Euthanasia and Assisted Suicide

Murder or mercy?

The newspapers today are full of the horrifying story of three children who were found dead in their family home in South London on Tuesday.  The children had all apparently been diagnosed with a severe genetic disorder (spinal muscular atrophy), that was likely to lead to death in early childhood. Their mother has today been charged with their murder.

There are relatively few details available at this stage, and doubtless more will emerge over coming days and months. It would be premature to comment on the specific circumstances of the case (and the family has asked the public and media to refrain from speculation). However, it is likely that as those details do emerge that commentary on the case will take up one of two themes. Some commentators will point to the enormous strain of caring for severely disabled and terminally ill children, and perhaps bemoan the lack of available supportive services. Others (perhaps with disability or with personal experience of caring for the disabled) will react with horror at the idea of a parent killing their child, and reject any attempt to use child disability as a form of excuse for the crime. Continue reading

How the Danziger Story Advances the Abortion Debate in America: Actual Futures, Moral Status, and Common Ground

It has become commonplace in recent years to note that the ‘abortion debate’ in America has become entrenched. Indeed, there seem to be few issues in contemporary politics that elicit less common ground than the abortion debate finds in its stalwartly pro-choice and pro-life opponents. It is just as common, if not more so, these days to speak of the ‘attack on Roe v. Wade’ or ‘the attack on women’s rights,’ particularly in light of recent findings that more abortion restrictions were enacted between 2011 and 2013 in the U.S. than in the entire previous decade. Now more than ever, especially for the pro-choice movement, it is necessary to conceptualize novel approaches to the questions of the beginning, end, and quality of life that sit at the heart of the abortion debate. Here I examine a recent case and how it has the potential to advance this debate. Continue reading

Assisted Suicide in Scotland

Kevin McKenna offers a spirited critique ( of Margo MacDonald’s bill on assisted suicide, proposed recently to the Scottish Parliament.

 Behind the rhetorical references to the ‘culture of death’ MacDonald is seeking to introduce in Scotland, and her ‘deathly obsession’, there are some old arguments, which remain as weak as ever. Continue reading

Three Arguments Against the Belgian Child Euthanasia Bill Criticised

By Luke J Davies. Follow Luke on Twitter.

Last week the upper house of the Belgian Federal Parliament voted (50 to 17) that euthanasia should be legal for children suffering from a terminal illness that is causing severe physical pain. [1] The bill legalizing the practice requires that the child understand what euthanasia is, and that parents provide their written consent. Unlike the Netherlands, which allows euthanasia for children over the age of 12, there will be no minimum age in Belgium. (Find the story here, here, here, and here.)

The passing of this bill, which has yet to be turned into a law [2], has been met with severe criticism in Belgium and abroad, mostly from religious and conservative groups. From what I have read, there are three main lines of argument against allowing euthanasia for children. The first maintains that allowing euthanasia for children is the first in a long series of steps that will lead to some Third Reich-like eugenics program. The second maintains that children do not have the capacity to make a decision to be euthanized. The third maintains that the legalization of euthanasia for children would lead to parents or health care professionals putting pressure on children to opt for that choice. I believe that each of these arguments fails to demonstrate that the bill should not pass, and will spend the remainder of this post explaining why.  

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A not-so-great escape: suicide in prison

Christian Brown is a newly qualified junior doctor with an interest in psychiatry and ethics. 

Early last month, Ariel Castro, convicted kidnapper, rapist, and murderer, used a bed sheet and a window-ledge to commit suicide in his prison cell. He was just four weeks into a life sentence. Recently on this blog, Rebecca Roache wrote a post about the possibility of enhancing prison sentences – today, I’d like to consider the right-to-die of inmates, and the role of medical professionals in their suicidal behaviour.

Inside the walls of our high security prisons, small numbers of prisoners face life-long sentences, deprived of all but the minimum of human contact, and confined for most of the day to their cells. Some people argue that it can be rational to commit suicide – for the purposes of this post, I’ll refer to suicidal acts which are voluntary, informed, and the individual shown to have mental capacity, as ‘rational suicide’. If one accepts this, it is hard to imagine a more subjectively powerful circumstance in which to kill oneself than at the outset of a life sentence. Indeed, suicide rates among prisoners are around six times higher than those of the general male population. Of course, a proportion of these cases will not meet the criteria for ‘rational suicide’, but let’s consider those that do. Continue reading

The Law on Assisted Suicide: Time for the Buck to Stop

Yesterday, three judges representing the England and Wales Court of Appeal unanimously dismissed a challenge to a High Court ruling that Parliament, rather than judges, should decide whether the law on assisted dying should change.  The challenge was mounted by Paul Lamb (who is paralysed from the neck down and wishes to end his life, but is physically unable to do so) and Jane Nicklinson (the widow of Tony Nicklinson, a sufferer of locked-in syndrome who unsuccessfully appealed to the High Court to change the law on assisted suicide prior to his death). Continue reading

Jeff McMahan and John Broome discuss the value of life and the badness of death

Wednesday the 6th of February saw two of the most prominent ethicists of our time engage in a (friendly) debate on two crucial, related philosophical questions: the value of life and the badness of death. (You can listen to the podcast of the debate here.) In a room filled to capacity at the Oxford Philosophy Faculty, Jeff McMahan, Professor of Philosophy at Rutgers University, and John Broome, White’s Professor of Moral Philosophy at the University of Oxford, discussed their respective views on these questions, explaining in turn where they agreed and disagreed with each other and why, using rigorous, sophisticated philosophical arguments.

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Patient L’s Autonomy

‘Patient L’ is a man in a vegetative state, under the care of Pennine Acute Hospitals Trust. The Trust has placed a Do Not Rescuscitate order in his notes, yet his family claim that he himself would want to be revived if his condition deteriorated, because of his faith in Islam. The court of protection has now decided in favour of the Trust.

The Trust’s claim is that it is in Patient L’s best interests to be allowed to die, whereas Patient L himself – if we are to believe his family (and there seems little reason not to) – would almost certainly disagree. Continue reading

Physician Assisted Suicide and the Conflict Between Autonomy and Non-Maleficence

In the run-up to the 6th November ballot in Massachussets concerning the prescription of medication to end life, two prominent US physicians, Dr. Ronald Pies and Dr. John Grohol, have been debating the pros and cons of physician assisted suicide (PAS). In his article, Dr Ronald Pies argues against the legalisation of PAS, claiming in the title of his essay that “medical ethics must sometimes trump patient choice”. Although Pies’ acknowledges that respect for autonomy is one of the four cardinal principles in medical ethics, he goes on to claim that “. . . medical ethics must set limits on a patient’s autonomous requests” in the light of another of these cardinal principles, namely the principle of non-maleficence. What are we to make of this claim? Continue reading

Euthanasia and Human Rights

Tony Nicklinson is 58, and suffers from locked-in syndrome. His mind is as sharp as it ever was, but for the last seven years, as the result of a stroke, he has been entirely physically dependent on others, able to move only his eyes and eyelids. Just recently, his condition has worsened, and he is in constant pain and discomfort. As seems entirely reasonable, he wants to die. But of course he will need assistance to do so, and anyone who helps him will run the risk of prosecution for murder.

Nicklinson, along with another man in a similar position, recently applied to the High Court. Their lawyers had two main arguments. The first was that the ‘necessity’ defence for murder in the common law should be extended to cover cases such as Nicklinson’s, since forcing him to continue to live is not a reasonable option. They argued also that taking that option would violate his right under article 8 of the European Convention, contrary to s1 and 6 of the Human Rights Act 1998. That article provides that:

1. Everyone has the right to respect for his private and family life, his home and his correspondence.

2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

Nicklinson’s lawyers argued that forcing him to continue to live violates his autonomy and dignity and is therefore a violation of Article 8.

The High Court decided (see paras. 75-87) to allow Nicklinson’s torment to continue, primarily because it believed that, as was claimed in the earlier cases of Bland and Inglis, it is for Parliament to decide whether to change the law on euthanasia: the issues are too complicated and opinions too varied for the court to be competent to make a decision; any change would be controversial and so a matter for Parliament; and it might also lead to bad consequences, such as pressure’s being put on the vulnerable to end their lives.

These seem to me somewhat weak arguments. The issues are in fact quite clear, and it is not the job of a court to seek to enforce any public opinion, even majority opinion (if it were, the death penalty would have to be reintroduced for child-killers). It is true that any change would be controversial, and certainly it is an issue that Parliament should discuss (and surely would have done, were Nicklinson’s request to have been granted). But the job of the court was to decide whether Nicklinson’s human rights are being violated and to let Parliament deal with the wider issues. Finally, the judgement says nothing about how the Justices assessed the consequences of acceding to Nicklinson’s request. Certainly, leaving things as they are will lead to some very bad consequences, for Nicklinson and others in his position. Nor do courts usually take what are almost certainly very small risks into account when deciding matters of law. It is not the role of a court to consider such consequentialist factors when making its decisions. That is a matter for those making the law, not those executing it, as H.L.A. Hart and John Rawls demonstrated clearly many years ago. Of course, were voluntary euthanasia to be made legal, there would be need for a proper procedure to ensure informed consent. And it would be be the role of Parliament to develop such a procedure, once the Court’s decision had been passed down.

Para. 19 of the judgement says:

The common law is declared by the courts, which have the power to develop it. Section 6(1) makes it unlawful for a public authority to act in a way which is incompatible with a Convention right.

Since it is so plausible that there is a serious violation of human rights in forcing a citizen to undergo serious pain and discomfort, perhaps for many years, on the basis of an unsubstantiated claim about minor risk to others which could anyway be dealt with by Parliament, it seems likewise plausible that the High Court has acted unlawfully in this case. What makes things even worse is that its decision provides yet another precedent on which further inhumane and unjust decisions may be based in the future.