Euthanasia is a hot topic
that might come up in your Medical School interview
– and understanding this issue will help you when it comes to answering ethics questions
Euthanasia, sometimes known as ‘mercy killing’, refers to ending a patient’s life who is suffering from an incurable and/or painful disease, or who is in an irreversible coma.
Two types of euthanasia you need to know about include:
- Active euthanasia: when the acting person deliberately intervenes to end someone’s life. For example – a Doctor who injects a patient with terminal cancer an overdose of muscle relaxants to end their life would be considered to have carried out 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, with euthanasia punishable by life imprisonment, and assisted suicide 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 to be prescribed medication to administer themselves, that would end their lives. Their mental health would have had to been verified by two Doctors, one of which is 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, however, is different in that 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.
- February 2020. The British Medical Association (BMA), surveyed its members on assisted dying to inform a discussion and debate on their position. Currently, the BMA insists that assisted-suicide, voluntary and non-voluntary euthanasia should not be made legal in the UK and opposes any proposed law changes to work towards the legalisation of any of these.
- August 2020. Relatives of people who have previously brought legal cases for assisted dying have come together to make a joint inquiry into the current law. The new MP chairing the all-party parliamentary group on assisted dying says that there is increasing support in parliament for a ‘tight’ change in the law, to give terminally ill people more choice over how and when their lives end.
Euthanasia In Other Countries
As of 2018, euthanasia is legal in the Netherlands, Colombia, Luxembourg, Belgium and Canada. In addition, assisted suicide is legal in Switzerland, Germany, South Korea, Japan and some states in the US.
However, In February 2020, the highest court in Germany ruled that a law banning assisted suicide services was unconstitutional. Lawmakers must now draw up new laws to reflect this.
In Australia, a voluntary assisted dying scheme in the state of Western Australia was introduced. It joins 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, meaning it will now go to a public referendum in November 2020 of which the results will be binding.
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 law, as it stands, means that patients who want to end their lives have to travel abroad to end their life. In 2018, 43 people from the UK died at Dignitas and Life Circle (two facilities in Switzerland). It’s not how they would have chosen to die if the law allowed – usually at home surrounded by loved ones.
- Evidence shows that the public increasingly support assisted dying. Governments ought to represent the wishes of their people in a democracy. In March 2019, the Royal College of Physicians has now adopted a neutral stance on the topic of assisted dying. This was following a poll of around 7,000 of its members.
- 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 end their lives alone, who may not be able to carry out the ending of their life properly, leading to increased suffering. Legalising assisted dying will prevent these horrible deaths, similar to how legalising abortion prevented the deaths from botched backstreet abortions (despite many people still objecting to abortion on moral or religious grounds).
- The moral mores of society are constantly changing, and this legislation would reflect changing attitudes. There are no moral absolutes anymore. Even the prohibition on killing has exceptions, for example during war it is permissible to kill. Anyone who objects to assisted dying need not ask for help to die themselves – however, it cannot be used to justify removing the chance to help those who do not share those beliefs.
- 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 U.S 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.
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.