Euthanasia is defined as ‘the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma (1). It is the act of deliberately ending a person's life to relieve suffering. The word originates from the Greek language translating to ‘good death’. It involves an administration of drugs to gently shut down the body so that the patient dies. Due to both ethical and cultural reasons, euthanasia is illegal in many countries, including the UK. Although in places such as the Netherlands, Belgium and Canada the concept is legalized. Taking into account the regular attempts to change the current law, public opinion and the significant differences between the UK and other jurisdictions, it would be appropriate to consider again if the law should be reformed, which is what I shall be discussing.
Euthanasia itself can be split into four classifications, voluntary and non-voluntary euthanasia, and active and passive euthanasia. Voluntary involves a patient making a conscious decision to die and asks for help to do so as opposed to non-voluntary is where a person is unable to give their consent to treatment (for example because they are in a coma) and another person takes the decision on the patient’s behalf. Active euthanasia is sometimes used to refer to deliberately intervening in order to end someone’s life, such as injecting the patient with a large dose of sedatives. Passive euthanasia is referred to as causing someone’s death by withholding or withdrawing treatment which is necessary to maintain life(2). Assisted suicide is a topic closely related to Euthanasia, however in law they are treated as two completely different things. In assisted suicide a doctor will provide a patient with the means to end his own life, but the doctor will not administer it. For example, a doctor giving you an injection of morphine sufficient to cause your death, is considered to be euthanasia. However, if the doctor puts the hypodermic needle beside your bed, explains to you what it is and what it will do, leaves, and you later inject yourself, it is considered assisted suicide.
Arguments about euthanasia often hinge on ‘right to life’ and the ‘right to die’. The first is a widely accepted basic human right and moral value, based on the fact that people generally do wish to continue with life. But what should we do when seriously ill people no longer want to live? Do they have a right to die? Sufferers sometimes wish to commit suicide but do not have the physical strength or the means to do it painlessly. Like many problems of medical ethics, this has become more pressing recently. Centuries ago, most people died quite quickly and painfully when they had a serious injury or illness. Nowadays they can be treated, sometimes cured, and often kept alive almost indefinitely. Humanists believe that in a lot of circumstances, voluntary euthanasia is the morally right course of action to take. Many religious people, however, think that euthanasia is always morally wrong, regardless of whether the suffering person really wants to die.
UK’s current law:
In law, euthanasia has no special legal position in the UK. Instances described as euthanasia are treated as murder or manslaughter, depending on the circumstances and the maximum penalty is life imprisonment. This means that the concept of Euthanasia is completely illegal in the UK, and although it is often in debate, the law still remains. Between 2003 and 2006 ‘Lorde Joffe’ produced four attempts to introduce bills that would have legalized voluntary euthanasia, which were all were rejected by the UK Parliament. Currently, Dr Nigel Cox is the only British doctor to have been convicted of attempted euthanasia, he was presented a 12-month suspended sentence in 1992.(3) In regard to the principle of double effect(the good and bad effect of an action) , in 1957 Dr John Bodkin Adams was on trial, and it was ruled by Judge Devlin, that causing death through the administration of lethal drugs to a patient, if the intention is solely to alleviate pain, is not considered murder, even if death is a potential or even likely outcome. (4)
Current laws in other European countries:
The Netherlands, Belgium and Luxembourg are the three countries in Europe which allow the process to be legal. They allow their citizens to be presented with the opportunity to end their own life. The remaining European countries do not allow the concept of euthanasia. The Netherlands became the first country in the world that made it possible for doctors to assist people with dying. Both euthanasia and assisted suicide were allowed. Criteria was set which patients must fulfil in order to be considered for euthanasia. The candidate must be "suffering unbearably" with no hope of relief, however their condition does not have to be fatal(5). Belgium legalized euthanasia in 2008, and the new regulations allow a doctor to end a patient’s life if the patient requests it, has full mental capacity and has constant, unbearable, physical or mental suffering (6). Recipients do not necessarily need to have a deadly illness, but their illness must be incurable (senior author Kenneth Chambaere of the University of Brussels). A survey published in 2010 reported that those who died from euthanasia were more often younger, male cancer patients and normally die in their homes, peacefully. In almost all cases, the patient was suffering unbearable torment. There have been about 1,400 cases a year since the law was introduced, and a record 1,807 cases were recorded in 2013 (7). Belgium has now extended their euthanasia laws so that terminally ill minors can now qualify to be euthanized providing they fulfil the following criteria: "the patient must be conscious of their decision and understand the meaning of euthanasia", "the request must have been approved by the child's parents and medical team", "their illness must be terminal" and "they must be in great pain, with no available treatment to alleviate their distress"(8). Luxembourg became the third European country to allow both euthanasia and assisted suicide, after a bill was passed in March 2009. According to the bill, euthanasia was regulated by a “living will or advance directive”. Doctors will also be required to consult with an associate to guarantee that the patient has a terminal illness and is in a "grave and incurable condition" before euthanizing them(9). The extent of Belgium’s approach to euthanasia is at a significant variance compared to those of the UK, and the fact that two similar societies can treat dying patients so differently is a good reason to explore the argument further.
Arguments for euthanasia:
When people reach a position where they lose the ability to enjoy life, because they are so ill, they should have an option to take an alternative path. Instead, in the UK they are forced to deteriorate away into a person they will no longer recognize. Euthanasia will offer a much more peaceful and more dignified way to end one’s life. Legalisation can also put the family of the patient in a much more stable condition as they will no longer have to watch their loved one suffer in extreme torment. Life can be extremely difficult living with a terminal illness, and in many cases, death may be the better answer. If a terminally ill person wants to avoid excruciating pain and wants to end their life in a dignified manner, it is implied in the concept of liberty that we should allow it. End of life care can be incredibly expensive due to the increased need for specialists’ attention and for treatment. Those with terminal illnesses have even more expensive health care needs, and although their continued existence may be extremely meaningful to the those who love them, from an economic perspective their medication can be extremely costly. We are promised rights in the UK, but why don’t we have the rights to legally end our suffering and pain if that life is no longer wanted to be lived? 55% of people die in pain, is it their prerogative to die peacefully and with dignity? The total percentage of medical practitioners that support Euthanasia is 54% (10), and according to my survey, 68% of the people I asked support the notion. The largest ever poll took place on the 4th March 2015. The results showed that 82% of the public supported Lord Falconer’s proposed change in the law, it also clarified that 44% of the public would break the current law and help a loved one to die, even though the sentence for this crime is 14 years in prison, clearly showing that the general public are in favor of the law being reformed (11). People who are dying are not suicidal, they do not want to die but they do not have the choice to live. The legalisation of euthanasia can also put the terminally ill individual’s family in a more stable financial and emotional situation. And, more importantly, the choice of euthanasia is a personal one and no one should forget that it is not our own life we are talking about, but it’s the life of someone who is unquestionably sick. Euthanasia, in its many forms, is an inherent right that should not be infringed upon, though it is not being legalized in our country. Euthanasia involves choosing a dignified death, rather than one already set for the individual. When palliative care is no longer an option and treatment has failed time and time again, the option to choose "the good death" should remain open at all times. The act itself should always be a personal choice, based on the amount of suffering one will allow oneself to go through before they must give in. Euthanasia will always be in existence, now it is merely a choice of making it "acceptable" or "unacceptable" as far as the government is concerned. When death is inevitable, suffering should not be. Along with appropriate care, dying people deserve the choice to control the timing and manner of their death.
Arguments against euthanasia:
However, laws are in place for a reason and they aim to make society a better place, and legalizing euthanasia would be a dangerous precedent to set. Death and dying are not comfortable topics for discussion. They raise uneasy questions and anxieties, reminding us of our own frailty and vulnerability and opening up fears about the impending loss of our loved ones. The subject is a highly controversial and diverse topic, raising an array of sophisticated moral, ethical, social, philosophical, legal and religious concerns. Medical research has been ongoing for many years and there have been large quantities of money invested into medicine and treatments for ill people. It is believed that voluntary euthanasia is unnecessary because alternative treatments exist, and the concept of euthanasia itself undermines medical research. Not only this, but there are many religious and ethical reasons which deny the concept of euthanasia, as conflicts the word and the will of god. Buddhists, Catholics and Muslims all oppose euthanasia. Catholics believe that euthanasia is “a crime against god and a crime against life” whilst Muslims insist that life is “sacred” and that the life cycle must not be purposely ended. While legalising euthanasia may seem like a positive change for society, it would defy many religious beliefs and would disrespect their wishes. There are many ethical reasons as to why the law should not be reformed in the UK, raising a number of agonizing moral dilemmas. It raised many questions including the following- Is it ever going to be right to end a life? Under what circumstances can euthanasia be justifiable? Is there a moral difference between killing someone and letting them die? Voluntary euthanasia is the start of a ripple effect that leads to involuntary euthanasia and the killing of people who are thought undesirable. The line is very fine in some cases between euthanasia and murder, and by legalizing euthanasia murders may be passed off as euthanasia which can contradict the current laws on murder/man slaughter and would cause much dilemma to government institutions. The questioning of whether it is acceptable to end ones life carries much controversy. Euthanasia also exposes vulnerable people adding pressure to end their lives, including moral pressure on elderly relatives by selfish families and moral pressure to free up medical resources. As applied to the euthanasia debate, the slippery slope argument claims that the acceptance of certain practices, such as physician-assisted suicide or voluntary euthanasia, will invariably lead to the acceptance or practice of concepts which are deemed unacceptable, such as non-voluntary or involuntary euthanasia. A recent poll states that 70% of disabled people would be concerned if the law on assisted suicide were to change because they would feel it would lead to pressure being placed on disabled people to end their lives(12)Thus, it is argued, in order to prevent these unwelcome practices from occurring, we need to resist taking the first step, which is legalizing the lethal injection in the first place.
Recent attempts to reform the law:
Navigating the waters of the controversial subject can be hard, but many people believe it should ultimately be your personal decision to terminate your life. There have been various attempts to introduce legislation to change the legal situation regarding assisted suicide in the United Kingdom. In 1931 Dr C. Killick Millard, the President of the ‘Society Of Medical Officers Of Health’ proposed a Voluntary Euthanasia Bill for incurable patients (13). In England, the first attempt to reform the law was in 1936 by Lord Author Ponsonby and supported by the Euthanasia Society. In 1969, a Bill was introduced into the House of Lords by Lord Raglan. In 1970, the House of Commons debated the issue. Baroness Wootton introduced a Bill to the Lords in 1976 on the matter of "passive euthanasia". Between 2003 and 2006 Lord Joffe made four attempts to introduce bills that would have legalized assisted suicide and voluntary euthanasia. All were discussed and then rejected by Parliament. (14) A Bill to legalize assisted suicide was soundly defeated in the House of Commons in 2015 by 330 votes to 118. The proposal requested that people with fewer than six months to live could be prescribed a lethal dose of drugs, which they would consume themselves. Two doctors and a High Court judge would need to approve each case. Dr Peter Saunders, campaign director of Care Not Killing, welcomed the rejection of the legalization, stating that the current law existed to protect those who were sick, elderly depressed or disabled. He claimed that the current law “protects those that have no voice against exploitation and coercion, it acts as a powerful deterrent to would-be abusers and does not need changing”. However other members of the House of Commons including Sarah Wootton (chief executive of Dignity in Dying) claimed it was an “outrage” that MPs had gone against the views of the public majority of the public who supported the bill. She added that “dying people deserve better”. Conservative MP Caroline Spelman added that "the right to die can so easily become the duty to die" and she claimed the law already provided protection for the elderly and disabled. She was one of many MPs to argue that it was difficult to determine whether someone had six months or under to live. She also warned: "[The bill] changes the relationship between the doctor and their patient, it would not just legitimise suicide, but promote the participation of others in it."(15) The bill fell through due to the majority of MPs voting against it.
Recent cases:
In a country full of suffering, euthanasia could make the ‘fear of dying’ more acceptable. There have been many cases in the UK where terminally ill people have attempted to have their plea for euthanasia approved by the high court, all of which have failed. A case that caused great public sympathy was that of Daniel James, an up and coming young rugby player for the England youth squad. At just 22 years old, in 2007, James suffered from a spinal cord injury whilst playing rugby and was paralyzed from the chest downwards. After being denied euthanasia in the UK, Daniel made an attempt on his own life by swallowing an overdose while in care at Stoke Mandeville Hospital in October 2007, seven months after his injury. Six weeks later he was discharged and sent home, where he took a second overdose in January 2008. On that occasion, he was admitted to hospital, where a psychiatrist noted that he was ‘very angry and extremely hopeless’. He was also despondent that he had once again failed in his suicide bid. He refused any form of medical treatment and he still persisted that he wanted to die, and if he did not do so from his physical injuries, he would continue to attempt to end his life himself. In March 2008 Daniel applied to go to Dignitas, telling his mother that if he was to be rejected, he intended to move out of the family home into assisted accommodation and starve himself.(16) In September 2008, accompanied by his parents, he travelled to Dignitas where he took a lethal dose of barbiturates (a drug that acts as a central nervous system depressant).
Tony Nicklinson is another recent case of an individual being denied euthanasia. Tony suffered from a stroke which left him paralyzed from the neck down. The nature of the stroke led to ‘locked-in syndrome’, a rare condition in which conscious awareness and intelligence are unaffected, but the patient is almost totally paralyzed. He was only able to communicate through blinking and moving his head. Nicklinson, who lived an extremely active life prior to his stroke, playing sport and travelling around the world, found it unbearable to have to be washed, dressed and fed by carers, and moved from bed to wheelchair by means of a sling. He described his life as “dull, miserable, demeaning, undignified and intolerable” Tony pleaded to be euthanized, and he took his case to the Ministry of Justice, arguing that when he decided he wanted to die, the doctors who killed him should be immune from prosecution. He stated that he wanted to establish the right to die with dignity at a time of his chosing. After protracted legal argument, the case failed. The judges described Tony’s plight as ‘deeply moving’, demanding the most careful and sympathetic consideration. However, it was not for the High Court to decide weather the law about assisted dying should be changed and, if so, what safeguards should be put in place. ‘Under out system of government these are matters for Parliamentary scrutiny and not for the court on the facts of an individual case or cases. ‘Following the verdict, Nicklinson described himself as ‘devastated’. He started refusing food and deteriorated rapidly, dying from starving himself just six days after the court judgement(17) My third case involves a campaign group calling for a change to UK euthanasia laws after a Devon man tragically took his own life. Michael Parkins was just 40 years old when he jumped to his death in a Toys R Us car park, in front of crowds of shoppers, in May 2017. Michael was suffering from terminal heart failure and had been told he might only have weeks to live. He was living in extreme pain and torment, with much of his time spent on hospital beds. Prior to his death, Mr Parkins had researched euthanasia and wanted to travel to Switzerland to end his life. He had pleaded to be referred to the Dignitas assisted suicide clinic, but doctors in the UK are prevented from doing so by law. Instead of declining into a person he would no longer recognize, Micheal took matters into his own hands and committed suicide. Now, Campaign group ‘Dignity in Dying’ has called UK laws a “disgrace”, adding that this country is “lagging behind”. They propose for a new compassionate law to be made, which would allow assisted dying as a choice for terminally ill citizens (18).
There have been a number of cases in with euthanasia has been used in an undignified manner which has caused a large uproars and riots from anti-euthanasia protestors. One case in particular which arose to the public, involved a disturbing case of a 29-year-old woman who travelled to the Netherlands to be euthanized due to her depression. Aurelia Brouwers was killed by a lethal injection in January 2018, and her case has led to politicians speaking out about changing the law in the UK. Aurelia argued that she was “entitled to a dignified death” because of her “rotten life”, but it was later revealed that she suffered from depression and a borderline personality disorder (19). UK politicians were shocked by this case and claimed that “this is a case which illustrates the grave dangers presented by euthanasia and assisted dying”, and they stated that in situations such as these “treatment is needed not termination”. MP Fiona Bruce described it as “tragic” and stated that “the tragedy of her situation shows why it would be so dangerous for us in this country to heed the voices – few but shrill – of those calling for euthanasia to be legalized here” (20). It is cases like this where the dangers of legalizing euthanasia are crystalized, where healthy lives are taken when treatment could have been the superior response.
Technological advances:
Technological advances have seen a new invention which could revolutionize euthanasia and many of the complications involved with it. Dr Philip Nitschke has been named “the Elon Musk of assisted suicide” and his most recent creation has caught the attention of both advocates and adversaries. Named “Sarco”, it essentially allows a patient, who must meet certain qualifications, to self-administer liquid nitrogen to lower the oxygen level within the capsule and effectively take their own life. The invention of such a device raises the awareness of those who feel that assisted suicide is ethically and morally wrong however many support the general idea of the device. The principle of the machine involves the user having full control over their own morality(21). There are a variety of precautions in place in order to prevent misuse of the revolutionary pod, including an online pre-test that screens potential candidates to ensure they are of sound mind. During an interview Nitschke explained his own views of assisted suicide and mental illness: “I reject that idea. Someone’s death wish isn’t something that needs to be treated.” Every potential user of the ‘Sarco’ must be above the age of 50. An age restriction was set to satisfy some countries such as the US (a country that remains very far behind other countries in respect to their views on euthanasia and assisted suicide). A four-digit code would be given to the user of each individual Sarco, which is only given once the online mental test has been passed by the candidate. When the candidate enters their four-digit pin, the machine will unlock and be ready for use. The pin itself would only remain active for 24 hours, it’s also significant to note that the device can only be activated from the inside, preventing ‘any kind of foul-play from occurring’. Once activated, the oxygen level inside the pod drops as the machine fills with liquid nitrogen and shortly renders the user unconscious. “In about five minutes, the painless process is complete and the pod, which has a two-part design, can then double as a coffin.”A huge advantage of using this device as a means of euthanasia is that ‘Sarco’ removes a doctor acting as a gatekeeper to this world, meaning that there can be no murder or assisted suicide charges as technically the patient received no human help. By taking a doctor out of the equation, the user of ‘Sarco’ has complete control over their life. The device doesn’t use any needles or illegal drugs, ironically making the process of euthanasia “safe.” Dr Nitschke, the euthanasia enthusiast claims that ‘Sarco’ could “offer a peaceful and even elegant death”(22).
Conclusion:
The main risk of legalizing euthanasia is how the line between murder and euthanasia would lie unclear, and because of this, parliament and the high court are not in favor of the law being reformed as they believe it may cause ‘confusions’. However, there have now been six countries across the globe, and three in the EU that have legalised the lethal dosage of drugs, and in each case, the benefits of having it legalized have outweighed any negatives. Generally, the UK is quite a forward thinking and futuristic country, however, any discussion of a topic such as euthanasia is quickly shut down and disregarded, showing how the country is falling behind on modern day laws. One thing is certain – the intense pressure on the courts and politicians is not going away due to campaigners planning to regroup and point to their own polls showing 82% of the public back assisted dying and calls for change may yet intensify with an ageing population(23). We owe it to people who experience permanent and irreversible suffering, and to those who justifiably worry that this lies ahead of them, to do all we can to alleviate their distress. We generally live in a society where people fear about death, so why not make the concept more acceptable? Although religious beliefs can contribute heavily to one’s view of the topic, there are also ethical questions that need to be asked, including if it is fair to force a patient to live on in unbearable torment? The research and data I have gathered has allowed me to come to my own jurisdiction of the topic. I believe that legalizing euthanasia in the UK will have numerous benefits, not only to a society, but to individuals too, and that the UK in fact, is greatly out of step and massively ‘behind times’ with its current law. The UK government’s repeated unwillingness to review the law is unacceptable, especially in light of regular reports of people taking their own life at home or travelling to end their life. It’s time for the UK to legalize some form of euthanasia or assisted suicide. The experience and legal rules in the other European countries should form the basis for the discussion on the reform. Now would be the perfect time to give people who are suffering the fundamental human right to control life and how to end it.