Medical Law: Sanctity of Life - Essay Example

Medical Law: Sanctity of Life The development of legal and moral principles emerged well before the technological advances we have seen emerge in modern medicine. Yet, these moral, social, and legal values are the driving forces that govern medical values and clinical judgment. As is evident in case law, these no longer coincide. In this paper, the difficulties that are evident with the notion of the ‘Sanctity of Life’ as a guide to legal and moral action are examined from the viewpoint of contemporary cases and a number of scholarly commentaries. The analysis is developed in four parts. In Part One, features of the principle are examined: the principle’s ethical primacy, its special application to termination of life. In part two, the academic opinions that have contributed to the merit of Sanctity of Life as a basis for guiding medical ethics legislation are discussed. Part Three concludes with the argument that the sanctity of life principles is inadequate. A brief conclusion is presented at Part Four. The central tenant in this paper is that the underlying weaknesses make it unfavourable as a guiding principle. In the light of this, it should not be granted the status of an ethical principle, and as such has no merit as a basis for legislation or medical ethics. The ‘Sanctity of Life’ (SOL) The moral position, which upholds the ‘Sanctity of Life’, clearly deserves an introduction. As a concept, it has been frequently analysed yet rarely explicated or understood. Fundamentally, sanctity refers to human life as being sacred, God created all life and so it is to be respected and cherished1. The religious influence is clear and not surprisingly, appropriation has been observed in Protestant and Catholic discourse, and as evangelical moral rhetoric.2 Cultural influences are evident between Eastern and Western philosophical applications, the former applying the principle to all animal life, the latter only to human on the basis that humans are the most significant of the animal species (anthropectrism). The principle supported by the Human Rights Act (1998) and incorporated by the European Convention on Human Rights into English law. The doctrine is considered formative, “the key to human right which must trump all others”3. Importantly, proponents imbue sanctity with characteristics of a universal moral principle; thus, life per se has sanctity, it follows that the taking of life (under any circumstance) is immoral, inherently wrong, and therefore also illegal. There is a clear distinction from the perspective of ‘quality of life views’ that argue human (life) value can be influenced according to physical, emotional, social health with reference to ‘ill health’. Sanctity as an authority therefore is seen to trump over all values and medically based ethics such as those of utility, autonomy or beneficence. Life is to be chosen over nonlife values (ultimity), and that all life is equal (equality). Emmanuel Kant, undoubtedly the founder of modern philosophy view of ethics3,4,5, was that moral obligations derive not from God, society or culture, but from ‘reason by recognition of the natural moral law’. As a moral philosopher, he searched for principles, or ‘axioms’ in order to guide or build laws of freedom. In the Metaphysics of Morals (1797),4 Kant defined ethics more precisely in terms of obligation without regard for any possible external lawgiving. The principles that define moral philosophy are those according to which everything should happen, whilst allowing for conditions under which what should happen often does not happen5. That the sanctity of life can be viewed as an axiom can be reflected by Kant’s position that suicide was ‘wholly opposed to the supreme principle of all duty6’. Jewell (2005) however reflecting a view that that sanctity of life is one such axiom would lead to a conundrum7 between the axiom of the sanctity of life in direct contradiction with that of the axiom of respect for autonomy. “Denying a reasonable request for euthanasia is a breach of the self-evident value of autonomy. Acceding to the request is a breach of the sanctity of life”8. Moreover, healthcare professionals who hold the termination of life on the basis of ‘Quality of Life’ adds the lawyer of complexity and for ethical / legal debate played out in the courtroom. A coherently agreed definition of SOL is elusive as the issue it wishes to regulate. Keown (2006)9 holds that “human life is a basic good but that it is not the highest good and that there is therefore no duty to preserve it at all costs”. In contrast, Jewell (2005) holds “that the taking of (human) life is intrinsically wrong, that this is a self-evident principle, and that this principle has a special and superior status compared to other ethical”.10 It is immediately apparent that a singular definition of SOL is unlikely to sufficient when dealing with the divergence and complexity that has fuelled the controversy surrounding the termination of individuals’ life. The proponents of the sanctity of life offer it as a moral principle that is not contingent upon circumstances and clearly reflect the Kantanian moral philosophy alluded to above. As noted by Jewell (2005)11 there are clear moral inconsistencies particularly evident in the United States where opposition to euthanasia based on the principle of sanctity of life exists in a society governed by death penalty and contentious wars. Moreover, it can be argued that the philosophy behind the principle is erred, and, reflected by the fact the law has yet to acquire coherent moral content12. Nonetheless, the principle is directly challenged when death is medically terminated (actively or passively) as in euthanasia. Both euthanasia and physician assisted suicides remain criminalized in the current British Medical Association (BMA) guidelines, recently revised in 200613. The doctrine of SOL takes a comparable stance, suicide that has since been decriminalized as unethical14. The guidelines detail various grounds under which the termination of a patient’s life with involvement of healthcare professionals is acceptable, at least legally if not morally15 (perhaps in an effort to address the limitations of this position). Nonetheless, the guidelines are clearly faithful to the doctrine of Sanctity of Life (SOL) in an attempt to provide a charted process by which these murky legal, ethical and moral waters are to be navigated. It is emphatic that under the authority of SOL principle, the “worthiness of an individual’s life” should never be guiding medical considerations. Practically, and legally, this is reflects a significant and controversial juxtaposition. Reflected by Price (2007)16based on hypocrisy, ‘quality of life’ is recognized as a variable in spite of the SOL proponents claims. As a practical reality therefore, medical practice would appear at odds with the SOL values as outlined in the bodies own ethical guidelines, and also evident in case law. In Re A (Conjoined Twins) [2001] ruling was sought over surgical separation required to save the lives of either twins, or at least one of them. From the onset was the risk to both lives, but more so for one than the other. Under SOL doctrine the ‘worthiness of a person’s life’ cannot be used as a determinant as would have been required in this case. Yet the circumstances required just that in order to determine which twin was best suited for survival thus arguing for the sacrifice of the weaker twin at the expense of the stronger. The inadequacies of the framework were recognized in the judgment that followed with a clear departure from SOL principle and justified surgical intervention based on various grounds key among which included reliance on ‘worthiness of life’ as a determinant17. Elsewhere, (Re C)18, a minor, the court firstly gave clear consideration to underlying ‘quality of life’ conditions such as disability in making termination of life decisions,19 but in addition, observed that the “futility of the treatment is to be judged by the child’s best interests which in turn depends on the quality of life which might be achieved by the child through the proposed treatment”.20 Both observations are therefore fundamentally inconsistent with the SOL doctrine and by extension acknowledge treatment decisions guided not imposed by the SOL vacuum. As articulated by Price (2007)21; “The specter of one individual judging the quality of life of another gives rise to potent fears. But such decisions, however difficult, must be made if incompetent patients are not to be subjected to the aggressive over-treatment to which competent patients would rightly object” Judicial evaluation of a patient’s quality of life was also evident in Re B where leave was given by the court to withdraw life-sustaining treatment22. It is clear that the sanctity of life when applied to these matters is therefore of limited (if any) use, on the basis that there is no credence given to the concept of autonomy, nor indeed, human rights23. For example, does not the right to life also confer a right to choose what to do with that right?24 “It is murder deliberately to hasten death by however short a period of time. "No doctor, nor any man, no more in the case of the dying than of the healthy, has the right deliberately to cut the thread of life:" Reg. v. Adams (unreported), 8 April 1957. From a legal point of view, the law has put in place a mechanism that is prone to clash with other demanding rights such that posing the reluctance to separate and provide guideline on handling the conflict between the right to life and the right to autonomy25. Human beings have the capability and potential of coming up with informed decision which would enable them to be independent and being able to embrace own decision-making mechanisms. Therefore, any matter touching on ethics could be resolve with ease as suggested by Kant, which would include issues touching on euthanasia. The ability to make decisions independently is what forms the fundamental basis for ethics. Therefore, because of this, life should be cherished and appreciated and every moment of decision-making should add up to some relevance because at one point in life death will put a halt to this. The focal point in determining the life of a human is attached to the brain function, which carries out all activities we perceive as human being, and once it fails then life is gone. On this premise to focus on upholding life would simply imply that the independence of an individual is safeguarded. However, where circumstance would dictate that the life lived is not worth due to some terminal illness then it would be prudent to let go the person to ease the burden and pain suffered. However, this notwithstanding the proponent of the sanctity of life has the proposition that life is more than being able to be independent in decisions making which displays no value in palliative care that resulted in a drug-induced haze and so it would be better for the preservation of comatose patients. Human life is what brings about the principles behind the sanctity of life. One distinguishing feature of human is that of being independent. Being able to make independent decisions is essential. A human being ought to be able to exercise his own choice of decision-making mechanism. Where a formula for making independent decision would be in existence then it would simplify the task of making informed choices and decisions on a single plane. However, this is not the case and this will always vary. There have always been varying recognition of what amounts to a sanctity of life which as a result varying decisions has been on the rampant and the law has constantly assisted or rather facilitated the recognition of one kind of the interpretation which has taken ground. Due to the rigidity of such interpretation as to the nature of sanctity of life many difficulties has risen and has cause misery where it would have been avoided26. The difficulty in the line of interpretation as to the nature of sanctity of life has resulted to varying individual and/or collective interests which in turn has influenced the varying conflicting outcome in the legislature as well as the judiciary27 resulting in the “difficult choices…[that]… may have to be made by the executive of the legislature between the rights of the individual and the needs of society”.28 Consequently there has been a persistent clash between what is entitled to an individual and those belonging to the collective members or the society at large since at no particular point has an agreement been reached as to the group which is entitled to the absolute right.29 Therefore where such unclear perspective exists it would amount then where an individual is denied the chance to terminate his/her life as a result of some terminal illness or pain, this same issue would not affect the interest of the society and due to this is it that no assistance is to be afforded for one to die?30 On the other hand, where one feels unable to continue with life and would like to be assisted by another person to terminate his/her life would this be possible?31 Based on the aforementioned it can be said that no clarity is provided as to the manner of protection of right to be upheld. This can be attributed to the protection of rights of those who are seriously sick (terminally sick) who can be seen as a breach to the very independence of making own decisions and as result it moves on to affect the society as well.32 In dealing with the sanctity of life it would be prudent to point out that nothing is absolute and hence it is an exercise in vain “doctors have never been under a duty to preserve life at all costs”.33 In dealing with the principles of the sanctity of life, it would be illogical to say that best interest would no longer play a vital role when dealing with the aspect of making an independent decision. A good example is portrayed by the open legislative instruments, which has not capture a mode of addressing the matter when the best interest of the individual comes into existence. The healthcare professionals should be aware that in the scenario given the autonomy of the patient is paramount and overrides his/her decisions. However, where the patient is unable to make an intelligent decision then assistance from the medics is to be allowed. However, the most profound mechanism that provides guidance on what to do is captured in the case law, which is developed by the courts. Again, any assistance required by the patient in fulfilling some issues then the expert report and/or advice will be allowed in which case34. Therefore, informed decisions are capable of being made where the decisions made by the help of a combined force could lead to medical benefits because of indulging in legal technicalities/ethical decision35. Strategies by which SL may respond to objections If it were ethical for a patient to request assisted euthanasia then, prima facie, it would be ethical to provide it. In Leslie Burke, the patient succumbed from an illness that made communication very difficult. The patient had the knowledge that in case of any withdrawal of treatment then death would be inevitable but had nothing to control in fact. As a point or last resort, he sought a court order, which was to the effect that the Human Right Act guaranteed right to life36. Indeed the court came to his aid and decided that his right to medical attention was to be maintained until the end of life of the person, which was a positive move as opposed to allowing the shortened stance of life to overcome him. Based on this matter the moral perspective is on the moral belief of the sanctity of life37. The law has generally supported the argument for the primacy of the sanctity of life over the patient’s wishes and welfare. Therefore, consideration of the patient’s wishes and welfare provides the rationale for professional and ethical decisions. However, this consideration is trumped by the sanctity of life principle, and only by the sanctity of life principle. Because of this principle of sanctity of life not being absolute, the law provides succinctly that it does not allow engaging in the practise of terminating life and so even allowing resuscitation is not necessary. Furthermore under Article 3 of the Human Rights Act 1998 (the prohibition on torture, and cruel and inhuman treatment) encompasses the right to die with dignity.  In effect, then, the law recognises what has been called a ‘qualified’ sanctity of life principle (Stauch et al. 2002).  It is qualified because according to the law a person’s quality of life might be such that it is not in his/her best interests to prolong it.  In Airedale N.H.S. Trust v Bland38 the family of a young boy in persistent vegetative state (pvs), sought leave to remove cut off his breathing apparatus and discontinue tube feeding.  The outcome highlighted the rare circumstances where an individual’s life would be permitted to come to and end whilst in the care of medical professional39. The Inadequacy of the Principle of Sanctity of life Life is a thing that is cherished at every moment. As enunciated above the trend with which the medical practitioners rely based on sanctity of life has proven not adequate to hold water with regard to the moral and/or legal implications. In recent times, the world has been transformed by the globalization tendencies that have subjected issues touching on human rights to be a focal point in upholding the dignity of the person. When the issue of sanctity of life is brought to light, it proffers some challenging issues as regard to the standards envisage in the legal sphere as well as the moral realm. In dealing with the legal dimensions, the view on sanctity of life has received varying views and opinions. It is the sphere of international borders that the medical practitioners ethical issues has come out with differing views which when looked at closely poses the same challenge of using the basis of sanctity of life when dealing with the termination of life40. The debate to as to whether the healthcare practitioners while terminating life on the basis of either sanctity of life or quality of life can well be demonstrate when dealing with the issue of abortion. On this premise when the issue of sanctity of life or quality of life is raised then the aspect of legal norm, which is based on human rights perspective comes into being. It is the vast constellation of human rights that form the ground for upholding and respecting human life and dignity. The legal mechanisms such as those found in the international human rights instruments tend to provide protection and guarantee of the entrenched rights, which in most cases are found in the fundamental documents of respective countries especially the constitutions41. Life is given status and value such that sanctions are elucidated to eradicate any tendencies of depriving one life or in other cases abusing it. The world has come into a consensus in appreciating the importance of life and the need to protect it in by all means42. On the other hand when dealing with moral aspect, it normally does not fall under the realm of law per se and so do the ethical matters. Therefore, commonly ethical principles are perceived as just guiding principles on what amounts to be right (good) or wrong (bad). The healthcare professionals are directed by such principles in their daily performance of the duties and decision making as well. When matters touching on termination of life arise then a complication in handling the issue arises since in reality the person’s life is in as much is entitled to him/her is also guaranteed and protected by law. In this case the healthcare professional relying on the ethical background in making such difficult decisions as aforementioned will eventual lead to repercussions from the law. Normally the four basic principles relied upon by the medical fraternity in dealing with issues touching on ethics is the namely; Beneficience- which deals with the benefits outweighing the risk, Autonomy- the right of patient to decide the kind of treatment he/she wants, Justice- deals with equality and equity and Non-malefiecience- which prefers that the patients should be kept informed. These ethical principles are the corner stone of dilemma in the healthcare professional when making decision touching on the health of the patient43. However, when it comes to the issue of terminating life, the ethical principles has no basis at all and should not be relied on when making decisions. The law should be left to take precedence in coming up with the way forward44. The Bland issue display the manner in which different standard can be utilized as another way to value life.45 This is because life is governed by the law and so everything is to be done vide the law failure to which sanctions will be instigated or invoked. On this premise, the aspect of raising the principle of sanctity of life as elucidate above will not hold water when it comes to issue touching on the termination of life in the medical realm. This is because the background notion for this principle emanates from the moral perspective, which has no valid basis in law. Pro-sanctity would argue that denying those under tormenting pain to end their life is immoral. In fact, this may be linked to natural law, which dictate reason as the guiding torch, which when scrutinized from the religious point of view will eventually depict that life emanates from a superior being and so its termination is only subject to the supreme beings power46. Therefore, no human being has the exclusive right or mandate of terminating another’s life, which of course supports the moral course and hence subjects the qualification of the sanctity of life to a nullity. Based on the above expositions the life we as human lead is valued not in the extent of Sanctity of Life or rather on the Quality of Life we lead which cannot stand test at all times but some aspects of life to be valued has to take precedence over them. We are endowed with reason to guide us through life and it is this same attribute that enables us to appreciate the multi-dimensional approaches with which we value our lives and every capability surrounding us. Thus, in conclusion it is clear based on the current evidence that the limitations of the SOL doctrine is inherent on it ‘burden of treatment’ perspective which is insufficient, contradictory, parochial and impractical. Read More