Ethics of End of Life Flashcards
What principles should be used to guide medical decisions at the end of life ?
– Respect for autonomy
– Beneficence
– Non-maleficence
– Justice (= Distribution + Rights + Legal)
– Law
– Sanctity of Life
Define the hospice movement.
- Movement which started in 1967 in St. Christopher’s Hospice by Dame Cicely Saunders.
- Based on “a concept where there is a shift of emphasis from conventional care that focuses on quantity of life, towards a commitment to care which enhances the quality of life.”
- The focus of care in the hospice (palliative care) is based on a holistic view of the person (Physical, Emotional, Psychological, Spiritual, Social)
- Often involves a focus on pain management
Defined palliative care.
That which relieves the symptoms of a disease or condition without dealing with the underlying cause
Define euthanasia.
X intentionally kills Y, or permits Y’s death, for Y’s benefit (to relieve suffering).
What are the main kinds of euthanasia ? Define each.
DISTINCTION BY ACTION:
Active euthanasia: X performs an action which itself results in Y’s death
Passive euthanasia: X allows Y to die. X withholds life prolonging treatment or withdraws life-prolonging treatment
DISTINCTION BY CHOICE:
Voluntary euthanasia: Euthanasia when Y competently requests death himself
Non-voluntary euthanasia: Euthanasia when Y is not competent to express a preference
Involuntary euthanasia: Death is against Y’s competent wishes, although X permits or imposes death for Y’s benefit
Define suicide.
Y intentionally kills himself
Define assisted suicide.
X intentionally helps Y to kill himself
Define murder.
X intentionally kills Y
Provide an example of a real life case of active euthanasia.
- Lilian Boys, 70 years old woman with rheumatoid arthritic, pain of which was beyond analgesics
- Expected to die within days or weeks
- Asked her Dr to kill her
- Dr Cox injected lethal dose of potassium chloride (killed her)
- Found guilty of and charged with attempted murder (not charged with murder because she was cremated before police knew so could not be proven that she died from injection rather than her disease
- GMC allowed him to keep working subject to conditions
Provide an example of a real life case of passive euthanasia.
- In 1989, 21 yr old Anthony Bland was seriously hurt when crushed by overcrowding at the Hillsborough football stadium
- Attempts to resuscitate him resulted in his being permanently unconscious and with no prospect of ever gaining consciousness (permanent/persistent vegetative state)
- After 3 years, the Hospital Trust applied to the court for a ruling as to whether it would be lawful to discontinue Bland’s life support which would inevitably lead to death
- The case went to the House of Lords
- Eventually was allowed to die
Provide an example of a real life case of medical suicide.
DPP DECISION ON PROSECUTION - THE DEATH BY SUICIDE OF DANIEL JAMES, 2008
– Daniel (23 yrs old) was seriously injured in a rugby accident and paralysed
– He died at the Dignitas clinic in Switzerland in 2008, accompanied by his parents
– Enough evidence existed to prosecute Daniel’s parents and a family friend
– DPP decided that it was not in the public interest to prosecute
• Note: DPP will exercise his discretion retrospectively, once all the facts of the police investigation are in front of him, not prospectively (cannot tell the family in advance if they will be charged if the family asks before the action)
Provide an example of a real life case of refused assisted suicide.
R (ON THE APPLICATION OF PRETTY) v DIRECTOR OF PUBLIC PROSECUTIONS, 2001
– Dianne Pretty suffered from motor neurone disease (progressive and degenerative terminal illness – person’s mental faculties remain sharp, while their body fails)
– Mrs Pretty’s husband was willing to help her commit suicide but the couple were anxious that he would be prosecuted (under Suicide Act, 1961)
– Mrs Pretty asked the DPP to give an undertaking that he would not consent to Mr Pretty’s prosecution
– She sought judicial review of his refusal
– She died 12 days after her appeal was rejected by the European Court of Human Rights
Explain the the doctrine of double effect in relation to pain relief at the end of life.
- You cannot give a drug with the intention to kill another person
- However, increasing doses of painkiller can be given to alleviate pain, with the possibility of causing death
- Ethical distinction between intending death, and foreseeing death
Provide examples to discuss the ethics of omission vs acts.
- CASES OF SMITH AND JONES
ACTING: Smith sneaks into the bathroom of his 6 yr old cousin and drowns him, arranging things so that it will look like an accident. The reason Smith does this is that the death of his cousin results into his coming into a large inheritance.
OMITTING: Jones stands to gain a similar large inheritance from the death of his 6 yr old cousin. Like Smith, Jones sneaks into the bathroom with the intention of drowning his cousin.
The cousin, however, accidentally slips and knocks his head and drowns in the bath. Jones could easily have saved his cousin, but instead stands ready to push the child’s head back under. However, this does not prove necessary.
- CASES OF ROBINSON AND DAVIES
OMITTING: Robinson does not give £100 to a charity that is helping to combat starvation in a poor
country. As a result, one person dies from starvation who would have lived had Robinson sent the money
ACTING: Davies does send £100 but also sends a poisoned food parcel for use by a charity
distributing food donations. The overall and intended result is that one person is killed
from the poisoned food parcel and another person’s life is saved by the £100 donation
What are possible reasons to allow active euthanasia ?
- Consistency (if suicide is legal, then what about those who are disabled by disease and cannot commit suicide, e.g. case of Pretty)
- From passive to active (We allow passive euthanasia. That can lead to a slow and unpleasant death. Active would make it shorter and not as unpleasant)
- From painkillers to lethal injections (Doctrine of Double effect is allowed to increase painkillers, so are lethal injections so different morally?)
- Appeal to principles: autonomy and beneficence (mercy) (although no one can demand a treatment option (autonomy), can only refuse a treatment so applies to passive euthanasia more than active)
- Benefits of regulation (this happens already, so may as well allow it and regulate it. This would allows standardising, guidelines, and doctors are therefore not left vulnerable)
