'Legalise Euthanasia' Says Ethics Professor

[Angel]

Euthanasia should be legalised, according to a leading British professor of medical ethics.

Emeritus Professor Len Doyal called for the legalisation of both voluntary and non-voluntary euthanasia in Britain.

Prof Doyle claimed doctor assisted deaths are taking place in Britain on a "regular and recurring basis" and need to be better regulated.

Highly respected Prof Doyal is Emeritus Professor of Medical Ethics at Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, and his comments are sure to spark controversy in the medical world.

Writing in The Royal Society of Medicine’s Clinical Ethics journal, Professor Doyal said: "Doctor assisted deaths are taking place on a regular and recurring basis in the UK. They should be better regulated.

"When doctors withdraw life-sustaining treatment, such as feeding tubes from severely incompetent patients, it should morally be recognised for what it is - euthanasia where death is foreseen with certainty.

"Doctors may not want to admit this and couch their decision in terms such as ‘alleviating suffering’ but withdrawal of life sustaining treatment from severely incompetent patients is morally equivalent to active euthanasia."

Professor Doyal added: "If doctors can already choose not to keep uncomprehending patients alive because they believe that life is of no further benefit to them, why should their death be needlessly prolonged?

"It is ironic that much of the debate about euthanasia has been so focussed on competent patients. Withdrawing feeding tubes, ventilators or antibiotics from incompetent patients may result in a slow, painful and incomprehensible death that could be avoided through the legalisation of non-voluntary active euthanasia."

Prof Doyal also criticised Lord Joffe's Bill, which would make it legal for doctors to prescribe drugs that a terminally-ill person could take to end his or her own life, for not going far enough.

Former human rights lawyer Lord Joffe, a former chairman of Oxfam, estimated that 650 people a year would use the medication. However Anglican and Catholic church leaders have spoken out against voluntary euthanasia.

Referring specifically to the Joffe Bill, Professor Doyal claimed: "Some supporters of euthanasia remain silent about non-voluntary euthanasia, presumably because they believe that focusing on voluntary euthanasia offers a better chance of legalisation. Yet in doing so, they ignore important arguments for their own position.

"If doctors are now allowed control – and should be able to exert even more control over – the deaths of severely incompetent patients, why should competent patients not be able to control the circumstances of their own deaths if this is what they wish?

"Proponents of voluntary euthanasia should support non-voluntary euthanasia under appropriate circumstances and with proper regulation."

Professor Doyal lectures, publishes and consults widely and has been a member of the BMA Ethics Committee for nine years

[Angel]

Richard Smith
Having watched the trend for years, I predict it may well be an option for me. I'm 54.

In 1978 I published one of my first articles in a medical journal - on abortion. It prompted howls of protest, and so did every article on abortion for the next 10 years. But slowly the protesters, some of them very well organised, ran out of steam. We moved - do I dare say progressed? - over a 50-year time scale from refusing termination of pregnancy in a woman whose life was threatened by pregnancy to, effectively, abortion on demand.

I feel I'm watching a similar progression with euthanasia. Len Doyal, "one of Britain's top medical ethicists", arguing that active euthanasia can be acceptable is another step along the path. Len may be in the vanguard, but much of the population is close behind. Other countries and states - the Netherlands, Belgium, Switzerland, Oregon, the Northern Territories - are ahead, but surely a post-religious country like Britain will quickly follow. Lord Joffe's bill on physician-assisted suicide may have been put on ice, but it'll soon be warmed up.

The progression is mostly led not by doctors or ethicists, but - as it should be - by the people. Why not euthanasia, many think. "I don't want to hang around demented, incontinent, a burden, incapable of joy. I'll get out while the going's relatively good. I'll not be shoved in one of those miserable homes. I'll call the shots." This view is becoming particularly strong as the "baby boomers" confront their deaths. We've had much more privileged lives - and much more choice - than our parents, and we'd like to keep it that way to the end.

Medical ethicists have a fancy word for this kind of thinking: autonomy. People are in charge of their own destiny. They don't have to do what doctors, teachers, politicians or ethicists say. One school of medical ethicists (not favoured by Len) believes that all ethical issues can be analysed using four principles. Autonomy is one. The others are beneficence (do good), non-malificence (do no evil - a la Google), and justice. Non-malificence would not favour killing somebody, but Len argues that it may be better to actively kill somebody who has no consciousness than to allow them to starve them to death.

Doctors (and the Pope) have always seen a difference between active killing and either "masterly inactivity" that culminates in death or giving people a high quantity of a drug to help relieve symptoms knowing that the dosage will kill them. Philosophers generally don't see a difference. But it's the doctors and not the philosophers who are doing (or not doing) the business, and they feel they have special rights. One response has been to suggest "philosopher assisted suicide". You don't need to know much medicine to hand somebody a lethal cocktail.

And there's the rub. It's OK to kill yourself. Why shouldn't a doctor help you out? Isn't that what doctors are supposed to do? Aren't we meant to be creating a "patient-led NHS"? Many doctors unsurprisingly feel deeply uncomfortable about shortening life, but it seems that the majority have done it at some time - usually by giving patients strong pain-relieving drugs that they know will kill them. Is it better that this is done within a legal framework whereby they could potentially be prosecuted or would it be better for everybody to accept that it happens and change the law?


Richard Smith (Profile)

Richard Smith is chief executive of UnitedHealth Europe, a subsidiary of the UnitedHealth Group that works with public health systems in Europe. A member of the board of the Public Library of Science, he is also a visiting professor at the London School of Tropical Medicine and a member of the governing council of St George’s, University of London.

Previously he was editor of the British Medical Journal and chief executive of the BMJ Publishing Group. Having qualified in medicine in Edinburgh, he worked in hospital in Scotland and New Zealand before joining the BMJ. He also worked for six years as a television doctor with the BBC and TV-AM and has a degree in management science from the Stanford Business School.

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