Facing the Issue: Euthanasia

Euthanasia means many different things to different people. In the strictest sense, euthanasia is defined as "the intentional killing by act or omission of a person whose life is felt not to be worth living".

As health professionals (a doctor and nurse) working in the NHS, the issue of euthanasia in its truest sense is not a major day-to-day, practical issue. There are, however, many difficult and controversial areas surrounding life and death in hospitals, which come under the umbrella of euthanasia. In particular, issues of actively not treating patients in the knowledge that the patient is likely to die without intervention, or the withdrawal of treatments that are prolonging patient's life, when it is clear that there is no longer any real hope of recovery.

As Christians, we always try to underpin our decision making on the word of God as written in the Bible. This tells us that human beings are unique in being made in the image of God and as such our lives have special value. The sixth commandment clearly states that "You shall not murder". The Hebrew word used refers to the intentional killing of an innocent human being. Jesus affirmed the commandments in his sermon on the mount.

There must be a boundary between allowing an inevitable disease process to run its course while allowing the person a dignified death, and the deliberate bringing of a person's life to an end because it is perceived to be "no longer worth living". However, it can be difficult to know where that boundary is. We attempt to illustrate this in the case scenarios below:

The case of Diane Pretty illustrates a problem of euthanasia in its truest sense. She was a 42 year old woman in the final stages of motor neurone disease (MND), a severely disabling, incurable and fatal condition. She wished to commit suicide, but was too disabled to do so. She wanted her husband to assist her in committing suicide, but the courts were unable to assure her that he would not be prosecuted for this. She took this decision to the Court of Appeal who upheld the original decision. She based her case principally on two types of assertion. The first was that if she continued in the course of her MND she would suffer from severe pain and disability and distressing symptoms, would undergo inhuman and degrading treatment, and would be compelled to endure her condition unrelieved. The second was that the blanket prohibition in English law on assisting someone to commit suicide was against the European Convention on Human Rights. She has subsequently died from her illness.

Do you think that her husband (or her doctor) should have been allowed to assist her to commit suicide?

A second case is of a woman who had suffered severe spinal injuries in a fall and was paralysed from the neck down. The paralysis had also affected the muscles that allow her to breathe, and she required a ventilator to stay alive. This is very similar to the problem that affected Christopher Reeve, who played Superman in the Superman movies. The woman argued that her quality of life was so poor that she wished the ventilator to be turned off. The inevitable consequence of this would be her death. She took the case to Court and the judge remarked how clearly she had thought the issues through. The Court decided that it was within her rights to refuse medical treatment and her ventilator was indeed turned off.

Did the court make the correct decision in your opinion?

A patient has cancer which has spread to a number of places in their body, and has failed to respond to treatment. The disease is now terminal and the patient has deteriorated and probably only has a matter of weeks to live. The cancer is causing a lot of pain and requires large doses of strong pain killing drugs to relieve the pain. The patient's doctor is aware that the drugs may affect the patient's breathing and using such large doses may hasten the patient's death, but there is no other way of relieving the patients pain. This is the principle of 'double effect' - when an action has two effects - one good and one bad.

Is the doctor justified in giving the drugs?

An 86 year old woman is admitted to hospital by her GP. She has had two strokes in the past and is very disabled. The strokes have also affected her memory and she has dementia. She lives in a nursing home where she is well cared for and appears reasonably happy. In the last few days she has become more unwell, and she is very breathless. Investigations show she has severe pneumonia and in addition her kidneys are failing. The doctor knows that he could send her to intensive care and use a ventilator to keep her alive, whilst hoping that the antibiotics may treat her pneumonia. He is also aware that the chances of her surviving this illness are very poor (probably less than 1 in 10). He also has to decide, if she should die, whether she should receive cardiac resuscitation. He is aware that this would be very undignified and would have virtually no chance of success. He decides to give her antibiotics, though he is unsure whether this is the right decision, as he feels perhaps he should "let nature take it's course", but he decides she should not go to intensive care or receive cardiac resuscitation.
Improved medical knowledge have improved doctor's ability to keep people alive in the face of severe medical problems. Some treatments are medically useless in that their benefits are outweighed by the suffering that they cause the patient. But there is a world of difference between saying that a treatment is useless (and therefore not worth giving) and that a patient is useless (and therefore not worth treating).

Did the doctor make the right decision?

This section has been contributed by Dr. Paul Lambert, MA, BM, BCh, MRCP, Specialist Registrar in Diabetes and Endocrinology, and his wife, Mrs. Rebecca Lambert, RGN, DipN, Practice Development Nurse.