HEC Forum (2007) 19 (2): 145–159. DOI 10.

1007/s10730-007-9036-3

© Springer 2007

The Slippery Slope of the Middle Ground: Reconsidering Euthanasia in Britain

Peter Kakuk

It is an irony of progress that some of the most powerful technological advances in modern medical care that have made it possible to save the lives of thousands of people have also provided the means to prolong the suffering of others. They might be considered to be victims of medical technology that has developed in the last few decades with immense rapidity. Overly aggressive treatment in the final stages of terminal illness has exacerbated concerns regarding painfully prolonged deaths. Alongside these developments has appeared an expanding public awareness concerning individual rights under the law and the value of self-determination has gained in importance even in the legal context of healthcare. Although both the law and the medical profession have responded to the challenges of technological progress and social change, the limited possibilities for people to make decisions about the manner of their death has been insufficient to resolve the situation. There exists lively debate and an increasing number of ongoing wide-ranging research programmes that focus on the controversial issue of end-of-life decisions in modern medical care. Britain is no exception to the case, indeed: “Parliament is to re-examine the question of helping terminally ill people to die, ten years after the possibility of making it legal was rejected by the House of Lords Select Committee on Medical Ethics” (BMJ, 2003, p. 1186). More recently, a House of Lords Select Committee report has been published that would seem to take us one step further toward implementing new legislation regarding assisted suicide and voluntary euthanasia in the United Kingdom, but: “…the committee was divided on whether the law should be changed” (BMJ, 2005, p. 807). In what follows, I present a line of argumentation supporting the view that further legislation might be necessary on the issue. It constitutes a critique of the views of those who consider that the contemporary legal framework and medical practice concerning end-of-life issues might be problematic to a certain extent, but
_____________________________________________________________________________________ Peter Kakuk, M.A., Institute of Behavioral Sciences of the University of Debrecen Medical and Health Sciences Center, Nagyerdei Blvd. 98, P.O. Box 45, 4012 Debrecen, Hungary; email: kakukp@med.unideb.hu.

146 HEC Forum (2007) 19 (2): 145–159. and lack of clarity in. A few years ago McCall Smith presented. are not worth changing in light of the possible consequences. 194). Moreover. But is it realistic to think that by making a special case of homicide under the law that the strength and authority of the law would be weakened? Are there other ways for the law to lose its strength and authority? Before attempting to answer these questions we will discuss McCall Smith’s arguments in more detail as well as the main problems in current law concerning end-of-life medical decisions. he also explicitly states that there is neither a need for legislation. p. both circumstances may well. therefore. As McCall Smith states: “…if we make euthanasia a special case. The word eu-thanasia (good/easy-death) of Greek origin cannot be employed without the emergence of concomitant problems. moreover. as Brazier observes: “The uncertainties and doubts that affect public attitudes towards the euthanasia debate are compounded by misunderstanding about. nor lacks a historical connotation with serious import. He is acutely aware that such a stance might be unacceptable for both “opposed parties” in the euthanasia debate and. nor a further need for extensive clarification by the courts on the subject. 1999. and might originate due to his worries concerning the long-term consequences of legal permission of euthanasia. The term is neither transparent. in a paper of his. The source may lie elsewhere. 194). both its concepts and its empirical findings are controversial. 197). According to him. To name is to create. lead us to an understanding that fails to grasp the real question that is currently being asked (Macklin. according to his view on current law: “risks being branded as both complacent and conservative” (p. p. some influential arguments supporting the view that the current United Kingdom law on euthanasia had reached a satisfactory level. So why is he taking these risks that accompany the position of the middle ground? Anyone who is familiar with British legal cases of the last decade concerning end-of-life medical decisions cannot seriously think that his position drives from a real satisfaction with the state of the law on this issue. the current law on this issue: “…represents the achievement of a morally sensitive compromise which should be left undisturbed…which satisfies the complex needs of a delicately-nuanced problem” (1999. the relevant law” (2003. In the euthanasia debate concepts are of great importance. 439). But first we should make some preliminary remarks regarding the general nature of the euthanasia debate. we run the risk of destabilising the law of homicide” (p. p. . In the same paper. Preliminary Remarks The issue is very complex.

1999. he is liable to prosecution as is the layman” (Mason. 147 111-114. the decisions of the U.S. or starting point. rather than purely a debate for moral philosophers. their approach to gain a reliable overview of the trends and decisions of the U. Although U.S. including the most often occurring withdrawal of treatment in the case of terminally ill patients. 202). However. involving lawyers. This entails their having a very limited concept of euthanasia in mind. nor should we overlook the relevance of the moral context of the issue.S. Arguments from the Middle Ground McCall Smith’s basic presumption. Proctor. An adherent of the latter could gain some relevance in his argument. and the number of decisions within the country.S. 2002. Euthanasia involves killing.HEC Forum (2007) 19 (2): 145–159. in the legal context there is an insistence that these cases do not constitute euthanasia. and killing is prohibited. withholding treatment. McCall and Laurie. The term generally used as ‘good death’ or ‘easing the passing’ that might be applied for a wide range of end-of-life practices. If a doctor intends to kill. cases are not binding for British judges. and it is this which makes it inevitable that the debate is a legal one. in discussing the issue of euthanasia is that: “[It] cannot be considered in isolation from the broader law of homicide. But will . because of the many courts in the U. they stress the importance of autonomous decision and the restriction that results from the exceptional circumstances of a particular medical condition. lay and professional” (McCall Smith. When an end-oflife decision is legally permitted it gains a special name such as medical futility. It should be explicitly stated that the majority of proponents of the legalisation of a wider variety of end-of-life practices have the following goal in mind: they do not desire competent people who are terminally ill and who experience unbearable suffering to be deprived of the possibility to die with dignity. referred as the passive/active distinction. A widely used British textbook says: “While motive is irrelevant. p. p. but never euthanasia. 1988). insofar as he could not avoid reflecting somehow upon one of the central moral issues of the euthanasia debate. 531). it should also be added that we should neither consider it in isolation from the context of current medical practice. those occasions when the premature termination of life is the intended aim. In British legal practice the term euthanasia is preserved to denote the prohibited acts. We think no one would question the relevance of the legal context in the public debate concerning euthanasia. intention is all important. In their arguments. withdrawing treatment or palliative care. courts might raise difficulties. courts might be relevant to a certain extent. However.

Interpreting the practical meaning and consequences of the moral philosophical criticism on the passive/active distinction in the context of the euthanasia debate. We have seen how they struggled to describe the role of doctors in these cases as an omission. However. 2 All ER 449. 2002. 881)..g. on the other. similar to switching off the ventilator in the case of a patient whose life is sustained by artificial ventilation. But those cases wherein previously initiated treatment has been withdrawn could pose serious problems in the light of the passive/active distinction. it was left in place but no further nutrients were provided for the tube to convey to the patient’s stomach. and physician assisted suicide and voluntary active euthanasia. ventilation. essentially what is being done is to omit to feed or ventilate. We would agree with McCall Smith’s opinion that this distinction “does express a widespread moral intuition. B. It is relatively clear that withholding life-sustaining treatment—e. since to do so would be to introduce intolerable fine distinctions.—on request by a competent patient could be described as omission. that would not be a positive act… In my judgement. p. the mere failure to continue to do what you have previously done is not. on the one side. because the distinction is inconsistent in the light of different exemplary cases. we would not go so far as to state that it has no relevance in our everyday moral lives. This is what creates the difference between killing and letting die. In part.148 HEC Forum (2007) 19 (2): 145–159. How can we think of switching off the ventilator as a passive act when authorized by a doctor? Judges were uneasy with this distinction. It is undoubtedly a positive act. Lord Browne-Wilkinson argued: Apart from the act of removing the naso-gastric tube. cardiopulmonary resuscitation. The act is permitted because it can be described as an omission on the part of the doctor. in any ordinary sense to do anything positive. If instead of removing the naso-gastric tube. p. on the contrary it is by definition an omission to do what you have previously done…The positive act of removing the naso-gastric tube presents more difficulty. In the case of Ms. But in my judgement in neither case should the act be classified as positive. etc. this is what justifies the drawing of a boundary between withholding and withdrawing treatment. 202). and there is every reason for giving such intuitions a central role in our morality” (1999. the removal of the naso-gastric tube or the switching off a ventilator are merely incidents of that omission (B v NHS Trust. he have given adequate consideration to the context of current medical practice? The passive/active distinction plays a crucial role in distinguishing between prohibited and permitted acts in different end-of-life medical practices. we do not see why it should not be possible to give .

p. p. 149 up the absolute decisive role given to this distinction in interpreting complex end-of-life practices. p. we have some reasons to think that his answer remains unsatisfactory until he gives further justification that the ‘cautious admittance’ of another exception to the firm rule of the prohibition of killing would lead us to a worse place than . Further. He states that: … we cannot assume that gradual extensions of a principle will not bring us inexorably to a place where we can identify. McCall Smith has two different answers to this question. 205)? Would it be a serious misinterpretation to detect some inconsistency in this part of his reasoning? Maybe yes. then it is important to ensure that our criminal law embodies a firm rule that all taking of life is punishable as a serious offence. in advance. What could it mean in light of the fact that McCall Smith accepts that there could be “circumstances in which death is preferable to life” (1999.HEC Forum (2007) 19 (2): 145–159. According to McCall Smith. his or her medical condition. In its generality this would appear to be a strong argument. There are other morally relevant characteristics of endof-life practices that should play a more significant role in the final analysis. 205). p. and so forth. where the strength of the old prohibition is diminished and morally unacceptable practices of killing start to flourish without the possibility of controlling them (van der Burg. Any exception to this rule is only cautiously admitted (1999. 204). although we can easily recognize in this justification a version of the more familiar slippery slope argument. 1991. he cites the example of self-defense as the only case where the firm rule finds an exception. However. the decisive role given to the passive/active distinction is justified by the practical realities of the law of homicide: If it is the case—which it is—that we regard the prohibition against killing as a basic moral value. McCall Smith does not make it explicit. as he says: “…we cannot trust ourselves to distinguish between the meritorious and the unmeritorious” (1999. we do not wish to be…The prohibition against killing has to be absolute because the making of any exception to it will destabilise the value we currently accord to human life… (1999. and it seems that it is of the more dubious ‘apocalyptic type’: with the legalisation of assisted suicide we would start slipping into a society that radically transforms its moral and legal framework to a point whereby human life is not respected. nonetheless we should be more concerned with his second justification for the maintaining of a ‘deep prohibition’ of the taking of human life. such as the wishes of the patient. 43). Here we must ask whether it would be possible to imagine a cautious admittance of another exception. 205). p. The first answer expresses some scepticism concerning our capability to differentiate between the good and the bad.

1999. This is what we referred to previously as the context of current medical practice. current empirical findings—that focus on the question of physicians’ attitudes concerning euthanasia—demonstrate that many doctors would choose to legalize euthanasia (Meier. but they need not to describe their act. Moreover.. Kevorkian in the United States and Mr. Vincent. these findings suggest that the law regulating the issue is not satisfactory. Emmons and Wallenstein et al. Shipman in England. This leads us to our second problem. that McCall Smith seems to overlook another relevant context in the euthanasia debate besides the moral and legal one. 1268). In the concluding lines of his paper he refers to doctors thus: … [They] know full well what they are doing when they are increasing a dose of diamorphine. p. He does not cite any empirical findings that might support this opinion. the one we are at now. 1332). as an act of killing. p. then why should they be denied the comfort it affords them (McCall Smith. seem to be misplaced when surprisingly large numbers of doctors are prepared to confess in private that they have participated in active voluntary euthanasia (Zinn. to themselves or to others. they are not among those who are trying to bring about changes in the law. This seems to suggest that the physicians themselves are satisfied with the current law and that they would be eager to situate themselves in the ‘middle ground’. 2001. but if it accords with a moral distinction which is meaningful for doctors. 1998. but because it is inconsistent and uncertain within the legal context as well. We have good reason to think that it is not satisfaction with the current law that renders physicians ‘silent’ on the issue.150 HEC Forum (2007) 19 (2): 145–159. It is certain that physician assisted suicide takes place as part of health care. but rather the complexities and public misunderstandings surrounding the issue of euthanasia. 1994. . McCall Smith’s slippery slope worries. 206)? According to McCall Smith: “…it is not medical opinion which is pressing for changes in the law” (1999. 200). 9% said that they had (Ward and Tate. Peretti-Watel. 2003). not just because it is inconsistent from a moral point of view. p.. This gives us reason enough to suggest that current medical practice concerning end-of-life decisions differs from McCall Smith’s expectations. In a British study. p. Bendiane and Pegliasco et al. ergo. 1999. like Dr. nevertheless. in the light of current medical practice. namely. This approach has been described as hypocritical. when 424 doctors were asked: “Have you ever taken active steps to bring about the death of a patient who asked you to do so?”. and the controversial figures who have gained great publicity in recent years.

1993). but he didn’t think that it might kill him. He acknowledged later that the baby had hit the floor hard. The doctor who decided whether or not to administer the drug could not do his job.HEC Forum (2007) 19 (2): 145–159. by throwing him on a hard surface. as described below. Following Lord Mustill’s words: “‘mercy killing’ by active means is murder…that the doctor’s motives are kindly will for some. 1997). 151 Legal Uncertainties Deliberately taking the life of another person constitutes murder.L. there was still much for the doctor to do and he was entitled to do all that was proper and necessary to relieve pain and suffering even if the measures he took might incidentally shorten life by hours or perhaps even longer. by hours or months. although not for all. the intention is solely to produce the good effect. Adams defence was that the treatment was designed to promote comfort. The only exception to this is justified by the doctrine of double effect (DDE). Dr. even with humane motives. This is used in justification when adequate painmanagement may hasten a patient’s death. as he referred differently as to the limits of shorting life. Adams. but this makes no difference in law” (AirDale NHS Trust v Bland. that teaches us that an act which produces a bad effect is nevertheless morally permissible if: the action is good in itself. 2003. v Adams. p.. it is applicable only in cases of terminally ill patients as part of palliative care (Brazier. stated: If the first purpose of medicine—the restoration of health—could no longer be achieved. can be charged with murder. The law would also be clearer had the House of Lords in Woolin—a non-medical case—not ruled that where the consequence of an act is foreseen as virtually certain. Devlin J. 1 All ER 821. The trial judge told . Woolin killed his baby son in a burst of anger. any doctor who practices voluntary euthanasia or mercy killing. 1993. and there is sufficient reason to permit the bad effect. It overtly relies on the intention of an act. in his summing up to the jury. active euthanasia is murder according to English law. 441). and if it was the right and proper treatment. 773). although he accepted that there was a risk of injury. the good effect is not produced through the bad effect.R. v Woolin [1997]. Although the legal application of the doctrine is not crystal clear in its meaning. Mr. p. Whatever the circumstances are. The doctrine itself poses several objections that indicate the problematic character of its legal usage (Quill. Dresser and Brock. His ruling is endorsed in the case of Anthony Bland. Thus. that consequence is intended (R. 4 All ER 103). which in a clinical setting could be highly ambiguous (Quill. p. Crim. The rule regarding DDE was spelt out in the case of Dr. the fact that it shortened life did not convict him of murder (R. if he were thinking in terms of hours or months of life. 1957. 850). transform the moral quality of his act.

2). since to insist upon treatment against a patient’s wishes amounts to battery. complied with his patient’s wishes (Airdale NHS Trust v Bland. then a doctor who accedes to such a request might be said to be aiding suicide. Refusal of treatment by a competent patient is accepted. 2002). Questions and ambiguities surround suicide. as is stated in the Act: “A person who aids. All ER 465) made it clear that a mentally competent adult patient enjoys an absolute right to refuse further treatment even when refusing treatment means certain death (see also: Re MB [1997] 2 FLR 426 (1997) 38 BMLR 175 and Ms B v An NHS Hospital Trust [2002] EWHC 429). it is still not lawful. in so far as there is no right to suicide. AC 789). and as Lord Goff puts it in Bland: … there is no question of the patient having committed suicide. as Thorpe J. Since 1961—as McCall Smith remarked “before the flowering of the autonomy stressing philosophy”—it has no longer been a criminal offence to commit suicide. It is simply that the patient has. and the doctor has. 1 All ER 677). or an attempt to commit suicide. the jury that they might infer intention if they were satisfied that Mr.1 The 1961 Act does not define what suicide is. doctors would be damned if they did not and damned if they did (2002. . 270). Aiding suicide by the impersonal distribution of advice and information is not likely to attract legal sanctions. Woolin appreciated the substantial risk of serious harm by throwing the baby. And. nor therefore of the doctor having aided or abetted him in so doing. It became difficult to reconcile the Woolin case concept of intention with the application of DDE.152 HEC Forum (2007) 19 (2): 145–159. abets. as was established in the Suicide Act of that year. declined to consent to treatment which might or could have the effect of prolonging his life. As Freeman puts it: If refusal of treatment amounts to suicide. McCall Smith and Laurie. The refusal of treatment is not suicide. thus. However. stated: “…the refusal of nutrition and medical treatment in the exercise of the right of selfdetermination does not constitute an act of suicide” (Secretary of the State for Home Department v Robb. as he is entitled to do. as the individuals’ right to self-determination became the determining factor in any situation of therapeutic conflict (Mason. in accordance with his duty. The conflation of foresight and intention has already forced the Court of Appeal in the unique case of Re A into nuanced speculations to rescue doctors who separated conjoined twins. as was stated in Attorney-General v Able (1984. QB 795). p. while it is decriminalised. 1993. He was convicted of murder. shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years” (s. in the light of section 2 this could cause some uncertainties. counsels or procures the suicide of another. The Court of Appeal in Re T (1992. 1995. knowing that the weaker would die from a potential charge of murder.

Mrs. 2002. in effect. The DPP refused to give such an assurance. 266. that refusal of treatment does not involve a selfinitiated condition. Is it to be realistically expected that a doctor should always be certain what the intent of the patient is in refusing treatment? Can it be clearly evaluated? What was Ms. that if he assisted in his wife’s suicide he would not be prosecuted. and with the intention of achieving death. it is arguable that the person is. This is what the husband of Diane Pretty was asking for: a guarantee from the DPP. p. or swallow and had to be fed by tube. p. 153 Although there existed no explicit argument behind this that might support the statement that the refusal of treatment does not constitute suicide. Otlowski questions this position by pointing out: “if a person deliberately chooses not to move from the path of an avalanche. In her book on euthanasia. attention seeking. The Suicide Act of 1961 [section 2(4)] requires the consent of the Director of Public Prosecution (DPP). committing suicide” (1997. According to the law. a patient might have a variety of reasons for refusing treatment. 2002). B’s intent? Cases: Pretty. was losing all ability to use her muscles. p. 63). it is not required on the part of a doctor to respect the wish of the patient to withhold or withdraw treatment. the underlying premise could be that suicide requires an act and can not be a result of an omission (Kennedy. could barely speak. Pretty grounded her challenge upon s. so she asked for a judicial review. refusal with the intention of making a political statement.HEC Forum (2007) 19 (2): 145–159. lacks substance and results in an undesirable distortion of legal principles (p. She argued that a blanket . 69). Her application failed before the Divisional Court (2001.2 of the Suicide Act in the European Convention on Human Rights. suicide could be committed by omission also. 1976. for example: there is no worthwhile treatment for his or her medical condition. he has discretion which must be exercised “in accordance with the law” (Case of Pretty v United Kingdom. 1 FLR 268. Thus. 316). Bland and Ms. as Otlowski clearly argues: The characterisation of a patient’s refusal of treatment as falling outside the realm of suicide on the grounds that the patient lacks a specific intent to die and further. B Diane Pretty was suffering from the last stages of motor neurone disease. In practical terms. quoted in Freeman. as did her subsequent appeal to the House of Lords (2002. in the case of suicidal intent. that treatment is disproportionate to what it can achieve. All ER (D) 251). or refuses to leave a burning building. HL). 1 All ER 1. so she took her case to Strasbourg.

was drafted against the background of Nazism and the Holocaust. including rights over the individual’s own body” (p. Maybe it is possible to consider death as being an event that falls outside the life of the individual. then an individual should not be deprived of such a basic decision. namely. 2002. For reasons of brevity we shall focus upon articles 2 and 8. Lord Bingham said that: …any attempt to base a right to die on Article 8 founders exactly the same objection as the attempt based on Article 2.” Lord Bingham regarded Article 2 as embodying the traditional doctrine of the sanctity of life. Article 8 provides for the respect of private life and was widely interpreted as means of protecting a range of individual interests. moral and psychological integrity of the individual. prohibition of assisted suicide contravened her human rights. and the European Court of Human Rights accepted that her right for respect for her private life was being interfered with (paragraph 67). though it considered this justified by Article 8(2) (paragraph 78). Both the House of Lords and the European Court rejected her other challenges. 2. 8. Article 2 does not constitute a right to life. The ECHR Article 2 states that: “Everyone’s right to life shall be protected by the law. p. 9 and 14. 280). The Convention. and suicide assisted without the intervention of a physician. suicide. Therefore. nor a right to self-determination—as was interpreted by Mrs. physician-assisted suicide. The manner of one’s death should not be separated from the life cycle of a given individual. Pretty (p. although he avoids drawing the conclusion that there is a positive obligation to give .154 HEC Forum (2007) 19 (2): 145–159. it should be remembered. But for whose benefit would that be? For Diane Pretty.M. 1). 3. According to Lord Hope. if Lord Bingham accepts that Article 8 protects “the physical.R. that the alleged right would extinguish the very benefit on which it is supposedly based (p. but the dying process evidently falls within that of life. these are not benefits which derive protection from an Article framed to protect the sanctity of life (Case of Pretty v United Kingdom. 268)—and it does not state that: “an individual has a right to choose death rather than life” (p. The Divisional Court was moved by her argument based upon Article 8 (2001. 306). to make a decision about the manner of living and dying.L. It seemed to be too radical a step to interpret as a right to die. She relied on five articles. 273). 280). it would have been her last opportunity to exercise her agency. 63 B. since these have the most relevance regarding our question. Lord Hope seems to accept this argument. as he argues: Whatever the benefits which…attach to voluntary euthanasia.

the case was not without some difficulties. it had to be decided what was in his best interest (F. or for the protection of the rights and freedom of others.or non-voluntary ways of dying? Anthony Bland suffered crush injuries at Hillsborough football stadium that resulted in catastrophic and irreversible damage to his brain. Bland was not competent to decide and his family could not be appointed as guardians of their adult son. this would stretch the meaning of respect for private life too far (p. v West Berkshire Health Authority. and the law permitted the act that led to his death. for the protection of health or morals. with the concurrence of his family. For Lord Steyn the prohibition on assisted suicide is “within the range of discretion of parliament to strike the balance between the interests of the community and the rights of individuals” (p. This allows for interference by a public authority with the Article 8(1) right “in accordance with the law’ if this ‘is necessary in a democratic society in the interests of national security. 1989. As in previous medical cases concerning incompetent patients. They argued that artificial feeding constitutes treatment and a responsible body of medical opinion supports the withdrawal of treatment in cases of PVS.” The disastrous consequence they identify is abuse. Lord Goff. Pretty was able to indicate what she wanted.HEC Forum (2007) 19 (2): 145–159. is that . Pretty’s claim accorded with Article 8(1). but the law prevented her husband from doing anything about it. Tony Bland could not exercise any such autonomy. for the prevention of disorder or crime. Lord Keith and Lord Lowry’s conclusion was supported by medical opinion as well as professional guidelines on diagnosis and confirmation of PVS. 155 effect to her wish to end her own life by means of assisted suicide. where the judges had to decide upon questions of life and death as in the case of Pretty. The slippery slope worry and the protection of the weak and the vulnerable could not attain such a significant position in the jurisdiction in the Bland case. 310). a kind of slippery slope worry. which must not be shirked. public safety or the economic wellbeing of the country. The House of Lords unanimously granted the declaration. without making it explicit. 299). the hospital applied for a declaration that they might legally discontinue artificial feeding and hydrating. Lord Hope was also concerned with the need “to avoid abuse and to protect the weak and the vulnerable” (p. as Lord Mustill expressed: “The distressing truth. However. All three of the Lords who pronounced on the issue agreed that even if Mrs. In medical terminology he was in persistent vegetative state (PVS). Are we not misplacing the Rubicon when our attention is not focused upon the differences between different forms of voluntary and in. 2 All ER 545). He had existed in this condition for two years when. According to him. 310). it would fail under Article 8(2).

Since Re T the Court of Appeal has made it explicit that a mentally competent adult patient enjoys an absolute right to refuse further treatment even where refusing treatment means certain death. Pretty’s. Conclusion On suicide the law is unclear. The other aspect has to do with the slippery slope worries that—as we have seen—played a crucial role in the Pretty case. The important criteria is the evidence that refusal of treatment is free and informed (Re T. Mrs. Under current English law concerning the issue of euthanasia the decisive role given to the passive/active distinction and the doctrine of double effect is highly questionable. so she instructed her doctors to switch off the ventilator.156 HEC Forum (2007) 19 (2): 145–159. 1992. treatment not in his interests could and must be withdrawn. why is it not possible in cases of competent patients. 2 All ER 449). p. They’ve made certain safeguards and restrictions for this practice. that were acceded to because she wanted discontinuation of treatment. The potential for abuse is . She was paralysed from the neck down and could only breathe with a ventilator. Keown. on its relationship to other end-of-life decisions it is confused. As Brazier puts it: “The legerdemain by which their Lordships classified removal of a feeding tube as an omission not an act provokes charges of covert legalization of euthanasia” (2003. CA. Although the judges recognized the dangers inherent in their decision. Pretty was in a more perilous condition than Ms. 4 All ER 465. who was not in a terminal condition. 1997). p. She did not want to survive in such a condition. because she wanted active assistance with her decision to die. Pretty? The case of Ms. However. 450). If it is possible to make restrictions and safeguards that enable us to protect the weak and the vulnerable. 1993. B’s wishes. She asked for a judicial review and was held to be competent. B and was much closer to death. but it was Ms. 894). B is that of a woman who suffered a haemorrhage in the spinal column of her neck (Re B. 2002. for he has no best interests of any kind” (Quill. Thus. the proposed conduct is not in the best interests of Anthony Bland. they also saw the possibility for controlling this end-of-life practice. 1993. One is that the way the judges described the role of doctors in Bland’s death is too speculative to be acceptable both for the proponents and the opponents of the legalisation of euthanasia (Finnis. like that of Mrs. The doctors refused her request on the grounds that she was not competent. There are two problematic aspects of the Bland case that have some relevance to our argument. and not Mrs. pp. 93-95). Recovery was unlikely and rehabilitation programmes were not acceptable for her.

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