Editorial: A time to live, a time to die? An exploration of the arguments surrounding the legalisation of assisted suicide (original) (raw)
Related papers
2007
Background: Debates over legalisation of physician-assisted suicide (PAS) or euthanasia often warn of a ''slippery slope'', predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period. Methods: The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998-2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government-commissioned nationwide studies of end-of-life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. ''… no matter how carefully any guidelines are framed, assisted suicide and euthanasia will be practiced through the prism of social inequality and bias that characterizes the delivery of services in all segments of our society, including health care. The practices will pose the greatest risks to those who are poor, elderly, members of a minority group, or without access to good medical care.'' New York State Task Force on Life and the Law, 1994 1 ''… the State has an interest in protecting vulnerable groups-including the poor, the elderly, and disabled persons-from abuse, neglect, and mistakes. The Court of Appeals [Ninth Circuit] dismissed the State's concern that disadvantaged persons might be pressured into physician assisted suicide as ludicrous on its face.…We have recognized, however, the real risk of subtle coercion and undue influence in end of life situations …'' US Supreme Court, joint opinion in Washington v Glucksberg (1997) and Vacco v Quill (1997) 2 ''Euthanasia and assisted suicide are opposed by almost every national medical association and prohibited by the law codes of almost all countries. … If euthanasia or assisted suicide or both are permitted for competent, suffering, terminally ill patients, there may be legal challenges … to extend these practices to others who are not competent, suffering or terminally ill. Such extension is the ''slippery slope'' that many fear.'' Canadian Medical Association, 1998 3 ''Both society in general and the medical profession in particular have important duties to safeguard the value of human life. This duty applies especially to the most vulnerable members of society-the sick, the elderly, the poor, ethnic minorities, and other vulnerable persons. In the long run, such persons might come to be further discounted by society, or even to view themselves as unproductive and burdensome, and on that basis, ''appropriate'' candidates for assistance with suicide.'' ''… the ramifications [of legalization] are too disturbing for the … value our society places on life, especially on the lives of disabled, incompetent, and vulnerable persons.''
The Case Against Euthanasia and Assisted Suicide
2016
The arguments in favour of legalising voluntary euthanasia and doctor-assisted suicide initially appear convincing. We should, it is said, respect people’s autonomy, euthanasia is a compassionate response to unbearable suffering, it has (supposedly) worked well in those nations that have implemented it, and so on. But on closer analysis, the arguments are far less persuasive. Such a new law is unnecessary given the current legal ability of all but the most incapacitated to take their own life and the availability of palliative care. Any euthanasia law — even one carefully drafted with requisite safeguards — is susceptible to noncompliance and vulnerable to abuse. Moreover, any law would face the ineradicable reality of self-imposed pressure the vulnerable experience to “do the right thing”. This article sets out ten reasons why euthanasia should not be legalised and contends that the case for decriminalising it has not been made out by the proponents of it.
Euthanasia in the UK and the need for a legislative change.
The scope of this essay is to critically analyze whether it is ethically moral to refuse physician assistance in dying to people who suffer unbearably due to terminal illnesses ,and whether it should be recognized trough an English law reform. The present writer will try to address the ongoing debate towards the current law of physician assisted dying, taking into account arguments in favor of a legal change that will allow physician assisted dying and arguments against it. The ethical issues of the right to die , the sanctity of life , the quality of life will be considered. First of all, a definition of euthanasia is necessary .There are many definitions of euthanasia. According to the Oxford English Dictionary euthanasia is: the action of inducing a gentle and easy death. Used (especially) with reference to a proposal that the law should sanction the putting painlessly to death of those suffering from incurable and extremely painful diseases. While the House of Lords Select Committee on Medical Ethics's definition is emphasizing the actor's intention : " a deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering. " Peter Singer defines euthanasia as " the killing of those who are incurably ill and in great pain or distress , for the sake of those killed , and in order to spare them further suffering or distress. " 1 Euthanasia is either voluntary or involuntary. In voluntary euthanasia this action is carried out at the request of the person killed whereas in involuntary although the person killed is capable of consenting to his/her own death ,but fails to do so, either because he/she is not asked, or because he/she is asked and chooses to go on living. In other words, non-voluntary euthanasia occurs when the individual is incompetent to consent to or refuse euthanasia and has make no prior decision. Assisted suicide is included in the term euthanasia and can be any act which intentionally helps somebody to commit suicide, by providing the means to do so such as a prescription for lethal medication , the supply of such medication. Physician-assisted suicide (PAS) is defined as taking place when a doctor intentionally helps a person to commit suicide by providing drugs for self-administration , at that person's voluntary and competent request 2. Whereas , the word " assisted dying " which was first used in Lord Joffe's Assisted Dying for the Terminally Ill Bill (2004) describes both euthanasia and PAS. Particularly, the Bill referred to medical involvement in taking life(the prescription and possibly the administration of lethal doses of medication). The term " assisted dying " may seemed misleading as it was about deliberate acts to end life, not about assisting in the natural dying process .
Comparative reflections upon the Assisted Dying Bill 2013: A plea for a more European approach
Medical Law International, 2013
Comparative reflections upon the Assisted Dying Bill 2013: a plea for a more European approach 'It will generally be found that, as soon as the terrors of life reach the point at which they outweigh the terrors of death, a man will put an end to his life.' Arthur Schopenhauer 1 assisted dying 4 remains topical, not least due to the steady stream of cases considered by the courts where individuals have sought to challenge the absolute prohibition of assistance that currently applies. 5 The courts have long recognised the need for Parliament to consider endof-life decision-making, consistently noting that any repeal of the prohibition must be undertaken by the legislature rather than by judicial creativity. 6 Nevertheless, a number of courts and committees have concluded that legalisation should not occur, a recommendation based not only on a concern to uphold the sanctity of life, but also due to the perception thatit would simply not be possible to legalise assisted dying whilst incorporating sufficient safeguards within the legislation to protect the vulnerable. 7 The latest Bill to seek to legalise assisted dying in England and Wales is Lord Falconer's Assisted Dying Bill 2013, a Private Member's Bill designed to legalise physician assisted suicide (PAS) for the terminally ill. 8 This article assesses the validity of the argument that the inherent problems of legalisation are insurmountable by evaluating the safeguards incorporated into the Assisted Dying Bill 2013 and reflecting upon the experience of the statutory regulation of assisted dying in three other jurisdictions: the Netherlands and Belgium, representing the European model of regulation, and Oregon, illustrating the American approach to regulating assisted dying. 9 Part one of this 4 Assisted dying is used in varying contexts to refer to only PAS (as in the case of the Assisted Dying Bill 2013), or to encompass both PAS and AVE. Throughout this article reference to assisted dying should be taken to include either or both forms of assistance, unless otherwise indicated. As discussed below, the form taken by assistance is of little import see below at 000.
Euthanasia and the terminally ill: Can the civil killing of others be eroded?.
Crisis: The Journal of …, 1998
The present paper assesses attitudes towards the ending of life among a sample of 100 terminally ill hospice patients. Such a sample best provides an insight into the demand for euthanasia in this most extreme of circumstances. Of the completed interviews (64), 43 patients were fully aware of the implications of their condition; 35 expressed a definite opinion regarding euthanasia, 22 of whom favored the individual's right to choose the timing of death. Only 6 of these 22 were fully competent at the time of the interview and were not suffering from any depressive disorder. The implications of these results point to the need to consider the prevalence of depression, anxiety, and related disorders among those who seek an end to life. A failure to do so is likely to affect legislation worldwide and, in turn, civilization itself.
The Ethical and Legal Desirability of Physician Assisted Suicide and Active Voluntary Euthanasia
The question of whether a framework legalising physician assisted dying ought to be adopted in the UK engages conflicting ethical ideologies towards the value of life and the rights of individuals. Currently the law in the UK prohibits ‘mercy killing’, absolutely on the grounds of murder, irrespective of permission or good will . The law surrounding assisted suicide is however enshrined in Statute as a particular offence. The Suicide Act 1961 criminalises “an act capable of encouraging or assisting the suicide or attempted suicide of another person” . This law is unique in that it renders an accessory liable to conviction when the principal individual does not themselves commit a criminal offence . However, following a number of high profile cases involving individuals with debilitating illnesses who wished assistance in committing suicide and a growing public consensus on the desirability of pro-assistance legislation , Parliament is reviewing Lord Falconer’s ‘Assisted Dying Bill’ which aims to legalise the practice in limited circumstances. In this essay it will be asserted that the ethical desirability of legalising physician assisted suicide (PAS) and active voluntary suicide (AVE) rests upon the value of life and the ethics of suicide itself. Consequently, before any consideration of the ethics on legislation can be accurately made it must first be shown whether suicide itself can be ethically justified. This essay will address this issue by considering the conflicting ethical concepts of the inherent sanctity of life and theories on the importance of autonomy and self-determination. Upon concluding that it is indeed the latter aspects of human life that give it value, it will be argued that an ethical continuum exists that allows for the extrapolation of the ethical justifiability of suicide to PAS and AVE.
Assisted Dying Bill for England and Wales
This opinion paper is aimed to suggest an improved set of guidelines for physician-assisted suicide. Thus it is very practical, based on 25 years of research in eight countries and it does not expand on the underpinning theoretical basis for the guidelines. I have been an advocate of physician-assisted suicide and explained the reasoning elsewhere, primarily in The Right to Die with Dignity and Euthanasia in the Netherlands. I support the idea that patients should be able to decide the time of their death with the help and support of the medical profession. People have human dignity. At the end of their lives, the medical profession should respect their wishes and help them to the best of their abilities. By ‘dignity’ it is meant worthiness, merit. The Oxford English Dictionary defines it as “the state or quality of being worthy of honour or respect”. Kant explained that human beings are end in themselves and that for something to be an end in itself, “it doesn’t have mere relative value (a price) but has intrinsic value (i.e. dignity)”. He further elucidated that autonomy is the basis for the dignity of human nature and of every rational nature. Kant calls dignity an unconditional and incomparable worth that admits of no equivalent. All rational creatures have it, by virtue of their reason, and dignity constrains the ways in which we can legitimately interact. In a similar fashion, Dworkin asserted that individuals have a right to dignity because they are human. I argue that dignity is both objective and subjective concept. It is socially constructed and made up of values and feelings that one feels about oneself, about one’s self-worth and respect. It is further argued that legislation of physician-assisted suicide is a matter of moral necessity and political expediency.
Recent Developments in the Reform of English Law on Assisted Suicide
European Journal of Health Law, 2009
Assisted suicide remains a deeply contested issue in the UK. Recently three Assisted Dying for the Terminally Ill Bills were introduced in a three year period, all of which failed. Despite the provision of clear and precise safeguards, at each reading the House of Lords fixed largely on the traditional slippery slope and sanctity of life positions; a disproportionate reliance on theological determinism in particular prevented informed rational debate. People are living longer often with chronic, incurable diseases and palliative care is frequently of poor quality or even unavailable in the UK and it is unacceptable that individuals 'suffering unbearably' in their final days have no available domestic alternative. Yet the courts have consistently declined to prosecute in cases where friends and relatives have accompanied terminally ill persons abroad to die, against the provisions of the 1961 Suicide Act s2(1). This article critically assesses recent developments in English l...