Is euthanasia morally permissible, and does a person have a right to choose the time and manner of their death?
Euthanasia: active and passive, voluntary, non-voluntary and involuntary, the acts and omissions distinction and double effect, autonomy and the slippery slope, and sanctity-of-life and quality-of-life arguments.
The ethics of euthanasia in SQA Advanced Higher RMPS Medical Ethics. Covers active and passive, voluntary, non-voluntary and involuntary euthanasia, the acts and omissions distinction and double effect, autonomy and the slippery slope, and sanctity-of-life and quality-of-life arguments, with how to evaluate the debate.
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What this key area is asking
Euthanasia is the second medical issue, and the central battleground between autonomy and quality of life on one side and the sanctity of life on the other. You must understand the types of euthanasia (active and passive; voluntary, non-voluntary and involuntary), the acts and omissions distinction and the doctrine of double effect, the autonomy argument and the slippery slope objection, and the sanctity-of-life and quality-of-life arguments, then evaluate whether euthanasia can be justified.
Types of euthanasia
These distinctions matter because most arguments apply to specific types: the autonomy argument is strongest for voluntary euthanasia, while non-voluntary and involuntary cases raise consent and abuse worries. Confusing the types is a common and costly error.
Acts and omissions, and double effect
Both distinctions try to permit some end-of-life decisions while forbidding deliberate killing. James Rachels famously challenges the acts and omissions distinction: if the outcome (death) and the intention are the same, letting die can be morally equivalent to killing, so the distinction may not carry the weight claimed. Engaging this objection is central to a strong evaluation.
The autonomy and quality-of-life case
Autonomy is a powerful principle because it underpins much of modern medical ethics (consent, refusal of treatment). The argument is strongest for voluntary euthanasia of a competent, suffering patient, and weakest where consent is doubtful.
The sanctity-of-life and slippery-slope case
These objections target both the principle (the sanctity of life) and the practice (the social risks of legalisation). A strong evaluation weighs whether safeguards can contain the slippery slope, and whether autonomy is truly unlimited or can be overridden by non-maleficence.
Worked example
Try this
Q1. What is the difference between voluntary, non-voluntary and involuntary euthanasia? [2 marks]
- Cue. Voluntary is at the competent person's request; non-voluntary is where the person cannot consent (for example a coma); involuntary is against the person's will.
Q2. What is the doctrine of double effect in end-of-life care? [2 marks]
- Cue. That an act with a good intended effect (relieving pain) may be permissible even if it has a foreseen but unintended bad effect (hastening death), provided the bad effect is not the aim or the means.
Exam-style practice questions
Practice questions written in the style of SQA exam questions on this dot point, with worked answer explainers. The year tag is the paper they imitate, not the source.
SQA AH (Medical Ethics)20 marksHow convincing is the argument that respect for autonomy justifies voluntary euthanasia?Show worked answer →
A strong essay sets out the autonomy argument, deploys the counter-arguments, and reaches a judgement.
Explain the argument: a competent person has the right to make decisions about their own life, including, on this view, the time and manner of their death; respecting autonomy and relieving unbearable suffering (a quality-of-life concern) together justify allowing voluntary euthanasia or assisted dying. Then bring in the objections. The sanctity-of-life view holds that intentionally ending an innocent life is always wrong, autonomy notwithstanding, and that life is not ours to dispose of. The slippery slope argues that permitting voluntary euthanasia risks sliding to non-voluntary or involuntary cases and pressure on the vulnerable. Others question how free a choice made under suffering, depression or fear of being a burden really is, limiting genuine autonomy. Evaluate: autonomy is a powerful principle and underpins much of medical ethics, but it is not unlimited, can conflict with non-maleficence, and the slippery-slope and consent worries are weighty. Conclude with a judgement on how convincing the autonomy argument is, perhaps distinguishing voluntary from other forms.
SQA AH (Medical Ethics)12 marksExplain the distinction between active and passive euthanasia, and the acts and omissions doctrine.Show worked answer →
The marks reward accurate definitions and the moral point of the distinction.
Active euthanasia is intentionally ending a life by a deliberate act (for example administering a lethal drug); passive euthanasia is allowing a person to die by withholding or withdrawing treatment. The acts and omissions doctrine holds that there is a moral difference between killing (an act) and letting die (an omission): on this view passive euthanasia, as letting die, may be permissible where active euthanasia, as killing, is not. The doctrine of double effect is related: an act with a good intended effect (relieving pain) may be permissible even if it has a foreseen but unintended bad effect (hastening death), provided the bad effect is not the means or the aim. A full answer explains why some hold the act/omission and intended/foreseen distinctions to be morally significant, and notes the objection (from utilitarians such as Rachels) that if the outcome and intention are the same, the act/omission distinction may not carry the moral weight claimed.
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