End of Life Ethics and Law

Question 1

When do we begin palliative care?

Answer 1

Difficult, may cause anxiety and anger
Doctors often feel “failure” - but doctor’s role is not always to cure
Fostering & respecting patients’ autonomy is key
Based on a value judgment that curative treatment is not in patient best interests

Question 2

Components of a good death?

Answer 2

Pain and symptom management
Clear decision-making
Preparation for death
Completion
Contributing to others
Affirmation of the whole person

Question 3

Give the definitions for:
suicide, assisted suicide and euthanasia

Answer 3

Suicide: Death caused by self-directed injurious behaviour w intent to die
Assisted Suicide: assisting/encouraging a person to kill themselves
Euthanasia (“a good death”): ending ones life for their benefit eg relieve pain

Question 4

What is the law in england with regards to suicide and euthanasia?

Answer 4

Suicide is not unlawful in England
Assisted suicide is illegal: one who aids, abets, or procures the suicide of another shall be liable on conviction
Euthanasia is illegal in England and is a form of homicide

Question 5

What is the difference between active and passive euthanasia? What are the other types?

Answer 5

Actively injecting patient w sedatives, vs withholding treatment vital for life
Euthanasia can also be non voluntary- patient is unable to give their consent, someone else makes the decision on their behalf or they gave consent way back in the past
Involuntary euthanasia- patient killed against wishes aka murdaaaa

Question 6

Describe the mental capacity & human rights act

Answer 6

Mental Capacity Act (2005) states that patients w capacity can refuse life-saving treatment.
Human Rights Act (1998): protects the right to freedom from degrading treatment and the right to private and family life

Question 7

What is DDE?

Answer 7

Doctrine of Double Effect: If the following obtain the act is permissible:
Nature of the act is not bad
At least one of the act’s consequences is good
At least one of the act’s consequences is bad
A sufficiently serious reason for allowing the bad consequence
The bad is not a means to the good consequence
Agent foresees the bad but intends the good consequence

Question 8

Describe the ethics of DDE- what does this principle capture and what are the opposing views against it?

Give a law supporting DDE

Answer 8

The principle captures that what matters from a moral standpoint is our intentions

Opponents of the doctrine (primarily consequentialists) argue that this is a wretched subterfuge. The consequences are the same: death. The intentions do not matter.

LEGALITY: a doctor may lawfully administer painkilling drugs despite knowing than an incidental effect will be to abbreviate the patients life
Lord Goff in Airedale NHS Trust v. Bland [1993]

Question 9

What is the international perspective on euthanasia?

Answer 9

Assisted suicide is lawful in the Netherlands (2001), Belgium (2002), Switzerland (1940) and parts of USA, Canada (2016)
Uruguay + Colombia considering
Death tourism on the rise

Question 10

Under DPP guidance, what factors contribute to prosecution of someone who has done assisted suicide?

Answer 10

 Under 18
capacity questioned
No clear, settled and informed wish to die
Process not initiated by person who dies
No terminal illness, severe and incurable physical disability or severe degenerative disease
 Not motivated by compassion
Evidence of persuasion, coercion, undue pressure

Vice versa for against prosecution