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Limits on the Right of Autonomy in Respect of End of Life Decision Making

Limits on the Right of Autonomy in Respect of End of Life Decision Making

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An essay for the 2012 Undergraduate Awards Competition by Lynda Horgan. Originally submitted for Law at University College Cork, with lecturer Dr. Mary Donnelly in the category of Law
An essay for the 2012 Undergraduate Awards Competition by Lynda Horgan. Originally submitted for Law at University College Cork, with lecturer Dr. Mary Donnelly in the category of Law

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Published by: Undergraduate Awards on Aug 31, 2012
Copyright:Attribution Non-commercial

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03/26/2014

 
Limits on the Right of Autonomy in Respect of End of Life DecisionMaking
End of life decision making is one of the most, if not the most, controversial areas inmedical law. For decades it has vexed the courts, legislators and academics alike, aseach has tried to disentangle the law, from ethics and morality, in an effort to establishconcrete principles regarding such decisions. This essay will address three key aspectsof end of life decision-making, namely, euthanasia, assisted suicide and advancedirectives.Since the right to refuse treatment is now firmly established in Irish law, and it is nolonger a criminal offence to end your life, it is but a short step to hold that the limit placed on a person’s freedom to request active steps be taken to end their life is anunjustifiable limit placed on the right of autonomy. There are, of course, difficulties inlegislating for such broad moral issues, but because they are difficult does not absolvethe legislature from addressing them. A framework regulating both euthanasia andassisted suicide would seem inevitable in time. Limits on one’s freedom of choice inend of life decision making are increasingly appearing unjustified in light of movements away from a culture of medical paternalism, towards greater freedom of choice and patient autonomy. The proposals to recognise advance directives areaccepted as a move in the right direction and it is to be hoped that further steps will betaken to promote self determination in end of life decision making in the future.
 
Limits on the Right of Autonomy in Respect of End of Life DecisionMaking
End of life decision making is one of the most, if not the most, controversial areas inmedical law. For decades it has vexed the courts, legislators and academics alike, aseach has tried to disentangle the law, from ethics and morality, in an effort to establishconcrete principles regarding such decisions. This essay will address three key aspectsof end of life decision-making, namely, euthanasia, assisted suicide and advancedirectives.Euthanasia is seen as deliberately ending a person’s life with the general motivationof ending pain and suffering. The final step in euthanasia is taken by a third party,while assisted suicide, on the other hand, merely involves third party assistance. Bothare unlawful in most European jurisdictions, including Ireland and the UnitedKingdom, thereby, making it legally impossible to consent to your own death. Masonand McCall Smith argue, however, that since the right to self-determination has now justified the legalisation of suicide, “[t]he door is thereby opened for consideringeuthanasia as a morally acceptable practice.”
1
In deciding whether limits on a person’sright to autonomy are justified, it is necessary to balance the interests of the State in preserving the sanctity of life against the right of an individual to self-determination.While increasingly, the rights of the patient are winning out, it seems that society isstill reluctant to push the boundaries and accept euthanasia as a lawful act.
1
Mason & McCall Smith,
 Law and Medical Ethics,
4th ed.
 
(London, Dublin,Edinburgh: Butterworths, 1994), pp. 314.
 
There have never been any Irish prosecutions for euthanasia nor assisted suicide but itis likely that the case of 
 R v Cox
2
 
would be applied if the issue arose before the IrishCourts. Dr. Cox treated a terminally ill woman who continuously requested his help toend her life. Eventually he obliged and administered an injection of potassiumchloride. He later stated what he had done and was prosecuted for attempted murder.The Court took an alternative view of intention here and found that if the intentionwere to relieve pain, regardless of whether the physician knows that this would speedup the patient’s death, he would not be guilty of murder. If, however, the intentionwere to end life, it would be murder. Despite the fact that Dr. Cox used a substancewhich has no analgesic effect, he was found guilty of attempted murder and receiveda one year suspended sentence. This minimal sentence was probably due to the factthat he was certainly not a murderer as the word is commonly understood.
3
 Thedecision was later approved by the House of Lords in
 Airedale National HealthService Trust v Bland.
4
Huxtable notes that Dr. Cox “is the only doctor to have been convicted for practicingeuthanasia in recent decades” despite the numerous revelations of such occurrences.He advocates for “a more robust articulation” of the doctrine of double effect “so thatthe innocent can continue to practice appropriate pain relief, but also that the guiltyare unable to hide behind legal confusion.”
5
This would seem to strike the appropriate
2
 
 R v Cox
[1992] 12 B.M.L.R. 38.
3
Mason & McCall Smith,
 Law and Medical Ethics,
4th ed.
 
(London, Dublin,Edinburgh: Butterworths, 1994).
4
 
 Airedale National Health Service Trust v Blan
[1993] A.C. 789.
5
Huxtable,
 Euthanasia, Ethics and the Law: From Conflict to Compromise
(Oxon:Routledge-Cavendish, 2007), pp. 79.

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