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Should the law on euthanasia and physician assisted suicide be changed?
September 23, 2005Taking the final step: changing the law on euthanasia and physician assisted suicide BMJ Volume 331, pp 681-93
Next month's debate in the House of Lords could begin the process of changing the law on euthanasia and physician assisted suicide. To help doctors decide where they stand, this week's BMJ publishes a range of opinions.
People who want assisted suicide should have the same rights as patients who can end their lives by refusing life sustaining treatment, argues retired barrister Margaret Branthwaite.
She points out that public support for legislation to permit assisted dying has grown from 69% in 1976 to 82% in 2004, and that most professional bodies have now adopted a neutral stance.
Data from countries where assisted dying has been legalised also answer some of the concerns expressed by opponents of the proposed legislation, she adds. For example, in the US state of Oregon, the number of assisted suicides has changed little under Oregon's Death with Dignity Act.
These views are echoed in an ethical analysis by Professor Torbjorn Tannsjo, who argues that a system for euthanasia would mean that people could approach the terminal phase of their lives without fear. "They would know that, if, when their turn comes, and things turn out to be terrible, they have a way out," he writes.
But in another article, senior palliative care doctors warn that legalised euthanasia would leave vulnerable groups open to therapeutic killing without consent.
Rob George and colleagues argue that assisted suicide cannot be separated from euthanasia, and reject the arguments that legalised euthanasia promotes autonomy of the dying in general or that any safeguards are ethically sustainable.
Before another bill is laid before parliament, doctors must consider all the moral and practical implications of legalisation, they write.
The adequacy of safeguards in any proposed legislation will also be a priority for the British Medical Association, which has recently adopted a neutral policy on assisted dying. From the BMA's perspective, a neutral position entails a campaign for better palliative care, robust safeguards for patients, training and support for health professionals, and clear conscientious objection clauses.
Finally, research among doctors in the Netherlands shows that, although with the introduction of review procedures for euthanasia and physician-assisted suicide the public oversight and legal control has increased, almost half of all euthanasia and physician assisted suicide are still not reported.
BMJ-British Medical Journal
She points out that public support for legislation to permit assisted dying has grown from 69% in 1976 to 82% in 2004, and that most professional bodies have now adopted a neutral stance.
Data from countries where assisted dying has been legalised also answer some of the concerns expressed by opponents of the proposed legislation, she adds. For example, in the US state of Oregon, the number of assisted suicides has changed little under Oregon's Death with Dignity Act.
These views are echoed in an ethical analysis by Professor Torbjorn Tannsjo, who argues that a system for euthanasia would mean that people could approach the terminal phase of their lives without fear. "They would know that, if, when their turn comes, and things turn out to be terrible, they have a way out," he writes.
But in another article, senior palliative care doctors warn that legalised euthanasia would leave vulnerable groups open to therapeutic killing without consent.
Rob George and colleagues argue that assisted suicide cannot be separated from euthanasia, and reject the arguments that legalised euthanasia promotes autonomy of the dying in general or that any safeguards are ethically sustainable.
Before another bill is laid before parliament, doctors must consider all the moral and practical implications of legalisation, they write.
The adequacy of safeguards in any proposed legislation will also be a priority for the British Medical Association, which has recently adopted a neutral policy on assisted dying. From the BMA's perspective, a neutral position entails a campaign for better palliative care, robust safeguards for patients, training and support for health professionals, and clear conscientious objection clauses.
Finally, research among doctors in the Netherlands shows that, although with the introduction of review procedures for euthanasia and physician-assisted suicide the public oversight and legal control has increased, almost half of all euthanasia and physician assisted suicide are still not reported.
BMJ-British Medical Journal
Physician-assisted suicide does not increase severity of depression, grief among family members
Unlike other forms of suicide, physician assisted death does not cause substantial regret, or a sense of rejection among surviving family members.
Vulnerable groups are not at higher risk of physician-assisted death
Claims that vulnerable groups, such as the elderly and people with physical or mental disabilities, are at an increased risk of physician assisted death are not supported by evidence, says an expert in this week's BMJ.
Active euthanasia and physician assisted suicide should be legalised
Last month Diane Pretty was refused the legal right to choose the circumstances of her own death. In this week's BMJ, Professors Len and Lesley Doyal argue that this decision is morally wrong and that the law should be changed. If Mrs Pretty was permanently and severely incompetent, and if her doctors believed that medical treatment could provide no benefit because of her inability ever to engage in self directed activity, then legally they could withdraw life sustaining treatments. Yet, she cannot invite them actively to end her life and to advise them about how this should be done. This decision becomes all the more morally questionable when we realise that Mrs Pretty can refuse life susta
Euthanasia does not seem to be under effective control in the Netherlands
The practice of voluntary euthanasia is not being effectively controlled in the Netherlands, suggests the evidence from research in the Journal of Medical Ethics. In the Netherlands physician-assisted death is still subject to criminal law, but has been widely practised and tolerated for well over a decade, according to strict safeguards established by the Royal Dutch Medical Association in 1984.
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