ASSISTED DYING

Some medico-scientific and ethical aspects

John Bryant

Plymouth CiS, Feb 2013

WHEN MAY I DIE AND WHEN AM I DEAD?

•Ethical frameworks•Medical ethics•Science, Medicine and Demographics•Issues and Implications

A THOUGHT WITH WHICH TO BEGIN

• There are two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.

Albert Einstein

ETHICAL FRAMEWORKS

• Deontology (Duty-based; Kantian Ethics)

• Consequentialism (Results-based)• Virtue (Character-based -Aristotle,

Aquinas)• [Natural Law – Aristotle, Aquinas]

• Communitarian Aspects – Michael Sandel, Stanley Hauerwas

David SharpDied, May 2006300m below summit

Thanks to Dr Donal O’Mathuna for this example

MEDICAL ETHICS Beneficence, Do good Non-malificence Don’t do harm Justice Treat people fairly Autonomy Respect individual rights

Beauchamp & Childress, Principles of Biomedical Ethics

What type of ethical system is this? What about wisdom and

compassion?

THE STATE OF PLAY

• Life expectancy

• Medical progress

• Defining death

• Difficult dying

LIFE EXPECTANCY• Life-spans are increasing each day by an

average of two hours.• Great Britain, averages• 1930, Men – 60• 1970, Men – 68, Women - 71• 2012, Men – 79, Women – 83

• But note huge differences, even within one city, eg Glasgow

Country Average life expectancy, years

Monaco 89.7Singapore 83.8Switzerland 81.2Denmark 78.8USA 78.5Sri Lanka 75.9Jamaica 73.4India 67.1Kenya 63.1Botswana 55.7Zambia 52.6Swaziland 49.4Republic of South Africa

49.4

Note:In Africa, averages are lowered by childhood deaths and by HIV/AIDS

Data from CIA World Fact Book

THE DOWNSIDE

• Frequencies of dementia in the UK, 2012  

• Age 40–64 1 in 1400• Age 65-69 1 in 100• Age 70-79 1 in 25• Over 80 1 in 6

HEART

LUNGS BRAIN

It used to be easy: when the heart had stoppedbeating and breathing had ceased, the person had died. Since 1976 in the UK, cessation of brain stem function has also been taken as an indication of death. However, with our increased understanding of the relationship between heart, lung and brain function and our technological ability to provide replacements for at least some of those functions, defining death has become more difficult and this has led in turn to cases in which deciding about continuing or stopping treatment is very problematic.  

Dúirt mé leat go raibh mé breoite Spike Milligan

THE ISSUES

• Voluntary euthanasia• Involuntary euthanasia• Assisted suicide• Withdrawing or withholding

treatment

IMPORTANT QUESTIONS

• Can euthanasia ever be justified?• Can killing ever be caring?• When should medical treatment be

withdrawn or withheld?• Is there a difference between killing a

person and letting them die?• Is there a moral difference between

euthanasia and assisted suicide?

IMPORTANT QUESTIONS

• Why shouldn’t I decide when I want to die?

• Isn’t it my right to make decisions about my own life?

IMPORTANT QUESTIONS

• What about the doctor’s part in all this?

• How does euthanasia / assisted suicide relate to the commandment ‘You shall not kill’?

• Is there a ‘Christian view’?

LEGAL EUTHANASIA

• Belgium•Netherlands•Luxembourg

• In Belgium and Netherlands, teenagers as young as 13-years old may opt for euthanasia

OTHER LEGAL ASPECTS

• Assisted suicide is legal in Switzerland, and in three US states

• But withdrawing or with-holding treatment, where further treatment is deemed ‘futile’, is legal in most countries. Some call this ‘passive euthanasia.’

MEDICAL ETHICS

Beneficence, Do good Non-malificence Don’t do harm Justice Treat people fairly Autonomy Respect individual

rights

What about wisdom and compassion?

HOW DO WE APPLY MEDICAL ETHICS?

• Compassion – ‘condemned to life’ (does beneficence exclude ‘mercy killing’?)

• Autonomy – it’s my life• Openness – it happens anyway• But ...• Is ending someone’s life the only way

to show compassion?• Does my exercise of autonomy affect

other people?

A SLIPPERY SLOPE?

What ‘form’ might a slippery slope take in this instance?

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Chapter 7 is entitledMedical Technology: fromGamete to Grave