Euthanasia and Physician-Assisted Suicide as Sensitive Issues That Entail Judicious Treatment - Case Study Example

Right to Die Euthanasia and physician assisted suicide are sensitive issues that entail judicious treatment. Euthanasia has been legalised in several European countries. However, doctors in the United Kingdom are unwilling to terminate the life of patients, even in the most serious of cases. This is not the situation obtaining in some of the other countries, and the doctors of the UK are of the opinion that patients, with terminal diseases, must be provided with comfort and palliative care to enhance the quality of their life. This is the best possible way to relieve patients of their suffering, instead of subjecting them to euthanasia or other drastic methods of ending life1. English law deems euthanasia or assisted suicide to be illegal; and it does not authorise any person to hasten the death of another individual. In the case of R v Cox, the defendant, Dr. Cox administered a lethal dose of drug to his patient, in order to relive her of excruciating pain. That injection proved fatal to that patient. It was held by the court that Dr. Cox was guilty of attempted murder; and it sentenced him to a year in prison2. However, in Airedale N.H.S. Trust v Bland, the House of Lords held that the life supporting systems attached to the patient should be withdrawn, by the hospital. This ruling was given, with the intention of permitting the patient to die with dignity3. The strategy employed in the Bland case was passive euthanasia. Under this approach, an individual’s life can be terminated without seeking his consent, in the matter. Following the House of Lords’ decision, the plaintiff hospital removed the tubes connected to Tony Bland. This move resulted in the death of Bland4. The underlying reasoning behind this decision was that medical treatment was not in the best interests of Tony Bland. The removal of life supporting feeding includes the withdrawal of nutrition, hydration and other life – support mechanisms. This is disturbing in the extreme. Therefore, it is preferable to continue the life sustaining mechanisms, till such time as the patient remains alive. This yardstick is to be applied, even to the patients, suffering from terminal diseases. Euthanasia by omission, per se, is a gross violation of medical ethics5. In this case, the consent of Tony Bland was not sought by the doctors to end his death. Moreover, Tony Bland was not dying; and the attending doctors, merely disconnected the tubes that supplied nutrition and hydration, which were indispensable for sustaining his life. This is grim development, as it places patients who are not in a position to communicate, in grave danger6. Bland died on account of starvation and dehydration. Such death entails suffering for a week or two. The British Medical Association established the code of conduct to be adhered to by doctors, in the UK. Subsequent to the Bland’s case, the code of conduct proposed by the British Medical Association was held to be compatible with the doctors’ duty of care. However, it was conceded that the life of a patient could be terminated, by discontinuing food and water to a patient, who was beyond cure7. In Re A (Male Sterilisation), it was held that emotional, medical and other welfare issues, constituted the best interests of the patient8. The task of ascertaining the best interests of a patient entails an intricate evaluation of the sanctity of life, the right to self-determination and the right to a dignified death9. In general, this onerous task depends on the facts of the case. The reasoning in the House of Lords decision in Bland was adopted by the High Court of Justice in National Health Service Trust AVM and NHS Trust B v H. Consequently, the High Court of Justice held that there was no compulsion, under the ECHR, for the continuance of life sustaining care in all situations10. However, it was clarified by the Court of Appeals that courts were precluded from recommending treatment that would have otherwise been deemed to be illegal. The case of Dianne Pretty established the stance of English law with regard to assisted suicide. Dianne Pretty, who had been diagnosed as suffering from Motor Neurone Disease in 1999; decided to end her life at home. It was her wish to die in the presence of her family members. As such, she was desirous of ending her life, as she had no penchant for leading a life that was replete with physical and psychological suffering11. There was extraordinary support for her from around the nation. Many people expressed their sympathy for her state of suffering, and supported her wish to die with dignity. Despite such overwhelming pressure from society, the court did not allow her to commit assisted suicide. Subsequently, she invoked the ECtHR, which refused to consider her case12. The outcome of Dianne Pretty’s totally untenable situation was that she left no stone unturned, in her quest to undertake assisted suicide. The failure of her efforts, in this endeavour, in the UK, compelled her to approach the European Court of Human Rights, in order to endure assisted suicide. In the course of this enterprise, she asserted that the 1961 Suicide Act of the UK was a gross violation of Articles 2, 3, 8, 9, and 14 of the ECHR13. As brought to the fore in Pretty v United Kingdom; Article 8 of the European Convention on Human Rights (ECHR), guarantees personal privacy. The right to decline medical treatment and the right to bodily and physical integrity derive from the provisions of this article14. Dianne Pretty contended that the Human Rights Act incorporated a right to die15. She also asserted that this right empowered her to choose the time and manner of death. However, the court discounted her argument and did not permit her to commit assisted suicide. Moreover, Diane Pretty requested the court to exclude her husband from criminal liability, if he assisted her in ending her life. The court refused to give any such assurance, in the event of his helping her in such endeavour16. Thus, there is no right to die, and the UK does not permit euthanasia or assisted death. The retraction of nutrition was deemed to be an act of omission and not commission, in F v West Berkshire Health Authority, by the House of Lords17. Consequently, the cessation of life support systems from patients in a persistent vegetative state, constituted euthanasia by omission and not deliberate euthanasia. A right to consent was provided to patients, in order to resolve the discord resulting from the best interests of patients, the right to self determination and sanctity of life. Specifically, this right enabled a patient to decline medical interventions that could prolong or save life. Moreover, even an incompetent patient can exercise the right to dignity; which in turn, ensures their quality of life; however, this necessitates pertinent assessment18. The House of Lords affirmed in Re B that courts had been seen to take on the role of responsible parents, in ensuring the best interests of a child. However; no court could adopt standards that surpassed or differed from what a reasonable parent would have adopted, under similar circumstances; whilst discharging the duties of the state, in accordance with the standard of parens patriae19. In Re J, the court conceded that the injuries sustained by an infant, made it impossible for it to tolerate life. It also held that given a choice, the infant would prefer to end its life20. In this case the Court adopted the principle of parens patriae; which is equally appropriate for incompetent adults. The chief requirement in such cases is to balance the best interests of the patient against the sanctity of life. Accordingly, the unbearable pain and torment of the child was the sole issue considered for disregarding the sanctity of life. In Re J, the importance of arriving at a well thought-out assessment of the benefits and drawbacks of terminating treatment to a child was stressed. Such assessment must be from the perspective of what would be in the best interests of the child. Consequently, the court decided that re ventilation was to be withheld. As a result, the appeal against the cessation of re ventilation was set aside21. An individual’s freedom to live in the manner that he chooses derives from the notion of personal autonomy. This freedom presumes that individuals enjoy the right to do whatever they please with their life. Furthermore, an individual perspective regarding life can be entertained by an individual, on account of personal autonomy and the right to self determination22. All the same, no individual is provided with total autonomy. Higher brain death has not been accepted as the legal definition of death. As such, debates relating to the inviolability of life have been limited to the question of whether there is an obligation to keep a terminally ill or permanently insensate person alive. The cessation of medical interventions, in respect of patients, whose brain stops functioning; violates the fundamental principle of sanctity of life23. In order to obtain treatment, adult patients should have submitted an advance medical directive and they should also be competent. In the absence of these factors, the courts will not permit treatment that conforms to the wishes of the patient24. The treatment provided to patients, in the absence of advance medical directives, will be in accordance with the professional expertise and proclivities of the attending physicians. The UK judiciary firmly believes that patients in a permanent vegetative state enjoy life that is of a poor quality. Therefore, the UK courts recommend the cessation of life prolonging medical interventions. It has been the practice for the courts to defer to the physician, in respect of whether life sustaining care is to be continued. Moreover, the physicians’ evaluation regarding the best interest of the patient, Vis – a – Vis continuation of life prolonging treatment, has in general been accepted by the judiciary25. The UK has ensured the right to dignity of patients, consequent to its ratification of the ECHR in 1998. Article 3 of the ECHR declares that no person is to be subjected to inhuman treatment. A patient can refute the state’s presumption in favour of life, by invoking the right to dignity26. In the year 2004, the UK registered 584,791 deaths throughout the nation. Of these, 936 deaths had been due to voluntary euthanasia. In 1931 cases, physicians had terminated the life of the patient, without obtaining their consent27. In a recent case, Debbie Purdy, a female patient, suffering from multiple sclerosis approached the House of Lords; in order to obtain a clarification regarding assisted suicide. Their Lordships made it clear that there was no change in the law, and that Parliament would not change the existing legislation. The judiciary as well as the legislature were keen to ensure that susceptible and vulnerable people were not coerced or manipulated into ending their life. Most importantly, in the words of Baroness Finlay, there is no indication that the UK government will change the law, to permit acts of assisted suicide (Baroness). The various factors considered by the judiciary in the United Kingdom, whilst ruling in cases dealing with assisted suicide are autonomy, self determination, beneficence, non – malfeasance and paternalistic intervention. A careful perusal of their decisions, makes it abundantly clear that they are not in favour of active euthanasia, as in the Dianne Pretty case ; whereas they have shown no such eschewal towards passive euthanasia, which was depicted in the Tony Bland case. From the foregoing it can be concluded that on occasion, the English courts permit assisted suicide, after carefully considering the best interests of the patient who is on the threshold of death. However, euthanasia per se is disallowed by these courts on the grounds that it is unethical. Bibliography Airedale NHS Trust v Bland (1933) 1 All ER 821 Article 2 of the Human Rights Act 1998 Article 8, The Convention for the Protection of Human Rights and Fundamental Freedoms. Baroness Finlay of Llandaff. Debbie Purdy case not a green light to assisted suicide says Baroness Finlay . 30 July 2009. 9 December 2009 . BBC NEWS, Euthanasia ‘extremely rare in UK’, 17 January 2006, 8 December 2009 Chaloner, C and K Sanders, ‘Euthanasia: the legal issues, 2007, 8 December 2009 . D. Mendelson & T. S. Jost, ‘A Comparative Study of the Law of Palliative Care and End-of-Life Treatment’, Medicine & Ethics Journal of Law, vol. 31 (2003), p. 130 Dianne Pretty’s Right – to – Die case: High Court clears way for Judicial Review, 31 August 2001, 8 December 2009 . Dr Ubaldus de Vries, 2004, ‘A Dutch Perspective: The Limits of Lawful Euthanasia’, Annals of Health Law, Loyola University, Chicago, vol 13, p 365 Euthanasia, 8 December 2009 F v West Berkshire Health Authority (Mental Health Act Commission intervening) (1989) 2 All ER 545 at 563 Feldhammer, J.D., 2006, ‘Medical Torture: End of Life Decision-Making in the United Kingdom and United States’, Cardozo Journal of International and Comparative Law, vol 14(2), pp 533-539 Janna Satz Nugent, 2003, ‘Walking into the sea of legal fiction: An examination of the European court of Human Rights, Pretty v United Kingdom and the Universal right to die’, Journal of Transnational Law & Policy, Florida State University, vol 13, p183 Ozimic, Anthony and Dr John Fleming, ’What is Euthanasia by neglect and why is it wrong?’ 8 December 2009 Pretty v United Kingdom (European Court of Human Rights) (2002) 2 FLR 45 R.S. Magnusson, 1997, ‘The Sanctity of Life and the Right to Die: Social and Jurisprudential Aspects of the Euthanasia Debate in Australia and the United States’, Pacific Rim Law & Political Journal, vol 6, p1 R v Cox (1992) 12 BMLR 38 Re A (2000) 1FLR 549 Re B (a minor) (wardship: sterilization) (1987) 2 All ER 206 at 212 Re J (1990) 3 All ER 930 Results of first ever UK-wide study into Euthanasia and end – of – life decisions, 17 January 2006, 8 December 2009 Tony Bland and PVS, June 2002, 8 December 2009 Read More