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Some people lose some of their freedom,
l to make decisions,
l have rational thought,
l be able to freely take action.
It is the freedom to take action that is often lost in health care situations.
l it is essential that their sense of personhood be maintained.
l They must believe in themselves as a valued person.
l It is the uniqueness of each person that is their personhood *
l Q: Is compassion an adequate reason for ending the life of a person who is suffering terribly and who has no hope of recovery?
Euthanasia
l Euthanasia from the Greek and means;
‘a quiet easy death’.
The Ethics of Euthanasia
l Euthanasia raises agonising moral questions like these:
l is it ever right for another person to end the life of a terminally ill patient who is in severe pain or enduring other suffering?
l if euthanasia is sometimes right, under what circumstances is it right?
l is there any moral difference between killing someone and letting them die?
Killing or letting die
l Euthanasia can be carried out either by doing something, such as giving a lethal injection, or by not to do something necessary to keep the person alive (for example failing to keep their feeding tube going).
l “Extraordinary” medical care
l It is not euthanasia if a patient dies as a result of refusing extraordinary or
burdensome medical treatment.
The Doctrine of Double Effect.
l Euthanasia and pain relief
l It”s not euthanasia to give a drug in order to reduce pain, even though the drug causes the patient to die sooner. This is because the doctor”s intention was to relieve the pain, not to kill the patient. This argument is sometimes known as the
Doctrine of Double Effect.
Why people want euthanasia
l Most people think unbearable pain is the main reason people seek euthanasia, but some surveys in the USA and the Netherlands showed that less than a third of requests for euthanasia were because of severe pain.
l Terminally ill people can have their quality of life severely damaged by physical conditions such as incontinence, nausea and vomiting, breathlessness, paralysis, difficulty in swallowing…
l Psychological factors that cause people to think of euthanasia include depression, fear of loss of control or of dignity, feeling a burden, or dislike of being dependent.
What is the current criminal law on deliberate euthanasia in Britain and other European states?
Euthanasia or “mercy killing” is popularly taken to mean the practice of helping severely-ill people to die, either at their request or by taking the decision to withdraw life support.
‘Decriminalisation & Euthanasia
l Euthanasia has been “decriminalised” in a number of European countries, namely The Netherlands, Belgium and Switzerland.
l Additionally, the US state of Oregon has a “Death with Dignity Act” and Australia the Northern Territories ruling.
The law in the UK
l As the law stands in England, Wales and Scotland, deliberate or “active” euthanasia will normally leave anyone assisting suicide or death liable for murder.
l Within English law, a difference is made between acting and refraining to act; the latter is referred to in English law as an act of omission.
Dr Arthur”s case. Child”s death
A similar question arose in Dr Arthur”s case which concerned the birth of John Pearson, born in June 1980 in Derby City Hospital. Diagnosed immediately with Down”s syndrome he remained in the care of Dr Arthur, a very experienced consultant paediatrician. The child died three days after his birth, and Dr Arthur was charge with the baby”s murder. It was alleged that he, in accordance with the child”s parents” wishes, had caused, or intended to cause, the child”s death by starvation.
It was alleged that he had been withholding the basic essential to life – food – and that the consultant had succeeded in starving the baby John to death. In October 1981, the trial of Dr Arthur opened at Leicester Crown Court before Judge Farquharson and a jury. Dr Arthur pleaded not guilty to murder. This was reported on in a controversial article by Malcolm Muggeridge, a “pro-life” supporter, in the Daily Mail – two days into the trial. On page six, it read:
“The mongol murder baby trial. Baby given a hunger drug to kill him” and “Consultant accused of murdering child that parents did not want.”
This, in itself, became a legal battle regarding contempt of court. The editor and the journalist were later acquitted. In November 1981, Dr Arthur was acquitted of murder, by direction of the trial judge and by the jury of attempted murder.
Airedale NHS Trust v Bland [1993]).
l Withdrawing treatment
l There have been recent cases which have moved the law forward.
l One landmark ruling was the 1993 Bland case (Airedale NHS Trust v Bland [1993]).
l Anthony Bland was a 17-year-old left severely brain damaged after the Hillsborough Football Stadium disaster in April 1989.
l Nottingham Forest and Liverpool played their FA Cup semi-final match at stadium in Sheffield, and too many supporters were allowed into the old stadium, causing a fatal crush of many supporters.
Airedale NHS Trust v Bland [1993]). 2
l Degenerative disease
Against Euthanasia
l Religious arguments
l Euthanasia is against the word and will of God
l Euthanasia weakens society”s respect for the sanctity of life
l Suffering may have value
l Voluntary euthanasia is the start of a slippery slope that leads to involuntary euthanasia and the killing of people who are thought undesirable
Ethical arguments
l Euthanasia weakens society”s respect for the sanctity of life
l Accepting euthanasia accepts that some lives (those of the disabled or sick) are worth less than others
l Voluntary euthanasia is the start of a slippery slope that leads to involuntary euthanasia and the killing of people who are thought undesirable
l Euthanasia might not be in a person”s best interests
l Euthanasia affects other people”s rights, not just those of the patient
Practical arguments 1
l Proper palliative care makes euthanasia unnecessary
l There”s no way of properly regulating euthanasia
l Allowing euthanasia will lead to less good care for the terminally ill
l Allowing euthanasia undermines the comittment of doctors and nurses to saving lives
l Euthanasia may become a cost-effective way to treat the terminally ill
l Allowing euthanasia will discourage the search for new cures and treatments for the terminally ill
l Euthanasia undermines the motivation to provide good care for the dying, and good pain relief
Practical arguments 2
l Euthanasia gives too much power to doctors
l Euthanasia exposes vulnerable people to pressure to end their lives
l Moral pressure on elderly relatives by selfish families
l Moral pressure to free up medical resources
l Patients who are abandoned by their families may feel euthanasia is the only solution
For Euthanasia
l It”s not possible to regulate euthanasia
l Euthanasia opponents don”t believe that it is possible to draft laws and guidelines that will prevent the abuse of euthanasia.
l It”s possible but very difficult
l Those in favour of euthanasia think that there is no reason why euthanasia can”t be controlled by proper regulation, but even they fear that regulations won”t deal with people who want to implement euthanasia for bad motives.
Some rules are better than none!
l It”s hard to think that creating a structure to regulate euthanasia will have a worse result than not having any regulations at all.
l Since euthanasia will continue to take place, even though it”s illegal, it would surely be better to make it legal and regulate it so as to minimize abuse.
l In order to ensure that requests are properly considered, both by the patient, the family, and the authorities, regulations need to build in a time-period for reconsideration.
l Proper regulation must also make sure that a patient was receiving good palliative care before a request for euthanasia is considered.
l Although the procedures outlined above are time-consuming and expensive, that does not mean that they are impractical.
The Dutch approach 2
l must be convinced that the patient has made a voluntary and well-considered request to die
l must be convinced that the patient is facing interminable and unendurable suffering
l has informed the patient about his situation and his prospects
l together with the patient, must be convinced that there is no other reasonable solution
l has consulted at least one other independent doctor who has seen the patient
l and given his written assessment of the due care requirements as referred to in the points above
l has helped the patient to die with due medical care
The Dutch approach 3
l The Dutch law also permits euthanasia for non-adults. Children of 16 and 17 can make their own decision, but their parents must be involved in the decision-making process regarding the ending of their life. For children aged 12 to 16, the approval of parents or guardian is required.
The Dutch approach 4
l If a patient can no longer express their wishes, but made a written statement containing a request for termination of life before they became incompetent, a doctor is allowed to carry out their request providing the other conditions are met.
l Two thirds of the requests for euthanasia that are put to doctors are refused. Neither doctors nor nurses can ever be censured for failing to comply with requests for euthanasia.
Human beings have the right to die when and how they want to
l In…cases where there are no dependants who might exert pressure one way or the other, the right of the individual to choose should be paramount. So long as the patient is lucid, and his or her intent is clear beyond doubt, there need be no further questions.
l The Independent, March 2002
Religious objections
Religious opponents disagree because they believe that the right to decide when a person dies belongs to God.
Airdale NHS Trust v Bland (1993)
Sir Stephen Brown granted declaration that it was in patients best interest that his feeding regime be withdrawn. Appealed to HL.
Lord Goff of Chieveley (Airdale NHS Trust v Bland [1993] 1 All E.R. 521; [1993] A.C. 879)
1) I am of the opinion that there is nevertheless no absolute obligation upon the doctor who has the patient in his care to prolong his life, regardless of the circumstances.
Airdale NHS Trust v Bland (1993)
2) As I have already indicated, the former [withdrawing treatment] may be lawful, either because the doctor is giving effect to his patients wishes by withholding the treatment of care, or even in certain circumstances in which (on principles of which I shall describe) the patient is incapacitated from stating whether or not he gives his consent.
3) But it is not lawful for a doctor to administer a drug to his patient to bring about his death, even though that course is prompted by a humanitarian desire to end his suffering, however great that suffering may be.
Withholding & Refraining From Treatment
Withholding treatment
Refraining from treatment. Justified if treatment considered futile and unnecessarily burdensome
Deliberate withholding of treatment is unlawful, may lead to criminal prosecution & accusation of malpractice
Withdrawing treatment
More difficult than withholding treatment not begun
Doctrine of Double
l Is it appropriate to sedate a patient into unconsciousness? Thus,
l provided that the good effect is what is intended and the bad effect is a foreseen but unintended side effect, then the action is ethically acceptable.
References:
Principles of Biomedical Ethics, Beauchamp and Childress, (Oxford University press, 5th Edition, 2001)
Medical Ethics and Law; Hope, Savulescu, Hendrick (Churchill Livingston, 2003) at page 167
End of life decision-making in six European countries: descriptive study. The Lancet, volume 362, Issue 9381 (2 August 2003), Pages 345 – 350
“Cardiopulmonary Resuscitation: Who makes the decision?” (1994) 308 BMJ 1677
“Views of Elderly patients and their relatives on Cardiopulmonary Resuscitation”
(1994) 308 BMJ 1677
Neonatal euthanasia: moral considerations and criminal liability, Mark Sklansky, JME, February 2001
“Marginally effective medical care: Ethical analysis of issues in Cardiopulmonary Resuscitation (CPR)” (1997) 23 J Med Ethics 361
Marjorie B Zucker and Howard D Zucker (eds.) Medical Futility and the Evaluation of Life-Sustaining Interventions, Cambridge Oxford University Press, 1997
Fiona Randall and RS Downie, Palliative Care Ethics: A companion for all Specialities. Oxford University Press, 1999 (second edition)
Stefan Timmermans, Sudden Death and the Myth of CPR, Temple University Press, 1999
Palliative Medicine, 2003; 17(2): 94-184, 222-224
Journal of Medical Ethics, October 2001, (Vol 27, No 5) a series of interesting
articles on CPR
End of Life decision making within intensive care -objective, consistent, defensible? Ravenscroft and Bell, JME, December 2000
Advance directives are the solution to Dr Campbell’s problem for voluntary euthanasia, A Flew, JME, June 1999
J. Rachels, The End of Life (Oxford, 1986)
Hope T., Savulescu J., Hendrick J. (2008) Medical ethics and law: The core curriculum 2nd edn. London: Churchill Livingstone.
Recommended
Harris, J. (2005) The value of life. An introduction to medical ethics. London: Routledge.
Hoffman, D. and Rowe J. (2006) Human rights in the UK: An introduction to the Human Rights Act 1998 2nd edn. Harlow: Pearson Education.
Jackson, E. (2010) Medical law: Text, cases and materials. Oxford: Oxford University Press.
Mason, J.K. and Laurie, G.T. (2006) Mason and McCall Smith’s law and medical ethics, 7th edn. Oxford: Oxford University Press.
Montgomery, J. (2005) Health care law, 2nd edn. Oxford: Oxford University Press.
Background
Banks, S. (2004) Ethics, accountability and the social professions. Basingstoke: Palgrave Macmillan.
Beauchamp, T. L. and Childress, J. F. (2009) Principles of biomedical ethics, 6th edn. Oxford: Oxford University Press.
Billington, R. (2003) Living philosophy, an introduction to moral thought. London: Routledge.
Bone S. (2001) Osborne’s Concise Law Dictionary. 9th Ed Sweet & Maxwell. London
Clark, C. (2000) Social work ethics: politics, principles and practice. Basingstoke: Macmillan.
Cook, R., Dickens, B. and Fathalla, M. (2003) Reproductive health and human rights: integrating medical ethics and law. Oxford: Oxford University Press.
Corey, G., Corey, M and Callanan, P. (2010) Issues and ethics in the helping professions. Wadsworth: Cengage Learning.
Garwood – Gowers A, Tingle J, Wheat K. (2005) Contemporary Issues in Healthcare Law and Ethics. Elselvier, Butterworth Heinmann. London
Herring J. (2008) Medical Law and Ethics 2nd Ed. Oxford University Press, Oxford.
Hope T. (2004) Medical Ethics. A Very Short Introduction. Oxford University Press, Oxford
Johns, R. (2006) Using the law in social work. Exeter: Learning Matters.
Sheldon, S. and Thompson, M. (1998) Feminist perspectives on health care law. London: Routledge.
Slapper G., Kelly D .(2006) The English Legal System 8th Ed Routledge Cavendish, Oxford
Journals
Journal of Medical Ethics
Medical Law Review
Medicine, Science and Law
Nursing Ethics: an international journal for healthcare professionals
Websites
www.bioethics.net – bioethics website
www.biome.ac.uk – biomedics website
www.bailii.org – legal references and old legal cases
www.lawcrawler.findlaw.com – legal resource
www.lawreports.co.uk – law reports
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