Medical homicide

The term euthanasia (the Greek for good death) has come to mean the deliberate killing of sick or disabled persons for supposedly merciful reasons or mercy killing.

The case against euthanasia

SPUC opposes euthanasia because:

• it is the deliberate killing of human beings—a violation of the right to life
• it is contrary to medical ethics, putting doctors in the role of killers
• it assumes that the lives of the terminally ill and disabled are not worth living and so should be ended

Patient autonomy and the right to life

The case for euthanasia is often argued on the basis of the patient's freedom to decide on his or her own treatment. This is called patient autonomy. While a patient is capable of giving valid consent, a doctor cannot treat the patient unless they give consent. However, the patient must also act ethically and so cannot refuse treatment in order to end his or her life. This would be suicide.

In Britain, someone who attempts suicide is not punished. Parliament knows that people who try to kill themselves need help not punishment. However, assisted suicide is still illegal and anyone who helps another person to commit suicide will be punished. This is because no one has the right to end another person's life, or to end his or her own life. This is because the right to life is inalienable; it cannot be removed.

If the law allowed some individuals to volunteer for euthanasia, this would threaten the right to life of others, especially the elderly, the terminally ill and the disabled. Legal euthanasia would allow doctors to kill because they accept that a patient's life is no longer worthwhile. If it is seen as a benefit to kill patients who consent to euthanasia, it is then easy to argue that others should not be denied death simply because they cannot ask for it, e.g. if they are in a coma. Courts in Britain and other countries have already allowed some incapacitated patients to be starved to death. This challenges the idea that if euthanasia was legalised it would remain voluntary.

Euthanasia versus good medical practice

Opposition to euthanasia does not mean insisting on medical treatment at all costs. Good medical practice requires doctors to recognise that sometimes it is not right to continue treatment. For example, a doctor can end a cancer patient’s chemotherapy treatment if it is not working, even if this means the patient will die.

Sometimes a distinction is made between active euthanasia (e.g. a lethal injection) and passive euthanasia, withholding or withdrawing treatment. Withholding or discontinuing treatment is only euthanasia if it is done to end the patient’s life. Sometimes a treatment can be withdrawn without the patient’s consent if it will only prolong the dying process in a terminally ill patient.

The doctor's intention is very important. Sometimes painkillers used to control pain can also shorten the patient’s life. If the doctor means to control the patient’s pain then this is not euthanasia even if the painkillers also cause the patient to die sooner.

Tube feeding and the so-called persistent vegetative state

In several countries (including Britain) courts have allowed doctors to stop tube feeding patients with severe brain damage who are said to be in a persistent vegetative state* (PVS). This is euthanasia if the intention is to end the patient's life. Tube feeding is not a burden to the patient, and is only futile if it is not nourishing the patient. Even if food and water are supplied with medical assistance (a tube), they are not intended to cure illness. We cannot live without food and water and it is unjust to take this away simply because the patient cannot feed themselves.

Most people do not know how unpleasant it is to die of hunger or thirst. As well as a dry mouth and excessive thirst, dehydration can lead to:

• confusion and restlessness
• impaired speech
• increased risk of bed sores
• circulatory failure
• severe kidney pain and general distress
• renal failure, hyperkalaemia, cardiac arrest
• rise in opiod metabolites – constipation, nausea, mynoclonus, seizures

This is clearly not the dignified death that those in favour of euthanasia claim to want for patients in PVS. When relatives see the effects of withdrawing food and water they may call for euthanasia by lethal injection as a quicker and kinder way to end life. This is what some pro-euthanasia campaigners also want.

* The persistent vegetative state is increasingly referred to simply as the vegetative state. The use of vegetative is misleading because it suggests that the person is no longer human. This condition would be better described as a "persistent non-responsive state".

Advance directives

Advance directives or living wills tell a doctor how a patient wants to be treated if they become ill in the future and cannot tell the doctor themselves. It may tell the doctor not to give treatment if the patient becomes paralysed, incontinent, unable to communicate, or in need of artificial life support. An advance directive might not ask for euthanasia, but it could be used to demand that the doctor end the patient’s life by, for example, asking the doctor to stop tube feeding. Advance directives are an important part of the campaign for legal euthanasia. If the law required a doctor to act on the instructions of an advance directive it would help to introduce euthanasia.

Advance directives may help a doctor by describing what the patient wants but if the doctor has to obey them, they can stop him/her from acting in the patient's best interests. A patient may not realise that refusing treatment in some cases will not lead to an earlier and easier death. Instead it may lead to greater suffering with the doctor unable to help because the patient’s advance directive does not allow treatment.

Deciding when life ends

Brain stem death has been used to decide that death is imminent and inevitable and so treatment can be discontinued. However, some people suggest that brain stem death is death itself. Others go further and suggest that patients with certain forms of brain damage, such as persistent vegetative state, are already dead.

Pro-life doctors and ethicists believe that a patient is not dead until there is evidence of both brain stem death and the end of other vital functions, e.g. the ability to receive nourishment from food and water or the ability to breathe on your own. Patients who have volunteered for organ donation would therefore not have their lives ended before natural death has occurred.

See also the Linacre Centre's material on euthanasia.

SPUC Scotland Paper 2
The Case Against Euthanasia
Revised June 2002

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