Euthanasia is the intentional act of putting an end to a patient’s life to relieve the pain and suffering. It is comprised of two Greek words – Eu and Thanatos meaning, literally, ‘a good death’. Today, ‘euthanasia’ is generally understood to mean the bringing about of a good death- ‘mercy killing’ where one person, A, ends the life of another person. B, for the sake of B. The country most well-known for performing euthanasia is the Netherlands.
Most of the people who undergo euthanasia usually have an incurable illness. But it is simply not limited to that, there may be instances where someone might simply want to end their life. The attitude towards the practice differs between individuals and populations. Death is something which every living being in this world has in common. With the rapid progress in medical science and human rights, the has been continuous discussions and debates on the procedure. Every single opinion expressed is backed up by sound arguments. The number of proponents and opponents have increased to appoint where it has become difficult to simply say one is correct over the other.
Although it has considerably lefts its mark on the law, it is more debated and discussed in medical and religious communities. The topic has had its fair share of controversies even creeping into sensitive topics like abortion. The topic has been widely discussed in the media, by politicians, lawyers and even the common man.
This dissertation provides a comprehensive study on what euthanasia or physician assisted suicide is, that is its origin in the pages of history. The practices performed by people of ancient civilisation and their views towards the procedures. The dissertation will also examine the countries in which euthanasia has been legalized, how it has affected not only the other laws of the country but also the impact of the law on peoples’ lives and rights, including its mark in the United Kingdom. The landmark case and policy decisions which have caused ups and downs and the constant clash with European Convention on Human Rights and also the Human Rights Act. I will also discuss arguments for and against euthanasia, including the viewpoints of people around the globe, as well as the positives and negatives it has had in the form of cases studies. I will also discuss why the UK is still very firm on the prohibition of euthanasia and whether euthanasia should be legalized in the UK and recent developments in that regard. I will be using the word euthanasia and physician assisted suicide or just assisted suicide as they are interlinked and in used in different countries to describe the same procedure.
Euthanasia has different classifications, they are:
- Voluntary Euthanasia is where at the request or consent of the patient, their life in ended. This is legal in some countries e.g. Belgium, Netherlands, Luxembourg and throughout United States as per Cruzan.
- Non-Voluntary Euthanasia is where the patient’s consent is unavailable, or they cannot give consent or not in a position to give consent, such as babies or patients with dementia. Then someone else in place of them decides that it would be in the person’s best intertest to end their life. This is illegal in all countries.
- Involuntary Euthanasia is where the person or patient wants to live but because they are in a vegetative state, a family member or someone on their behalf takes the decision to end his life. This is also illegal and is usually considered as murder.
Euthanasia is also carried out in various ways:
- Active Euthanasia is something done to the person to make them die quicker by administering lethal a drugs and injections.
- Passive Euthanasia is withdrawing any form of treatment which could extend a patient’s life by omission, such as turning off life support machine, removing feeding tube etc.
Another term that is often associated with euthanasia is Physician Assisted Suicide. Physician-assisted suicide or death (PAS, PAD) refers to the practice where a physician provides a potentially lethal medication to a terminally ill, suffering patient at his request that he can take (or not) at a time of his own choosing to end his life. It is also called physician-assisted suicide, physician aid-in-dying, and patient administered hastened death.
1) The first use of the word euthanasia was by Suetonius, in his De Vita Caesarum–Divus Augustus (The Lives of the Caesars–The Deified Augustus)
2) Greece: In ancient Greece, mixed and conflicting views about suicide and euthanasia were expressed. In Athens and Sparta, individuals who had committed suicide would have their right hand severed from the corpse and would not be given a proper burial with all the traditional rituals. One of the most influential figures in Greek History Plato expressed the view that individuals with sick and miserable existence should be given the chance to die. That it was better to “leave the unhealthy to die”. The Greeks however were very tolerant of both infanticide and active euthanasia before the coming of Christianity.
3) There were many physicians who did perform mercy killings and abortions. Greek philosopher Pythagoras was completely against euthanasia because he believed that man was the protector of all life on earth placed by God and that he is not allowed to escape his own will. Hippocrates a physician and follower of the Pythagorean tradition created the Hippocratic oath which effectively condemns the practice of euthanasia. Although the Hippocratic oath was created for the purpose that physicians would not administer lethal drugs, the physicians were more supportive of assisted death and did not want to prolong suffering.
4) Another historic figure Aristotle was much more accepting of the practice and considered it to be morally acceptable depending on the circumstances. A branch of philosophers who practiced a stoicism practiced the ways to live in accordance with nature. As death was a natural and inevitable part of life, stoicism also advocated for ease of suffering through ending one’s life. . Patients suffering extreme pain and incurable terminal illness were made to drink medicine by physicians which was a poisoned drink. In Rome, euthanasia was considered as murder.
5) In the Middle Ages in Europe, Christian teaching opposed euthanasia for the same reason as Judaism. Christianity brought more respect to human beings. Accordingly, every individual has the right to live since God creates human beings and they belong to Him and not themselves. Death is for God to decree, not man. After the advent of Christianity, the Hippocratic oath was then strengthened which forbade euthanasia.
6) In Mesopotamia, euthanasia was forbidden by the Assyrian physicians. In Sparta, new born male children were examined for signs of disability or sickliness, if they were found with such disabilities or ailments, they would be killed.
7) In the 15th Century, Sir Thomas More was the first Christian to recommend euthanasia in his book called Utopia. English philosopher Francis Bacon advocated for the prolongation of life. From his works it appears likely he was for ‘mercy killing’ or physician assisted suicide.
8) In the 19th Century euthanasia was regarded as a peaceful death. The first advocate of euthanasia in the 19th century was a man named Samuel Williams who wrote a paper on euthanasia. His work went on to be rejected and unnoticed until a man named Lionel Tollemache took over his work and began writing in the Fortnightly weekly. His work was dismissed as revolutionary but soon similar views were starting to emerge. In 1895 a German lawyer by the name of Jost wrote in his book titled “Killing Law” that ill patients who had no hope of surviving and wanted death should be allowed to die. According to him a person with an incurable disease has very little life value.
9) The 20th century is where most of the major events and law regarding euthanasia started to appear. More proposals came to Ohio and Iowa but they were all rejected. In 1920, two German professors (Karl Binding and Alfred Hoche) published a book called “Permitting the Destruction of Life Unworthy of Living” The book cited that mentally and physically ill, physically disabled were dangerous and financially burdensome to the society and that there should be a legal basis to kill them. Their argument although very controversial was influential in the Nazi T-4 euthanasia program.
10) Adolf Hitler admired their work and propagandised the idea. In 1935 the Nazi party approved euthanasia for children and adults who could not be cured and “useless”. Although German doctors did take the Hippocratic oath, it was replaced by the ‘Gesundheit’, this was an oath to the health of the Nazi state. A German doctor would thus be allowed to kill a patient to promote the interest of the Reich. Anyone who was deemed to useless could be sent to the gas chambers to be exterminated. Anyone from physically handicapped to mentally ill, in short anyone with a disease who could not work for the state could be sent there without needing the consent of the patient. In 1939 began the dreaded T4 program which promoted the elimination of life which was not worthy of living. This started with children aged three or above who showed signs of disability. It quickly spread to adults and elders. An estimated 250,000-350,000 Germans were put to death as they were incurable and were eliminated.
Many countries over the years have Legalized Euthanasia. Some have firmly rooted it in their legislation and received praise while others have strung web of controversies.
1) Netherlands: Netherlands was the first country to legalize euthanasia and physician assisted suicide in April 2002. It is called the Termination of Life on Request and Assisted Suicide (Review Procedures) Act. In order to qualify, some conditions needed to be met: the patient must be suffering unbearable pain, the illness the patient is suffering from must be incurable and the request for the procedure must be an informed decision in full consciousness by the patient. This legislation however, was met with heavy backlash. “Around 10% to 15% of the people who come to us looking for information actually commit suicide”, says Ton Vink, head De Einder (Horizon).
2) Belgium: Belgium became the second country to legalize euthanasia in 2002. It allows adults who are in constant physical and metal pain and which is incurable to request euthanasia. The law imposes certain criteria here as well. The patient must be legally competent and conscious at the moment of making the request; the request is voluntary; the patient is in a medically futile condition of constant and unbearable physical or mental suffering that cannot be alleviated. But it did not end there, On February 13, 2014, an amendment was brought to the act which allowed minors of all age to request euthanasia. The amendment states that the minor must possess the ability to judge their state of affairs when in a “medically futile condition of constant and unbearable physical suffering that cannot be alleviated and that will, within a short period of time, result in death, and results from serious and incurable disorder caused by illness or accident.”
3) Switzerland: Article 115 of the Swiss Criminal Code states that any person who for selfish motives incites or assists another to commit or attempt to commit suicide shall. If that other person thereafter commits or attempts to commit suicide, be liable to a custodial sentence not exceeding five years. Any role in voluntary euthanasia is prohibited. Although the law prohibits active participation in euthanasia it does not prohibit the administering of lethal drugs as long as the recipient actively administers the drug. The law only allows physicians to provide the means to carry out suicide and it must not be done in self-interest. One organisation regarding euthanasia in Switzerland that must be mentioned and that is ‘Dignitas’. It is a non-profit society which provides assisted suicide to the patients who become its members. It was founded in 1998 with a view to help members suffering from incurable physical and mental illnesses to ‘die with dignity’. The members must be of sound judgement, can bring their deaths themselves. Since euthanasia is illegal in UK or Germany, people travel to Switzerland to perform assisted suicide. As active euthanasia is illegal, the physicians only prescribe lethal drugs and that is how Dignitas has not been caught under the Swiss Criminal Code.
4) Luxemburg: In 16 March 2009, the Right to Die with Dignity law was passed. The law covers both euthanasia and physician- assisted suicide. The law permits euthanasia subject to certain conditions. The patient must be legally competent; the patient must have authorisation from parents or guardians if between the ages of 16 and 18; the request must be voluntary; the patient must suffer from an incurable condition and is in a state of unbearable physical or mental pain and the patient must respect the conditions and procedures prescribed by the law.
5) Canada: Canada amended their Criminal Code in 2016 to include medical assistance in dying. In order to be eligible for medical assistance in dying, the following criteria must be met. They are: the person must be eligible for health services provided by the government; be at least 18 years of age and mentally competent; must suffer from an incurable medical condition; must make a voluntary request for the procedure and given informed consent to receive medical assistance in dying.
6) United States of America: Oregon was the first state in USA to legalize physician assisted suicide for terminally ill patients (those who only have 6 months or less to live). A decade later, Washington approved the same law. This was followed by Vermont in 2013, California and Colorado in 2016. The Oregon Death With Dignity Act came into force in 1997. It was only available to the resident so Oregon. The law does not apply to euthanasia, mercy killing or assisted suicide. The requirement to comply with the provisions are: the individual seeking this should be terminally ill i.e. they must have less than six months to live; there first must be an oral request and then a written request which must be witnessed by two witnesses. One more oral request must be made before the doctor provides the prescription.
7) Australia: The Northern territory in Australia became the first legislature in the world to enact law on voluntary euthanasia. The act came into force in 1996. It was called ‘Rights on the Terminally Ill Act’. The requirement to request euthanasia was the patient would be examined the physician for the illness and be assessed whether or not the patient would be eligible for euthanasia. This criterion was later made stricter. The patient would need the consent of four doctors: The physician who would assist the patient in dying; a physician specialising in the illness the patient is stricken with; a physiatrist to confirm that the patient is making an informed decision and is not suffering from depression or any other mental illness and a physician to explain all palliative care available to the patient. Under the act Bob Dent became the first person to end his life by the help of his physician Dr. Philip Nitschke. The act however was overruled by the federal parliament in March 1997 and Euthanasia laws act was enacted in 1997.
According to Section 2 of the Suicide act 1961, assisting a suicide is crime in England, Wales and Northern Ireland. Those convicted could face up to 14 years in prison. Scotland does not have such a law but helping a person to die may lead to that person being prosecuted for murder. It is true that UK law prevents people wanting to die to ask for medical assistance to end their lives but over the years a trend has emerged that is if people cannot end their lives here they travel abroad. People from the UK travel to countries like Switzerland and Belgium to end their lives but that too comes with great cost and hardship. Many have ended their own lives resulting in gruesome deaths often making news headlines.
The first landmark case of euthanasia in UK was of Pretty v United Kingdom . She had motor Neuron Disease as a result she wanted her husband’s help to end her life. She then asked the government not to persecute her. However her case in the House of Lords was rejected. It was stated that the right to life does not include the right to die. It is then that Mrs Pretty took her case to the European Court of Human Rights (ECtHR) in 2002. She argued that the right to life allowed her to choose whether she wanted to keep on living. The ECtHR however disagreed. Their argument was that right to life could not interpreted as a right to die. When discussing the ban on assisted suicide, the court stated that it was to protect vulnerable people. Had it been successful, it would have struck down the legal ban on assisted suicide.
Perhaps one of the biggest cases in UK regarding Euthanasia comes from Debbie Purdy . She was diagnosed with Multiple Sclerosis in 1995. It is after that began a long legal battle in which Mrs Purdy came out victorious. She wanted to travel to Switzerland as the ban on assisted was still strong. Because of her condition she was unable to travel alone and wanted the assistance of her husband. The assistance however would be caught under Section 2(1) of the Suicide Act 1961. Mrs Purdy then applied for judicial review on account of the Director of Public Prosecutions (DPP) refusal to publish whether her husband would be prosecuted under Section 2(4) of the act. Her line of argument was under Article 8 of the European Convention on Human rights namely the right to a private and family life. The case eventually ended up in the House of Lords, it had to decide whether the DPP had a legal obligation to publish his policy regarding prosecution under Section 2(1) of the act. After a unanimous decision it allowed the appeal. This forced the DPP to publish policy under the aforementioned section. Lord Hope delivered the leading judgement. This resulted in the DPP to create a policy in February 2010 which deals with cases of assisted suicide. It states sixteen public interest factors for prosecution and six factors against prosecution.
The next case which sheds light on the presence of euthanasia in UK is Nicklinson. Tony Nicklinson had a stroke in 2005 which left him paralyzed. He could only move his head and his eyes. He wanted
1. the high court to state it was lawful for a doctor to help him end his life. If that was refused
2. A declaration that the current law on of England and Wales infringed his right to respect for his private life under Article 8 of the ECHR.
The high court refused in both forms. Mr Nicklinson then declined all food and dies of Pneumonia on August 2012. His wife Jane the became a party to the proceedings and lodged an appeal. Mr Lamb was then joined as a claimant in the court of Appeal. Mr Lamb applied for the same relief that was sought by Mr Nicklinson. The court of Appeal dismissed the appeal. The second appeal concerned an individual named Martin. He suffered a brain stroke in 20018 and whished to end his life by going to Switzerland. He applied to bring a change to the DPP’s 2010 policy so that people who are responsible for taking care of patients such as carers could assist Mr. Martin to commit suicide through Dignitas without the fear of being prosecuted. His appeal failed in the high court but was partially successful in the Court of Appeal in that it held the DPP’s 2010 policy was not clear in relation to persecution of professionals.
The Supreme court rejected Mr Nicklinson and Mr Lamb’s claims. There is however a silver lining. The court decided that the statute was incompatible with Article 8 of ECHR. The court gave Parliament the opportunity to consider legislating to allow people like Mr Nicklinson and Mr. Lamb to end their lives. The court also stated that the Parliament should consider debating the legislation in the near future. If it did not the court would then issue a declaration of incompatibility. Some justice also gave guidance on how new legislation might come into force. This can be taken as a clear warning that if Parliament fails to take nay action in the near future the court may.
In 2009 Lord Falconer’s proposed amendment to the Coroner’s and Justice Bill to remove risk of prosecution from taking their relatives to a country where assisted suicide was legal was defeated 194 votes to 141.
2018-9-8-1536426072