Death with Dignity Issue Discussing - Assignment Example

Contents …………………………………………………………………………………..…2 Executive summary…………………………………………………………………….……..2 Rationale……………………………………………………………………………………..3 Objectives………………………………………………………………………………..…...4 Ethical considerations in giving permission to euthanasia………………………… …….…4 Protocol needed for a more humane treatment for Patients like Maria………………….….12 References Appendices Death with Dignity A Report Prepared for the Minister of Health Abstract: Mercy killing or euthanasia is a much-debated issue all over the world. Different countries hold different views on euthanasia and so as their respective legal bodies. In Sweden it is allowed and in UK it is prohibited. Euthanasia again is divided into passive and active euthanasia and the law does not hold same view regarding this two. In this dubious state regarding euthanasia patients suffering form terminal illness are the prime sufferers. Should euthanasia be legalized or it should be left as it is. The following paper leads an investigative report on moral, ethical and legal grounds on this issue at the back ground of a case study of a young girl Maria who is suffering from motor neuron disease a terminal illness and has only one year to survive. Moreover the paper suggests some recommendations for the Minister of Health in order to facilitate euthanasia in a just way. Executive Summary: Death with dignity or euthanasia is a much-debated issue in the world. Apart from Oregon in other states of USA it’s prohibited and in United Kingdom the debate is still going on over its acceptance. Interestingly in UK by The Suicide Act 1961, suicide has been legalized under certain circumstances but ending one’s life with the help of another is strictly prohibited. However it has been observed that assisted suicide is the only outlet or route of escape available to the people suffering from terminal illness, since in most of the cases they are not capable of doing it by their own. This report will enlighten the dubious factors hovering around this faint demarcation of suicide and assisted suicide and also will highlight the necessity of euthanasia to be legalized. In this effort a case study of Maria a young girl suffering from motor neuron disease has been considered. Maria whose fate was sealed as soon as she was detected with the mentioned disease, was bed ridden and paralysed to that extent that she cannot put an end to her life by her own. Her mother and family was strongly in favour of assisting her to end her life to avoid the later stage complicacies and pain mainly arising from respiratory failure; but were never granted permission for the same. It should be noted since motor neuron disease leaves the mind almost unaffected hence it is obvious that Maria opined the same with her mother and family. This report aims at considering the case of euthanasia in a detailed manner and explores the ethical, legal and moral grounds in favour or against the same. The report also aims to figure out an appropriate point where euthanasia should be legalized and in its way to achieve that goal the report also suggests a set of recommendations. Rationale of the Report: Firstly historical evidence points to the fact that many clinical cases have been faced so far where a person with terminal illness and suffering like hell but the people around her even knowing the ultimate outcome remained neutral considering the red eyes of law. Examples in UK can be found from the instance from Mrs. Dianne Petty and Debbie Purdy. This report focuses on the justification of that act. Secondly according to Griffiths many medical professionals consciously or unwillingly considers voluntary euthanasia; an estimate put this number at 12 percent. (Griffiths, 1999) However the difference between voluntary and involuntary euthanasia often becomes thin and ironical ultimately leading to unjust social outcome. The report aims to analyse if it is worth to legalize euthanasia to pave the way for a balanced outcome. Thirdly, there are around 5000 sufferers of the mentioned disease in UK (Motor Neurone Disease - New Research Revealed, 2010) with a final outcome that only carries a grey shed; this report focuses their probable state with the case study of Maria, Mrs. Dianne Petty and Debbie Purdy. Last but not the least the report focuses on the British law regarding Euthanasia and moves forward to prescribe a number of recommendations favouring the eventual justification of Euthanasia in certain circumstances. Objectives: 1. Analyze Euthanasia in a detailed manner and either to justify or to reject the mentioned action. 2. A brief discussion on ethical, legal and moral grounds leading to this outcome 3. To discuss, in brief the dubious concept and foggy demarcation between voluntary and involuntary euthanasia. 4. Considering different laws related with euthanasia; encompassing their evolution and current status 5. Providing a futuristic outlook; through a set of recommendations regarding euthanasia. 6. Highlight the case studies related mainly with UK and present forward the agony that Mrs. Dianne Petty and Debbie Purdy was subject of and Maria is still experiencing. Ethical considerations in giving permission to euthanasia: Ethics as regarded by Gillies (2009) is a mean or way to a decent life. Ethics helps us to understand and analyze a situation in order to qualify it as a reasonable decent event. In other words unless we take ethical stand regarding a particular event; our society might meet its breaking point and anarchy might be unleashed. However ethical consideration often creates divergence between ideas in medical treatment. It has been observed by Holloway (2004) that often a medically unavoidable circumstance leads us to a point where conflict of ideas on ethical ground relating to the outcome of that particular action occurs. It is obvious that while responding to the ethical issues the medical practitioners will resort to clinical tools and practises supported by pre formed policies and procedures. The medical practitioners have to abide by four principles; autonomy, non-maleficence, beneficence and justice. These principles are governed by ethical theories namely Utilitarianism, deontology, and consequentialism. All these together as referred by Melden (2008); help to reach an ethically correct decision. These principles and ethics are presented below in a tabular form. Beneficence: Beneficence is considered as the action of doing what is regarded as benign or good. This is regarded as a possible solution provider to an ethical conflict. This particular principle is well knitted with the ethical theory of utilitarianism and for this reason will also occupy some portion at the later part of this report. (Edelman & Mandel, 2005) Relation of Beneficence to this case study: Providing relief to a patient suffering from terminal illness like motor neuron disease through one’s action is an example of beneficence. Respect for Autonomy: Respect for Autonomy refers to a situation where individuals are capable of deciding (well informed) them regarding the final outcome of their mortal life. A relation between autonomy and beneficence might be drawn. This relation might be illustrated through An individual who is free to choose an action for his good without any influence or hindrance from outside. (Edelman & Mandel, 2005) Relation of Autonomy to this case study: Autonomy has a strong connection with this case study. Presence of Autonomy means that patients like Maria who are suffering from terminal disease like motor neuron disease will be able to choose whether to continue or to put an end to their dreaded life irrespective of what others think or like. Various types of autonomy: i) A medical professional or in broader terms the authority if exerts its power on Maria to carry on with her life against her will then it is known as Paternalistic autonomy. (Olaru, 2009) ii) The other view of autonomy is known as libertarian view of autonomy. Here priority is given to the patients wish against the medical practitioner or the authority. For the considered case study; Maria if allowed to put an end to her life with the assistance from her fellow members (since she can not do it by herself considering that she is paralysed due to the dreaded disease) then it would be considered that her libertarian autonomy has been respected. However before doing so all the possible ways and outcomes should be discussed to Maria so that she can choose the best alternative available to her. Justice: In ordinary or usual circumstances all the actions taken in order to provide the patient ailment in tune with his beneficence and autonomy should be reliable, reasonable and practical to the patient’s circumstances. However this changes with the patient’s condition and under critical circumstances, decisions should be made by a medical professional based on the prevailing and surrounding conditions of the patient. (Olaru, 2009) Relation of Justice to the case study: In no sense Maria’s condition is usual or normal. She is suffering from a dreaded disease like Motor neuron disease and the final outcome is known to even her. At later stages of this disease patient usually suffers from chocking and the experience is beyond the explanation of words. To avoid this situation euthanasia might be considered and that in no sense beyond the realm of justice. Non-maleficence: In terms of medical practise Non-maleficence is known as avoiding harm to patients. Medical professionals must avoid any action on their behalf that might cause any harm to patients. Without any doubt all most all-medical interventions to seme extent cause harm to patients but it should be kept in mind that such harm should be much less than the benefits that the patient is going to receive from that treatment (Edelman & Mandel, 2005) Relation of Non-maleficence to the case study: Maria is suffering from a terminal illness that has a proven medical history of non-survival of the patient. Moreover the patients usually meet their end within four years of the detection of the disease. Again the end scenario is painful as motor neuron disease leaves the mind unaffected but paralyses the other body parts. Courting this, at end death comes through chocking and that is immensely painful. At this circumstance euthanasia seems to be a boon to the patient since it allows a more peaceful death. Again no medicine can do any good to her, beside we can not ignore the wrong doing they will once they are inside her body, and hence providing medicine comes directly into conflict with the principle of non-maleficence. As discussed earlier, ethics leads us to reach a more socially just outcome. The three theories of ethics that have been considered are deontology by Immanuel Kant, consequentialism and utilitarianism by John Stuart Mill. A short description of these theories with their connectivity with the present case of euthanasia has been provided in the following table. Deontology: Immanuel Kant was the first proponent of Deontology. The theory of Deontology regarding ethics states that people should abide by their obligations and duties in their effort to analyse an ethical dilemma. Here obligations and duties of an individual refer to that person’s indulgence in another individual and the society. In Deontology living for carrying out one’s duty and obligations for others have been considered ethically most correct thing. (Furrow, 2005) Relation of Deontology to the mentioned case study: As mentioned that Deontology considers the rightful execution of one’s duties and responsibilities to others as the most ethical. Maria is suffering and her suffering has no end rather it will increase as she will approach her end. It is well documented that most of the patients suffering from motor neuron disease dies at the end of chocking. This happens when the patient fails to breathe owing to the paralysis of lungs. Ironically motor neuron disease leaves the mind almost unaffected and the patient is capable of experiencing each moment of her trauma. Maria as paralysed so she can’t end her life by herself. Only if someone helps her in her euthanasia she will be able to attain a more peaceful and painless death. In these critical circumstances helping Maria would only be easing up her death this is the foremost duty and obligation that might be rightfully accomplished by her fellow members or medical practitioners. Consequentialism: According to Consequentialism a right action always produces the best result and this is the only condition that an action can be justified as right. (Sinnott-Armstrong 2006). Relation of Consequentialism to the mentioned case study: Maria is sure to embrace a dreadful death. Her living is only to linger her pain on this mortal earth. Any sort of treatment or medicine is surely not the best possible alternative since they will only linger her suffering. At this circumstance euthanasia seems to be the most humane alternative and just act that she can resort to. Utilitarianism: John Stuart Mill was the founder of Utilitarianism doctrine of ethics. This doctrine evolved from the notion that prediction of consequences is possible. Action providing best possible consequence leading to greater benefit than the rest is regarded as just. Utilitarianism gives the liberty to predict possible outcomes and reference them regarding their priorities as a person decide about the best. (Mill, 1863) Relation of Consequentialism to the mentioned case study: Maria’s mother and family opined that euthanasia is the best way to relieve their daughter from the eventual pain and suffering that she will be facing without any chance of recovery. They have thought other alternatives like providing drugs to lessen her pain yet came up with this assisted suicide thing. Without any ambiguity they have thought of an action that will provide the best possible outcome for their daughter, hence their action is ethically just. However the law prevents them from accomplishing them so it is unjust according to utilitarian theory of justice. Conclusion: In a civilized world ethical consideration is regarded as the root to decision making. Bereft of ethics a socially just solution of any dilemma and conflict is impossible. However interpretation of ethics and principles even within the mentioned theories often leads to further confusion and that seems to be influencing legalizing euthanasia or providing permission to the mother and family of Maria to lead her to an assisted suicide. In the following part Euthanasia and Maria’s case has been dealt in terms of law. Legal prohibition of Euthanasia and case of Maria in the light of previous cases: The Suicide act 1961 legalizes suicide in UK. The act states that a person unwilling to continue his/her life has the right to put an end to it. The law also states that a person surviving the suicide should not be prosecuted under the UK law. However the same law more precisely The Suicide Act 1961 under Section 2(1) prohibits assisting in Suicide and refers to an imprisonment of 14 years for this crime. Again section 2 subpar 4 of the same act also states that assisted suicide would not be granted its due recognition unless it is supported by the Directors of Public Prosecution. The Suicide Act 1961 also distinguishes between the passive and active Euthanasia. Passive euthanasia is the act where the doctor withdraws the life support for the patient at the will of the patient himself (This is bit different from involuntary euthanasia where the patient does not have any acceptance or refusal of the forthcoming life-ending act. This happens when the patient is in a vegetative state for long without any chance or hope of recovery.). As an example, a patient in ventilation might refuse to linger his/her life anymore through that life support at the verge of no hope of recovery. Active euthanasia on the other hand is a single or collection of steps leading to patient’s death before time. This might be an overdose of painkillers or sleeping pills. The difference between these two types of euthanasia can be illustrated as “in active euthanasia, something is done to end the patients life; in passive euthanasia, something is not done that would have preserved the patients life.” (Types of Euthanasia, 2001) The Suicide act 1961 was amended in 1993 and in special circumstances passive euthanasia has been permitted under the UK law. Active euthanasia however remains legally prohibited in UK. Owing to this prohibition Maria cannot embrace death in a peaceful and painless manner even if a gruesome final outcome awaits her. Before Maria two cases in UK shook the legal foundation of euthanasia in UK. The first one belonged to Mrs. Dianne Pretty and the second one to Debbie Purdy. Like Maria Mrs. Pretty was diagnosed with motor neuron disease and was paralysed to that extent that she was not able to carry on even nominal day to day work by herself “Everybody, like yourself and myself, we can do everything for ourselves. We have the right to refuse whatever we wish to refuse. Diane has not…” (Wilson, 2001) She was afraid of the unavoidable end and was not willing to die in a manner when her breathing chocks within herself. To avoid that, she with her husband appealed to the court, to permit her to embrace death with the help of her husband “I want the court to know that I want the right to die at the time of my choosing, with dignity, now that I have lost all functions apart from my mind.” (Wilson, 2001) Ironically Mrs. Pretty who can’t even swallow a medicine by herself was permitted to die only by self-execution. Moreover it was clearly told to her by the honourable court that if her husband helps her in her quest for death, he would be prosecuted according to the law. Her appeal was turned down by the high court of England, the Director of Public Prosecution, House of Lords and even by the court of Strasbourg. (Dyer, 2002) Petty’s cause was strongly supported by Deborah Annets (The Director of Voluntary Euthanasia Society) and moreover by the common British people. A survey conducted that time showed that 90% of the British people wanted the law governing assisted suicide to be changed. However nothing positive happened in favour of euthanasia during the mortal life of Mrs. Pretty and she passed away on 11th of March 2002. At the time of her death according to her husband she was in pain and suffering from immense breathing problem. This again justifies the just claim of Mrs. Pretty to embrace a pre mature death with the help of her husband. The case is no different for Debie Purdy who shared the same consequences as Mrs. Pretty. Mrs. Purdy was suffering from a degenerative disease and decided to put an end to his life with the help of her husband. However she checked her action once she learned that in such case her husband would be reckoned as a criminal (The two subpara’s mentioned before under article 2). Since article 8 (section 7) of the human rights act 1998 goes in conflict with Suicide Act 1961, Debbie Purdy with her husband forwarded an appeal for a judicial review of the Suicide Act 1961 (the directions of the Suicide Act 1961 is considered to be undemocratic and inhumane in comparison with the Human Rights Act 1998) However appeal of Mrs. Purdy was turned down by Director of Public Prosecutions, the High Court of the country and the House of Lords. House of Lords moved one step forward to state that suicide is beyond the realm of Article 8 of the Human Rights Act and the Director of Public Prosecutors is vested with the power to determine the time and need of prosecution and thus beyond the consonance of the Article 8 subpar 2 of the Human Rights Act 1998 (Powell, 2009. p. 475) Similar to the above two cases Maria is courting the same fate and the law seems to be in similar darkness as it was. Her mother and family was not granted permission to assist her to get freed from this agony through assisted suicide (Euthanasia) and is only permitted to give her diamorphine through doctors who have strictly said a no regarding helping her to embrace a dignified death. At this circumstance they are planning to visit in countries where Euthanasia has legal validation to materialise their determination to provide Maria a dignified death like many other Britons are doing. Protocol needed for a more humane treatment for Patients like Maria: The first and foremost challenge to euthanasia is form religion itself. The United Kingdom is predominantly Christian and under Christianity suicide is a sin. To the Christians god is the creator of life and the sole authority to take it away. A human can never be god and thus resorting to suicide is a sin. Though this circumstance has changed since the introduction of The Suicide Act 1961, which conveyed that people saved trying suicide would be beyond the prosecution of UK law. Yet the act suffers from serious shortcomings. First of all since the law allows passive euthanasia under certain circumstances; patients like Maria could never get benefit of that. In motor neuron disease the body slowly moves into a paralytic state and the patient can not put an end to his/her life by own. They need active euthanasia since following all the principles and ethics discussed earlier this is the most just act or alternative available. Therefore active euthanasia needs to be legalized under UK law so that patient like Maria can die in a painless and peaceful way. It is well known that ideas are diverse and they often are mutually conflicting. This happens as no two persons are same and their ethical understandings governed by their principals are diverse and different as well. This only announces that a human condition might as well classify differently to different person. If we solely depend on the human subject to state or to make us understand his/her situation; we might step up into a slippery slope of social degradation. To avoid such state consent of a medical board together with the thoughts of the patient’s family and the patient might be used as the ultimate guide to euthanasia. It has often been observed that authority formed through institutionalisation often ends up in bureaucratic nexus. A chance of bribery of the authority vested with the power to grant the right of euthanasia cannot also be ignored. Especially if property or insurance related matters are connected with the person’s life seeking euthanasia. To avoid such social malice a board might be governed with intellectuals from different spheres and subject and should be put at the top of the euthanasia governing body. At present House of Lords is there but a non-political body will fare better in this regard. A hypothetical structure of the euthanasia approving body has been given below. The recommended structure of the euthanasia approving committee The state needs to understand what it is actually protecting through its law? Is it lingering the death instead of life without providing a green signal to active euthanasia? It is clear and historically proven that certain terminal disease has no hope to get any better. Often such disease makes the patient and his family and fellows hopelessly observe his/her downfall in a painful way. If there is no hope for a patient after all the medication he is going through, then this is useless and even economically non viable. Moreover the end moments for diseases like motor neuron disease are very painful and no medicine can lessen this pain. An active mind witnessing fast erosion of his/her body is something far beyond the best option one can avail. Mrs. Pretty and Mrs. Debie Purdy have experienced the same as their helpless husbands watched them to bid bye to their life. Maria’s case would not be any different if the law governing the active euthanasia is not changed and that change needs to come with immediate effect since she has only one more year to live. UK has to learn that how to coexist with a legal validity for active euthanasia from countries likes Sweden where euthanasia is legal. (Swiss group helped 22 Brits die, 2004) Moreover many people from UK who are suffering from terminal illness are travelling to these countries to embrace a dignified death. This is doing nothing but to incorporate inequality even in death in UK. People with money can avail that sort of an alternative where those bereft of it have to die in their motherland suffering every bit of pain that these terminal diseases have in store for them. Government should take active role in preventing this outflow for two reasons. Firstly people gong in other countries to die leaves their motherland with a bad memory and that often echoed in the words and feelings of their family members (Half of Britons would consider euthanasia abroad 2004). Secondly the law will create a just field for all those suffering from terminal illness in terms of embracing a painless and peaceful death. A public awareness should be built regarding euthanasia. A survey on a yes and no basis among the people of UK will also help to know the actual feelings of the UK population on euthanasia. Since it has already been noted before, that 90% people surveyed favoured Mrs. Dianne Pretty’s claim to death; hence this might also help in influencing the government to form a law legalizing euthanasia. Formation and implementation of a law falls short to generate proper outcome if proper awareness regarding that law is not promoted and spread. Once the law is formed doctors and common people alike should be made aware through media about every bit of nooks regarding this law. This is to ensure that they can resort to this law when needed. Considering all the above recommendations it can be said to form and implement all the above a proper political will is in its utmost need. Often politicians fall short of the just action in pressure of the power group or they try to maintain a mid way to keep their vote bank stable. Politics should not be mixed in life and death matters and the soon the politicians and the government realises it the better it is. Appendix: Maria is a young girl suffering from motor neuron disease. 5 years back the same disease got her father away from her and now it is her turn. Ironically in this disease a person’s mind remains almost unaffected yet her body parts paralyses one by one. Finally death comes through respiratory failure and to be more precise through chocking. Patients suffering from motor neuron disease die within 5 to 4 years of detection and Maria has only one year left. Considering the pain she is about to endure in her last days; her mother and family are strictly in favour of guiding her to a dignified death. However the doctors said that they could only offer diamorphine that will reduce her breathing problem but hasten her death. However they have strictly refused euthanasia since it is illegal. Courting this situation Maria’s mother and her family is thinking of going to some country where euthanasia is legal. References Griffiths, P. (1999) ‘Physician-Assisted Suicide and Voluntary Euthanasia: Is it Time the UK Law Caught Up?’ Nursing Ethics, Vol.6, no. 2, March, pp. 107-117. Available at: http://www.thehealthierlife.co.uk/natural-health-articles/brain-nervous/motor-neurone-disease-research-00247.html (accessed on March 12, 2011) Gillies. C.M. (2009) ‘Ethics in primary care: theory and practice’ InnoViT. vol 2 (3) pgs 183-190 Holloway, D. (2004) ‘Ethical Dilemmas in Community Learning Disability Nursing: What helps nurses resolve ethical dilemmas that result from choices made by people with learning disabilities’ Learning Disabilities Vol: 8 Melden, A.I. (2008), Ethical Theories, Koebel Press Sinnott-Armstrong, A ‘Consequentialism’ , Available at: http://plato.stanford.edu/entries/consequentialism/ (accessed on March 12, 2011) “Types of euthanasia”, (2001), pregnantpause.org. available at: http://www.pregnantpause.org/euth/types.htm (accessed on March 12, 2011) Wilson, J.(2001) ‘Terminally ill woman fights for right to death’. Guardian. Available at:, http://www.guardian.co.uk/society/2001/aug/21/health (accessed on March 12, 2011) Mill, J.S. (1863), Utilitarianism, Parker, Son & Bourn Dyer, C. (2002), ‘Pretty’s legal battle for dignity of death’, Guardian. Available at:, http://www.guardian.co.uk/society/2002/may/13/health.healthandwellbeing1 (accessed on March 12, 2011) Powell, D. (2009). ‘House of Lords’. 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