Euthanasia and Assisted Dying

Euthanasia Defined

Euthanasia, sometimes known as ‘mercy killing’, refers to ending a patient’s life who is suffering from an incurable and/or painful disease, or is in an irreversible coma.

Two types of euthanasia you should know about are:

• Active euthanasia: When the acting person deliberately intervenes to end someone’s life. For example – a Doctor injecting a patient who has terminal cancer with an overdose of muscle relaxants to end their life would be considered active euthanasia.

• Passive euthanasia: Where a person causes death by withholding or withdrawing treatment that is necessary to maintain life. For example – withholding antibiotics from someone who has bacterial pneumonia.

We can also categorise euthanasia as:

• Voluntary euthanasia: Where euthanasia is carried out at the request of the person who dies.
• Involuntary euthanasia: When the patient who dies wants to live but is killed anyway (normally called manslaughter or murder).

You also need to understand two more terms: assisted suicide and assisted dying.

• Assisted suicide: The only difference between this and euthanasia is the person who actually performs the final act. In assisted suicide, the physician intentionally gives the patients the means to take the lethal medication themselves. For active euthanasia, the physician is the one who commits the act that directly causes death i.e. by injecting lethal drugs.
• Assisted dying: This is a sub-term of assisted suicide but is only used in the context of when a patient who is already dying, i.e. terminally ill, asks for help to die. Assisted dying is not usually used in the context of bringing about the deaths of patients who are not already dying (for example, paralysed patients or those who have found out that they have developed a condition in the future i.e. Huntington’s Disease).

It is important to understand the different types of euthanasia so that you don’t confuse assisted dying with the related debate of euthanasia.

Euthanasia In The UK

Both euthanasia and assisted suicide are illegal in the UK. Euthanasia is punishable by life imprisonment, while assisted suicide is illegal under the 1961 Suicide Act and punishable by up to 14 years in prison.

It’s important to understand the difference between passive euthanasia and withdrawing treatment in a person’s best interests. Passive euthanasia is illegal in the UK. However, the NHS states that withdrawing life-sustaining care when in a patient’s best interests can form part of good palliative care (and should not be confused with ‘passive euthanasia’).

There have been a number of legal challenges on this topic:

• 2015. A bill was brought forward that aimed to let terminally ill patients in the last six months of their lives be prescribed medication to administer themselves, which would end their lives. Their mental health would need to have been verified by two Doctors, one of which would be independent. The House of Commons rejected the bill by 330 to 118.
• 2018. The UK Supreme Court ruled that legal permission is no longer needed to withdraw treatment from patients in a permanent vegetative state. The British Medical Association (BMA) and Royal College of Physicians (RCP) subsequently published guidance for healthcare professionals on when they are allowed to withdraw care.
• May 2019. Paul Lamb, who lives with chronic pain following a car crash, renewed a bid for the right to die after losing a Supreme Court case in 2014. Since this time, three other bills were introduced to Parliament with the hope of legalising assisted suicide. All three failed and, importantly, were regarding patients with terminal illness expected to die within six months. Mr Lamb’s case is different from these because he is not terminally ill and could live for many years.
• September 2019. 80-year-old Mavis Eccleston was cleared of murder and manslaughter after getting her husband the prescription medication he needed to overdose. Mr Eccleston was a cancer patient, and his wife Mavis was respecting his wishes, according to daughter Joy. Not wanting to live without her husband, Mavis also took an overdose and recovered in hospital after being found unconscious.
• November 2019. 49-year-old Paul Newby lost his High Court case that was challenging assisted dying. Mr Newby proposed that Judges should thoroughly examine a large amount of evidence before deciding if assisted dying is incompatible with his human rights.
• August 2020. Relatives of people who had previously brought legal cases for assisted dying came together to make a joint inquiry into the current law.
• September 2021. Members of the British Medical Association (BMA) voted to adopt a neutral stance on assisted dying, with 49% in favour, 48% opposed and 3% abstaining. Before this, the BMA had opposed assisting dying, so the new stance could potentially pave the way towards a future change in the law.

Euthanasia In Other Countries

Euthanasia is currently legal in the Netherlands, Colombia, Luxembourg, Belgium, Canada, Spain, New Zealand and some parts of Australia. Assisted suicide is legal in certain other countries, in addition to certain areas of the US.

In Australia, a voluntary assisted dying scheme in the state of Western Australia was introduced, joining the state of Victoria, which also allows voluntary assisted suicide. The scheme allows Doctors to prescribe drugs for self-administration and administer them where the patient is unable.

In New Zealand, the End of Life Choice Bill was passed by Parliament in 2019 and received 65.1% of the vote in a binding public referendum in 2020. The new law came into effect in November 2021.

Arguments In Support Of Euthanasia:

• No matter how excellent our palliative care services may be, there will always be some patients for whom their illness causes intolerable suffering. To help those patients end their lives would be the compassionate thing to do to end their suffering.
• Autonomy is one of the four pillars of medical ethics. This means allowing patients to decide for themselves when to end their lives at a point where medical treatment is no longer able to prolong life and is not providing adequate symptom control.
• The current UK law, as it stands, means that patients who want to end their lives have to travel abroad to do so. In 2018, 43 people from the UK died at Dignitas and Life Circle (two facilities in Switzerland). It is likely not how they would have chosen to die (usually at home surrounded by loved ones) if the law allowed.
• Evidence shows that the public increasingly supports assisted dying. Governments ought to represent the wishes of their people in a democracy.
• A change in the law would also provide comfort to the dying from knowing that the option is there, even if they choose not to take it.
• In our liberal society, we allow people to make their own decisions about their health and lifestyles, as long as they do not harm other people. Choosing to end your life would not cause direct harm to others. It is, therefore, your right to do as you wish – you are the best judge of what’s best for you.
• When assisted dying is illegal, there will be people who try to end their lives alone and may not be able to carry  it out properly, leading to increased suffering. Legalising assisted dying would prevent such deaths, similar to how legalising abortion prevented deaths from botched backstreet abortions (despite many people still objecting to abortion on moral or religious grounds).
• The moral norms of society are constantly changing, and this legislation would reflect changing attitudes.
• Some Doctors argue that the legislation would provide a clearer legal framework for end-of-life care. There is a concern that current decisions about end-of-life care can hinge on the doctrine of double effect, whereby it is legal to give a patient treatment that may shorten their life if the Doctor’s main goal is to relieve their pain.
• There is a similar law in the US state of Oregon called the ‘Death with Dignity’ Act. The Oregon Hospice Association was initially opposed to the legislation. However, it withdrew its opposition after eight years conceding that there was “no evidence that assisted dying has undermined Oregon’s end-of-life care or harmed the interests of vulnerable people”. The numbers of people dying there have not increased – lending weight to the argument that the legislation wouldn’t bring about the deaths of more people, it would lead to more people having a ‘good’ death.

Arguments Against Euthanasia

• Many argue that the legislation would “turn Doctors into executioners”. This is at odds with the principle of non-maleficence which means do no harm. However, this principle could also be used to argue for the other side – that Doctors are causing more harm by prolonging suffering.
• Many are concerned that if the law on assisted dying is changed now, this paves the way for the law to change to apply to more people. For example, Belgium now has a law that legalises euthanasia for children.
• Another concern is that the legislation could be used to justify assisted dying in vulnerable groups, such as those with disabilities and mental illnesses. The legislation sends out a message that, where a life falls short of certain conditions, it is not worth preserving.
• The legislation debated does not deal with the issue of those with terminal illnesses who are unable to take their own lives. It would not help those with illnesses such as locked-in syndrome or motor neurone disease.
• Although autonomy is a pillar of medical ethics, patients still do not have a right to demand treatment and Doctors can refuse treatments they believe not to be in the patient’s best interests. The drugs prescribed to end life could be seen as a ‘treatment’ like any other.
• Although public support for assisted dying is growing, governments are generally in a better position than individuals to understand and foresee the effects of individual actions or a change in the law on society.
• The legislation also assumes that Doctors are at all times benevolent. If the patient asks for help to die and helping the patient would be the easier route for the Doctor, theoretically, this could lead to an increase in deaths that otherwise would not have occurred. These decisions are irreversible.
• Another significant concern is that vulnerable people may feel pressure to spare their carers the burden of looking after them or, worse, might be bullied into choosing death. There could never be sufficient safeguards to ensure that a patient is not being softly pressurised – either by their own families or by societal expectations.
• It could be argued that the potential negative consequences of this legislation – the premature ending of lives – outweigh the small number of people this would benefit.

Interview Questions

Euthanasia may come up during your interview as ethics or empathy questions. Some example questions include:

• Do you agree with euthanasia?
• How does euthanasia encroach on a patient’s autonomy and consent?
• Does euthanasia have a place in modern Medicine?

If you want to try your hand at more interview questions, check out our Interview Question Bank.