Euthanasia

Question 1

Distinction between act and omission

Answer 1

Act - physically doing something
Omission - failure to do something / taking something away
→ More difficult to justify causing death than preventing it

Question 2

Passive and active euthanasia

Answer 2

Passive = omission e.g. refusal or withdrawal of treatment
Active = where cause death

Question 3

3 types of ‘voluntary’ euthanasia

Answer 3

1. Voluntary = causing P death at their request, their consent.
   (Vol active = positive act which brings about death which is controversial)
2. Non-voluntary = causing the P’s death without the consent or objection of the patient - no consent
3. Involuntary = causing P’s death against her wishes - murder or intentional killing

Question 4

FOR euthanasia - autonomy

Answer 4

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

Question 5

FOR - inference from permissibility of suicide

Answer 5

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)

Question 6

FOR - beneficience

Answer 6

All practitioners should perform the best for their patients - how do we determine best interest?
Death with dignity

Question 7

Airdale NHS Hospital v Bland

Answer 7

No longer in Bland’s best interest to be kept alive, in vegetative state for 2+ years

Question 8

FOR - discrimination against disabled

Answer 8

Suicide only accessible to those who have physical capacity and financial resources
→ Suicide tourism

Question 9

FOR - economic reality

Answer 9

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?

Question 10

AGAINST - sanctity of life

Answer 10

Roman catholics believe all live is sacred and valuable, regardless of the quality

Question 11

AGAINST - become the status quo

Answer 11

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

Question 12

AGAINST - risk of abuse

Answer 12

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

Question 13

AGAINST - degradation of doc-patient rela

Answer 13

If ass suicide normalised, risk trust will break down and docs will stop acting in best interest of patient

Question 14

Dr Cox

Answer 14

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

Question 15

Murder =

Answer 15

1) D caused death
2) D intended death or GBH
3) D has no defence

Question 16

Doctrine of double effect

Answer 16

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

Question 17

Bodkin Adams

Answer 17

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

Question 18

Airedale NHS v Bland - Goff

Answer 18

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

Question 19

Double effect defences

Answer 19

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

Question 20

Issues with double-effect

Answer 20

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?

Question 21

Neuberger report

Answer 21

Guidelines concerning end of life care - criticisms focuses on people who were put on it too early and some financial motives

Question 22

R (Nicklinson) v Ministry of Justice

Answer 22

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)

Question 23

Primary challenges with domestic law - conflict with ECHR?

Answer 23

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

Question 24

Debbie Purdy (R v DPP)

Answer 24

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

Question 25

System in the Netherlands

Answer 25

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

Question 26

Queries about dutch law - J Williamson

Answer 26

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

Question 27

Oregon in America

Answer 27

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

Question 28

Assisted dying bill no 2

Answer 28

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