Euthanasia, Assisted Suicide Euthanasia, Assisted Suicide and the Right to Resuscitationand the Right to Resuscitation

1212thth November 2007 November 2007

Lorna Walker and Alan DavidsonLorna Walker and Alan Davidson

An Overview…An Overview…

What is euthanasia?What is euthanasia?

What ethical/legal/medical issues are What ethical/legal/medical issues are involved?involved?

Some examplesSome examples

Case studiesCase studies

Ideas About EuthanasiaIdeas About Euthanasia

Assisted suicideAssisted suicide The right to die: a basic human right?The right to die: a basic human right? Slippery slopeSlippery slope Dying with dignityDying with dignity Risks involvedRisks involved Legalised in HollandLegalised in Holland

Some DefinitionsSome Definitions Active euthanasiaActive euthanasia

– A person directly and deliberately causes a patient’s A person directly and deliberately causes a patient’s deathdeath

Assisted suicideAssisted suicide– A person who wants to die needs help to kill A person who wants to die needs help to kill

themselves, asks for and receives itthemselves, asks for and receives it DNR: do not resuscitateDNR: do not resuscitate Indirect euthanasiaIndirect euthanasia

– Providing treatment to reduce pain with the known side Providing treatment to reduce pain with the known side effect of causing the patient to die soonereffect of causing the patient to die sooner

Some More DefinitionsSome More Definitions

Involuntary euthanasiaInvoluntary euthanasia– Patient wants to live but is killed anyway: murder!Patient wants to live but is killed anyway: murder!

Living willLiving will– Document in which patient states what they want Document in which patient states what they want

regarding treatment and euthanasiaregarding treatment and euthanasia PAS: physician (doctor) assisted suicidePAS: physician (doctor) assisted suicide Non-voluntary euthanasiaNon-voluntary euthanasia

– Patient cannot ask for or make a meaningful choice Patient cannot ask for or make a meaningful choice between living and dying and an appropriate person between living and dying and an appropriate person takes a decision on their behalf in accordance with takes a decision on their behalf in accordance with previously expressed wishespreviously expressed wishes

Relevant EthicsRelevant Ethics Religious viewsReligious views Pro-life arguments v. the right to choose to diePro-life arguments v. the right to choose to die The lines between euthanasia, assisted The lines between euthanasia, assisted

suicide and murdersuicide and murder The law:The law:

– A person can choose to take their own life without A person can choose to take their own life without risking the legal and religious ‘punishment’ of 50 risking the legal and religious ‘punishment’ of 50 years ago. Why then can an individual not ask for years ago. Why then can an individual not ask for help to die?help to die?

A Wide Spectrum of Views!A Wide Spectrum of Views!

Egalitarian: the right to choose when and Egalitarian: the right to choose when and how to die is a basic civil libertyhow to die is a basic civil liberty

Religious: all life is sacred and should be Religious: all life is sacred and should be defended; death should not be hasteneddefended; death should not be hastened

Doctrine of double effect: Allows use of Doctrine of double effect: Allows use of drugs that will shorten life if the primary aim drugs that will shorten life if the primary aim is to reduce painis to reduce pain

Some ExamplesSome Examples

Diane PrettyDiane Pretty

Terry SchiavoTerry Schiavo

Charlotte WyattCharlotte Wyatt

Diane PrettyDiane Pretty

Requested the right to have her husband Requested the right to have her husband ‘help her die’ without facing legal ‘help her die’ without facing legal consequences, taking her case as far as the consequences, taking her case as far as the European Court of Human RightsEuropean Court of Human Rights

Was refused this right, dying naturally of Was refused this right, dying naturally of complications of motor neurone disease complications of motor neurone disease (MND) in 2002(MND) in 2002

Why??Why??

MND is a disease causing gradual paralysis MND is a disease causing gradual paralysis of the entire bodyof the entire body

Eventually patients cannot move, speak or Eventually patients cannot move, speak or swallow and suffer from severe swallow and suffer from severe breathlessnessbreathlessness

Mrs Pretty feared the choking and asphyxia Mrs Pretty feared the choking and asphyxia (suffocation) associated with the disease(suffocation) associated with the disease

““The law has taken all my rights away”The law has taken all my rights away”

What happened...What happened...

““I want to have a quick death, without I want to have a quick death, without suffering, at home, surrounded by my family suffering, at home, surrounded by my family so I can say goodbye to them”so I can say goodbye to them”

““Diane had to go through the one thing she Diane had to go through the one thing she had foreseen and was afraid of – and there had foreseen and was afraid of – and there was nothing I could do to help”was nothing I could do to help”

““Mrs Pretty’s death was perfectly normal, Mrs Pretty’s death was perfectly normal, natural and peaceful”natural and peaceful”

So...So...

Mr + Mrs Pretty did not get what they Mr + Mrs Pretty did not get what they wished; had they done, arguably it would wished; had they done, arguably it would have paved the way for similar caseshave paved the way for similar cases

A good outcome? A bad one? Was it fair?A good outcome? A bad one? Was it fair? What if the patient had been older, or asking What if the patient had been older, or asking

a doctor to help?a doctor to help?

Terry SchiavoTerry Schiavo

Young woman who fell into a vegetative state in Young woman who fell into a vegetative state in 19901990

Because her heart stopped, depriving her brain Because her heart stopped, depriving her brain of oxygen, for a few minutes, she was in a of oxygen, for a few minutes, she was in a ‘conscious coma’‘conscious coma’

Drs stated that she was incapable of Drs stated that she was incapable of communication or normal life, and would never communication or normal life, and would never recoverrecover

What complicated the situation?What complicated the situation?

Mr SchiavoMr Schiavo

Mrs Schiavo’s husband had power of attorney Mrs Schiavo’s husband had power of attorney over her – her next of kin. He was able to over her – her next of kin. He was able to appeal to have medical decisions madeappeal to have medical decisions made

In 1998 he began a legal battle to have her In 1998 he began a legal battle to have her feeding tube withdrawn, meaning that his wife feeding tube withdrawn, meaning that his wife would effectively starve to deathwould effectively starve to death

He claimed this is what his wife would have He claimed this is what his wife would have wantedwanted

But!But!

Terri’s parents did not agree with her Terri’s parents did not agree with her husbandhusband

They believed she should be given the They believed she should be given the chance to recover, saying she was capable chance to recover, saying she was capable of meaningful communicationof meaningful communication

They contested Mr Schiavo’s caseThey contested Mr Schiavo’s case Who won?Who won?

A natural death?A natural death?

In February 2005, 15 years since the onset In February 2005, 15 years since the onset of the ‘coma’, Terri Schiavo had her feeding of the ‘coma’, Terri Schiavo had her feeding tube withdrawntube withdrawn

This was after 7 years of court acting, during This was after 7 years of court acting, during which the decision was overturned many which the decision was overturned many timestimes

She died in her husband’s arms 13 days She died in her husband’s arms 13 days after the tube was removedafter the tube was removed

Charlotte WyattCharlotte Wyatt

Born 3 months prematurely, so suffers Born 3 months prematurely, so suffers serious heart and lung damageserious heart and lung damage

Baby Charlotte was resuscitated several Baby Charlotte was resuscitated several times when very young, but doctors felt this times when very young, but doctors felt this was not only futile but painful and cruel for a was not only futile but painful and cruel for a young baby to undergoyoung baby to undergo

After parents refused to have Charlotte After parents refused to have Charlotte classified as NFR, doctors took the case to classified as NFR, doctors took the case to courtcourt

What the courts said...What the courts said...

Medical opinion was that Charlotte would not Medical opinion was that Charlotte would not survive infancy and would never be able to survive infancy and would never be able to leave hospitalleave hospital

Her care was costing the NHS a lot of money Her care was costing the NHS a lot of money – by the time the case reached court an – by the time the case reached court an estimated £1.1million had been spentestimated £1.1million had been spent

The court said that Charlotte must be kept The court said that Charlotte must be kept free from pain, allowed time with her parents free from pain, allowed time with her parents and allowed to die naturally: DNRand allowed to die naturally: DNR

But...But...

Charlotte Wyatt celebrated her 4Charlotte Wyatt celebrated her 4thth birthday birthday this Octoberthis October

She is now in foster care, no longer She is now in foster care, no longer requiring to permanently stay in hospitalrequiring to permanently stay in hospital

The DNR ruling remains validThe DNR ruling remains valid Watch this space...similar cases have had Watch this space...similar cases have had

similar results despite Charlotte’s survival similar results despite Charlotte’s survival

Case StudiesCase Studies

Have a think about the following casesHave a think about the following cases What are the religious, legal and medical What are the religious, legal and medical

viewpoints?viewpoints? What would you do?What would you do? Discuss!Discuss!

Case 1Case 1

A 22 year old is involved in a motorcycle A 22 year old is involved in a motorcycle accident and is left in a coma. Doctors say accident and is left in a coma. Doctors say it is unlikely he will recover from his it is unlikely he will recover from his vegetative state and encourage his parents vegetative state and encourage his parents to consider switching off his life support to consider switching off his life support machine.machine.

What are the pro’s and cons of keeping What are the pro’s and cons of keeping on/switching off the machine? What issues on/switching off the machine? What issues might affect the parents’ decision?might affect the parents’ decision?

Case 2Case 2

A 72 year old man slips in the shower leavig A 72 year old man slips in the shower leavig him paralysed from the waist down. Unable him paralysed from the waist down. Unable to enjoy his previous pastimes such as golf to enjoy his previous pastimes such as golf he becomes miserable. He makes no effort he becomes miserable. He makes no effort to do anything during the day and starts to do anything during the day and starts telling nursing staff it’s “his time”, and wants telling nursing staff it’s “his time”, and wants to end his life.to end his life.

What should be done for this man? What should be done for this man? What/who must be considered?What/who must be considered?

Case 3Case 3

A 46 year old has a sudden worsening of A 46 year old has a sudden worsening of her multiple sclerosis, becoming deeply her multiple sclerosis, becoming deeply depressed. Her husband claims she now depressed. Her husband claims she now wants to end her suffering and now regularly wants to end her suffering and now regularly expresses this wish despite never having expresses this wish despite never having mentioned this before now.mentioned this before now.

What legal and emotional issues are What legal and emotional issues are involved in this case?involved in this case?

Case 4Case 4

A 33 year old drug addict is admitted to A&E A 33 year old drug addict is admitted to A&E after an overdose. She slips into a coma after an overdose. She slips into a coma from which she seems unlikely to recover. from which she seems unlikely to recover. With no family to consult the senior doctor With no family to consult the senior doctor says that it is probably best to just switch off says that it is probably best to just switch off her life support machine, as if she does her life support machine, as if she does recover she will only return to drugs recover she will only return to drugs anyway.anyway.

Discuss what issues are involved here.Discuss what issues are involved here.

Case 5Case 5 A young girl is rushed to hospital after a car A young girl is rushed to hospital after a car

accident, requiring emergency surgery. The accident, requiring emergency surgery. The mother arrives saying the family are Jehovah’s mother arrives saying the family are Jehovah’s witnesses and so she does not want the child to witnesses and so she does not want the child to receive a blood transfusion. The medical team receive a blood transfusion. The medical team follow the mother’s wishes but despite their best follow the mother’s wishes but despite their best efforts the girl dies.efforts the girl dies.

Is this euthanasia? Did the doctors make the right Is this euthanasia? Did the doctors make the right decision? Should any legal action be acted decision? Should any legal action be acted against the mother or doctors?against the mother or doctors?

Any questions????Any questions????