This article appears in the November 2002 edition of the Catholic Medical Quarterly
Where Has the Sanctity of Life Gone?
The debates on whether the provision of nutrition and fluids is treatment or basic care and whether treatment that is futile or burdensome can be withdrawn has tended to neglect the principle of the sanctity of life. Clinical and legal arguments have replaced fundamental belief. Perhaps the term with its connotation of holiness is too much for the non-believer: for them the 'inviolability of human life might be preferred. Whichever term is used it should be remembered that a prohibition on intentional killing is central to that pre-Christian fount of medical ethics, the Hippocratic Oath, and its reaffirmation in the Declaration of Geneva. Even Lord Goff noted in Bland that the sanctity principle has long been recognised in most if not all civilised societies in the modern world. Article 2 of the European Convention for example provides:
Everyone's right to life shall be protected by law. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which this penalty is provided by law.
Thus intentional killing is murder. Although human life is a basic good, it is not the highest good. The core of our doctrine is the principle prohibiting intentional killing, not an injunction requiring the preservation of life at all costs.
In this country our law has been promulgated by the Bland Judgement which neatly sidestepped the 'inviolability of human life' with its possible charge of murder. It did so by stating that the withdrawal of nutrition and fluid was not a positive act but an act of omission. Withdrawal was no different from withholding it in the first place; the doctor is simply allowing the patient to die as a result of his preexisting condition. This is the legal basis now adopted by our judges.
But the Law Lords in the Bland case were confused. Three of them had no doubt that the purpose of discontinuing the feeding was to cause the death of Tony Bland. The other two adopted a neutral stance. We are left with a remarkable piece of legal juggling. It was compounded by the judges passing the buck to the medical profession, referring to what they called the 'overwhelming evidence' in the medical profession that tube feeding is regarded as 'medical treatment' that could be withdrawn when regarded as futile. It was not in the patient s 'best interests'. For good measure they threw in the Bolam Test, an act promoting accordance with the views of a responsible body of medical opinion.
So the debate ignored the sanctity of life. We are left with what is now seen as a 'the culture of death'. In fact what we have in the world of the liberal theorists is 'choices for death' as is evidenced from a book by the eminent Professor Dworkin, Life's Dominion (1) with its opening sentence 'Abortion, which means killing a human embryo, and euthanasia which means killing a person out of kindness, are both choices for death'. What he attempts to portray is that the lives of very young and very old or infirm human beings are not valuable in a way which makes it wrong to kill them or makes it right for the law to protect them against being killed. Underlying this concept is his belief in a dualistic understanding of the human being as a non-bodily person (that is, the self-aware, conscious, and desiring 'self' ) who inhabits and uses as a mere instrument a non-personal body. The notion entails that human beings comprise two separate entities: a body and a person. Sir Stephen Brown, for example, referred to Tony Bland as 'his spirit has left him and all that remains is the shell of his body... which is kept functioning as a biological unit' (2) Similarly, Lord Justice Hoffman said 'His body is alive, but he has no life, in the sense that even the most pitifully handicapped but conscious human being has a life'. Bland's existence was, he added, a 'Humiliation': he was 'grotesquely alive' (3), It is interesting that he admitted he had been influenced by reading the manuscript of Professor Dworkin's book Life's Dominion. Such an untenable philosophy was amply repudiated in the Submission to the Select Committee of the House of Lords on Medical Ethics by the Linacre Centre in 1994.
It is important to understand that there is a strategy adopted by Professor Dworkin and others to respond to the general situation of liberalism in our current society, as exposed by Robert George (4). It does not directly attack traditional sanctity of life principles or understandings or cast doubt on their reasonableness or truth. What it does, rather, is to rule out as illegitimate for public policy making these and other principles, their reasonableness and even their truth notwithstanding. It leaves them in place as quite possibly good reasons for certain forms of private action and restraint (such as not having an abortion or taking one's own life), but it excludes them from the class of 'public reasons' that is, reasons justifying the restriction of liberty in certain contexts.
R. Dworkin, Life s Dominion: An argument about Abortion, Euthanasia and individual Freedom. New York: Knopf 1993: 3.
 A.C. 789 at p.804
ibid at p.825
Robert P, George, The Political Theory of the culture of death, in Culture of Life - Culture of Death, p.49, London The Linacre Centre.