It is as well that the deliberations of an Edinburgh court, which recently gave permission for feeding and breathing tubes to be removed from a woman who had been in a persistent vegetative state for four years, did not come under the scrutiny of Peter Singer. His latest work, Rethinking Life and Death, begins with a catalogue of such cases, arguments and adjudications and his neat, philosophical fingers dissect the contradictions and ambiguities that bedevil our every attempt to say what it is we are doing and why we ought or ought not do it.

It is a work that promises to be deeply controversial and even shocking and, in part, it certainly is. It may cause some card-carying donors a degree of unease to realise that, under an increasing number of legal systems, a pink, warm, supple, breathing body can be pronounced dead, particularly in the context of a medical ward waiting to remove organs for transplant. It will certainly shock many a layman to learn that babies born with no brain can be, and sometimes are kept alive indefinitely without there being even the faintest hope that they might achieve consciousness. But it is not the enormity of the situations which Singer so graphically describes that is intended to shock. That is reserved for the ethical rather than the medical analysis.

Singer's central thesis is that we are unable to progress the debate coherently because we are lumbered with a worn-out traditional ethic which posits as central the concept of the sanctity of life. "Brain death", as Singer remarks, is a queer concept, used only in relation to human beings and one that medical personnel, let alone undertakers, do not actually believe in themselves. But it fulfils a need. Better say that this person is already dead than face the real issue that modern medical techniques present; that where once we were able to think in terms of lives lived, pleasantly or painfully, happily or unhappily, we must now think in terms of some lives unlived and unlivable.

We should recognise, Singer says, that not all lives are of equal worth and it is the recognition of this fact, rather than convoluted attempts to redefine death, that will enable us to move to a new ethic based on compassion and common sense which will allow us to take organs from a living being or intentionally bring about the death of another in clearly defined cases such as anencephaly or persistent vegetative state.

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Of course, such an analysis depends upon the force of the concept of the sanctity of life. If you mean, as Singer takes you to mean, that there are no justifications ever for failing to prolong a life to its utmost limits using all the mechanical and chemical means at your disposal, then it is not difficult to show cases where such action is clearly cruel or pointless. But if you mean to convey that in our painful searchings for a just, humane and compassionate response to the possibilities that medical science now offers, we must never think of others, even anencephalic babies, as mere commodities, then that is another matter. To terminate the life of another, even when we are sure we are perfectly right to do so, can and does provoke our deepest moral anxieties. That it does so is not an indication of our need for ethical cleansing but a way of remaining human in a sometimes inhuman world.

Judith Hughes is director, The Derwent Initiative, Newcastle, and a director of the Newcastle Centre for Applied Philosophy.

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