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Euthanasia and Assisted Suicide

Killing is killing – or is it?

In the
headlines this week is the tragic story of Frances Inglis, whom a jury at the Old Bailey found guilty of murdering her disabled son Tom
and sentenced to nine years in jail. Tom Inglis had been left severely
braindamaged after falling from a moving ambulance in 2007, throwing his mother
in a state of deep distress. She refused to believe an (apparently isolated)
encouraging prognosis from one of the doctors at the hospital, and concluded
that it was her duty to release her son from the “living hell” in which he found himself. Horrified on learning that the only legal way of
allowing her son to die was an application to the High Court for Tom’s food and
water to be withdrawn, Frances Inglis decided to take action on her own. After
a first unsuccessful attempt 14 months earlier, she took her son’s life by
injecting him with a lethal dose of heroin in November 2008.

 

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Should parents decide? The case of RB

In the Family Court yesterday, a controversial case that has been widely reported in the media came to a premature close. The father of baby RB, a severely physically disabled 13 month-old infant, withdrew his opposition to the plan by RB’s mother and doctors to take him off life support. It is believed that in the near future doctors will stop breathing machines and allow RB to die. The court did not, in the end, make a judgement about this case, though a statement of endorsement by Justice Macfarlane yesterday suggests that it would have reached the same conclusion.

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Switzerland gets tough on suicide clinics

The Swiss
government (the Federal Council) has recently announced its intention to crack
down on “suicide tourism” and to severely restrict the activities of suicide clinics like Dignitas and
Exit, which have regularly made the headlines outside Switzerland in the last
few years (particularly Dignitas), as foreigners make up a large proportion of
the hundreds of people they help to die every year. The government is proposing two draft Bills for public deliberation until March. The first option is an outright ban on suicide clinics; were it to become law, clinics like Dignitas and Exit would simply have to close down. Such an extreme measure, however, doesn’t have the favors of most members of the Federal Council, and probably won’t have those of the Parliament either. The second option is more likely to prove popular, and I will thus focus on it: it would involve much stricter regulations – rather than a ban – being imposed on the activities of these clinics. Violations of those regulations would involve sanctions of up to five years in prison.

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Non-resisted suicide and depression

In late 2007 a young woman with a history of depression and several previous suicide attempts presented to an emergency department following an overdose. She gave doctors a copy of her living will, written 3 days previously, in which she made it clear that she wanted no measures to be taken to save her life. Earlier this week Roger Crisp and Julian Savulescu argued separately in this blog that the wishes of competent patients to end their lives should be respected. But if we believe that suicide can be rationally sought, and should sometimes not be resisted, should this include those who have been diagnosed with depression?

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Living Wills and Assisted Suicide

Kerrie Wooltorton is believed to have been the first person to use a living will as part of a successful attempt to commit suicide: http://www.guardian.co.uk/society/2009/oct/01/living-will-suicide-legal . The 26-year-old wrote her will, and then three days later took poison and called an ambulance. The will said that no steps were to be taken to prolong her life, and that she desired only to be made as comfortable as possible and not to die alone.

If doctors had kept her alive, they may have been open to legal action. Indeed any interference with Wooltorton against her wishes could have been interpreted as an assault. But might there nevertheless be a moral case for ignoring a living will in such circumstances?

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T-illegal actions and the case for legal ambiguity

Question: When is a crime not a crime? Answer: when it will never be prosecuted.

The release this week by the Director of Public Prosecutions of his interim policy on prosecution of assisted suicide raises a number of questions – as discussed yesterday in this blog by Simon Rippon. The new policy formalises what has been informal for some time, that family members of patients with terminal illnesses (or other serious conditions) who help the patients to travel overseas to access assisted suicide are unlikely to be prosecuted for their actions. But their actions will still be technically criminal. Should there be a class of ambiguous actions that are neither legal, nor illegal?

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Assisted Suicide and Accusations

As a result of a court ruling requiring clarification of the law, the UK's Director of Public Prosecutions (DPP), Keir Starmer, yesterday issued some guidelines concerning the legal grey area of assisted suicide. The DPP published a list of factors that will weigh in favour of and against prosecutions for assisted suicide.

Care Not Killing (CNK), a UK umbrella group for organisations and individuals that oppose legalising assisted suicide and euthanasia, says that under the new guidelines:

it is envisaged that prosecutions for assisted suicide will be less likely where the deceased was terminally ill or suffering from a severe and incurable physical disability or a severe degenerative physical condition from which there is no possibility of recovery. [T]his classification … implies that the lives of a whole group of people … are less deserving of the law's protection than are others.

This kind of objection crops up frequently to laws that make special provision for some groups of people and not others. But does it hold up to scrutiny here? The guidelines do not state that the terminally ill, severely and incurably disabled, and those suffering a severe degenerative physical condition (hereafter, for brevity: The Unfortunate) are less deserving of anything than others, so if they do indeed imply that The Unfortunate are less deserving of the law's protection than others, it must be because the DPP's justification for the guidelines presupposes this judgment.

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A change of heart

Earlier this week fourteen-year old Hannah Jones received a heart transplant. This is eight months after Hannah hit the news for her refusal to have the surgery. There was much debate in the media (including this blog) at the time about whether or not teenagers should be allowed to refuse life-saving treatment, though overall there was a lot of support for Hannah’s decision.

But in the last week Hannah has apparently changed her mind, and elected to have the surgical procedure. What is the significance of this for the decision to go along with her earlier choice? Hannah might well have died in the last 8 months, in which case she would never have had a chance to rethink her position on transplants. Does the fact that she has now changed her mind give us more reason, in future, to overrule similar patients who are declining live-saving treatment?

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Life or no-life on the ventilator: the argument from parental freedom

In the High Court this week, parents of nine-month old infant OT are fighting a request by doctors to turn off the infant’s life support. The infant has been on a breathing machine since 3 weeks of age, and apparently has severe brain damage. This case has obvious echoes with the highly publicised case of Charlotte Wyatt, and the earlier case of baby MB. In both those instances courts ruled in the parents’ favour and life support was continued.

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Bad doctor, bad prosecutor or bad laws?

Ethics, medical practice and the law should ideally coincide. But as a current affair in Sweden shows, it is all too easy for them to collide.

On March 2 police took a doctor into custody at the Astrid Lindgren Children's Hospital in front of her colleauges, suspected of killing an infant. The background is tragic: last year a three month pre-term infant suffered a stroke, causing serious brain damage. This was likely due to a medical mistake that was duly reported. Some months afterwards the dying infant was taken of ventilaton and died, with the consent of the parents. She was given high doses the painkiller morphine and anaesthetic thiopental to prevent suffering. Apparently the prosecutor investigating the initial medical mistake noticed these high levels and decided to investigate whether manslaughter had taken place. Much criticism has been aimed at the prosecutor for the heavy-handed use of the police and putting the doctor into arrest, especially since the events occured several months ago and it is very unlikely there is any danger of tampering with evidence. But it is more troubling that the doctors involved (at least given currently available information) were acting according to standard medical praxis. Are a sizeable fraction of the Swedish medical profession guilty of manslaughter?

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