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

By John Keown | Go to book overview

PART VI
Passive euthanasia: withholding/withdrawing
treatment and tube-feeding with intent to kill

It was tempting to stop writing at the end of the last chapter and to limit the book to an elucidation and exploration of the slippery slope arguments against legalising VAE and PAS. To have stopped writing would, however, have been to ignore an aspect of the debate which, despite its importance, commands relatively little attention. This is the question whether the law and professional medical ethics do, and should, permit doctors intentionally to end patients' lives, and intentionally assist them to commit suicide, by withholding/withdrawing treatment and tube-feeding. Without at least some consideration of this question, this book would have overlooked an important dimension of the euthanasia debate. Part VI therefore considers whether English law and professional medical ethics permit passive euthanasia (PE), that is,the withholding/withdrawing of medical treatment (or tube-delivered food and fluids) by a doctor with intent to kill. Itconcludes that they do and that this is inconsistent with their continued opposition to the active, intentional killing of patients. What is said in this part in relation to English law has important implications for other jurisdictions – not least the USA – in which (as will be suggested in the conclusions to this Part) some courts have also moved from 'inviolability' towards 'Quality'.

Chapter 19 illustrates the English courts' condonation of PE by examining the landmark decision of the Law Lords in the Tony Bland case in 1993. Chapter 20, by analysing the BMA's recent Guidance on Withholding and Withdrawing Medical Treatment, illustrates the medical profession's acceptance of the proposition, central to the case for both VAE and NVAE, that the lives of certain patients are not worth living and that it is permissible for that reason to withhold/withdraw life-preserving treatment, or tube-feeding, from them. Chapter 21 discusses a private member's bill which sought to restore 'moral and intellectual shape' to law and medical ethics after the Bland case and the BMA guidance, and suggests that the opposition to that bill by the government and the BMA was confused and inconsistent.

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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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