Euthanasia, Ethics, and Public Policy: An Argument against Legalisation

By John Keown | Go to book overview

Introduction

Despite the major advances in medicine and palliative care witnessed by the last century, many patients, even in affluent Western nations, still die in pain and distress. Some entreat their doctors to put an end to their suffering either by killing them or by helping them to kill themselves. In almost every country in the world, a doctor who complies with such a request commits the offence of murder or assisted suicide and faces a lengthy term of imprisonment and professional disgrace.

Yet many people think it should be lawful for a doctor to end a suffering patient's life on request, either by administering a lethal injection or by assisting the patient to commit suicide.1 Organisations campaigning for legal reform, such as the Hemlock Society in the USA or the Voluntary Euthanasia Society (VES) in the UK, are not proposing that a doctor should be allowed to kill2 patients whenever

____________________
1
Lord Goff, the former Senior Law Lord, has quoted a poll, conducted on behalf of the Voluntary Euthanasia Society in England, which contained the following proposition: 'Some people say that the law should allow adults to receive medical help to a peaceful death if they suffer from an incurable physical illness that is intolerable to them, provided they have previously requested such help in writing.' His Lordship pointed out that when this was first put to the public in the early 1960s, 50% of those approached agreed with it, but that in 1993 the figure had risen to 79% ('A Matter of Life and Death' (1995) 3 Med L Rev 1, 11). His Lordship also pointed out, however, that the proposition raised a number of fundamental questions which cannot be expressed in a simple question suitable for an opinion poll, and that the proposition was ambiguous. What, for example, did those polled understand by 'medical help'?
2
Some advocates of VAE object to the use of the word 'kill' in this context. They argue that 'killing' is a word which, like 'rape', connotes a lack of consent, and that in discussions of VAE the word 'kill' is misleading and emotive. See Jean Davies, 'Raping and Making Love Are Different Concepts: So Are Killing and Voluntary Euthanasia' (1988) 14 J Med Ethics 148. A counter-argument is that the normal definition of 'rape' is sexual intercourse without consent, but that the normal definition of 'kill' is simply 'put to death; cause the death of, deprive of life' (The New Shorter Oxford English Dictionary (1993) I, 1487). One can, therefore, kill with or without consent. It makes perfect sense, for example, for a soldier to say, 'My wounded comrade on the battlefield asked me to put him out of his misery, and so I killed him.' And, although it is true that the word 'kill' carries potentially emotive overtones, these overtones simply reflect the inherent moral gravity of taking life.

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Euthanasia, Ethics, and Public Policy: An Argument against Legalisation
Table of contents

Table of contents

  • Title Page *
  • Contents vii
  • Preface xi
  • Foreword xiii
  • Acknowledgments xv
  • Table of Cases xvi
  • Abbreviations xviii
  • Introduction 1
  • Part I - Definitions 7
  • 1 - 'Voluntary Euthanasia' 9
  • 2 - Intended V. Foreseen Life-Shortening 18
  • 3 - 'Physician-Assisted Suicide' 31
  • Part II - The Ethical Debate: Human Life, Autonomy, Legal Hypocrisy, and the Slippery Slope 37
  • 4 - The Value of Human Life 39
  • 5 - The Value of Autonomy 52
  • 6 - Legal Hypocrisy? 58
  • 7 - The Slippery Slope Arguments 70
  • Part III - The Dutch Experience: Controlling Vae? Condoning Nvae? 81
  • 8 - The Guidelines 83
  • 9 - The First Survey: the Incidence of 'Euthanasia' 91
  • 10 - Breach of the Guidelines 103
  • 11 - The Slide Towards Nvae 115
  • 12 - The Second Survey 125
  • 13 - The Dutch in Denial? 136
  • Part IV - Australia and the United States 151
  • 14 - The Northern Territory: Rotti 153
  • 15 - Oregon: the Death with Dignity Act 167
  • Part V - Expert Opinion 181
  • 16 - Expert Committees 183
  • 17 - Supreme Courts 191
  • 18 - Medical Associations 208
  • Part VI - Passive Euthanasia: Withholding/withdrawing Treatment and Tube-Feeding with Intent to Kill 215
  • 19 - The Tony Bland Case 217
  • 20 - Beyond Bland: the Bma Guidance on Withholding/withdrawing Medical Treatment 239
  • 21 - The Winterton Bill 260
  • Conclusions 273
  • Afterword: the Diane Pretty Case 282
  • Bibliography 292
  • Index 303
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