Euthanasia Flashcards
Distinction between act and omission
Act - physically doing something
Omission - failure to do something / taking something away
→ More difficult to justify causing death than preventing it
Passive and active euthanasia
Passive = omission e.g. refusal or withdrawal of treatment Active = where cause death
3 types of ‘voluntary’ euthanasia
- Voluntary = causing P death at their request, their consent.
(Vol active = positive act which brings about death which is controversial) - Non-voluntary = causing the P’s death without the consent or objection of the patient - no consent
- Involuntary = causing P’s death against her wishes - murder or intentional killing
FOR euthanasia - autonomy
Docs duty to inform of relevant risks
Respect autonomy - right to life (art 2 ECHR), why not right to death - CONSISTENCY in law?
May have a negative impact - refusal to treatment, needs to be limits in that you cannot have whatever you want
FOR - inference from permissibility of suicide
Suicide Act 1961 - permits suicide (not criminal anymore)
Social attitudes towards it are changing
If permissible to allow suicide, surely a 3rd party helping should be allowed (ass suicide)
FOR - beneficience
All practitioners should perform the best for their patients - how do we determine best interest?
Death with dignity
Airdale NHS Hospital v Bland
No longer in Bland’s best interest to be kept alive, in vegetative state for 2+ years
FOR - discrimination against disabled
Suicide only accessible to those who have physical capacity and financial resources
→ Suicide tourism
FOR - economic reality
Medical resources are scarce, end of life care is expensive and more economically productive to give those resources to people who are alive / need it?
AGAINST - sanctity of life
Roman catholics believe all live is sacred and valuable, regardless of the quality
AGAINST - become the status quo
Worry it will become the ‘norm’ and acceptable in society. Is a delicate topic. If Ass. suicide is legalised, may create pressure on people to commit it. Dangers of legalisation v respect for autonomy
AGAINST - risk of abuse
Slippery slope
Could become a self-defence to killing humans, that there was an honest and proportionate but could be abused.
People who want to commit are already vulnerable (may be sufferers of mental illnesses which are curable) - position of influence from 3rd party
AGAINST - degradation of doc-patient rela
If ass suicide normalised, risk trust will break down and docs will stop acting in best interest of patient
Dr Cox
Patient in great pain, no therapeutic options. Repeated requests to die. Dr injected potassium chloride which has NO pain relieving qualities - only intention was to bring about death of patient. Held: convicted of attempted murder
→ Drugs to relieve suffering will be fully justified under ‘double effect’ doctrine, even if it hastens moment of death. Purpose cannot be to hasten death only
Murder =
1) D caused death
2) D intended death or GBH
3) D has no defence
Doctrine of double effect
Thomas Aquinas - it is permissible to cause an evil consequence where this is a necessary result of a well intended act to produce a good consequence, and where to do so is proportionate
Bodkin Adams
Doctrine of double effect
Purpose of medicine = restoration of health - has to come first. Then Doc is entitled to take steps to relieve pain and suffering even if it may incidentally shorten life. Needs to be in best interest, without foreseeing shortening of life
→ Purpose cannot be to hasten death - Dr Cox
Airedale NHS v Bland - Goff
Lord Goff est a rule that when a patient is dying, say, of cancer, doc can administer pain killing drugs despite effect on span of P’s life - made in best interest then it will be lawful
→ Also said removal of feeding tube = omission not an act. Also discontinuance of life support = omission
Double effect defences
Defence based on lack of causation
De minimis - matter is so trivial, not worth judicial scrutiny
Defence based on lack of intent - double effect allows docs to be confident they will not face charges
Issues with double-effect
Permits docs to be confident they will not face charges
May lead to culture of managing patients with a view to their death
What degree of shortening life is acceptable?
Neuberger report
Guidelines concerning end of life care - criticisms focuses on people who were put on it too early and some financial motives
R (Nicklinson) v Ministry of Justice
COA refused to allow necessity defence in cases of euthanasia
N had catastrophic stroke aged 51, paralysed. He didn’t refer to any life shattering experience, but of many smaller inconveniences/distresses - not able to go to toilet by himself
N sought 2 declarations: 1) that it be lawful for doc to assist him in terminating his life or 2) declaration that law was incompetent under Art 8 ECHR (right to private life)
Primary challenges with domestic law - conflict with ECHR?
Art 2 right to life - right to death too?
Art 3 right against inhuman and degrading torture
Art 8 right to private family life
Art 14 right against discrimination - NICKLINSON
Debbie Purdy (R v DPP)
Argued Art 8 right to private life ECHR, and right to receive lawful euthanasia in Switzerland - tourism possible. Also wanted right to involve husband free of prosecution. Court did not find its blanket ban of Euthanasia as inconsistent with convention rights
System in the Netherlands
Legalised Euthanasia “purposefully ending life, on request”
System of reporting to track data - aims of transparency
Strict procedure docs must follow “prudent practice guidelines”
→ P must make voluntary and well considered request and their condition must be unbearable and hopeless
Queries about dutch law - J Williamson
Slippery slope once the door is open. Politicians and activists attempt to use it
But - 50% of healthcare costs occur in last 6 months of life
Oregon in America
Death with dignity ACT - adult who is capable, attend consultations. Has to be diagnosed with terminal illness, 2 witnesses. Only legalises prescribing lethal dose, not assisted dying, not euthanasia
Assisted dying bill no 2
Rejected in parliament
Effect was to make assisted dying lawful and provide defence to a criminal charge
More than 90% of people are FOR assisted dying bill (Guardian March 2019) for those with terminal illnesses
