ASSISTED DYING
Some medico-scientific and
ethical aspects
John Bryant
Plymouth CiS, Feb 2013
WHEN MAY I DIE AND
WHEN AM I DEAD?
•Ethical frameworks
•Medical ethics
•Science, Medicine and Demographics
•Issues and Implications
A THOUGHT WITH WHICH
TO BEGIN
• There are two ways to live your life.
One is as though nothing is a miracle.
The other is as though everything is a
miracle.
Albert Einstein
ETHICAL FRAMEWORKS
• Deontology (Duty-based; Kantian Ethics)
• Consequentialism (Results-based)
• Virtue (Character-based -Aristotle,
Aquinas)
• [Natural Law – Aristotle, Aquinas]
• Communitarian Aspects
– Michael Sandel, Stanley Hauerwas
David Sharp
Died, May 2006
300m below summit
Thanks to Dr Donal
O’Mathuna for this example
MEDICAL ETHICS
 Beneficence, Do good
 Non-malificence Don’t do harm
 Justice Treat people fairly
 Autonomy Respect individual rights
Beauchamp & Childress, Principles of Biomedical
Ethics
 What type of ethical system is
this?
 What about wisdom and
compassion?
THE STATE OF PLAY
• Life expectancy
• Medical progress
• Defining death
• Difficult dying
LIFE EXPECTANCY
• Life-spans are increasing each day by
an average of two hours.
• Great Britain, averages
• 1930, Men – 60
• 1970, Men – 68, Women - 71
• 2012, Men – 79, Women – 83
• But note huge differences, even
within one city, eg Glasgow
Country
Monaco
Singapore
Switzerland
Denmark
USA
Sri Lanka
Jamaica
India
Kenya
Botswana
Zambia
Swaziland
Republic of South
Africa
Average life
expectancy, years
89.7
83.8
81.2
78.8
78.5
75.9
73.4
67.1
63.1
55.7
52.6
49.4
49.4
Note:
In Africa,
averages are
lowered by
childhood
deaths and
by
HIV/AIDS
Data from
CIA World
Fact Book
THE DOWNSIDE
• Frequencies of dementia in the UK,
2012
• Age 40–64 1 in 1400
• Age 65-69 1 in 100
• Age 70-79 1 in 25
• Over 80
1 in 6
HEART
LUNGS
BRAIN
It used to be easy: when the heart had stopped
beating and breathing had ceased, the person had died.
Since 1976 in the UK, cessation of brain stem function has
also been taken as an indication of death. However, with
our increased understanding of the relationship between
heart, lung and brain function and our technological ability
to provide replacements for at least some of those
functions, defining death has become more difficult and
this has led in turn to cases in which deciding about
continuing or stopping treatment is very problematic.
Dúirt mé leat go raibh mé breoite
Spike Milligan
THE ISSUES
•
•
•
•
Voluntary euthanasia
Involuntary euthanasia
Assisted suicide
Withdrawing or withholding
treatment
IMPORTANT QUESTIONS
• Can euthanasia ever be justified?
• Can killing ever be caring?
• When should medical treatment be withdrawn or
withheld?
• Is there a difference between killing a person
and letting them die?
• Is there a moral difference between euthanasia
and assisted suicide?
IMPORTANT QUESTIONS
• Why shouldn’t I decide when I want
to die?
• Isn’t it my right to make decisions
about my own life?
IMPORTANT QUESTIONS
• What about the doctor’s part in all
this?
• How does euthanasia / assisted
suicide relate to the commandment
‘You shall not kill’?
• Is there a ‘Christian view’?
LEGAL EUTHANASIA
• Belgium
• Netherlands
• Luxembourg
• In Belgium and Netherlands,
teenagers as young as 13-years old
may opt for euthanasia
OTHER LEGAL ASPECTS
• Assisted suicide is legal in
Switzerland, and in three US states
• But withdrawing or with-holding
treatment, where further treatment
is deemed ‘futile’, is legal in most
countries. Some call this ‘passive
euthanasia.’
MEDICAL ETHICS
 Beneficence, Do good
 Non-malificence Don’t do harm
 Justice Treat people fairly
 Autonomy Respect individual rights
 What about wisdom and
compassion?
HOW DO WE APPLY
MEDICAL ETHICS?
• Compassion – ‘condemned to life’ (does
beneficence exclude ‘mercy killing’?)
• Autonomy – it’s my life
• Openness – it happens anyway
• But ...
• Is ending someone’s life the only way
to show compassion?
• Does my exercise of autonomy affect
other people?
A SLIPPERY SLOPE?
What ‘form’ might a slippery slope take in this
instance?
Chapter 7 is entitled
Medical Technology: from
Gamete to Grave
Coming out in March
Publisher: Lion
A bargain at £9.99!