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Euthanasia

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: (1) the coma cannot be due to reversible causes, (2) several components of the brain stem including the respiratory centre must be permanently destroyed and (3) the patient must be unable to breathe spontaneously. Brain stem death must be confirmed by two medical practitioners.

Now that we’ve got that out of the way, let’s talk about 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.

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?).

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. Euthanasia can be voluntary (patient is competent and requests death), non-voluntary (patient cannot express an opinion) or involuntary (patient hasn’t expressly consented but is killed anyway).

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 and the end result of both is the death of the patient, 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.

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 whether it was the injection that actually killed the patient, and not 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.

The Oregon Death With Dignity Act states that in Oregon, Washington State, Montana and Vermont in the USA, if a patient makes a written request 15 days apart then they may be given lethal medications.

How to answer a question about euthanasia

This is a very interesting situation because all four principles come into play and they seem to be at odds with each other. Justice and non-maleficence standing on one side with it being wrong to kill another human and beneficence and autonomy on the other suggesting it is better to end their suffering and allow them to die with dignity on their own terms. 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.

1-  R (Pretty) v DPP [2002] and Pretty v UK [2002]

2-  Airedale National Health Service v Bland [1993]

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2019-08-15T16:23:49+00:00Medical Ethics|Comments Off on Euthanasia

About the Author:

I'm a medical student at Cambridge University, and one of the co-founders of 6med. I created the BMAT Crash Course and Interview Crash Course, and helped code BMAT Ninja and UKCAT Ninja. If you need a hand with anything, feel free to give me a shout!