The subject of euthanasia is one of the most controversial
and hotly debated ethical issues in recent history. In any situation involving
the decision to end someone’s life, there will always be conflicting moral and
ethical dilemmas. Currently, euthanasia has no special place in UK law.
However, its practice can be interpreted as assisted suicide, carrying a maximum
prison sentence of 14 years. Several unsuccessful attempts have been made to
change legislation and legalise its practice in the UK, the latest of which
lost by 148 votes to 100 in the House of Lords in May 2006. However, the
practice of euthanasia is currently legal in Belgium, Luxembourg, Holland,
Oregon (USA) and Switzerland. So why is it illegal in the United Kingdom? First
of all, we need a definition for euthanasia:
“The act or practice of killing or allowing death from natural causes,
for reasons of mercy, i.e., in order to release a person or animal from
incurable disease, intolerable suffering, or undignified death.” (Beauchamp and
Walters, Contemporary Issues in Bioethics, 5th ed) There are two forms of
euthanasia – voluntary and involuntary. In this essay, I shall explore the
debate using the four ethical principles of beneficence, non maleficence,
justice and autonomy as the framework. Since the potential for involuntary
euthanasia to exist in modern society is imponderable, I shall only discuss the
voluntary form.
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| Death Doctor? |
Whilst on the subject of doctors and what they signed up
for, we must also consider euthanasia from the angle of non maleficence. That
is to say, a doctor should do no harm to their patient. There are so many cases
in which it is hard to see whether a doctor is doing harm or not. For example,
secondary euthanasia – administering a drug with the intention of helping a
patient whilst also foreseeing a potential risk to their life is not considered
illegal. The current law on this is very unclear and has been subject to a lot
of criticism in recent years. Lord
Browne-Wilkinson asked, “how can it be lawful to allow a patient to die slowly,
though painlessly, over a period of weeks from lack of food but unlawful to
produce his immediate death by a lethal injection, thereby saving his family
from yet another ordeal to add to the tragedy that has already struck them”
admitted that he found it “difficult to find a moral answer to that question”. So is a doctor doing more harm by not
assisting the patient in committing suicide and keeping them alive against
their own will? In this case, I think the answer is yes but only for a small
minority of cases. Taking a life is fundamentally wrong and goes against one of
the oldest and most venerated moral injunctions “thou shalt not kill.”
Stretching all the way back to the origins of the medical professions,
Hippocrates scribed in the original Hippocratic oath that a doctor must swear
to do no harm to their patient. Currently, it is impossible to impose
medication on a patient against their own will, as they have the option to
reject it. Besides, can there really be anything more harmful to life than
terminating it altogether?
This leads to my next point about a patients autonomy. Every
doctor must respect their patient’s autonomy – their control over their own
body. It is indeed true that everyone has the right to die and has control over
their body. The suicide act was reformed in 1961, legalising it. However, also
under the suicide act, anyone who “aids, abets, counsels or procures” in the
suicide (or attempted suicide) will be liable for a prison sentence of up to 14
years. By the letter of the law, if a family member arranged for their
suffering relative to go to Switzerland and commit suicide in a dignitas
clinic, they could face a prison sentence on returning to the UK. This has
indeed happened – a family member was prosecuted for helping their sick
relative go to Switzerland but this fell at a very early stage with the crown
prosecution deciding that it would not be sensible to prosecute them. So if it
has been made legal to commit suicide, why can’t someone assist you in carrying
out a legal act if you are physically unable to do it yourself? My personal
take on this question is that the law was only changed in recognition of the
fact that people who attempt to commit suicide need mental help rather than a
lengthy prison sentence. There is also the slippery slope argument about
legalising assisted suicide, but since every law is open to abuse, I don’t feel
that the argument that legalising assisted suicide would lead to people
murdering each other under the guise of assisting suicide, as they had the
consent of the victim as one which is strong enough not to be countered by
strict regulations in any legalisation of euthanasia. The argument about autonomy
is one which is often brought up but never really carries any substantial
weight. A patient’s autonomy is an important principle but also one which must
be balanced with other ethical precepts, such as the doctor’s duty to avoid
harm in its wildest sense. There must be a playoff between acting in the
patient’s best interest and respecting their autonomy in every ethical issue in
medicine and in my opinion, respecting a terminally ill patient’s autonomy is
often outweighed by the doctors duty to act in their best interest, especially
when the patient may not be in a mentally fit state to dictate what they want.
The final angle I shall explore on this is that of justice.
Justice is a loosely defined term in this context because we must consider
justice from society’s perspective as well as the patient, their family and the
doctor. The law has no place for murder, perhaps one of the largest
contributing factors to the stable society we enjoy today. From society’s point
of view, it may be unjust not to allow someone who wants to but cannot commit
suicide to be assisted in doing so. However, it is equally unjust to legalise
mercy killing and assisted suicide, as such a system, however well regulated,
would be open to such a wave of abuse that it would be impossible to coexist in
a land where killing can be justified on the basis that it was by mutual
consent. I agree that it is unjust not to allow people in certain extreme cases
to be assisted in committing suicide and this view is shared by very many
people. On 12 March 2012, there was a landmark ruling by Mr Justice Charles on
Tony Nicklinson’s case to have a full hearing on having his physician assist him
in suicide without facing prosecution. The case of Tony Nicklinson prompted enormous
sympathy. Before his stroke he led an active life, working in Dubai as an
engineer. For more than six years he has needed constant care - an active mind
locked inside a paralysed body. His family do not want to go to Switzerland and
don’t want him to die from starvation. This just shows how despite me having a
strong view on this argument, it is impossible to categorically state that
euthanasia is an evil concept in every regard. I believe that since he clearly
has the right mental capacity to decide on his life and is merely making
provisions for the future when he may not be in such a fit state, his case is a
legitimate one. However, I don’t believe that it stands much of a chance in the
hearing for reasons stated above and covered in my conclusion.
Therefore, to conclude, I do not believe that the pro-euthanasia
arguments are sufficient reason to weaken society's prohibition of intentional
killing. Such a prohibition is the cornerstone of law and of social
relationships. In response to the examples of unbearable pain, I point to the
unparalleled palliative care system which exists in the UK. The purpose of this
system is to relieve patients of their pain. However, the observation by Lord
Browne-Wilkinson is one which cannot be ignored. When phrased in the way it
was, it appeals to every emotive sense in our bodies. Although it is my
personal view that the status quo does not accommodate all cases of terminally
ill patients which is wrong, my answer to why euthanasia is considered illegal
in the UK and why the UK does not follow the few European countries which have
legalised euthanasia is simple. It would be impossible to regulate in today’s
society. As the BMA states, it protects each one of us impartially, embodying
the belief that we all are equal. We do not want that protection to be
diminished. We acknowledge that there are individual cases in which euthanasia
may be seen by some to be appropriate. But individual cases cannot reasonably
establish the foundations of a policy which would have such serious and
widespread repercussions. Despite the focus of every enquiry being on the
victim, dying is not only a personal or individual affair. The death of a
person affects the lives of others, often in ways and to an extent which cannot
be foreseen. The issue of euthanasia is one in which the interests of the
individual cannot be separated from the interests of society as a whole. It is
also my personal view that such a ruling; legalising mercy killing/assisted
suicide would compromise the relationship of absolute trust which every single
person can enjoy in the UK. The guidelines against euthanasia exist in our
country for the sole reason to safeguard the interests of society as a
whole.
References:
Introduction to medical ethics – Tony Hope
BBC Ethics – euthanasia
BMA policy on euthanasia
