Euthanasia is a highly debated topic. Medical Schools do not steer clear of controversial topics so you can expect to be quizzed on them during your interviews. To help you with the topic, we have explained what it is, outlined some more well-known cases and finished with a few example interview questions and model answers.
What is Euthanasia?
Euthanasia is described as bringing about the death of a person either through action or omission for his or her own sake. It means bringing about a quiet and easy death.
To clarify this further, let’s look at what it means to be dead.
What is the legal definition of death?
The legal definition of death is brain stem death as the person is said to have stopped being alive in anything but a mechanical sense. According to the Department of Health’s A Code of Practice for the Diagnosis of Brain Stem Death (1998), in order for a doctor to diagnose death:
- The coma cannot be due to reversible causes.
- Several components of the brain stem including the respiratory centre must be permanently destroyed.
- The patient must be unable to breathe spontaneously.
Brain stem death must be confirmed by two medical practitioners.
The Different Types of Euthanasia:
Euthanasia has multiple categories such as voluntary and involuntary, and passive and active.
Voluntary and Involuntary Euthanasia
As described by Medical News Today:
- Voluntary is when euthanasia is conducted with consent.
- Non-voluntary is euthanasia conducted on a person who cannot provide consent due to reasons from their health condition. The decision is then made by another person based on the patient’s quality of life and suffering.
- Involuntary consists of euthanasia being performed on a patient who has the ability to provide informed consent, but does not. This could be because they do not want to die or they may not have been asked. The name for this is muder.
Passive and Active Euthanasia
- Passive is difficult to define because it is not precise. It could be when life-sustaining treatments are not given or when a patient is given increasing doses of medication that become toxic, such as strong painkillers. However, people argue that this is not euthanasia as the intention was not to kill the patient.
- Active is when something is done to a patient to make them die more quickly. This could be giving drugs with the intention of bringing about death.
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Euthanasia Debate
Now we know what euthanasia is, here are the main arguments for and against it.
For
Those who argue in favour of euthanasia say that doctors have a duty to relieve suffering and respect a patient’s autonomy and give them the option to die with dignity.
They would say that it is better to live a shorter amount of time with a better quality of life than to prolong life but suffer throughout (but does this imply some lives are simply not worth living?).
Against
However, doctors also have a duty not to kill and with the availability of palliative care and hospices, there are limits to autonomy and even if euthanised, the death may not be dignified.
Also, there are a lot of slippery slopes to consider with the potential for the elderly or terminally ill feeling duty-bound to ask for death, or even coerced into doing so by greedy relatives wanting to profit from inheritance money.
The Current State of Affairs
Although suicide is not illegal in the UK, assisting suicide is. So basically, euthanasia is (currently) illegal.
Consequentialists would argue that as patients have the right to refuse life-saving treatment, and doctors cannot force them to receive it, the result of both is the death of the patient. Therefore, euthanasia already exists (and is already legal).
Deontologists, however, would say that this is not the case as it is the intention of the doctor that is key, and it must be considered whether the doctor was aiming to bring about the patient’s death or simply just foreseeing it.
The Principle of Double Effect says that it is permissible to act to relieve a patient’s pain, even if the foreseeable consequence is that their life is shortened. It’s the equivalent of saying “I’m giving you this drug that will ease your pain, but we both know that it’ll probably shorten your life as a side effect, and we’re both cool with that”. This is fine.
Euthanasia Cases
What’s not fine is what Dr. Cox did in 1992. He gave a lethal injection of potassium chloride to an elderly patient who was suffering from agonising pain due to rheumatoid arthritis. He was found guilty, as KCl is not an analgesic so he could not claim double effect, however, as he was charged for attempted murder and not murder, the judge suspended his sentence and he was not struck off by the GMC and continued to practice as a doctor. He was charged with attempted murder rather than murder because it couldn’t be proved if it was the injection that actually killed the patient, rather than just her illness.
In 1999, Dr. David Moor was acquitted (found not guilty) of giving patients large doses of diamorphine as he was able to claim that they were given to ease/control pain and not to kill.
Then there’s the case of Diane Pretty who suffered from motor neurone disease and wanted the Director of Public Prosecutions not to prosecute her husband if he helped her with assisted suicide. She claimed that the Suicide Act (1961) infringed upon her Human Rights. Specifically, Articles 2 (the right to life), 3 (the right not to suffer torture or inhuman and degrading treatment) and 8 (the right to respect for private and family life) but her case was dismissed by the DPP, the House of Lords and the European Court of Human Rights as a right to life does not equate to a right to live. Even if she considered her medical condition torture/inhuman/degrading, it was not state inflicted and so they could not be held responsible, and although the European Court agreed that allowing to choose the circumstances in which one dies does fall under the constrains of Article 8, interference on the court’s behalf was necessary to protect more vulnerable people in the state who could in future be taken advantage of and forced to commit “suicide”.
In a case in 1993 (2-), Tony Bland who went into a persistent vegetative state following the Hillsborough disaster had his feeding tube withdrawn, but this was not considered murdered as it no longer promoted his best interests (had he requested that the tube not be removed, then removing it would have been murder).
In Holland, euthanasia was decriminalised in 1993 and formalised in 2002. Doctors must have an explicit, long-standing, informed and voluntary request from the patient and it must be a last resort. A second doctor must be consulted and the case must be reported. About 2.5% all deaths in Holland are due to euthanasia with only 54% being reported and 1000 having made no explicit requests and 250 being involuntary. Apparently in Holland, old people are worried about going to hospital because they fear being euthanised!
In Belgium, euthanasia was legalised in 2002 with a euthanasia committee supposed to examine every case. It represents 2% of all deaths in the country, but a study found that 66/208 cases had not been preceded by a request. This is obviously bad.
In Switzerland, assisted suicide is legal as long as it is for altruistic motives. You probably know about Dignitas, the famous euthanasia clinic in Switzerland.
There are clear arguments both ways, but the danger of the slippery slope of “will people who feel like a burden feel forced to opt for euthanasia?” and the shoddy record-keeping of those countries where it has been legalised, seems to solidify the case for most countries to stay opposing the practice.
Euthanasia - Medicine Interview Practice Questions
Finally, let’s look at some practice interview questions related to euthanasia.
Why is euthanasia such a controversial topic?
Euthanasia is a topic that comes up a lot in many ethical discussions in medicine. It is a very controversial topic as the definition of euthanasia itself is a complicated one and it also stands in fundamental conflict with what it means to be a doctor: to preserve life.
A Bad Response: “Euthanasia describes the medical killing of people. It can be seen as controversial as the bottom line is that it is murder to end a life. In euthanasia, a doctor kills his patient because the patient’s life is considered not worth living and he (the patient) would be better off being dead. In that sense, it represents the most merciful step to take.”
A Good Response: “Euthanasia is a controversial topic for a multitude of reasons that come from a variety of different backgrounds. One of the reasons for controversy lies in the very definition of euthanasia. Euthanasia is defined as the ending of life to alleviate suffering. This almost makes it sound like a form of treatment. The controversy arises when one considers the very meaning of being a doctor. It is the doctor’s duty to safeguard and protect life, not to end it. On the other hand, the idea of duty of care and patient well-being is the very thing that may justify the ending of life to alleviate suffering. In essence, the controversy on an ethical level arises in part from the conflict between safeguarding life and ending it to reduce suffering.
Other causes for controversy lie in issues such as communication where the question is asked how, for example, a comatose or paralysed patient can communicate their wish to live or die. A further point to take into consideration is the idea of life not worth living. Once we accept that there is a life that can be declared as not worth living, where does that lead us? Some fear that it will lead to a slippery slope where definitions of unworthy life become increasingly arbitrary.
The GMC code of good medical practice and UK law currently don’t permit euthanasia.”
What is the difference between euthanasia and physician-assisted suicide?
Euthanasia is the act of deliberately ending a person’s life to relieve suffering. Assisted suicide is the act of deliberately assisting or encouraging another person to kill themselves. In a practical example, a doctor administering a patient with a lethal injection to stop their suffering would be euthanasia. If the doctor handed the lethal injection to the patient so they injected it themselves, this would be physician-assisted suicide. The best answers to this question will go beyond knowing the different definitions to being able to interpret what implications these definitions have on the differences between euthanasia and physician-assisted suicide legally and ethically.
A Bad Response: “Aren’t they basically the same thing? It means when a doctor helps someone who is seriously ill to die so that they are not in any more pain. I know it is illegal and I think maybe that when it is counted as murder, then it is euthanasia and when it’s counted as manslaughter then it is called physician-assisted suicide.”
A Good Response: “The difference between euthanasia and physician-assisted dying is that in the former, the doctor is actually doing the act that kills the patient, whereas, in the latter, the doctor is merely assisting the patient to kill themselves. There are several important differences between the two. For example, in physician-assisted suicide, the patient’s desire to die is, by definition, a requirement. This is not necessarily the case for euthanasia, which can be voluntary, non-voluntary or involuntary. It is because of this that some people argue that physician-assisted suicide is more morally acceptable because it is in accordance with patient autonomy whereas euthanasia is not necessarily. However, it is sometimes argued that this discriminates against those who are too disabled to commit suicide, even with physician-assistance, and that in these cases, active voluntary euthanasia should be allowed as ultimately the intention is the same. Legally, there is also a big difference – active euthanasia is regarded as murder or manslaughter whereas physician-assisted dying is not, though it is still illegal.”
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