Medical Law for Euthanasia - Essay Example

? Medical Law of the of the Medical Law Euthanasia constitutes a deliberate omission or intervention that has as itsobjective, the termination of the life of an individual, in order to assuage persistent pain or suffering. Undoubtedly euthanasia and assisted suicide have several consequences for healthcare (Sanders & Chaloner, 2007, p. 41). Patients in a permanent vegetative state would perforce suffer a life of grossly inferior quality, in the opinion of the courts of the UK. In order to lend succour to such patients, the courts have frequently recommended the discontinuance of life prolonging medical procedures. Moreover, the evaluation of the physicians, with regard to the continuance or otherwise of the patient’s life, is bestowed with primacy. In many instances the courts have agreed with the physicians’ evaluation that it would defeat the best interests of the patient to continue with life prolonging medical measures (Mendelson & Jost, 2003, p. 131). The 1993 case of Airedale NHS v Bland proved to be a landmark case in the area of cessation of artificial feeding and therapy. The court permitted the withdrawal of treatment from persons in a persistent vegetative state (PVS). In this case, the defendant Anthony Bland was in PVS as a result of having been asphyxiated in a stampede. The physicians attending upon him proposed the discontinuation of artificial feeding and antibiotic therapy (Tibballs, 2007, p. 233). Subsequent to undergoing a persistent vegetative state for three years, a court order was procured by the physicians attending upon Bland. This order permitted the medical authorities to write finis to the indignity and degradation that had become an integral and overwhelming component of this hapless individual’s life. It was the considered opinion of the judges, ruling in this case that the inability of Bland to execute a will had prevented an earlier end to his pain and indignity filled life (Docker, 2000). It was clearly realised by the medical authorities that such cessation of feeding and treatment would result in death by starvation. However, such a course of action would not cause discomfort to the patient. It was also assumed that it would be in the best interests of Bland to legally discontinue the life sustaining treatment and tube feeding. Lord Hoffmann opined that the discontinuation of treatment was not only in the best interests of Bland but was also aimed at stopping the humiliation being undergone by him and to prevent distress to his family members. According to Lord Mustill, Bland had to be allowed to die in the best interests of the community. He further stated that this decision was in the best interests of the family members of Anthony Bland (Tibballs, 2007, p. 233). While pronouncing judgement in the Bland case, one of the presiding judges stated that the States of the Union in the US, which had enacted laws to permit living wills, there was an explicit exclusion of terminating life by discontinuing nourishment and hydration (Ozimic & Fleming, 2011). It is the duty of a doctor to take into account, the best interests of a patient. However, there is an erroneous presumption that the best interests of the patient can be determined only by reference to the patient’s wishes, prior to his becoming incapacitated. The choice exercised by a patient need not necessarily be in his best interests, on every occasion (Ozimic & Fleming, 2011). In addition, ignoring the wishes of an incompetent person, should not be invariably be deemed to be disrespectful to the patient, and in contravention of his rights. Although, patient autonomy is of considerable significance, doctors take other factors, such as life and health, and the provision of adequate health care in order to support the health and life of the patient. With respect to an incapacitated individual, who cannot exercise autonomy, such interests assume paramountcy. Nevertheless, despite a diminution in autonomy, the incapacitated individual possesses fundamental dignity and the right to live, due to being human (Ozimic & Fleming, 2011). The common law and most of the civil law nations enshrine the principle that an adult in possession of his faculties possesses the capacity to refuse or consent to medical treatment. The fact that refusal to undergo medical treatment could prove to be detrimental to the interests of the patient has no bearing on the right of the latter to refuse medical intervention(Mendelson & Jost, 2003, p. 130). However, such refusal has to be given in writing and in an unequivocal manner. Criticism from different quarters was levelled against the decision in Airedale NHS Trust v Bland. In this context, it was contended that the sanctity of human life had been disregarded. Specifically, the House of Lords had ignored the principle of sanctity of human life, which precludes premeditated killing. Thus, even patients afflicted with a terminal ailment should not be deprived of life, regardless of whether such termination of life is by omission or by some intentional act (Keown, 1998, p. 258). The issue of euthanasia generates hotly contested debates relating to medical ethics and several other principles. Some of the important principles of medical ethics are non-maleficence, beneficence, autonomy, and justice. These bioethical principles play an important role in the analysis of medical ethics. These principles have to be borne in mind whilst analysing euthanasia. Another important principle in this area is that of confidentiality, which constitutes the cornerstone of bioethical principles (Green, 2001). The medical professional is required to respect the autonomy of the patient. Moreover, the patient has the right to control information relating to his health. The physician or medical professional has to maintain the secrecy of the medical information of his patients. In addition, such entities have to act beneficently towards their patients. All these measures are encompassed by the principle of confidentiality (Green, 2001). Under this principle, the doctor should not disclose the medical information of a patient, in the absence of the consent of the latter. The state is required by section 2 of the European Convention on Human Rights to desist from taking the life of a person, unless it is in the context of a lawful execution. Consequently, failure of the State to provide medical treatment, in instances where such deprivation of treatment would result in the death of the patient, constitutes a breach of the European Convention on Human Rights. However, in the Bland case, the House of Lords limited its ruling to the withdrawal of treatment (Airedale NHS Trust v Bland , 1993). In the context of providing palliative care to the terminally ill their Lordships held that this was beyond its scope. Article 8 of the European Convention on Human Rights, empowers individuals with the right to physical integrity, which can also be understood as the right to personal autonomy. Any physical intrusion has to necessarily be justifiable under Article 8(2) of the Convention. Moreover, treatment sans the consent of competent patients would be unlawful (The European Convention on Human Rights, 1950). A competent patient has the right to refuse treatment, even if the outcome of such refusal could prove to be fatal. This requires physicians to procure the consent of the competent patients, before providing them with treatment. Quite a few people are seized with the moral legitimacy of voluntary euthanasia. The latter involves an individual requesting others to end his life by adopting active measures. An instance is provided by a terminally ill patient requesting his physician to administer a lethal dose of a drug to end the former’s life. Those who oppose voluntary euthanasia tend to stress upon its latent deleterious effects on society and the individual (Sanders & Chaloner, 2007, p. 42). These entities contend that improvements in palliative care should be given preference over voluntary euthanasia. Furthermore, the opponents of voluntary euthanasia believe that the psychological requirements of the terminally ill should be addressed, in addition to interventions to reduce pain (Sanders & Chaloner, 2007, p. 42). In the UK, the practice of euthanasia is prohibited. However, there have been several cases in this area, which have generated a plethora of medical and ethical debates. A striking example is provided by the case of Pretty v DPP, wherein Diane Pretty sought the permission of the European Court of Human Rights, for her husband to administer a lethal injection to her, in order to end her life. This was not permitted by the Court, which nevertheless permitted the Member States of the European Union a margin of appreciation, whereby they could embark upon a judicial review, in such cases (Smartt, 2002). In the Diane Pretty case, the patient was diagnosed with Motor Neurone Disease, which frustrated her to the point of desiring death. The courts did not accede to her plea to permit assisted suicide. This was in direct contrast to Bland, where the court had permitted the withdrawal of sustenance and medical treatment. Diane Pretty’s appeal to the European Court of Human Rights fell on deaf ears, as the latter refused to take up her case (Pretty v United Kingdom , 2002). On occasion, the courts have been seen to disregard the wishes of the parents. For instance, in the Conjoined Twins case, the court ordered the separation of the conjoined twins, thereby causing the death of one of them. In addition, the plea of the parents that such separation should not be effected, as it would result in the death of one of the twins, was ignored by the court (Re A (Children) (Conjoined Twins: Surgical Separation) , 2000). It cannot be gainsaid that every individual is entitled to refuse medical treatment, and this derives from the principle of personal autonomy. This right was conceded by the European Court of Human Rights, in the Diane Pretty case. Personal privacy has been vouchsafed to all by Article 8 of the European Convention on Human Rights; which empowers the individual to refuse medical treatment (Mendelson & Jost, 2003, p.130). The House of Lords were of the opinion that the cessation of hydration and nutrition in F v West Berkshire Health Authority was merely an act of omission (F v West Berkshire Health Authority , 1989). In Re J the sanctity of life was ignored, as the unbearable pain and suffering of the child were deemed to be of greater consequence. This was contested by some legal luminaries, who were of the opinion that the sanctity of life could not be supplanted by any other consideration. This line of thought would require the courts to uphold the sanctity of life of patients, under all circumstances, including a permanent vegetative state (Re J , 1990). In Re A the mother of a mentally incapacitated adult beseeched the court to order a vasectomy on her son. She was of advanced age and after her demise her son would be institutionalised, where he could impregnate a female and thereby father a son. As this individual was not in a position to comprehend this situation, the mother was determined to have him sterilised. The court held that it was not in the best interests of the son to have him vasectomised, as the level of supervision that he would be subjected to would prove to be adequate to prevent such behaviour (Re A (Male Sterilisation), 2000). This decision was upheld by the Court of Appeal. The UK indicated its commitment to promoting the right to dignity of patients, by ratifying the European Convention on Human Rights. Article 3 of this Convention stipulates that no individual is to be subjected to torture, or inhuman or degrading treatment. This ratification was achieved by means of enacting the Human Rights Act 1998 (Dupre, 2011). Ostensibly, the right to dignity can be invoked by a patient to contest the state’s presumption relating to the continuance of life. There is a trend to promote the concept of quality of life, which in turn implies making decisions that are in the best interests of the patient. All the same, it is essential to recognise the fact that the cessation of life of a patient can never be in the best interests of that person. References The European Convention on Human Rights. (1950, November 4). Council of Europe The European Convention on Human Rights and its Five Protocols. Rome, Italy. F v West Berkshire Health Authority , 2 All ER 545 (1989). Re J , 3 All ER 930 (1990). Airedale NHS Trust v Bland , 1 All ER 821 HL (House of Lords 1993). Human Rights Act. (1998). United Kingdom: Crown copyright. Re A (Children) (Conjoined Twins: Surgical Separation) , EWCA Civ 254 (England and Wales Court of Appeal 2000). Re A (Male Sterilisation), 1 FLR 549 (Court of Appeal (Civil Division) 2000). Pretty v United Kingdom , 2 FLR 45 (European Court of Human Rights 2002). Docker, C. (2000). Cases in history. Retrieved March 29, 2011, from http://www.euthanasia.cc/cases.html#bland Dupre, C. (2011, March 24). What does dignity mean in a legal context? . Retrieved March 31, 2011, from The Guardian: http://www.ongo.com/v/620432/-1/175B1C74A90DB097/what-does-dignity-mean-in-a-legal-context Green, B. (2001, July). Medical Ethics. Retrieved March 30, 2011, from Medicine On – Line: http://priory.com/ethics.htm Keown, J. (1998). The Legal Revolution: from “Sanctity of Life” to “Quality of Life” and “Autonomy” . Journal of Contemporary Health Law & Policy, 14(2), 253 – 285. Mendelson, D., & Jost, T. S. (2003). A Comparative Study of the Law of Palliative Care and End-of-Life Treatment. The Journal of Law, Medicine & Ethics, 31(1), 130 – 143. Ozimic, A., & Fleming, J. (2011). What is Euthanasia by neglect and why is it wrong? Retrieved March 29, 2011, from Society for the Protection of Unborn Children: http://www.spuc.org.uk/ethics/euthanasia/mib/ethical-reflection Sanders, K., & Chaloner, C. (2007). Voluntary euthanasia: ethical concepts and definitions. Nursing Standard, 21(35), 41 – 44. Smartt, U. (2002, December 23). Euthanasia and the law. Retrieved March 30, 2011, from BBC NEWS: http://news.bbc.co.uk/2/hi/health/2600923.stm Tibballs, J. (2007, April). Legal basis for ethical withholding and withdrawing life-sustaining medical treatment from infants and children. Journal of Paediatrics and Child Health, 43(4), 230 – 236. Read More