Ethical issues at the end of life
'There should be no difference between the legality of switching on the machine and of switching it off The law does not expect a doctor to place every dying patient on a life-support machine, only where there is hope of recovery and the facilities exist.' 1
A baby born at 27 weeks' gestation suffered frequent collapses and required resuscitation and ventilator support. Ultrasound scans of her brain showed fluid-filled cavities where there should have been brain tissue. The view was taken that this tissue would not grow and the baby was likely to be blind, deaf, never able to sit up and have paralysis of both arms and legs. The baby would probably be able to feel pain but be unable to develop even limited intellectual abilities. If the baby suffers another collapse, ought she to be resuscitated and re-ventilated?
The above dilemma provides an illustration of a decision involving an individual who has never reached a level of autonomy sufficient to take their own decisions. Indeed, if the health care team's prognosis is correct, she will never achieve this capacity.
In this chapter, we consider dilemmas such as whether to forgo or prolong treatment and whether euthanasia is ever morally justifiable. These dilemmas are considered with respect to three different categories of individuals distinguished in