End of life care Flashcards
What is assisted suicide?
The act of an individual which does (or is intended to) encourage or assist the suicide or attempted suicide of another person.
Refusal of treatment and suicide
A competent patient who refuses life saving treatment is not committing suicide.
A competent patient is legally entitled to refuse all and any (even life sustaining) treatment. Complying with this refusal is not assisted suicide.
The doctrine of double effect
It is not unlawful to prescribe treatment which will necessarily hasten death if the intention is to relieve pain and suffering
Makes a distinction between intending to bring harm to a patient, and foreseeing that your actions may have bad consequences or side effects but not intending that those bas consequences should happen.
E.g. giving painkilling drugs to a cancer patient even though use of the drugs will shorten the patient’s life
What are the objections to the doctrine of double effect?
Distinction between intention and foresight is not ethically relevant - we are morally responsible for the outcomes we forsee as those we intend to do.
Motivation is more important than intention
The distinction is impractical - difficult to distinguish between intention and foresight in practice.
Acts and omissions in treatment
It is not unlawful to withold or withdraw medical treatment (even though the consequence of this is the patient’s death) if the decision is done in the patient’s best interests.
N.B. Acting with the intention of killing a person is murder. Failing to act to save a person’s life is not homicide unless you owe a special duty to that person (e.g. dr/pt, parent/child)
Withdrawing and witholding treatment
Withdrawing treatment and witholding treatment are the same legally.
Withdrawing treatment e.g. stopping artificial ventilation is an omission and not an act. Support is withdrawn and nature is allowed to take its course.
Failing to start treatment is also an omission. Not an act of killing if the patient dies.
Objections to acts and omissions
Lead to illogical and inhumane results - allows a patient to linger towards a painful death by omission when a doctor can act to produce the same result painlessly
Method of producing death should not carry moral weight - what matters is the doctor’s intention, not the method by which the result is produced.
Distinction between acts and omissions is too fluid in medicine - difficult to distinguish between an act of killing, and letting nature take its course.
Disputes on causation - there is an ethical difference between initiating a causal sequence and interrupting a causal sequence vs. allowing a causal sequence to continue its course.
Define euthanasia
Intentional killing another person, by act or omision with a view of removing the patient’s pain or a ending the life of a patient whose life if throught to not be worth living.
Difference between active and passive euthanasia
Active euthanasia (mercy killing) is carrying out an act which ends a patient’s life is illegal
Passive euthanasia is the withholding or withdrawing of medical treatment in the patient’s best interests. Not an act of killing, but a means of allowing the patient’s illness to take its natural course. Not illegal, even if the intention is to bring the patient’s life to an end.
Arguments in favour of euthanasia
Relief of intolerable suffering (non-maleficence): the duty of doctors is to prevent harm. This may justify the means of euthanasia in order to prevent extreme distress
Promotion of well-being and dignity (beneficence): System of legalised euthanasia would enable doctors to help patients maintain dignity at the end of life. Fulfils a duty of beneficence (doing good)
Respect for autonomy (patient choice): Failing to let patients with terminal disease choose their time of death is failing to respect their autonomy.
Justice: Allows fair access of treatment for the majority. Reduces life-prolonging/expensive treatments in patients who are unlikely to benefit.
Arguments against euthanasia
Sanctity of life: Life is valuable and precious. Every means should be taken to preserve life where possible.
Slippery slope: If any form of euthanasia were legalised it would have undesireable consequences e.g. vulnerable patient groups pressured into accepting euthanasia
Regulations are difficult to police: Deaths may be broughout about by the physician without patient request
Killing is never justified: Bringing about the end to someone’s life is always immoral, even in the context of extreme suffering.
Palliative care is a good alternative
