me finish there and I wish this.