Euthanasia & Assisted Suicide

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

SPUC opposes euthanasia because:

  • it is the deliberate killing of innocent 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 gravely ill and disabled are of less value than the lives of others.

Patient autonomy and the right to life

The case for euthanasia is often argued on the basis of autonomy–the patient’s freedom to make decisions about his or her own treatment. However, to invoke autonomy in this way involves a misunderstanding of the concept of autonomy, overlooking the principle that the patient’s freedom entails a responsibility to act ethically. While a patient is capable of giving valid consent, a doctor has no authority to treat the patient unless that consent is given. However, the patient cannot ethically refuse treatment with the intention to bring about his own death. The ethical objection to suicide is reflected in law. In Britain, for compassionate reasons, there are no legal penalties for a person who attempts suicide, but assisting a suicide remains an offence. Parliament recognised that people who have tried to kill themselves need help rather than punishment. There is therefore no legal right to suicide, and certainly no right to involve others in killing oneself. This is because the right to life is an inalienable right. No one may dispose of an innocent person’s life, and so one cannot, in justice, intentionally deprive oneself of life. If the law were to allow some individuals to volunteer for euthanasia, this would also threaten the right to life of others, especially the elderly, the gravely ill and the disabled. Legalisation of euthanasia would make a clear statement to society that it was permissible for private citizens (e.g. doctors) to kill because they accepted the view that a patient’s life was no longer worthwhile. If it is seen as a benefit to kill patients who consent to euthanasia, it is easy to argue that others should not be denied death simply because they cannot ask for it. Courts in Britain and other countries have already judged that some incapacitated patients may be starved to death and this challenges the notion that euthanasia would remain voluntary if allowed by statute law.

Euthanasia versus good medical practice

SPUC’s opposition to euthanasia does not mean that the society insists on medical treatment at all costs. The alternative to euthanasia is good medical practice, which requires doctors to recognise when it is appropriate not to continue treatment.

Sometimes a distinction is made between active euthanasia (e.g. a lethal injection) and passive euthanasia, which involves withholding or withdrawing treatment. However, it is misleading to describe withholding or discontinuing treatment as euthanasia unless this is done with the intention of killing the patient. Sometimes a treatment may properly be withdrawn even though the patient has consented to it, for example, when it is futile, merely prolonging the dying process in a terminally ill patient.The doctor’s intention is the critical distinction between euthanasia and good palliative care (treatment to relieve distressing symptoms). The dosage of painkillers necessary to control a patient’s pain may have the side effect of shortening his life. No moral objection arises as long as the drugs are not given with the intention of hastening the patient’s death, but only in order to control the pain.

Tube-feeding and the so-called persistent vegetative state

In several countries (including Britain) courts have authorised the withdrawal of tube-feeding from patients with severe brain damage who are said to be in a persistent vegetative state* (PVS). This amounts to euthanasia if done with the intention of bringing about the patient’s death. Tube-feeding does not become futile because it is thought that a patient has no awareness and will not recover, a judgement which is being increasingly questioned. Tube-feeding is not usually unduly burdensome, and only becomes futile if it no longer enables a patient to receive nourishment. Even if the provision of food and water require medical assistance, they are not intended to cure illness but are the basic means of sustaining life, which it is unjust to deny anyone on grounds of their disability. * The persistent vegetative state is increasingly referred to simply as the vegetative state. The use of vegetative in these expressions is gravely misleading since it suggests that a person in such a condition has somehow ceased to be human.

Advance directives

Advance directives are statements by a patient which typically contain instructions that, in the event of certain conditions arising (such as paralysis, incontinence, inability to communicate, the need for artificial life support), treatment should not be given. An advance directive is not necessarily a request for euthanasia, but such statements can be used to demand that doctors bring about the patient’s death by, for example, specifying that tube-feeding should be withheld. For this reason, advance directives, which, in this context, are often referred to as living wills, have become an important part of the campaign of the pro-euthanasia lobby. Legislation for living wills would facilitate the introduction of euthanasia, and this is the principal reason why SPUC opposes moves in Parliament to make advance directives legally binding. Doctors might act on an advance directive in circumstances which the patient did not foresee, or misinterpret the patient’s wishes. While advance directives may be helpful to doctors in forming an impression of the patient’s preferences, if they are binding, they are liable to tie the hands of doctors, preventing them from acting in the patient’s best interests. A patient may not realise that withholding treatment will not necessarily lead to an earlier death with less suffering. It may, in fact, lead to a bed-bound state with greater impairment of health.

Ascertaining when life ends

The criterion of brain stem death has been used to determine that death was imminent and inevitable, so that treatment could be discontinued. However, there has been a widespread tendency to regard brain stem death as signifying death itself. Some go further and suggest that patients with certain forms of brain damage, such as persistent vegetative state, should be regarded as dead. There is increasing concern among pro-life doctors and ethicists that a patient should not be regarded as dead until there is evidence of both brain stem death and the end of other vital functions. This would safeguard against ending the lives of patients who had volunteered for organ donation before natural death had occurred. An extended briefing is also avaliable from SPUC UK here.

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