Euthanasia is a word derived from the Greek meaning ‘gentle and easy death’ . The word, used in this wide sense, permits the assumption that everyone should be in favour of euthanasia: who could possibly advocate that anyone others should endure a long and painful death? However, the word is not consistently used in this sense and is often manipulated to support or oppose legalisation. Thus, there exists considerable debate surrounding the extent to which individuals should have control over their own death. This essay will consider the current legal position in regards to assisted suicide and euthanasia, alongside the various ethical arguments that underpin the debate around legislation. Further, it will be argued that the concept of autonomy should prevail as the primary ethical justification for the legalisation of assisted suicide and euthanasia whilst giving regard to the main critiques and concerns of the concept. It will be argued autonomy ‘is an important strand in the argument’ that demands legislation reform whereby voluntary and informed end-of-life decisions are permitted and legally executed.
“It has always been murder for a doctor [to] actively and intentionally hasten a patient’s death… however compassionate the motive… and whatever the… wishes of the patient .” Death in this way references assisted suicide and euthanasia, both are outlawed in the UK . Current legal positions favour “the significance of the sanctity of all human life. ” This was highlighted in Pretty where it was determined that article 2 imposes positive obligations onto the state to protect the lives of its citizens and that this is not an infringement of the claimant’s autonomy provided by article 8 . The courts consistently portray reluctance to recognise a right to die or be killed, subsequently undermining patient autonomy over end-of-life decisions. However the courts practice a very different approach regarding patient refusal of treatment. In Re B when the patient autonomously requested that the artificial ventilation keeping her alive be turned off, the courts held that doctor’s would be acting unlawfully if they did not adhere to her wishes, even if it lead to her death. Thus, it can be concluded, “the sanctity of life principle can be superseded by the need to respect autonomy. ” Moreover, competent patients can make an advanced directives refusing life-saving treatment, which must be respected . Where refusing treatment effects if the patient lives or dies, it could be convincingly argued that he enjoys a right to die. Therefore, there appear inconsistencies within the current law, whereby legislation on the right to life and the right to refuse treatment, conflict. Thus, the reluctance to legalise euthanasia seems illogical and requires clarification through reform. McLean argues ‘the competent refusal of treatment, and active assistance in dying are essentially facets of the same… plane’ , and ‘if autonomy is of such importance [in withholding treatment]… it might reasonably be expected that it would carry the same weight in all situations where people choose death’ . Alas, the courts continue to criminalise euthanasia and have determined the process of withdrawing treatment to be an omission and therefore, different to euthanasia. This explanation is unsatisfactory as a justification to the continued criminalisation of euthanasia and assisted suicide.
At the heart of the ethical debate surrounding the legalisation of assisted suicide and euthanasia is the autonomy principle. It argues that people should be permitted to live their lives as they wish and should be able to choose how they die. Dworkin has written: ‘Making someone die in a way that others approve, but he believes a horrifying contradiction of his life, is a devastating, odious form of tyranny. ’ Further, each person may have different views on what constitutes a good death – some may wish to prolong their life as far as possible whereas others may wish to die peacefully before life becomes undignified or painful. Therefore it seems reasonable to suggest that each person should be free to choose the way in which to die and if their preferred means of death requires the assistance of another, then they should be free to assist without the fear of criminal prosecution. Thus advocating the legalisation of assisted suicide and euthanasia to provide individuals with a wider range of options to choose between. Opposition in this area often focuses on the courts interpretation of article 2. Article 2 provides the right to life and thus far has no interpretable right to die attached to it. It remains a primary obstacle in the legalisation of euthanasia and assisted suicide, allowing life to undermine autonomous end-of-life decisions. However, it is sometimes argued that those who oppose autonomous end-of-life decisions do so in an attempt to impose their religious, ethical or personal beliefs onto others . Comparably, the right to life is founded upon the religious belief of the ‘sanctity of life’. Autonomy requires an absence of influence or coercion. Therefore, the principle of autonomy would argue that end-of-life decisions be legally available, free and voluntary for all.
Keown opposes legalisation of end-of-life decisions by arguing that decisions can never be truly autonomous because the capacity of the patient may be adversely affected by their condition . He therefore suggests incompatibility between autonomy and legalised end-of-life decisions. However, the established right to autonomously refuse medical treatment and request withdrawal of treatment undermines Keown’s argument . Thus, it cannot be convincingly argued that patient capacity is capable of weakening the argument in favour of legalising autonomous requests for euthanasia and assisted suicide.
“Opponents to euthanasia also appeal to autonomy: they worry that if euthanasia were legal people would be killed who really wanted to stay alive .” In Pretty the courts revealed concerns surrounding vulnerable patients that could develop in a legal system that permits assisted dying. It is feared that the legalisation of euthanasia could lead to “internal and external pressure to end one’s life ” by medical professionals and friends and family. The Netherlands is highlighted as a paradigm of this concern where “the elderly are beginning to look upon doctors as their enemies ”. Concerns regarding doctorial pressure upon patients to consider euthanasia must be resolved before legalisation can occur. The current law permits doctors to administer lethal quantities of drugs providing the primary intention is to relieve pain . It appears therefore, that under the present law doctors are permitted to kill patients and this has no known effect on autonomous requests for withdrawal of treatment. Thus, the argument that legalisation of autonomous requests for euthanasia could give rise to issues surrounding genuine consent is weak and incapable of undermining the argument favouring legalisation.
In conclusion, the principle of autonomy provides strong arguments in favour of the legalisation of euthanasia and assisted suicide, while critiques of this argument have been proven to be weak. Despite consistent refusal of the courts to recognise a right to be killed, they have upheld autonomy in relation to requests for withdrawal of treatment therefore demonstrating their willingness to supersede the currently upheld principle of the sanctity of life. Thus, it is argued that “legislation do no more than ensuring a means of obtaining unequivocal evidence of a free and informed choice to end-of-life decisions” and provide the “appropriate and humane mechanisms” to give effect to end-of-life decisions.