Hello everyone and welcome to this week's blog post. In this article, I will be discussing euthanasia. I will first describe some of the types of euthanasia. I will then examine how the law surrounding euthanasia differs between different countries.
What are euthanasia and assisted suicide?
According to the NHS, euthanasia is the 'act of deliberately ending a person's life to relieve their suffering'. Meanwhile, assisted suicide is 'the act of deliberately assisting another person to kill themselves'. In some jurisdictions, this includes the act of providing medicine to end someone's life or even purchasing plane tickets to take them to a country where euthanasia is legal.
There are a few different types of euthanasia depending on how it is performed. For example, there can be active euthanasia. This is where a substance is administered to a patient with their consent, which mercifully ends their life. Meanwhile, passive euthanasia occurs when life-sustaining treatment is not provided or withdrawn with the intent of mercifully ending someone's life.
In addition, indirect euthanasia occurs when medicines are prescribed for another purpose (e.g. providing pain relief) but the medicines also have the effect of ending the patient's life. In these cases, the primary intent of prescribing the medication must be to treat the disease or provide relief to the patient, not to end their life. Physician-assisted suicide is also another form of assisted suicide. This is when a licensed medical professional helps to end the patient's life after gaining their consent.
The types of euthanasia can also be split into two main groups. The first group is voluntary euthanasia, which occurs when the patient is able to consent to the procedure and communicate their decision. In addition, euthanasia can also be non-voluntary, such as in cases such as when life-saving treatment is withdrawn. In these cases, euthanasia only occurs as it is 'passive' and deemed to be in the best interests of the patient.
Is euthanasia legal in the UK?
The laws regarding euthanasia and assisted suicide vary from country to country. In the UK, the Suicide Act (1961) makes assisted suicide illegal. Those found guilty of helping someone else commit suicide can face up to 14 years in prison. Meanwhile, euthanasia is also illegal and is usually prosecuted as murder or manslaughter, with a maximum penalty of a life sentence.
Nonetheless, there was a case in the UK when Debbie Purdy launched a case to seek information about whether she would be prosecuted if she bought a plane ticket for her husband to Switzerland and helped him travel to a Dignitas Clinic there for euthanasia services. After this case, the Director of Public Prosecutions changed its guidelines and stated that people would not be prosecuted if it was not in society's best interests. Consequently, it is unlikely that those helping people travel to a euthanasia clinic would be prosecuted, as long as their actions were motivated by compassion.
In the map above, euthanasia is legal in countries in dark blue. It is illegal in countries in red. Meanwhile, the others have different restrictions depending on the type of euthanasia - green means physician-assisted suicide is legal and light blue means that passive euthanasia is legal.
Are there examples of euthanasia taking place in the UK?
There are several well-known cases of euthanasia taking place in the UK. For example, there was a case involving a patient (Lilian Boyes) and their doctor (Dr Nigel Cox) in 1991. After having been admitted to hospital in 1991, it was clear that Mrs Boyes's symptoms were no longer in control. She was terminally ill, and had been suffering from what her rheumatologists described as the 'worst case of rheumatoid arthritis they had encountered'.
She was in incredible pain - the Independent reported that 'any movement caused intense discomfort' and that she 'screamed at the slightest touch'. At the hospital, Mrs Boyes refused medical treatment and told Dr Cox that she wanted to end her life. When she did so, her sons were at her side and supported her decision. This led to Dr Cox administering a lethal dose of potassium chloride. Mrs Boyes died soon after.
While the facts of this case were not in dispute, the case was still hard to prosecute. This is because it hinged on the intentions of a caring doctor who was supported in their actions by the patient's relatives. In addition, both sides argued that this case was not about voluntary euthanasia. Instead, the defence argued that Dr Cox's main intention was to relieve his patient's pain. Meanwhile, the prosecution argued that Dr Cox's actions amounted to murder. Eventually, Dr Cox was found guilty of attempted murder (not murder as it was impossible to prove that the potassium chloride was responsible for the death of Mrs Boyles). Dr Cox was sentenced to a suspended prison sentence of 12 months, however, due to the nature of this case, was not struck off the GMC register.
There is a legal defence which was mentioned in association with this case called the 'doctrine of double effect'. This is a legal defence that is based on the intention of the doctor's actions. Since it is paramount that patients don't die after a long period of suffering without dignity, doctors have a duty to avoid this if possible, As such, it is legal for mediations to be prescribed if they alleviate this suffering, even if they increase the risk fo death. This defence would probably not have worked for Dr Cox, as potassium chloride is not a pain-relieving substance, nor would it have treated Mrs Boyes disease.
What are the arguments for allowing euthanasia?
One of the arguments in favour of euthanasia is that of patient autonomy. Autonomy, which is one of the fundamental principles of medical ethics, states that patients have a right to make their own decisions. Consequently, when patients are treated in the UK, they will be offered treatment options by their doctor, as well as the possible benefits and drawbacks of each. It is then up to the patient to decide which treatment option they want, or whether they want to refuse all treatment entirely.
Extended from this argument is the principle that humans have the right to die. This treatment states that, since people have a right to life and to refuse medical, they have the right to die as well. Furthermore, there is also the principle that patients can choose what is best for them - this dictates that patients should be allowed to choose euthanasia if they decide that it is the best course of action.
There is also the principle that people have the right to privacy. Consequently, this principle would mean that euthanasia should be allowed, as it is a private matter, and thus shouldn't be regulated by the state.
Moreover, euthanasia also gives patients the option of avoiding a long period of suffering and allows them to die with dignity. This is especially important for patients who can't be helped sufficiently by palliative care services and thus wouldn't have another option to relieve suffering.
What are the arguments against euthanasia and assisted suicide?
One of the main arguments against euthanasia and assisted suicide is a religious argument. This argument states that humans are the sacred creation of God. For this reason, human life is also sacred and God is the only being who can end it. In addition, if doctors or other medical professionals perform euthanasia, then they might be 'playing God'.
Likewise, there are also ethical objections to such a scheme. Doctors are bound to ethical obligations. For example, one of the pillars of medical ethics is beneficence, which states that doctors should always act for the good of their patients. Indeed, the International Code of Medical ethics states that 'a doctor shall always bear in mind the obligation to respect human life'. As a result, some would argue that carrying out euthanasia is unethical, especially for doctors and other medical professionals who have already agreed to these standards.
Additionally, patients might consent to the procedure but then change their minds when it is too late. For instance, a patient may consent to a procedure while they are in loads of pain. However, they could change their minds and wish for the euthanasia to be aborted during the procedure. If, for example, they had been anaesthetised at this stage, it would be impossible for them to communicate this decision and for the procedure to be stopped.
As such, if euthanasia is allowed, then there should be a waiting period between the patient consenting to euthanasia and the euthanasia being carried out. This would provide the patient with the chance to come to terms with their decision and change their minds if they wish.
Moreover, patients might also be pressured by their friends or family to consent to euthanasia. For example, there may be a significant estate that could be inherited. As a result, if euthanasia is allowed, then there would need to be considerable checks to ensure that patients were making their decision without outside influence.
Furthermore, patients may not want to be a burden on their relatives or society. For example, since care homes are very expensive, patients may feel pressure to opt for euthanasia instead of receiving care. It is very important that patients are protected from this and do not feel this pressure. Therefore, this is something that must be considered when debating whether euthanasia should be allowed.
In addition, investing in euthanasia services might also detract from palliative care services. Currently, palliative care services are incredibly important as they provide relief to patients and help control and treat terminal illnesses. As such, if palliative care services are incredibly strong, then there shouldn't be a need for euthanasia services, as the pain and suffering of patients can be prevented and patients can be provided with a dignified, natural death.
Consequently, those against euthanasia would argue that there is no use for euthanasia services. Instead, the funds that would have been spent on these services should be used to palliative care. In addition, offering euthanasia services may result in patients choosing to end their lives as they aren't aware of how effective palliative care services are.
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