What is meant by euthanasia?
Euthanasia
The word 'euthanasia' comes from the Greek words 'eu' and 'thanatos', which together mean 'a good death'. Today, the meaning of 'euthanasia' has widened, to include how that good death is brought about. Specifically, 'euthanasia' is understood to mean a good death brought about by a doctor providing drugs or an injection to bring a peaceful end to the dying process.
There is a great deal of debate surrounding the issue of euthanasia.
The right to decide
Some people believe that everyone has the right to choose how they live and die. Each person has value and is worthy of respect, has basic rights and freedoms and the power to control his or her destiny. There are campaigns to legalise assisted dying within a certain strictly defined circumstance that is fundamentally about choice.
Passive euthanasia versus active euthanasia
At the moment, doctors can legally practice 'passive' euthanasia - that is, taking away or with-holding treatment even if the person will die. However, doctors cannot directly help the person to die, for example, by giving a lethal injection. Many people argue that, in situations where a competent, terminally ill patient is asking for help to die, passive euthanasia has exactly the same moral and practical result as giving a lethal injection at the patient's request.
Quality of life - pain is not the only issue
Not everyone dies well. At least 5% of terminal pain cannot be fully controlled, even with the best care. Other distressing symptoms such as sickness, incontinence or breathlessness cannot always be helped or relieved.
But pain is certainly not the only issue in decisions about the end of life. What a patient thinks about their quality of life is often far more important. Many people do not want to spend the last days or weeks of their life in a way that, to them, is undignified.
Annie Lindsell, a campaigner for legalizing assisted dying, said the following before she died of Motor Neurone Disease in 1997:
"The hospice movement consistently maintains that in most cases it manages the pain of terminally ill patients. What they cannot control, however, is the loss of personal dignity and that is a very individual criterion that no one but the patient can comment on."
Having the power to take control over their life and death can help people to keep a measure of human dignity in the face of their suffering.
Euthanasia goes on already
At the moment, the law and current medical practice do not match up. In 1994 a survey published in the British Medical Journal showed that some doctors already help patients to die. Few doctors have been prosecuted and, like Dr Cox, who was convicted of attempted murder in 1992, they have always been treated with great sympathy. Doctors are also legally able to give pain-relieving treatment in such high doses that people may die more quickly. This is known as the 'double effect' - relieving the patient's suffering is the accepted consequence of such treatment, with death as an unintended outcome.
There are several organisations that argue that doctors should not be helping patients to die behind closed doors. Assisted dying should be openly discussed and regulated, to make sure that both patients and doctors are protected.
Just one possible option at the end of life
Making it legal to help a person to die does not threaten the hospice movement. Assisted dying should be just one of the options at the end of life. As Dr Pieter Admiraal, a well known Dutch supporter of voluntary euthanasia, has repeatedly stressed, there should be:
"No euthanasia without palliative care."
Only God can give and take away life
Some people believe that life is sacred and that no-one has the right to purposely take a life. Many religious people follow this principle, so do not agree with suicide and assisted dying. However, there are many religious people who do support voluntary euthanasia, such as the late vice-president Lord Soper, an important Methodist minister.
The slippery slope - voluntary euthanasia will soon lead to involuntary euthanasia
One of my own beliefs is that once we have made voluntary ...
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"No euthanasia without palliative care."
Only God can give and take away life
Some people believe that life is sacred and that no-one has the right to purposely take a life. Many religious people follow this principle, so do not agree with suicide and assisted dying. However, there are many religious people who do support voluntary euthanasia, such as the late vice-president Lord Soper, an important Methodist minister.
The slippery slope - voluntary euthanasia will soon lead to involuntary euthanasia
One of my own beliefs is that once we have made voluntary euthanasia legal, society will soon allow involuntary euthanasia. I have based this on the idea that if we change the law to allow a person to help somebody to die, we will not be able to control it. However I am aware that this is misleading and inaccurate - voluntary euthanasia is based on the right to choose for yourself. It is totally different from murder. There is no evidence to suggest that strictly controlled voluntary euthanasia would inevitably lead to the killing of the sick or elderly against their will. As Ronald Dworkin, professor of Law at Oxford and New York University, said in 1994:
"Of course doctors know the moral difference between helping people who beg to die and killing those who want to live. If anything, ignoring the pain of terminally ill patients pleading for death rather than trying to help them seems more likely to chill a doctor's human instincts."
It will have a damaging effect on society
Some people who do not agree with voluntary euthanasia argue that if it was legalised, it would damage the moral and social foundation of society by removing the traditional principle that man should not kill, and reduce the respect for human life. However, the idea that we should not kill is not absolute, even for those with religious beliefs - killing in war or self-defence is justified by most. We already let people die because they are allowed to refuse treatment which could save their life, and this has not damaged anyone's respect for the worth of human life.
Fear of abuse of the law
In any law which allowed a person to help someone to die, there would be safeguards to make sure that:
* the person is told everything about the process
* they are not forced into making a decision
* they are mentally able to make the decision
At the moment, no-one knows how much non-voluntary euthanasia is carried out because active euthanasia is practiced outside the law
Patients receive excellent palliative care, so euthanasia is unnecessary
Hospices do a wonderful job, making terminally ill patients comfortable and relieving their pain, but even experts in palliative care agree that not all pain can be fully controlled. Even if pain could be fully controlled, for many patients it is other aspects of their condition, such as losing their dignity, that lead them to consider an assisted death. Palliative care cannot entirely replace the need for voluntary euthanasia. Some people will always want this choice.
Euthanasia in the United Kingdom
In the United Kingdom, there is no law that deals directly with voluntary euthanasia. Cases where a person has helped someone to die are prosecuted either under the law dealing with murder, or under the law on suicide, depending on the circumstances.
But how do prosecutors define the difference between ending a person's life with his or her permission, and helping a person commit suicide? If a doctor, at a patient's request, gives him or her a lethal injection, he or she may be charged with murder. However, if a doctor simply places the lethal injection by the patient's side, and the patient injects himself or herself, the doctors would be charged with assisted suicide. This is a very awkward position for the doctor to be in as he has to make the decision to keep the person alive and in pain or to help he or she die painlessly and risk the chance of being charged with murder.
The Media and Euthanasia
Media polls regularly record huge majorities of people who support legalising voluntary euthanasia for the incurably ill. In October 1997, out of nearly 3,000 people who took part in a Sun newspaper telephone opinion poll, an amazing 97% said terminally ill people should have the right to die with dignity. The graph below shows the results of large scale statistical surveys on the topic carried out for us by NOP (National Opinion Polls).
The question asked was: "Some people say that the law should allow adults to receive medical help to an immediate peaceful death if they suffer from an incurable physical illness that is intolerable to them, provided they have previously requested such help in writing. Please tell me whether you agree or disagree with this?"
It is clear that a large majority agree, and this number is growing every year. The 1993 poll showed that sex, age, region or economic class made little difference to people's views on this subject. And, the majority of people from all religious groups were in favor of voluntary euthanasia.
In 1996, Britain's largest social research institute carried out an independent survey into the social attitudes of British people. The survey showed that 82% of British people agree with doctors helping patients to die if they have a disease that cannot be cured. They also support making such help legal.
It's no accident!
Those people who do not agree with their findings often criticise the wording of these polls. But, not even people who are against assisted dying can produce opinion poll results that are against voluntary euthanasia. In 1987, the British Section of the World Federation of Doctors Who Respect Human Life, who do not agree with voluntary euthanasia because of their religious beliefs, carried out a MORI poll. Overall, 72% of those surveyed said that voluntary euthanasia should be made legal.
Around the world
These figures are also mirrored in other countries. In the USA support for legalising voluntary euthanasia, as shown by Gallup poll results, has grown from 37% in 1947 to 75% in 1996. The Australian polls also back these results, with public support for voluntary euthanasia rising from 47% in 1962, to 78% in 1995. All around the world, voluntary euthanasia is supported by the majority of people.
Religion
Many of the arguments made against assisted dying come from a religious basis. The main source of this religious opposition comes from the Jewish-Christian religions. Out of these, the Roman Catholic Church is the strongest opponent. Islamic and Buddhist faiths also do not agree with euthanasia. The Sikh Darma and Hindu faiths have not taken an official position, and may leave it up to the individual. However, there are individuals within these religions, including ordinary believers and priests, who fully support voluntary euthanasia.
In a 1993 opinion poll, most religious people who were surveyed were in favor of medical aid in dying. Whilst 93% of people without religious belief supported this, 83%of Protestants, 73% of Roman Catholics and 60% of Jews were also in favor.
There are three basic arguments Jewish and Christian authorities make against helping a person to die.
. 'Sanctity of Life'
According to religious teaching, life is a gift from God. Only God can decide when a life begins and ends. Any deliberate killing of the innocent without God's authority is wrong, and against the natural law. This extends to situations where a person's life is ended at their request. Voluntary euthanasia breaks this principle - people do not have the right to choose for themselves.
2. Intentional killing is forbidden
The Sixth Commandment states that 'thou shalt not kill'. However, this has never been an absolute prohibition. In certain circumstances the church allows killing - in war, by capital punishment and in self-defence. Some argue that 'thou shalt not kill' is not an accurate translation of the original Hebrew, and that it really means 'thou shalt not murder'. However, whatever the translation, church authorities traditionally believe that voluntary euthanasia is against this Commandment.
What is a living will?
The living will (also known as an 'advance directive') allows people to leave instructions about their possible medical treatment, if ever a situation arises when they are no longer capable of making decisions or of communicating them. Living wills are an entirely separate issue from voluntary euthanasia, and should not be confused with the debate about assisted dying.
What does it do?
Many people fear that, if they become ill, they could face a situation where they may be given too much treatment when there is little or no chance of recovery, or given treatment which would leave them in a condition they could not cope with. A living will can show that in the future, under clearly defined circumstances, the patient does not want treatment which will help him or her to live longer, such as antibiotics, tube feeding or being kept alive indefinitely on a life support machine.
Is it legally binding?
Although there is no law that governs the use of living wills, in common law-refusing treatment beforehand will have a legal effect as long as it meets the following conditions:
. The person is mentally able, is not suffering any mental distress and is over 18 when he or she makes the request.
2. The person was fully informed about the nature and consequence of the living will at the time he or she made it.
3. The person is clear that the living will should apply to all situations or circumstances that arise later.
4. The person is not pressurised or influenced by anyone else when he or she made the decision.
5. The living will has not been changed either verbally or in writing since it was drawn up.
6. The person is now mentally incapable of making any decision because they are unconscious or otherwise unfit.
These conditions have been established by the judgements in a number of recent legal cases. In 1992, the Appeal Court (in the case of Re T) showed that when an informed and able patient has made a choice which is "clearly established and applicable in the circumstances" doctors would be bound by it. This view was also confirmed by later cases (Airedale NHS Trust v Bland 1993, and Re C 1994), which stated that a document was legally binding if it represented an informed refusal of specific treatments. The patient cannot refuse measures which are clearly appropriate in the circumstances and which are provided for all patients. These measures could include basic hygiene such as washing, pain relief and the offer of being fed. Also, the patient cannot refuse treatment where his or her refusal would conflict with an existing legal requirement or his or her condition would pose a risk to other patients and medical staff.
If a patient verbally tells the doctor that he or she does not want treatment, is this valid?
Yes. As long as the patient is mentally able and understands the effects of his or her request, and has made this request over a long period of time.
What if the patient is under 18?
Young people under 18 do not have the same rights as adults. However, the Children Act 1989 emphasised that the views of young people must be considered in matters regarding their own health care. Where it is possible and appropriate, the young person and their parents or legal guardians can make a joint decision about their health care.
Advantages and disadvantages.
When a medical team is faced with a difficult decision about what treatment or care to give to a patient who is not able to make a decision, a living will helps the team to know what the patient would have wanted if he or she had been conscious. However, the living will will still have to be interpreted to make sure that the situation it describes does still apply to the patient. Apart from allowing the patient to control the treatment he or she receives, the living will also gives the patient the opportunity to discuss difficult issues with close family and friends.
Who supports living wills?
The British Medical Association, the Patient's Association, the Royal College of Nursing and the Government have all confirmed that they support living wills. A recent survey of doctors conducted by The Sunday Times (November 1998) showed that 69% of British doctors think that it is a good idea for patients to make living wills.
Supporting statements.
Prime Minister Tony Blair, December 1997
"Contrary to what some have tried to assert, an advance directive is not a move towards legalising euthanasia. It is a way for patients to exercise their right to refuse treatment by anticipating a time when they may lose the capacity to make or convey the decision."
Public Health Minister, Tessa Jowell, July 1997
"A person who has the mental capacity to make a valid decision not to receive treatment is entitled to do so...Patients may express their refusal of a course of action or a particular treatment in advance of losing the mental capacity to decide or express their wishes."
