Debate: extraordinary means and the sanctity of life.

Ms Kuhse argues against the doctrine of 'the sanctity of life', against the application of acts and omissions doctrine in medical practice, and against the common assumption that there is a crucial moral difference between intentionally discontinuing ordinary medical treatment and intentionally discontinuing extra-ordinary medical treatment. Intentional acts or omissions which shorten life are in practice and must in theory be justified or rejected on the basis of the quality of life concerned, she argues. Such quality of life distinctions are needed in practice but they are logically incompatible with the doctrine of the sanctity of life; and the ordinaryl extraordinary means distinction cannot circumvent this incompatibility. Father Hughes in his conmnentary rejects Ms Kuhse's extretne interpretation of sanctity of life doctrine. He argues that the distinction between acts and omissions is relevant to medical practice and distinguishes between two different senses of 'omission' to support this. He finds Ms Kuhse's reliance on quality of life excessively reductionist and argues that her position seems to commit her to denying any moral difference between intending a death by withholding extraordinary treatment and intending a death by administering a lethal injection. That there is an important moral distinction here is a crucial intuition which supporters of the traditional view wish to maintain, even though 'the difficulty ... is to discover a philosophical means to support it'. While sanctity of life doctrines need development, they express 'a healthy presumption in favour of trying to preserve it'. In a final response Ms Kuhse replies to her commentator. Readers' attention is drawn also to the review by Professor Robin Downie on page 96 of a group of three papers entitled Prolongation of Life published by the Roman Catholic Linacre Centre.