Euthanasia and Assisted Suicide

Euthanasia and Perverse Incentives

by Toby Ord
October 30, 2008

Debbie Purdy is a British woman suffering from multiple sclerosis. Worried about her degenerating condition, she has planned to end her life at the Swiss clinic, Dignitas, which practices euthanasia for people with crippling medical conditions. The story entered the media when she challenged the British High Court to specify whether or not they would prosecute her husband if he went with her to Switzerland. Yesterday the High Court ruled that they would not provide any special advice about the likelihood of prosecution.

A key feature of this case is that the current law is creating a perverse incentive. Debbie Purdy has said that she is not prepared to risk the prosecution of her husband and thus in the absence of an advisory indicating he would not be prosecuted, she would travel to Dignitas by herself. However, since her condition is debilitating, she would have to undergo the travel and euthanasia at an earlier stage of the illness if she was to do it all by herself. The law would thus make things worse for her, as she would die while her life was still bearable and furthermore, she would die away from her husband. It would also be worse from the British Government’s point of view as presumably if they see euthanasia as bad, then premature euthanasia would be worse.

The objections to assisted suicide are misguided

by Alexandre Erler
October 21, 2008

In a recent article in The Observer, philosopher Mary Warnock makes an eloquent plea for assisted suicide in relation to the case of Daniel James, a 23-year old rugby player from Worcester who requested to be helped to die after an accident at a training session last year left him paralyzed from the chest down, and whose parents helped to fulfill his request by travelling with him to an assisted suicide clinic in Switzerland. Warnock has many sound points to make on this issue, and I will not repeat all of them here. Rather, I will consider some of the arguments that those opposed to assisted suicide have presented in response to that particular case.

The paradox of organ donation consent

by Dominic Wilkinson
October 20, 2008

In Australian newspapers today a Melbourne intensive care physician,
Jim Tibballs is reported as criticising current organ donation
guidelines on the grounds that donors are not actually dead at the time
that organs are removed. Other doctors have called Professor Tibballs’
comments “irresponsible” on the grounds that they might cause a
significant fall in organ donation rates.

Radical organ retrieval procedures

by Dominic Wilkinson
August 28, 2008

I wrote recently
about the controversial news that surgeons in Denver had taken organs,
including the hearts, from newborn infants who had died in intensive
care.
In recent years the retrieval of organs from patients whose hearts have
stopped (so-called donation after cardiac death, DCD) has become more
popular. In part this is because of the problem that there is a
shortage of organ donors who are brain dead. It is also because of the
recognition that when patients die after removal of life support, their
organs may still be viable for transplantation.

When the heart stops: harvesting organs from the newly (nearly) dead

by Dominic Wilkinson
August 14, 2008

In the New England Journal of Medicine yesterday, doctors from Denver reported on three controversial cases of heart transplantation from newborn infants. These cases are striking for several reasons. They were examples of so-called ‘donation after cardiac death’ (DCD), an increasingly frequent source of organs for transplantation, but done very rarely in newborns. They are controversial because the transplanted organs were hearts that were ‘restarted’ in recipients after they had stopped in the donor. Transplant surgeons waited only a relatively short period after the donor’s heart had stopped (75 seconds) before starting the organ retrieval process. These transplants raise serious questions about the diagnosis and definition of death.

The point of death

by Janet Radcliffe Richards
August 5, 2008

The Guardian yesterday reported the death of the man who had been so tragically shot in Antigua, with his wife, three weeks after their wedding. It began like this:

"Ben Mullany, the newlywed who was shot on honeymoon in Antigua in an attack that killed his wife, Catherine, died in hospital in Wales yesterday after his life support machine was switched off. The 31-year-old trainee physiotherapist, who had suffered a fractured skull and had a bullet lodged in the back of his head, was flown back to Britain while in a coma on Saturday. Tests carried out when his condition stabilised after the 24-hour journey established he was brain dead."

This is a familiar way of describing such happenings, even among clinical professionals. Brain death is pronounced, so the life support machine is switched off, and the patient dies. The clear implication is that brain death is not death. The machine is still keeping the patient alive, and it is switching off the machine that causes real death.

Care for the Dying and Cost-effectiveness

by Mark Sheehan
July 17, 2008

Yesterday’s news reports the launch of the Government’s End of Life Care Strategy for England. This strategy will dedicate in excess of £250 million allowing patients who are dying to decide, as the Times puts it, “where and how to die.” This is part of a programme to provide better care for the dying. According to the BBC, only one in five deaths takes place at home despite a comfortable majority expressing a preference for such familiar surroundings. This prioritisation raises some interesting ethical issues particularly in the light of cost-effectiveness considerations.

Activists and acts of mercy

by Dominic Wilkinson
July 3, 2008

In Germany this week, and in Australia recently, there has been public
concern and significant media attention about the actions of euthanasia
activists. A former government official and lawyer, Roger Kusch, went
public in Germany with a video of an elderly woman who he had helped to
die. In Australia, Phillip Nitschke has been criticised for his
involvement and subsequent comments about the death of Graeme Wylie a
man suffering from Alzheimer’s disease whose partner and close friend
have been found guilty of manslaughter.

Opponents of euthanasia have used these cases to argue against liberalisation of laws on assisted suicide or euthanasia.

When autonomy trumps sense: the costs of refusal to allow withdrawal of life support.

by Dominic Wilkinson
June 25, 2008

In Canada this week, an 84 year old man died after 9 months of treatment
in an intensive care unit. He had severe brain damage and multi-organ
failure, but his family sought a legal injunction to prevent doctors in
the intensive care unit from withdrawing life-support. Over the course
of his long intensive care stay, intensive care beds at a major trauma
centre were closed so that nurses could used instead to support his
care, and three doctors resigned from the hospital in protest at being
required to provide what they felt was ‘unethical’ treatment.

Legal Abortion Time-Limits: Arbitrary Limits Harm Women

by Practical Ethics
May 26, 2008

By Dr. Lachlan de Crespigny, Department of Obstetrics and Gynaecology, University of Melbourne

The vote by the British parliament to keep the upper legal limit on abortion at 24 weeks was headline news around the world. An article in The Economist (1) considers that the British were spared America’s abortion wars partly because Britain is less religious than America, but also because abortion laws are made in Parliament, where shades of grey can be debated, not in the courts, where black or white usually prevails.

Interestingly much of the debate was about ‘viability’ – the minimum gestational age at which a newborn is said to be capable of surviving with modern intensive care facilities. This is a simple across-the-board week count. But the survival rate of newborns also depends on many other factors, including where they are born (2, 3), fetal health including the presence or absence of an abnormality (which remains lawful where the child will be ‘seriously handicapped’), plus the condition of the newborn. While around half or so of 24 week newborns in Britain may survive, many or most of the abortions at around that gestation are of problem, or unhealthy, pregnancies.

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