Science blog: Can you end a patients life?

What is often forgotten is that medical doctors will also receive extensive training in medical ethics, a huge topic and one that is often the subject of intense debate. In today’s blog, I will start by listing some of the top ethics questions I ask when giving mock interviews to medical students:

(1)    As a NHS doctor, can you end a patient’s life?

(2)    There are long waiting lists for some types of organ donation; how is it decided who receives a donated organ?

(3)    You are a GP and a 12 year old girl comes into your practice asking to be prescribed the pill; do you give her the prescription?

(4)    A 40 year old patient with Down’s syndrome urgently needs to undergo an extensive and risky cardiac surgery; who do you need consent from?

(5)    Under what circumstances can you break doctor-patient confidentiality?

While to answer all these questions in full I could write a short novel, so I will only touch upon the first question today. Hopefully by this point you have already realized that this question is broaching the hot topic of euthanasia, a medical ethics issues that has seen fierce arguments from both sides. When starting to answer this question, the first goal is to actually answer the question – can you end a patient’s life? In short, the answer is yes, but only under certain circumstances. What this question is probing in particular is your understanding of active versus passive euthanasia and you should be quick to define the difference when answering. Simply put, in active euthanasia, you must do something active to end a person’s life, such as providing an overdose of a drug. In passive euthanasia, you end a person’s life through the removal of some form of life support without which, life cannot be sustained.  An example of the latter would be the removal of life support devices that are keeping an otherwise brain dead patient alive (Bonus Question: who’s choice is it to remove life support for a patient like this?). There is one further clarification; assisted suicide is not the same as active euthanasia. With assisted suicide, it must be the patient themselves who administers the fatal overdose, not a medical practitioner. This is the case in Switzerland, home of the famous Dignitas clinic where many foreigners, Britons included, have gone to end their own lives. The NHS website has a good summary of what I have described for you to review as well.

For Arguments 

• The right to die: many campaigners, in the UK and abroad, believe that being able to chose how and when one dies is a fundamental human right that should be universally available
• Dignity: patients with degenerative and terminal diseases often suffer great mental anguish and physical pain as they lose their physical capabilities. Many examples in the British press can be found centred on this core argument
• Other arguments range from the libertarian (Death is a private matter and if there is no harm to others, the state and other people have no right to interfere) to the survivalist (Allowing people to die may free up scarce health resources).

These are just some of the arguments that can be found for both sides of the argument. I urge you to do your own research on the topic and learn more about some of the current issues and high profile cases currently being deliberated by the courts.

On a final note, BBC Scotland did a fantastic interview with the famous author, Terry Pratchett, called “Choosing to die”. Terry, who has been diagnosed with Alzheimer’s disease, explores the topic of euthanasia and active suicide and follows the journey of one British man who goes to Dignitas in Scotland to end his life. Ironically, the film is not available in the UK as it films an actual death, something not permitted to be broadcasted in the UK. However, you can find the whole documentary in this link. It is absolutely essential viewing for any potential future doctors, as well as for anyone with even a passing interest in ethics.