Euthanasia and Assisted Dying

Euthanasia, assisted dying and withdrawing life support are very common interview questions and can be approached in many different ways. Begin with the four pillars of medical ethics, briefly describing both sides of the argument, and use this to come to a conclusion. The conclusion should always agree with the current law (justice). To elevate your response well above other candidates, we have also included other ethical arguments for and against, some relevant facts and figures, and finally links to the NHS constitution and the GMP.

Definitions

Euthanasia: The act of deliberately ending someones life in order to relieve suffering.

  • Active: When a doctor deliberately intervenes to end someones life (e.g. lethal injection).

  • Passive: When a doctor causes death by withholding or withdrawing life sustaining treatment (e.g. a ventilator or antibiotics).

  • Voluntary: When the patient requests euthanasia.

  • Involuntary: When the patient is unable to request euthanasia (e.g. in a coma) but the family request it on behalf of the patient.

Assisted Suicide: Euthanasia when it is self administered (e.g. the doctor prescribes an overdose of medication, but the patient takes it themselves).

Assisted Dying: Assisted suicide when the patient is already dying/terminal (e.g. has a prognosis of less than 6 months).

The History of Euthanasia

Euthanasia (legal in Switzerland, Canada, New Zealand etc.), child euthanasia (legal in Netherlands and Belgium) and assisted suicide (legal in Switzerland, Germany, Japan etc.) are all illegal in the UK under the Suicide Act 1961. This criminalises assisted suicide with a prison sentence of up to 14 years. However, the act of withdrawing or withholding life sustaining care is not illegal under the Suicide Act:

  • A patient may write a ‘advanced decision/directive’ which informs doctors not to use life sustaining care (e.g ventilation) if they deteriorate.

  • A doctor may withdraw life sustaining care in the patients best interests.

In 2018, the UK Supreme Court enabled doctors to withdraw life sustaining treatment without a court case if the doctors and the family agreed. However, if there is a disagreement, then it must be escalated to court (see: Alfie Evans and Charlie Gard Case Studies).

The public opinion on assisted dying is shifting:

  • Three bills have been introduced to parliament to legalise assisted suicide when the prognosis is less than 6 months, however, all three have failed.

  • BMA has also changed from an opposed position to a neutral one on assisted dying.

The Ethics of Euthanasia

The Four Pillars of Medical Ethics

Agreements

  • Patients have the right to autonomy in life; they should have the right to autonomy in death.

  • Doctors must maximise good for their patient and act in the patient’s best interests. When a patient doesn’t deem their life as worth living, euthanasia may be in their best interest.

  • To allow a patient to suffer is doing harm.

  • As euthanasia is against the law, there is no valid “justice argument” for euthanasia.

Conflicts

  • The doctor has the right to refuse a treatment if it’s not in the patient’s best interests (e.g a doctor can refuse antibiotics when the patient has a viral infection). Euthanasia can be considered not in the best interests of the patient and so the doctor can refuse euthanasia.

  • Palliative treatment may do more good whilst preserving life. Also, if euthanasia is easier for the doctor (by freeing up beds), this could potentially lead to a dangerous conflict of interest.

  • Killing a patient directly contradicts this pillar.

  • Euthanasia is currently against the law as it contradicts the ‘Right To Life.’

Other Arguments

FOR:

  • After certain acts in some US States which legalised assisted suicide, the total number of suicides did not increase. This suggests that legalisation improves deaths (makes them less traumatic for the person and family) but doesn’t increase them.

  • Legalising assisted suicide would reduce suffering for those attempting suicide. It can also be controlled, enabling the patient to receive support before making the critical decision.

  • Currently, people who want to end their life have to fly to other countries like Switzerland or Belgium to receive euthanasia or assisted suicide. This burdens the individual and family making a difficult time even worse. This is made more difficult for individuals who are immobile.

  • Currently, there is no clear end of life legal framework surrounding hastening death which leads to the ‘Doctrine of Double Effect:’ Some nurses overprescribe pain killers like morphine to “reduce pain” but also “shorten the prognosis” for people who are in a vegetative state or suffering. Or the ‘Doctrine of Doing and Allowing:’ A doctor must not kill the patient (doing) but they can withdraw antibiotics to allow the infection to kill the patient. Legalisation would provide a much clearer framework (see: Additional Theories of Ethics).

AGAINST:

  • Legalising euthanasia may lead to less favourable legislation, e.g. child euthanasia as seen in the Netherlands.

  • Very difficult to ensure full capacity and informed consent for someone in end of life care (risk of delirium, mental illness etc.).

The Theories of Ethics

  • Deontology: Killing is always wrong and can never be justified.

  • Virtue Ethics: Prudence. As long as you are motivated by care and thought for the patient, then virtue ethics can justify euthanasia.

Values of the NHS Constitution

  • Improving Lives

    • How can ending someone’s life possibly improve it?

    • If a life can’t be improved, surely death is favourable?

  • Respect and Dignity

    • Enabling a patient a dignified death is more important than prolonging suffering.

    • A patient’s wishes should be respected.

  • Equal Care

    Legalising euthanasia could affect vulnerable groups disproportionately:

    • Euthanasia suggests that some lives are not worth living.

    • Vulnerable individuals may be pressured by the thought of becoming burden.

GMP Quotes

  • “A doctor must […] act within the law.”

  • “Take all possible steps to alleviate pain and distress.”

  • “You must put patient safety first.”