Medical Ethics: the End of Life

Overview

Recall questions on the forms of euthanasia, acts and omissions, double effect, British legal cases, palliative care, religious and secular arguments on assisted dying, personhood, and the views of Singer, Glover and Wilcockson.

What you need to know

Answer each one before you reveal it.

Questions from this subtopic

Each one with the model answer underneath.

1. 1

   Distinguish the main forms of euthanasia.

   Model answer

   Voluntary euthanasia is carried out at the competent patient's request; non-voluntary where the patient cannot express a wish, as with a patient in a persistent vegetative state or a severely impaired newborn; involuntary against the patient's wishes, which almost everyone classes as murder. Active euthanasia involves an act that causes death, passive the withholding or withdrawing of treatment. Assisted dying or assisted suicide differs again, since the patient performs the final act themselves with help supplied by another.

2. 2

   Is the distinction between acts and omissions morally significant?

   Model answer

   Traditional medical ethics says yes: withdrawing a treatment that is futile or burdensome allows the disease to kill, while an injection makes the doctor the cause of death. Critics, including Glover and Singer, reply that where the intention and the outcome are identical the distinction is a fiction that produces a slower and more distressing death. Defenders answer that intention and causation are not fictions, and that abandoning the line would change the role of the doctor irreversibly.

3. 3

   How does double effect work in end-of-life care?

   Model answer

   A doctor may give the dose of an opioid needed to control severe pain even though it foreseeably shortens life, because the intention is pain relief rather than death and the shortening is not the means of relief. This has long allowed Catholic and other religious ethicists to accept aggressive symptom control while rejecting euthanasia. Palliative specialists add that in practice properly titrated pain relief rarely shortens life at all.

4. 4

   Which British legal cases matter here?

   Model answer

   In 1993 the House of Lords permitted the withdrawal of feeding from Tony Bland after Hillsborough, on the grounds that continued treatment was not in his interests. Diane Pretty failed at the European Court of Human Rights in 2002 to secure immunity for her husband if he helped her die. Debbie Purdy won a ruling in 2009 requiring the Director of Public Prosecutions to clarify when prosecution would follow, producing the 2010 guidance. Tony Nicklinson's case was rejected in 2014 with the Supreme Court indicating that the question was for Parliament, and Noel Conway's challenge failed in 2018.

5. 5

   What is the legal position, in Britain and elsewhere?

   Model answer

   In England and Wales assisting a suicide remains an offence under the Suicide Act 1961, though prosecution follows published guidance and compassionate assistance is often not pursued, while euthanasia is murder. Elsewhere, Oregon legalised physician-assisted dying in 1997, the Netherlands and Belgium legalised euthanasia in 2002, Switzerland permits assistance without a selfish motive, and Canada introduced medical assistance in dying in 2016. Parliament has repeatedly debated assisted dying bills without changing the law.

6. 6

   What is palliative care, and how does it change the argument?

   Model answer

   Care aimed at controlling symptoms and supporting the patient and family rather than at cure, developed by Cicely Saunders, who founded St Christopher's Hospice in 1967 and introduced the idea of total pain, encompassing physical, psychological, social and spiritual suffering. Opponents of assisted dying argue it shows the demand rests on fear of a bad death that good care can prevent, so the answer is better hospices rather than a change in the law. Supporters reply that palliative care cannot relieve every case and does not address a patient whose objection is to loss of independence rather than to pain.

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