Final Exit: Should the Double Effect Rule regarding the Legality of Euthanasia in the United Kingdom Be Laid to Rest?

Article excerpt


This Note explores the double effect rule that currently governs physician-assisted suicide cases in the United Kingdom. Recent events in the British medical and legal community have raised serious questions about the rule's adequacy, and have arguably created an environment in which Parliament must reexamine the validity of both the double effect rule and the laws governing active euthanasia.

After providing some historical background regarding the origins and development of the double effect rule, this Note surveys recent developments such as changing attitudes towards euthanasia and the public reaction to the Moor verdict, both of which have created an environment that is highly critical of the double effect rule. It then analyzes these criticisms in light of the widespread confusion that application of the rule has caused in both the medical and legal community, and the conspicuous failure of Parliament to respond by legislating on this topic.

This Note argues that the United Kingdom should move away from a rule that essentially turns a blind eye to euthanasia and toward one which makes physician-assisted suicide legal only when it is carried out under a number of stringent, well-defined procedures and safeguards. It then provides a legal framework designed to aid Parliament in creating a balanced law that provides doctors with clear guidelines regarding their conduct, while ensuring that patient and societal interests in curbing potential abuses in this area are addressed.


There is currently a lack of specific law in Britain dealing directly with voluntary active euthanasia.(1) Rather than address the issue through legislation, British Parliament directs courts to apply the principle of double effect in suspected voluntary active euthanasia cases in order to distinguish situations where a physician's actions intentionally hasten the death of a patient from those in which the death of the patient occurs as an unintentional secondary effect of treating a terminally ill patient's pain with drugs. Under the double effect principle, physicians may engage in an action which has both a positive and negative effect without prosecution if the action is undertaken with the intention of achieving only the possible good effect (pain relief), without intending the possible bad effect (death of the patient) even though it may be a foreseen consequence.(2) Although this principal attempts to allow those who are morally opposed to assisted suicide a framework in which to provide adequate pain relief without violating the integrity of traditional medical morality or their consciences, its application to end-of-life decisions has been met with widespread criticism from the British medical, legal, and general community. Among the biggest criticisms of the present system is that it allows physicians to comply with patient requests for death and avoid prosecution by misstating their primary intention in terms of pain relief.

This Note will examine both the historical and recent events that have led many to call for a change in the law regarding voluntary active euthanasia in Britain. Part II of this Note will explore the origins of the double effect principle and its initial application to euthanasia by the courts in the case of Adams. Part III will look at the changing attitudes regarding euthanasia which led many groups to present legislation to Parliament calling for a reexamination of the law. It will also explore the conspicuous failure to legislate by Parliament, especially in light of the recent decision in Moor and the tremendous reaction to its verdict by physicians, the Voluntary Euthanasia Society, the British Medical Association, and legal experts. Part IV will examine the specific criticisms that have been lodged against the double effect principle, from its naive reliance on subjective intentions to the harsh punishments that result from prosecuting doctors for murder after they fail to meet the principle's requirements. …