Med Essay - Legalising Euthanasia PDF

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Essay notes on the issue of legalising euthanasia...

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Key Q: Should euthanasia be legalized? What is euthanasia?  It means ‘a good death’  Ie: the killing a person in their best interests, typically to end their suffering  Typically, this is relevant when a person is terminally ill and is suffering great pain due to an illness/a disease, such that a peaceful and painless death is regarded as the best course of action to end their pain/suffering What does the current law of the UK say?  The intentional killing of an individual – regardless of whether it is at their request – is a criminal act o Dr Cox case o Would be treated as murder/manslaughter o In certain instances, would carry with it a mandatory life sentence of imprisonment  Crucially, suicide has been decriminalized by the enactment of the Suicide Act 1961, S.1.  However, assisted suicide is still decriminalized as provided in Suicide Act 1961, S.2(1). In light of this, debates on the legalization of euthanasia have taken place not only within the society, but by the legislators  Assisted Suicide Bill - rejected  The issue is that there are strong arguments on both sides – each with legitimate concerns The Q now is, whether this Bill should be passed – such that euthanasia would be legalized? Stance: it should be legalized  Although there are many strong arguments against the legalization of euthanasia – this essay argues that the concerns could arguably be rebutted, or are no longer relevant in this modern society o The Times (24 January 2007) reported – according to the 2007 British Social Attitudes survey, 80% of the public said they wanted the law changed to give terminally ill patients the right to dies with a doctor’s help o Furthermore, in the same survey, 45% supported giving patients with non-terminal illnesses the option of euthanasia  Current attitude of the law towards euthanasia

o Important note: suicide is now legal under the Suicide Act 1961, o Even though assisted suicide is still illegal – history has shown that CPS is reluctant to prosecute such cases  R (Daniel James) v DPP  Parents were not prosecuted  Distinguish from Inglis However, this essay would aim to tackle arguments put forward by the opponents, and to provide further reasons in favour of legalizing euthanasia.

Against euthanasia (1) sanctity of life

The sanctity of life principle  Reflects the belief that because people are made in God’s image, human life has an inherently sacred attribute that should be protected and respected at all times (Genesis 1:26)  While God gave humanity the authority to kill and eat other forms of life (Genesis 9:3), the murdering of other human beings are expressly forbidden – the penalty being death (Genesis 9:6) But this is easily rebuttable – esp by those who are nonreligious  This principle could arguably be irrelevant to the non-believers  Separation of church and state There are also non-religious views regarding the sanctity of life principle  By philosopher Immanuel Kant  That rational human beings should be treated as an end in themselves  And NOT as a means to something else  In other words, the fact that we are human – means that there is a value in itself So, the value of our lives is not dependent on anything else  Not dependent on whether we have a good life  As long as we live, there is value attached to our lives The argument follows:

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Rebuttal (1)

Due to this inherent value, we have to respect our lives Since the value of our lives is independent of other factors, it would be contrary to the principle if we were to kill someone just because they are terminally ill or suffering great pain To kill ourselves would be to treat ourselves as a means to our own ends

The argument that one should not be treated as an end in themselves seems hollow in light of passive euthanasia + double effect doctrine  Hence, it is widely acceptable and legally permissible for: o the withdrawal of treatment which would in effect result in the death of the patients, and o the treatment of a patient which could shorten life is allowed, if the intention were to alleviate pain – and not to kill  If life has intrinsic value, then all conditions in which it manifests should ostensibly be of the same value Furthermore, the principle of sanctity of life is not an absolute principle Have to consider other principles, such as quality of life and respect of autonomy On quality of life  What make a life good are the experiences of the person and their interaction with others o Barnard, ‘The Need for Euthanasia’: “A doctor who is unconcerned about the quality of life is inhumane; and the real enemy is not death but inhumanity”  Important to distinguish the difference between the futility of treatment and the worthwhileness of a person’s life o Keown, ‘Restoring Moral and Intellectual Shape to the Law After Bland’ o Takes “quality of life” to mean the

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“assessing of the worthwhileness of a person’s life…and if it falls below a certain threshold, it becomes a life not worth living o Argued that the HOL took this stance in Airedale NHS Trust v Bland Probability of recovery should not be confuses with futility of treatment o The probability of recovery refers to the patient’s “worthwhileness” – in the face of the degeneration that their condition has brought upon them o The inability to enjoy even the basic pleasures that were once taken for granted, let alone the more complex  directly reflects upon one’s quality of life o A life that can no longer be experience and in which relationship with others are impossible in a life that has lost its goodness

Counter-argument:  Arguably that the quality of life argument meant that certain lives are not worth living  By allowing certain people to die merely because they are no longer “worthy of living” argued to be derogatory  Eg: by allowing a person who is paralysed to die because it is agreed that his life is no longer living, would this send a message that the lives of those suffering from paralysis are valued less than others? On respect of autonomy  John Stuart Mill, ‘On Liberty’ o Outlines an argument for the freedom of an individual – where he created a defence towards “the rights of the individual against the state” – o Harm Principle  an individual has the right to behave as he wishes upon the condition that his behavior does not harm others  meaning: so long as the behavior is

isolated in its effect to the individual undertaking the court of action, society at large has no position to interfere  even if the action is causing direct harm to the individual himself o However, opponents could argue that the harm of euthanasia would not be isolated since it may bring harm to others – eg: emotional stress and pain to loved ones  This could be countered by questioning what “harm” really is.  There is a strong argument that by forcing someone to stay alive against his wish could be harmful  Dworkin: ‘making someone die in a way that others approve, but he believes a horrifying contradiction of his life is a form of tyranny’  Each person may have his own view of what is a good death  Furthermore, euthanasia could be argued to relieve the loved ones from emotional and financial burdens – hence, not harmful. For Death as part of life

Respect for autonomy provides that we should be able to choose how to live  So since death is considered a part of living – ie: the last phase of life - we should also be allowed to choose how to die  A person should be able to choose to die in dignity and without pain/suffering, esp since it is the last phase of his/her life Counter-argument: religious views that pain also accepted as part of life and have redemptive qualities  Hence, by legalizing euthanasia could arguably provide an escape from the pain  This deprives the individual from an opportunity of redemption and to prepare for afterlife Countered: weak argument as it does not apply to everyone

   Against euthanasia (2) Vulnerable to abuse

Only applies to believers – irrelevant to nonbelievers It would not be right for the law to impose religious views on everyone Separation of the church from the law

Opponents argue that the law regulating euthanasia could be vulnerable to abuse  Common proposal: should euthanasia be legalized, it could only be carried out by doctors  This would arguably place a lot of power in the hands of medical professionals  Doctors are disincentivised from keeping a terminally ill patient alive – may view that resources can be better allocated to a patient who has a better chance of recovery Argument follows that even if there are request for voluntary euthanasia – it is rare that these consents are free and voluntary  Legalizing euthanasia may place the certain categories of the society in a vulnerable position  Eg: the poor, old, terminally ill, severely handicapped  These people may feel pressured to die so as not to fell like a burden to their caretakers – be it, emotionally or financially  Even if they do not face such external pressures, an individual may be suffering from depression, or a false sense of worthlessness due to their conditions  These could affect their judgment – no real consent

Rebuttal (2) “vulnerable argument” is a myth

The “vulnerable argument” is a myth  According to Journal of Medical Ethics (2007)  Found the poor, elderly, minority or otherwise “vulnerable” groups were represented as infrequently as everyone else  Meaning: the supposedly vulnerable were no more likely to receive assisted death than anyone else  Hence, no evidence that legalizing euthanasia would lead to a spike in euthanasia rate, even for

the vulnerable However, it must be acknowledged that the countries in which euthanasia is legally permissible (Belgium, Luxembourg, Holland) are countries with better social safety nets  this means that the state provide better social welfare to the citizens  hence, the citizens for these countries have lower incentives to want to kill themselves  as they are better cared for – have better support system  this could be a major factor in the low euthanasia rate Especially in light of the austerity policies by the majority conservatives in the British parliament – welfare cuts, etc – the vulnerable may not be as disincentivised as those from Belgium, Lux and Switzerland from seeking euthanasia. However, a spike in euthanasia rate following its legalization is unlikely  although it is uncertain whether the UK would have a social net as good as those countries,  we cannot disregard that we have the NHS – where medical treatment and support is still readily available  this could arguably incentivise individuals to seek treatment and deter them away from seeking euthanasia  hence, those who eventually seek euthanasia would be those who have contemplated other medical alternatives and certain that euthanasia is in their best interest Against euthanasia (3) Alternatives – palliative care

Opponents argue that many of those seeking for euthanasia forget that there are alternatives to dying  most commonly argued: palliative care  the World Health Organisation states that palliative care affirms life and regards dying as a normal process – neither hastens nor postpones death  focuses on providing patients with relief from the

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Rebuttal (3)

symptoms, pain, physical stress and mental stress of a serious illness Hence, dying is no longer necessary – the pain and suffering which induced the individual to seek euthanasia could be alleviated.

The argument that palliative care is available as a alternative to euthanasia is only true in theory

Palliative care only (1) The effectiveness of palliative care is questionable works in theory,  although it is accepted that this medical approach not in practice is non-intrusive and targeted to provide comfort and support to patients, it may not necessarily eliminate the discomfort experienced by the patients (2) Even if palliative care is truly effective, it is questionable whether palliative care would be accessible to everyone  Palliative care is significantly more expensive than normal medical treatment provided  Specially trained staff and equipment  Hence, the poor may not be able to afford such palliative treatment even if it is within their contemplation  inaccessibility due to geographical limitations  Those from rural / less developed areas may not have access to proper palliative care For

The current law is inconsistent

Current law is uncertain and discriminatory – needs to be reformed

(i) On ambiguity in the application of the current law  The current law conflicts with the law as it is being enforced  Assisted suicide is a crime while suicide and passive euthanasia is legally permissible  Also, although case law demonstrates the CPS’ reluctance to prosecute individuals who helped loved ones to die, the decision to prosecution still lies in the exercise of discretion by the CPS  This uncertainty leaves doctors as well as wellmeaning individuals unprotected – unsure if they could help another person to die without being prosecuted.

(ii) On discriminatory the law is also inconsistent  in the sense that those who intend to die and are physically able to kill themselves – are allowed to commit suicide  however, since assisted suicide is criminalized, those who intend to die but are physically unable to kill themselves are unable to do so  This is a clear discrimination against the physically-handicapped

Must acknowledge that this issue was addressed in Pretty,  the ECHR held that, Art. 14 was engaged  but took the view that there were objective and reasonable justification not to distinguish the law between those who are able and unable to commit suicide Furthermore, this is in line with the rule of law (Bingham)  Bingham’s 3rd principle – that the law must be applied equally to all, save for objective differences which justify differentiation  Being physically disabled is not an object difference that justify a differentiation  esp when they are arguably more vulnerable to being taken advantage off Counterargument: euthanasia is already being carried out in practice  double doctrine effect, and  prosecution of assisted suicide through the exercise of discretion by the CPS...