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Giving

Euthanasia

The word euthanasia comes from the Greek eu and thanatos, which together mean 'good death.' Euthanasia, sometimes called 'mercy killing,' is defined as the intentional killing of a patient either by act or omission, supposedly in the person's own interest. Voluntary euthanasia is killing the person at the person's request. Involuntary euthanasia is killing the person without his request, and possibly against his will. Nonvoluntary euthanasia is killing a person unable to make such a request, such as a young child or a sufferer from dementia.


There has been increased pressure for legalised euthanasia in recent years.


Whilst euthanasia was illegal in the Netherlands, the Dutch authorities agreed doctors would not be prosecuted for performing euthanasia provided guidelines were observed. These stated that euthanasia was to be for people who were terminally ill, in irrelievable pain, after repeated requests, with the consent of two doctors, and reported to the authorities.


A Dutch Government report in 1991, however, said that active euthanasia was performed on 1,000 patients in 1990 without an explicit request from the patient, and intentional lethal doses of morphine-like drugs were given to 4,941 patients without the patient's knowledge. A report in 1996 said in 1995 euthanasia was performed on 900 patients without an explicit request from the patient, intentional lethal overdoses were given to 1,889 without the patient's knowledge and medical treatment was withheld from 3,644 with the aim of hastening death. Many doctors had performed euthanasia without seeking a second doctor's opinion. In 1990 only 18 per cent of cases and in 1995 only 41 per cent of cases were reported to the authorities.


Dr Herbert Hendin, an American physician who authored a 1997 report following a visit by doctors to research euthanasia in Holland, said virtually every guideline had either failed to protect patients, been modified or been violated, and euthanasia, originally intended for the exceptional case, had become an accepted way of dealing with serious or terminal illness. The Dutch Parliament's lower house finally legalised euthanasia in Holland in 2000. Approval by Parliament's upper house was granted in April, 2001.


Cases unreported


A Dutch TV programme in 2003 claimed doctors were now performing euthanasia on thousands of patients without bothering to report it, as required by law, because they considered reporting it too time-consuming. The programme claimed that to avoid the legal procedure, doctors were giving lethal does of morphine under the pretext of pain management, or rendering patients unconscious with sedatives and allowing them to die of dehydration and starvation. Researchers in Holland who surveyed 5,600 doctors and interviewed 500 doctors in 2003 said almost half the cases in Holland went unreported because doctors wanted to avoid the hassle involved and were concerned that regulations might have been breached.


Since euthanasia was legalised in Holland, euthanasia has been performed there on people who were not terminally ill, and on children. It is now to be extended to include euthanasia of infants.


Euthanasia was legalised in Australia's Northern Territory in 1996, but the legislation was later repealed by the federal government. Euthanasia was legalised in Belgium in 2002. The Belgian Medical Journal later reported that several times more cases of euthanasia were being carried out than were being officially recorded. In 2008, Luxembourg's Parliament voted to legalise euthanasia and assisted suicide. The law was expected to come into force several months later.


Assisted suicide is legal in the states of Oregon and Washington, but not in other states in the USA.


In Britain, euthanasia and doctor-assisted suicide are illegal.


In 1993 the House of Lords upheld decisions by the High Court and the Appeal Court that feeding by tube constituted medical treatment, and food and water could therefore be withheld from Tony Bland, a young man brain injured in the Hillsborough football stadium disaster, thus effectively starving him to death 'in his own best interests.' Tony Bland was not on a life-support machine, was not in pain, and fed and cared for could have lived for an indefinite period, but doctors said he was in 'persistent vegetative state' and his condition would not improve. This was the first time in history English courts sanctioned the death of an innocent man who was not already dying. Court permission was later given for food and water to be withdrawn from other brain-damaged patients, not all of them in 'persistent vegetative state.'


In 1994 a select committee appointed by the Government to consider euthanasia recommended the law should not be changed.


New guidelines


In 1997 the Government published a green paper describing euthanasia as 'a deliberate intervention with the express aim of ending life' (making no mention of killing by omission), suggesting legalising the withdrawal of food and water from patients, and suggesting making advance directives ('living wills') legally binding. (Living wills are documents that can be signed by people in advance stating they do not want treatment in the event of their becoming incapacitated. They are supported by organisations advocating euthanasia. They are opposed by pro-lifers for a variety of reasons; many consider their use introduces euthanasia by the back door.) Some pro-lifers claimed that politicians, while saying they were opposed to euthanasia, were leaving loopholes so that euthanasia could be introduced by the back door.


In January, 1999 the Times reported that the deaths of at least 50 patients were being investigated at hospitals around Britain. It said seven separate inquiries were under way into claims that doctors had withheld intravenous drips from dehydrated patients, often while they were under sedation, leaving the patients to die of thirst.


In June, 1999 the British Medical Association issued new guidelines to doctors saying doctors could withdraw treatment, including food and water, from seriously ill patients if they considered it in the patient's best interest. The guidelines say there should be no need to apply for the courts' permission. Relatives' wishes should be taken into account, but the doctors' decision should be final, unless relatives could persuade the courts otherwise.The General Medical Council also issued guidelines to doctors.


In 2000 the Medical Treatment (Prevention of Euthanasia) Bill, a private member's bill which would have made it illegal for a doctor intentionally to cause the death of a patient either by deliberate act or by omission, by withholding medication or food and water, failed in the House of Commons after the Government declined to support it.


In 2000, Scottish legislation allowed for 'welfare attorneys' who would be able to take decisions on behalf of patients unable to take decisions for themselves, including the withdrawal from the patient of food and fluids by tube.


In 2002 the British Government issued new guidance on treatment for patients who are mentally incapacitated and unable to take decisions for themselves. It said living wills must be complied with.


Assisted suicide


Two Private Member's Bills came before Parliament in 2003. Baroness Knight's Patient's Protection Bill would have made it illegal to withhold sustenance for the purpose of hastening or causing the death of a patient. Baroness Knight said hospital patients were being deliberately starved to death, which was in contravention of the Human Rights Act, which said that no one should be deprived of life intentionally. Lord Joffe's bill would have legalised assisted suicide, allowing terminally ill adults to request medical help to die. Neither bill became law.


Towards the end of 2003, however, it was decided a new House of Lords select committee should be appointed to consider assisted suicide. The Lords liaison committee said some 10 years had elapsed since the last committee's report, new legislation had been introduced in other countries, and there had been opinion polls in this country which needed to be taken into account. Lord Joffe's bill calling for the legislation of assisted suicide would be considered by the new committee. The committee was unable to agree on whether a change in the law was necessary, but said the issue should be the subject of early parliamentary debate.


Meanwhile, the Mental Capacity Bill was forced through Parliament by the Government. Although the bill had some good things in it, it made living wills legally binding, and legalised euthanasia by omission, making it possible for legally appointed proxies to order the withdrawal of food and water from patients unable to take decisions for themselves.


In 2005 the Government said publicly for the first time that a decision on whether or not to withdraw food and water from a sick patient could be affected by considerations of cost in keeping him alive. Because fitting a tube is a medical procedure, administering food and water by tube to patients unable to feed themselves is now considered medical treatment. During a court hearing in the Leslie Burke case, the Government claimed that 'a general right for an individual patient to require life-prolonging medical treatment has very serious implications for the functioning of the NHS. It may. . .lead to inefficient and unfairly skewed use of resources within the NHS.'


Leslie Burke, who had a degenerative brain condition, had petitioned the courts for the right to be given food and water when he was no longer able to speak for himself. The High Court agreed he should be kept alive unless his condition became 'intolerable.' The General Medical Council and the Government appealed the decision. The Appeal Court upheld the appeal, deciding that a patient could not demand treatment which the doctor considered averse to the patient's clinical needs. The European Court of Human Rights agreed. Despite human rights legislation which says that everyone has a right to life that should be protected by law, the European court said it would be 'burdensome' if doctors had to apply to the High Court every time they wished to end a life by withdrawing food and water.


Serious reservations


When euthanasia was debated in the House of Lords, peers were divided on the issue. In the autumn of 2005, Lord Joffe introduced a revised bill proposing legalisation of doctor-assisted suicide. Supporters of the bill made it clear that it was intended as a first step to legalised euthanasia. The bill came up for its second reading in the Lords in May, 2006, with a remarkable result. A sizeable number of peers were still in favour - but one peer, Lord Carlile, proposed an amendment delaying further progress on the bill for six months, which would effectively kill the bill for lack of parliamentary time. When the amendment went to the vote, it passed by 148 votes to 100. It was the first time for eight years a Private Member's Bill in the House of Lords had been defeated at that stage in its progress.


Although Dignity in Dying - the former Voluntary Euthanasia Society - claimed a majority of the public was in favour of the bill, disability groups and doctors had serious reservations. A poll of the Royal College of Physicians showed 73 per cent against the bill; 91 per cent of doctors involved in geriatric care and 95 per cent of doctors involved in palliative care were opposed to a change in the law. Members of the House of Lords were bombarded with letters and e-mails, the majority of them against the bill. It is believed the letters received by peers had an important effect on the result.


In 2006 the Royal College of Obstetricians and Gynaecologists said that killing badly disabled newborn babies should be an option. It called for a debate on whether active euthanasia of desperately ill newborns should be legalised.


The Mental Capacity Act, which said living wills must be observed and people granted power of attorney would be able to order doctors to withdraw treatment, including food and water, from a patient, finally became law in October, 2007. The British Medical Association said it would not support doctors who deliberately ignored patients' wishes.


In 2009 a proposal by Lord Falconer to make it no longer an offence to help someone travel abroad for assisted suicide was defeated in the House of Lords.


Shortly afterwards, events took a dramatic turn.


People who had taken relatives to Switzerland for assisted suicide had not been prosecuted because the Director of Public Prosecutions had not thought it expedient. But Debbie Purdy, a multiple sclerosis sufferer from Bradford, supported by Dignity in Dying, went to court seeking a guarantee that her husband would not be prosecuted for taking her to Switzerland to kill herself.


The High Court and the Appeal Court rejected her request. Judges said it would require Parliament to change the law. But when she appealed to the House of Lords, then the highest court in the UK, the law lords took a different view. They decided that the law needed clarification, and instructed the DPP to state clearly when someone would be prosecuted.


The DPP's interim guidelines said prosecution would be unlikely if the party assisting the suicide did not stand to benefit from the death, or was a spouse, relative or close friend, thus giving the green light to assisted suicide in these circumstances without the law having been changed by Parliament.


It was even suggested that Lord Phillips, the senior law lord, who had publicly expressed sympathy for assisted suicide, had taken advantage of the situation effectively to allow assisted suicide without Parliament.


The DPP's final guidelines after a period of consultation said individuals assisting a suicide would be unlikely to face prosecution if they were 'wholly motivated by compassion.' The DPP might be inclined to bring charges where the suspect was a doctor or nurse caring for the victim, where the suspect belonged to an organisation providing premises where people could commit suicide, or where the victim was encouraged to commit suicide by information provided by a publication or website.


Concerned agencies have pointed out that as the number of old people increases and there are increasing demands on NHS funds, so pressure to help the old and seriously ill to an early death can be expected to increase. An estimated two-thirds of NHS beds are occupied by people over 65 years old. The number of people over 85 has doubled in 15 years. There are now over a million men and women between 85 and 89 and 330,000 over 90. In the next 50 years, these numbers are expected to triple.


Practical alternative


Whilst pain in cases of terminal illness was once a real fear, tremendous strides in palliative care have been made in the past 30 years. Experts in pain relief now say patients in pain, including terminally ill patients, can be helped in 100 per cent of cases. Pain can be controlled perfectly acceptably in 95 per cent of cases. In many of the remaining five per cent pain can be helped by reducing movement which causes the pain. In the remaining very few cases, pain can be controlled by sedation.


Dr Robert Twycross, an internationally known expert on pain relief, says there is now no need for anyone to die in pain. In a booklet A pain-free death? published by the Medical Education Trust, he says tests at a major cancer centre showed complete relief from pain in 86 per cent of cases, adequate relief ('not what you'd call pain - I can forget it now') in 11 per cent of cases, and poor pain relief in only three per cent. In those three per cent, patients could be sedated so they slept without pain until death intervened. Dr Twycross quotes the World Health Organisation as saying that now a practical alternative to death in pain exists, there should be concentrated efforts to implement programmes of palliative hospice care rather than yielding to pressure for legal euthanasia.


Britain is fortunate in having one of the finest hospice services in the world (supported largely by voluntary funds) to care for terminally ill patients. In the year 2000, there were 3,152 beds in UK hospices. Each year about 250,000 UK patients benefit from hospice care, and 30,000 people die in hospice care. But more palliative care and better training in palliative care for doctors are still needed.


It is ironic, says the All-Party Parliamentary Group on Dying Well, that 30 or 40 years ago, when palliative care and the hospice movement were in their infancy and little could be done to remove the suffering of terminal illness, there was no serious mention of assisted suicide or euthanasia, while today, when such suffering can be dealt with and terminally ill people can die peacefully of natural causes, we are seeing a spate of bills seeking to legalise such killing.


Arguments for and against


In view of the continuing debate on the question of euthanasia, it is useful to be familiar with the arguments for and against. Proponents of euthanasia say a person's life is his own, and he should have a right to die when he wants to. Opponents point out that a 'right to die' for him would presumably mean 'an obligation to kill' for somebody else, and might eventually come to be regarded as a 'duty to die' for the old and sick. A doctor's job is to care and heal, not to kill.


Proponents of euthanasia say there would be strict safeguards if euthanasia were legalised. Opponents say it would be impossible to ensure adequate safeguards, and quote the situation in Holland as an example.


The Bible teaches that man, unlike the rest of the animal kingdom, is made in God's image and likeness (Gen 1:26, 27). It forbids the taking of innocent human life (Gen 9:6; Ex 20:13). For the Christian, the most important consideration will be You shall not murder (Ex 20:13).


Other questions to be considered:


Once it were decided that life did not have absolute value and some people's lives were not worth living, where would it stop? (The 'slippery slope' argument is a valid one. Permitting abortion for a few women led to abortion on demand. In Holland, voluntary euthanasia has led to involuntary euthanasia.)


What effect would the practice of euthanasia have on the medical profession?


What would be the effect on relationships between the medical profession and patients?


What would be the effect on the rest of society?


How would a euthanasia law affect respect for life in the community?


Could more be done to obviate people's feeling the need for euthanasia - providing more care for sick and elderly, visiting the old and lonely in private homes, hospital wards and old people's homes, providing more volunteers in hospices, letting people know they are precious, loved and cared for?


For further reading


Cameron, Nigel M. de S., ed. Death without Dignity: Euthanasia in perspective. Rutherford House Books, Edinburgh (1990).


Keown, John. Euthanasia Examined: Ethical, clinical and legal perspectives. Cambridge University Press, Cambridge (1997).


Ling, John R. Responding to the Culture of Death. Day One Publications, Epsom (2001).


Twycross, Robert. A pain-free death? Medical Education Trust, PO Box 17317, London SW3 4WJ.


Wyatt, John. Matters of Life and Death, 2nd edn. Inter-Varsity Press, Leicester/ Christian Medical Fellowship, London (2009).