#10044 - For Against Euthanasia - Medical Law and Ethics

FOR/AGAINST EUTHANASIA & ASSISTED SUICIDE

OPENING

1. Price (2009) – 18,000 patients in Britain medically assisted to die a year

2. Seale (2006)

• 63% deaths in England involved an ‘end of life decision’ by a medical practitioner.

• 32.8% involves a medical professional intervening to alleviate pain or undesirable symptoms with potentially life-shortening effect

• 30.3% were cases where potentially life-saving treatment was not given

• 0.16% euthanasia with patients request and

• 0.33% euthanasia without the patient’s consent

CURRENT LAW

1. ASSISTED SUICIDE = ILLEGAL

1. S.2(1) Suicide Act 1961 makes assisted suicide illegal. But, by virtue of section 2(4) no prosecution can be instituted without the consent of DPP

2. EUTHANASIA = MURDER

1. R (Nicklinson) v MOJ [2013]

• CA confirmed that euthanasia (including voluntary euthanasia) was murder. The defence of necessity could never be extended to cover the situation

• It’s for Parliament to decide otherwise

• three cases brought before CA involving men seriously disabled condition, the most famous being Tony Nicklinson, who had ‘locked-in syndrome’

• Current law upholds Art 2 ECHR right to life

3. SUICIDE AND ATTEMPTED SUICIDE ARE LEGAL

DEFINITIONS

1. These definitions from NHS Choices Online (2014)

2. EUTHANASIA

1. Huxtable says that there are a number of different definitions. Euthanasia translates to ‘good death’. NHS Choices online says ‘it is the act of deliberately ending a person’s life to relieve suffering’.

2. It can be divided into three forms:

• Voluntary euthanasia – Behaviour which caused the patient’s death at the patient’s request

• Non-voluntary euthanasia – Behaviour which causes euthanasia without the consent or objection of the patient (where they are unable to consent)

• Involuntary euthanasia – where a competent patient has not expressly consented to die (Biggs just regards this as murder)

3. ASSISTED SUICIDE

1. This is the act of deliberately assisting or encouraging another person to commit suicide (or attempt it)

4. SUICIDE AND ATTEMPTED SUICIDE ARE LEGAL

HOW IT WORKS IN REALITY

1. BMA (1996) – 22 our of 750 doctors have admitted to ending a patient’s life

2. It goes on all the time

ASSISTED DYING BILL

1. Lord Falconer’s Bill will have second reading in HoL on 18 July 2014

2. YouGov poll found that 76% adults support the Bill

3. The Bill will

1. provide safeguarded choice and control to terminally ill adults as to how they die

2. that terminally ill adults have explored all alternatives

3. legalese assisted suicide for people who are not dying (ie. disabled people or older people)

4. Legalise voluntary euthanasia where doctor administers life-ending medication. Under the Assisted Dying Bill the person choosing to end their life would take the final action to end their life, by taking prescribed life-ending medication

5. The Bill only applies to those people with mental capacity both at the time of their request and at the time of their death

CRUELTY ARGUMENT

1. We put down animals as it’s considered cruel to let them suffer with pain, why not extend this courtesy to humans? BUT

2. Bachelard – rejects this analogy on the basis that human fellowship and impact of death on others justifies distinguishing the deaths of humans and animals CONTRAST

3. Harris – he says that when humans lose those qualities which make them different from animals, such as consciousness and interactive abilities, why then are they still denied this right to die PLUS

UNDERMINES PALLIATIVE CARE

1. palliative care is available for humans, unlike animals

2. Magnusson – euthanasia would reduce this

3. This is multidisciplinary medical care that’s focused on relieving patients’ pain, monitoring their spiritual care and being considerate for patients’ family

4. Moveland and Rae – pain can be managed to endurable levels and where it is utterly unbearable always sedation

5. Zyic – palliative care is limited in The Netherlands, which may be linked to euthanasia being permissable

DOCTOR-PATIENT RELATIONSHIP

1. BMA (2009) – euthanasia may undermine doctors’ healing role FOR EXAMPLE

2. Zeigler (2009) – in Switzerland, where assisted suicide is permitted in certain circumstances, doctors play a minor role – it’s normally handled by private clinics

3. Price – fear amongst doctors in England that they will become agents of patients if it’s legalized HOWEVER

4. R(Burke) v GMC – established that a patient can’t demand that a doctor treat them in a way which is harmful – so doctor is not subordinate to patient (ie. consumerist relationship Morgan’s four models)

5. Hoffenberg – where a doctor decides to end a patient’s life, they are doing so not based on a moral decision, but out of an extension of their duty of care

PRAGMATIC: AVOID ARTIFICIAL AND INCONSISTENT DISTINCTIONS IN THE LAW

1. Williams – present law on euthanasia is illogical and unsupportable based on the following

2. ACTS/OMISSIONS

1. Omissions: a doctor has a duty to act unless the patient refuses consent or it’s not in the patients best interests (Bland) (ie. omissions are fine if in patient’s best interest)

2. This relates to causation, so omission doesn’t cause death, the underlying medical condition does BUT

3. Jackson – it’s an artificial distinction, more important is whether doctor thinks patient’s life should be artificially prolonged

4. James Rachels – ‘The doctrine that says that a baby may be allowed to dehydrate and wither, but may not be given an injection that would end his life without suffering, seems so patently cruel as to require no further refutation’

5. Beauchamp and Childress – say that this concept is so confusing it is not useful as a practical guide

6. Deep sedation: put patient in coma for pain-relief, then remove hydration – technically this is an omission – shows how the distinction can be manipulated

3. INTENTION/FORESIGHT

1. Bland – Lord Goff

• confirmed it’s illegal for a doctor to administer a drug to his patient to bring about his death, even if prompted by the humanitarian desire to end suffering. YET

• doctor can administer lawfully pain-relieving drugs if in patients best interests even if he knows that an incidental effect of that application will be to abbreviate the patient’s life (ie. highlighting it hinges on doctor’s intention)

2. Griffiths – very difficult to infer intent from the facts, would only be where a doctor admits it – meaning it is not practical

3. Warnock – sees the difference between intention and foresight as ‘absurdly pedantic’

4. Herring – it also means that there is an exception with doctors, as in R v Woolin the HL said that a jury is entitled to find mens rea of murder if person engages in conduct which is virtually certain to cause death, even if not primary purpose

4. DOCTRINE OF DOUBLE EFFECT

1. Keown – says that Bland has led to this doctrine, whereby, a doctor can be certain their act will cause death, but not intend that result. So even if you can foresee death, but not intend it, you will not be responsible for it BUT

2. Harris – says this is equivalent to saying, if I get drunk tonight I’m not responsible for the hangover tomorrow, which can’t be right

3. Huxtable – there is uncertainty as to whether the doctrine of double effect can be relied upon when the foreseen result is certain

AUTONOMY

1. PRO-AUTONOMY

1. Pedain – person’s decision respected not because it’s a good choice, but because it’s their choice

2. Harris – denying this right is the ultimate denial of respect for the person and ‘a form of tyranny’ (notice though that in R(Pretty) v DPP it wasn’t a breach of Art 3)

3. Dworkin – ‘making someone die in a way that others approve, but he believes a horrifying contradiction of his life, is a devastating odious form of tyranny’

4. CRITICAL INTEREST

1. Dworkin – says our ‘critical interests’ should be respected (these our the interests that make us who we are) HOWEVER

2. Harris – acknowledges how this opens the door to deny right to end life as it could seem incongruent with our critical interests during our life PLUS

3. Greasley – denies that how we die is a critical interest. Although Mann says that life insurance policies and pensions require people to take stock of death (+ advance directive link)

2. ANTI-AUTONOMY

1. AFFECTS FAMILY

1. HoL Select Committee (1993) – ‘dying is not only a personal or individual affair.’ Death affects others, so autonomy needs to be weighed against this

2. LACK OF COMPETENCE

1. Crul – no person suffering pain and anguish close to death is sufficiently competent to make the decision (but Re B undermines this as the woman wasn’t in pain then and still wanted to die)

2. Royal College of Psychiatrists (2006) – report showed that 99% patients seeking euthanasia who were treated for depression changed their mind

3. INCONGRUENT WITH AUTONOMY

1. Greasley – death is the end of choice and options, whereas autonomy is all about right to make choices, so the two are incongruent

4. HYPOCRISY IN DEBATE

1. Dworkin –accepted limit to it (ie. where predicted to die within 6 months)

2. Gormally – even supporters of autonomy contradict themselves

3. Keown – love-struck teenager. If we deny them, that means we’re limiting some people’s autonomy BUT

• Lillehammer – rejects this argument, saying that euthanasia should only be allowed where patient is competent, terminal and seeks it (which love-struck teenager wouldn’t satisfy)

DIGNITY

1. Biggs – many supporters of euthanasia argue in terms of protecting the dignity of dying person CONTRAST

2. Amarasekara and Bagaric – whilst letting someone die against their wishes may be undignified – killing someone shows no respect for dignity

3. Nuland – denies the idea that there is such a thing as a dignified death – it’s a painful and nasty experience

SANCTITY OF...