Moving from voluntary euthanasia to non-voluntary euthanasia: equality and compassion

Abstract.  The recent Dutch law legalising active voluntary euthanasia will reignite the euthanasia debate. An illuminating method for evaluating the moral status of a practice is to follow the implications of the practice to its logical conclusion. The argument for compassion is one of the central arguments in favour of voluntary active euthanasia. This argument applies perhaps even more forcefully in relation to incompetent patients. If active voluntary euthanasia is legalised, arguments based on compassion and equality will be directed towards legalising active non-voluntary euthanasia in order to make accelerated termination of death available also to the incompetent. The removal of discrimination against the incompetent has the potential to become as potent a catch-cry as the right to die. However, the legalisation of non-voluntary euthanasia is undesirable. A review of the relevant authorities reveals that there is no coherent and workable "best interests" test which can be invoked to decide whether an incompetent patient is better off dead. This provides a strong reason for not stepping onto the slippery path of permitting active voluntary euthanasia.     

Setting euthanasia on the level

Summary The House of Lords recently set up a Select Committee on Medical Ethics to consider euthanasia and related medical decisions at the end of life. This followed widespread publicity surrounding recent cases, particular the trial and conviction of a doctor for the attempted murder of a consenting terminally ill patient, and the House of Lords' ruling that it is not unlawful to withdraw life-sustaining treatment from a patient in a persistent vegetative state. This paper suggests a perspective on some of the moral issues and conflicts which the House of Lords will no doubt consider. A legal structure in which medical euthanasia could be both permitted and controlled is then proposed involving two complementary mechanisms, a formal Euthanasia Notification procedure and a system of Euthanasia Tribunals.Senior Registrar in the Psychiatry of Old Age to the United Medical and Dental Schools and the South East Thames Regional Health Authority.     

The permanently unconscious patient, non-feeding and euthanasia

Some sources condemn judicial decisions which authorize the withdrawal of artificial nutrition from permanently unconscious patients. These critics assert that withdrawal of nutrition from a preservable unconscious patient amounts to intentional killing of a helpless human being. Grave implications are seen for helpless patients. This article confronts these critics and their assertions. The author contends that the judicial approach which allows withdrawal of artificial nutrition is fully consistent with traditional medico-legal doctrines. The article articulates a standard--respect for human dignity--which justifies withdrawal of artificial nutrition from a permanently unconscious patient. The implications of this formula for other incompetent patients facing a protracted dying process is discussed. Finally, the article explains why active euthanasia can and ought to be distinguished from withdrawal of life-preserving medical intervention.