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Tuesday, 6 March 2012

Medical Ethics - Euthanasia

"Dr. X is a medical SHO (Senior House Officer) working in the stroke team. An 89 year old lady is admitted following a large stroke which has left her bedbound, incontinent, paralysed down one side and unable to speak. After a few days on Dr. X's ward she develops a chest infection which requires antibiotics. Her daughter tells Dr. X that her mother was always fit and active and it would have been her "worst nightmare" to live like this. She suggests that if her mother could speak, she would refuse the antibiotics."

Does Dr. X administer the antibiotics?

Firstly, it would be worth to clarify the situation. If Dr. X withholds the antibiotics on the daughter's request, allowing the mother to die, then this would be voluntary passive euthanasia. By this I mean that Dr. X would not be actively killing the mother (by injecting a large quantity of morphine, for example), but would simply be permitting her death by removing life-saving treatment. There is a very fine line between active and passive euthanasia, the former of which is illegal, the latter legal. The difference between active and passive euthanasia essentially relies on two key questions that must be asked:

1. Is Dr. X acting or omitting?
2. Is Dr. X intending death or foreseeing it?

Thus we can conclude that in this situation, Dr. X would commit passive euthanasia as he is omitting treatment, and foreseeing death. Death is somewhat intended, although in the realms of law and ethics, death here is passively intended and is thus considered to be foreseen instead. Please note that this is also voluntary passive euthanasia. This is because the mother's daughter has a clear duty of care for her mother - she is close family - as we assume her mother is incapable of making medical decisions due to her condition, therefore this is respecting the patient's autonomy and the daughter's decisions regarding her mother should be carried out as long as they are permissible and legal (i.e. not active euthanasia), regardless of whether Dr. X agrees with withdrawing the antibiotics. The daughter believes it is in her mother's best interests to die, and Dr. X should act accordingly. For Dr. X to go against her daughter's decision would be to commit, in legal terms, battery.

Some may argue against Dr. X allowing this passive euthanasia. The most common opposition comes from the absolute moral principle that killing is wrong in any situation. These opponents may accept there are some very difficult situations and sometimes killing may seem like the right thing to do, but they will always stick to that single, absolute principle that killing is wrong. However, I firmly believe we need to be more relative and flexible with situations like this. A reason these opponents might view killing as a harmful wrong is because of the harm of dying. For most people, dying now would be a great harm compared to living onwards. Thus if there is no harm caused in dying, then killing shouldn't be considered wrong. In the case of voluntary euthanasia, dying would be a benefit in the patient's eyes, not a harm, therefore I hold the position that the voluntary euthanasia would not be morally wrong. To quote Professor Hope:

"Those who argue that mercy killing is wrong in principle forget the conceptual link between the wrong of killing and the harm of dying…It is perverse to seek a sense of moral purity when this is gained at the expensive of the suffering of others."

I do indeed agree that having a first priority of seeking "moral purity" is essentially foolish. In my opinion, Dr. X must allow the withholding of antibiotics.

This is a tricky medical situation, but certainly a more common one.

This is just what I made of the situation,
Let me know what you think!
AJ

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