Medical Ethics: Euthanasia (Part 2)

Euthanasia Debate

Why it should be legalised?

1. Patient's best interest (Beneficence)

• Patient has a terminal illness or has an incurable fatal disease
• Without life support (active treatment) will die in a few days
• However if given life support, he/she can live for a few weeks
• No medication (antibiotics/ IV fluids) can stop the progression of the disease

In a case like this, is it really in the best interest of the patient to give him/her life-extending treatment or for him/her to die now? We need to consider whether or not the person's quality of life will be poor if given the life extending treatment.

If extending the person's life will also greatly decrease quality of life e.g. difficulty in breathing, then it will be in his/her best interest to die, due to the underlying fact that his/her quality of life is poor.

    2.  Respecting patient's wishes (Autonomy)

• E.g. Jehovah's Witness refusing life-saving blood transfusion
• Forcing treatment on a competent adult against the wishes of the patient would mean that the doctor is violating the person's rights. 

Arguments against euthanasia:

1. Killing is morally wrong
2. There might be a chance that the patient's condition will improve

For the first argument we can also point out that there is a distinct difference between killing (murder) and euthanasia. In the case of killing, the intention is for the patient to die whereas passive euthanasia, the main intention is to relieve pain. This means that although death may be foreseen, it is not the main intention.

Conclusion

The act of voluntary passive euthanasia should be legalised to the extend that there are strict regulations placed and the decision should be carefully made by both doctor and patient. 

It is the harm of death that makes killing a morally wrong thing to do and therefore, if it is the best interest for the patient to die (as they will suffer from increased pain), then mercy killing would no longer be a wrong but a morally right choice. 

Book used: Medical ethics (A very short introduction) - Tony Hope

4 Principles of Medical Ethics

Before we can move on to debating about ethical scenarios whether it be the enforcement of treatment under the Mental Health Act or abortion, we need to discuss the underlying principles behind medical ethics. These may conflict with one another as we will see later.

To make things easier we can say that these principles are like 'pillars' which builds the foundation of medical ethics. 

1. Autonomy

Literally meaning self-rule, it is the capacity to think, decide and act on the basis of the thought and make decisions freely and independently. 

Healthcare professionals can only provide information to ensure patient is fully informed in order to make a decision and respect their final decisions, even if they think that their patient has made the wrong decision. 

*To be able to make a decision, the patient has to have capacity (as assessed by the Mental Capacity Act 2005).

2. Beneficence

The simplified definition of this is to "promote what is best for the patient". However the patient's best interest may not always be what the patient wants. A healthcare professional may determine what is the best course of action for a particular patient, however, the patient would be entitled to their own views, as covered by patient autonomy.

These two principles conflict with one another when a competent patient chooses a course of action which is not in his or her best interest.

3. Non-maleficence

"Do no harm". Again, this may conflict with the other principles as although some treatment may be of benefit to the patient, it may also cause them some harm. 

E.g. Double doctrine effect 

This occurs when the act of doing something morally good may have a morally bad side effect, provided that the side effect is intended.

Doctors give morphine to patients who are terminally ill for the purpose of pain reliever. However, the use of morphine may also hasten death and therefore, causes a degree of harm on the patient. 

4. Justice

This can be divided into 4 components:

a) distributed justice 

• All patients in similar situations should have access to same health care
• Deals with the distribution of limited resources fairly

b) respect for the law

c) rights

d) retributive justice  

• Deals with the fitting of the punishment to the crime

E.g. Person with mental disorder commits a crime

Examples of ethical scenarios:

• Jehovah's Witness refusing blood transfusion 
  (assuming that patient is competent and requires life saving treatment)
• Should a doctor be allowed to give contraceptive pills to a 16 year old girl without parental consent? (Gillick competence)
• Should a doctor break confidentiality and tell the wife of his/her patient that her husband is HIV-positive?

Websites used :

http://www.bbc.co.uk/ethics/euthanasia/overview/doubleeffect.shtml

http://jme.bmj.com/content/29/5/275.full

http://www.ukcen.net/index.php/ethical_issues/ethical_frameworks/the_four_principles_of_biomedical_ethics

Medical Ethics: Euthanasia (Part 1)

Recently, I have been reading this book, Medical Ethics by Tony Hope.

In short, this book covers a variety of ethical issues and controversial problems held in our current society, weighing up both pros and cons by using logic and reasoning.







In this post I will be defining euthanasia, UK's stance on euthanasia and Netherland's law on euthanasia.

So, what is exactly is euthanasia? 

The word euthanasia itself comes from the Greek words eu thanatos, meaning good or easy death.
Euthanasia can be further divided into these categories:

• Active euthanasia

This occurs when someone (X) performs an action which directly results in person Y's death.

E.g. administration an overdose of legal medication

• Passive euthanasia

This is when someone (X) withholds or withdraws life-prolonging treatement

E.g. Failure to resuscitate,  halting medication

It can also be divided into these categories:

• Voluntary euthanasia

Patient Y competently requests death him/herself.

• Involuntary euthanasia

Death is against patient Y's wishes however, person X will either allow or impose death onto Y.

• Non-voluntary euthanasia

Patient Y does not have the ability (not competent) to express their preference

E.g. a severely newborn baby 

It should also be pointed that that although both euthanasia and suicide have different definitions. To distinguish the two, suicide can be further divided into:

• Suicide

Y intentionally kills himself

• Assisted suicide

Person X helps Y to kill himself

• Physician- assisted suicide

Physician X helps Y to kill himself

UK's stance on euthanasia?

The English law currently placed in the UK states that both active euthanasia and assisted suicide are illegal. The Suicide Act 1961 makes it an offence to encourage or assist a suicide or a suicide attempt in England and Wales.
In 2015, the assisted dying bill has been rejected by MPs in England and in Wales (118-330) despite public votes supporting the change of the bill.

This leads to some patients with terminal illnesses to travel to countries such as the Netherlands to receive either euthanasia (active) or physician assisted suicide in end of life clinics. Despite it being the first country to legalise this practice, there are strict boundaries to be maintained and exceeding these boundaries will make it a criminal offence.

The simplified requirements of active euthanasia in Netherlands:

1. Patient must face a future of unbearable, interminable suffering
2. Request must be voluntary and well-considered
3. Doctor and patient must be convinced there is no other solutions
4. Second medical opinion must be obtained and life must be ended in a medically appropriate way

One point to note is that for patients who are unable to express their wishes e.g. in comatose state, a written declaration of the patient's will will also be recognised and validated as consent. It is also currently illegal in Netherlands to deliberately end the life of a severely ill newborn.

Websites used:

http://www.dignityindying.org.uk/press-release/parliament-ignores-public-votes-assisted-dying-bill/
http://services.parliament.uk/bills/2015-16/assisteddyingno2.html
http://www.patientsrightscouncil.org/site/holland-background/
http://www.theguardian.com/lifeandstyle/2015/sep/11/assisted-dying-dutch-end-of-life-netherlands-unbearable-suffering
https://www.rnw.org/archive/faq-euthanasia-netherlands

Books used:
Medical Ethics, A Very Short Introduction- Tony Hope