Power of Life and Death

[AB Asks]

The news that a 30 year old woman lady with heart, lung and spinal conditions wants doctors to induce a coma-like state has reopened the issue of a patient's 'right to die'. Doctors looking after the lady have described the suggested measures as "unlawful and unethical" and have so far refused to act on them. The lady and her relatives intend to contest the decision in court. Do you think that the doctors should have the final say or should the patient/patient's family decide?

[Homer55]

I agree paul, i think that aslong as everyone agrees that no more can be done. it should be allowed.

[Octavius]

I don�t know much about the case other than from a news clip last night. The question here is, presuming she is well enough to demand/request this through the courts (she was certainly well enough to be interviewed on TV), why does she require the doctors to do it? Sounds a bit heartless, but can�t she just take some pills herself in a sort of suicidal way? Why does it have to be �assisted�?

If the doctors are to be condemned or reviled for assisted suicide, then surely THEY should be the ones deciding on what action (or inaction) THEY should take in accordance with the laws of the United Kingdom.

[Eve]

There was a discussion about this on news the other day...

http://www.theanswerbank.co.uk/News/Question36 4461.html

[Octavius]

Pa_ul, this is a question of bioethics. I am not convinced that doctors should have the power or the burden to make such decisions, and in 2006 both the Royal College of Physicians and the Royal College of General Practitioners voted against a change in the law on euthanasia. I am aware that suicide is different to euthanasia and there are many forms of it (voluntary, non voluntary, involuntary etc). This woman is asking for terminal sedation and this therefore requires doctors to act against their code of ethics does it not? I was merely suggesting perhaps a certain coup de grace.

[Octavius]

Well, yes. But I think (I am not too up to date on the law) it is still unlawful for a doctor to agree to it or carry it out, without an explicit order from the courts. Of course, this will be based upon professional and impartial medical opinion, and doctors� opinions will differ. It then becomes a legal process and the burden of responsibility � albeit technically � is removed from the doctor. I believe this is the same process for switching off life-support machines, or not as the case may be.

I do not believe that a doctor should be forced against their will, ethical code or humanitarian beliefs to end a life, when their professional purpose is to maintain and sustain it.

[Octavius]

Of course, but in this instance she is requesting terminal sedation which would need be initiated by a doctor. If they do that, then I think they are breaking the law � even if they agree in principle. Going back to my point, why can�t she �top� her self, rather than placing the burden on the doctors against their wishes and ethics? I am sure she could get a court order for DNR (do not resuscitate) if she did decide to go down that route.

[wleshbeetle]

it is totally her choice and the familys and nobody elses!! its her life not the media and the doctors!! who are they to say you have to live in constant pain for the rest of your life!! and would they think differently if it was their sister or daughter!! i think soo!!

leave the poor woman alone i say and let her live and end her life the way she wants too!! i wish her all the best!
xx

[smudge]

A few more similar posts on the subject:

http://www.theanswerbank.co.uk/Body-and-Soul/Q uestion203232.html

http://www.theanswerbank.co.uk/Body-and-Soul/Q uestion53666.html

[Imzadi]

Doctors are bound by the Hippocratic Oath which states that they should abstain from whatever is harmful or mischievous, and to not prescribe or administer a lethal dose of medicine to any patient even if asked to. This is the law as it stands today, altough some people agree it should be changed to suit modern needs. Suicide is an options for some, though most of the typical suicide methods are rather gruesome and result in a particularly uncomfortable and unsightly death. there is however the option of travelling to other parts of the world were it is legal or at the very least not a criminal offence.

[bednobs]

grrr this whole issue is very angermafying to me!
i cant believe that even that woman knows what she wants ... she wants morphine to sedate her. Morphine is a pain killer, and would only be used by docotors and nurses as such ... from the box of morphine tablets they showed on the telly ith her name and instructions on, shhe's only having 10 mg of mst twice a day ... hardly more pain killing effect than paracetamol and codiene combined (in fact less than the strongest co-codamol) why cant the morphine just be increased if she is in so much pain? to get to a point where her pain is better but shes not in a coma ... there is something in between!

[beryllium]

There is no right to die in British law, but there is a right of self-determination which goes as far as recognising your right to kill yourself. We have restrictions on what other people can do to you, but we do not have restrictions on what you can do to yourself. I am going to focus on a principle of law which you can use to stop people forcing life on you � self-determination.

Self-determination is bound up with two legal concepts, capacity and consent to treatment.

[beryllium]

Refusal of life-saving treatment: the patient's rights

Dr Bridget Dolan, November 1997

Dr Bridget Dolan is a barrister-at-law, and is Hon. Senior Lecturer in Forensic Psychology at St George's Hospital Medical School, London. She has researched the legality of living wills, and here explains the legal basis for patient self-determination.

There is no right to die in British law, but there is a right of self-determination which goes as far as recognising your right to kill yourself. We have restrictions on what other people can do to you, but we do not have restrictions on what you can do to yourself. I am going to focus on a principle of law which you can use to stop people forcing life on you � self-determination.

Self-determination is bound up with two legal concepts, capacity and consent to treatment.

Consent
Under common law a doctor may only administer treatment when a patient gives consent.

A competent person is entitled to reject a treatment or select an alternative treatment, even if the decision entails serious risk of death. The patient's reasons for withholding consent can be rational, irrational, unknown or even non-existent [1].This respect for patient autonomy is one of the guiding principles of our medical law. The principle of self-determination will, in most cases, prevail above the competing principle of sanctity of life and will protect the right of a patient to decide what is to happen even should the decision be contrary to medical advice and even should it bring about death.

[beryllium]

This has been confirmed by the highest court we have, the House of Lords. In the case of Bland [2] (the Hillsborough victim in persistent vegetative state), they laid down that the principle of sanctity of life is not an absolute one: "It does not compel a medical practitioner on pain of criminal sanctions to treat a patient who will die if he does not, contrary to the express wishes of the patient." The House of Lords has also endorsed the view that a doctor who proceeds without consent will be liable for trespass, assault or battery. This is regardless of whether the doctor believed that what they were doing was good for you, and regardless of whether the doctor had any hostility [3]. You don't even need to have suffered any harm from the doctor's actions to bring a successful action for damages.

[beryllium]

Valid 'informed' consent
For consent to be legally valid a patient must know in 'broad terms' what is involved in the suggested procedure or treatment [4], and must have been told of the side-effects. The doctor also has a duty to answer truthfully any questions about the treatment [5].

[beryllium]

Indicating consent
A conscious person can signal consent by words or gesture. In most of medicine, that is what happens: the fact that a patient voluntarily walks into the doctor's office or holds out their arm for an injection is taken as consent to treatment, and often no more than this is requested or supplied. It would be good practice in hospitals to use a consent form, but signatures on consent forms do not in themselves prove valid, binding consent. I've quite often seen forms which have been signed by relatives, and thus have no value at all. And even if you sign a consent form you can refuse and withdraw your consent at any time in the future and override your earlier consent.

[beryllium]

If you do refuse consent a doctor can try to persuade you to change your mind, but they can't put undue pressure on you. If they do, and they obtain your consent under duress, it would be completely invalid.

In order to be in a position to validly give consent or refuse treatment, you must first of course be competent to make the decision. It is very telling that it is not usually until somebody refuses treatment that competence becomes an issue