Euthanasia, Assisted Suicide and the Right to Resuscitation

1. Euthanasia, Assisted Suicide and the Right to Resuscitation 12th November 2007 Lorna Walker and Alan Davidson

2. An Overview… • What is euthanasia? • What ethical/legal/medical issues are involved? • Some examples • Case studies

3. Ideas About Euthanasia • Assisted suicide • The right to die: a basic human right? • Slippery slope • Dying with dignity • Risks involved • Legalised in Holland

4. Some Definitions • Active euthanasia • A person directly and deliberately causes a patient’s death • Assisted suicide • A person who wants to die needs help to kill themselves, asks for and receives it • DNR: do not resuscitate • Indirect euthanasia • Providing treatment to reduce pain with the known side effect of causing the patient to die sooner

5. Some More Definitions • Involuntary euthanasia • Patient wants to live but is killed anyway: murder! • Living will • Document in which patient states what they want regarding treatment and euthanasia • PAS: physician (doctor) assisted suicide • Non-voluntary euthanasia • Patient cannot ask for or make a meaningful choice between living and dying and an appropriate person takes a decision on their behalf in accordance with previously expressed wishes

6. Relevant Ethics • Religious views • Pro-life arguments v. the right to choose to die • The lines between euthanasia, assisted suicide and murder • The law: • A person can choose to take their own life without risking the legal and religious ‘punishment’ of 50 years ago. Why then can an individual not ask for help to die?

7. A Wide Spectrum of Views! • Egalitarian: the right to choose when and how to die is a basic civil liberty • Religious: all life is sacred and should be defended; death should not be hastened • Doctrine of double effect: Allows use of drugs that will shorten life if the primary aim is to reduce pain

8. Some Examples • Diane Pretty • Terry Schiavo • Charlotte Wyatt

9. Diane Pretty • Requested the right to have her husband ‘help her die’ without facing legal consequences, taking her case as far as the European Court of Human Rights • Was refused this right, dying naturally of complications of motor neurone disease (MND) in 2002

10. Why?? • MND is a disease causing gradual paralysis of the entire body • Eventually patients cannot move, speak or swallow and suffer from severe breathlessness • Mrs Pretty feared the choking and asphyxia (suffocation) associated with the disease • “The law has taken all my rights away”

11. What happened... • “I want to have a quick death, without suffering, at home, surrounded by my family so I can say goodbye to them” • “Diane had to go through the one thing she had foreseen and was afraid of – and there was nothing I could do to help” • “Mrs Pretty’s death was perfectly normal, natural and peaceful”

12. So... • Mr + Mrs Pretty did not get what they wished; had they done, arguably it would have paved the way for similar cases • A good outcome? A bad one? Was it fair? • What if the patient had been older, or asking a doctor to help?

13. Terry Schiavo • Young woman who fell into a vegetative state in 1990 • Because her heart stopped, depriving her brain of oxygen, for a few minutes, she was in a ‘conscious coma’ • Drs stated that she was incapable of communication or normal life, and would never recover • What complicated the situation?

14. Mr Schiavo • Mrs Schiavo’s husband had power of attorney over her – her next of kin. He was able to appeal to have medical decisions made • In 1998 he began a legal battle to have her feeding tube withdrawn, meaning that his wife would effectively starve to death • He claimed this is what his wife would have wanted

15. But! • Terri’s parents did not agree with her husband • They believed she should be given the chance to recover, saying she was capable of meaningful communication • They contested Mr Schiavo’s case • Who won?

16. A natural death? • In February 2005, 15 years since the onset of the ‘coma’, Terri Schiavo had her feeding tube withdrawn • This was after 7 years of court acting, during which the decision was overturned many times • She died in her husband’s arms 13 days after the tube was removed

17. Charlotte Wyatt • Born 3 months prematurely, so suffers serious heart and lung damage • Baby Charlotte was resuscitated several times when very young, but doctors felt this was not only futile but painful and cruel for a young baby to undergo • After parents refused to have Charlotte classified as NFR, doctors took the case to court

18. What the courts said... • Medical opinion was that Charlotte would not survive infancy and would never be able to leave hospital • Her care was costing the NHS a lot of money – by the time the case reached court an estimated £1.1million had been spent • The court said that Charlotte must be kept free from pain, allowed time with her parents and allowed to die naturally: DNR

19. But... • Charlotte Wyatt celebrated her 4th birthday this October • She is now in foster care, no longer requiring to permanently stay in hospital • The DNR ruling remains valid • Watch this space...similar cases have had similar results despite Charlotte’s survival

20. Case Studies • Have a think about the following cases • What are the religious, legal and medical viewpoints? • What would you do? • Discuss!

21. Case 1 A 22 year old is involved in a motorcycle accident and is left in a coma. Doctors say it is unlikely he will recover from his vegetative state and encourage his parents to consider switching off his life support machine. What are the pro’s and cons of keeping on/switching off the machine? What issues might affect the parents’ decision?

22. Case 2 • A 72 year old man slips in the shower leavig him paralysed from the waist down. Unable to enjoy his previous pastimes such as golf he becomes miserable. He makes no effort to do anything during the day and starts telling nursing staff it’s “his time”, and wants to end his life. • What should be done for this man? What/who must be considered?

23. Case 3 • A 46 year old has a sudden worsening of her multiple sclerosis, becoming deeply depressed. Her husband claims she now wants to end her suffering and now regularly expresses this wish despite never having mentioned this before now. • What legal and emotional issues are involved in this case?

24. Case 4 • A 33 year old drug addict is admitted to A&E after an overdose. She slips into a coma from which she seems unlikely to recover. With no family to consult the senior doctor says that it is probably best to just switch off her life support machine, as if she does recover she will only return to drugs anyway. • Discuss what issues are involved here.

25. Case 5 • A young girl is rushed to hospital after a car accident, requiring emergency surgery. The mother arrives saying the family are Jehovah’s witnesses and so she does not want the child to receive a blood transfusion. The medical team follow the mother’s wishes but despite their best efforts the girl dies. • Is this euthanasia? Did the doctors make the right decision? Should any legal action be acted against the mother or doctors?

26. Any questions????