Euthanasia Definitions

y y y y

y y

the intentional killing by act or omission of a dependent human being for his or her alleged benefit. (The key word here is "intentional". If death is not intended, it is not an act of euthanasia) Voluntary euthanasia: When the person who is killed has requested to be killed. Non-voluntary: When the person who is killed made no request and gave no consent. Involuntary euthanasia: When the person who is killed made an expressed wish to the contrary. Assisted suicide: Someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. When it is a doctor who helps another person to kill themselves it is called "physician assisted suicide." Euthanasia By Action: Intentionally causing a person's death by performing an action such as by giving a lethal injection. Euthanasia By Omission: Intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water.
Euthanasia:

What Euthanasia is NOT: There is no euthanasia unless the death is intentionally caused by what was done or not done. Thus, some medical actions that are often labeled "passive euthanasia" are no form of euthanasia, since the intention to take life is lacking. These acts include not commencing treatment that would not provide a benefit to the patient, withdrawing treatment that has been shown to be ineffective, too burdensome or is unwanted, and the giving of high doses of pain-killers that may endanger life, when they have been shown to be necessary. All those are part of good medical practice, endorsed by law, when they are properly carried out.

Euthanasia and physician assisted suicide

Euthanasia is the termination of a very sick person's life in order to relieve them of their suffering. In most cases euthanasia is carried out because the person who dies asks for it, but there are cases called euthanasia where a person can't make such a request.

What is Euthanasia?
Euthanasia is the termination of a very sick person's life in order to relieve them of their suffering. A person who undergoes euthanasia usually has an incurable condition. But there are other instances where some people want their life to be ended. In many cases, it is carried out at the person's request but there are times when they may be too ill and the decision is made by relatives, medics or, in some instances, the courts. The term is derived from the Greek word euthanatos which means easy death. Euthanasia is against the law in the UK where it is illegal to help anyone kill themselves. Voluntary euthanasia or assisted suicide can lead to imprisonment of up to 14 years. The issue has been at the centre of very heated debates for many years and is surrounded by religious, ethical and practical considerations. The ethics of euthanasia Euthanasia raises a number of agonising moral dilemmas: y is it ever right to end the life of a terminally ill patient who is undergoing severe pain and suffering? y y under what circumstances can euthanasia be justifiable, if at all? is there a moral difference between killing someone and letting them die? At the heart of these arguments are the different ideas that people have about the meaning and value of human existence. Should human beings have the right to decide on issues of life and death? There are also a number of arguments based on practical issues. Some people think that euthanasia shouldn't be allowed, even if it was morally right, because it could be abused and used as a cover for murder. Killing or letting die

Euthanasia can be carried out either by taking actions, including giving a lethal injection, or by not doing what is necessary to keep a person alive (such as failing to keep their feeding tube going). 'Extraordinary' medical care It is not euthanasia if a patient dies as a result of refusing extraordinary or burdensome medical treatment. Euthanasia and pain relief It's not euthanasia to give a drug in order to reduce pain, even though the drug causes the patient to die sooner. This is because the doctor's intention was to relieve the pain, not to kill the patient. This argument is sometimes known as the Doctrine of Double Effect. Mercy killing Very often people call euthanasia 'mercy killing', perhaps thinking of it for someone who is terminally ill and suffering prolonged, unbearable pain. Why people want euthanasia Most people think unbearable pain is the main reason people seek euthanasia, but some surveys in the USA and the Netherlands showed that less than a third of requests for euthanasia were because of severe pain. Terminally ill people can have their quality of life severely damaged by physical conditions such as incontinence, nausea and vomiting, breathlessness, paralysis and difficulty in swallowing. Psychological factors that cause people to think of euthanasia include depression, fearing loss of control or dignity, feeling a burden, or dislike of being dependent.

Ethical problems of euthanasia

Does an individual who has no hope of recovery have the right to decide how and when to end their life? Why euthanasia should be allowed Those in favour of euthanasia argue that a civilised society should allow people to die in dignity and without pain, and should allow others to help them do so if they cannot manage it on their own. They say that our bodies are our own, and we should be allowed to do what we want with them. So it's wrong to make anyone live longer than they want. In fact making people go on

living when they don't want to violates their personal freedom and human rights.It's immoral, they say to force people to continue living in suffering and pain. They add that as suicide is not a crime, euthanasia should not be a crime. Why euthanasia should be forbidden Religious opponents of euthanasia believe that life is given by God, and only God should decide when to end it. Other opponents fear that if euthanasia was made legal, thelaws regulating it would be abused, and people would be killed who didn't really want to die. The legal position Euthanasia is illegal in most countries, although doctors do sometimes carry out euthanasia even where it is illegal. Euthanasia is illegal in Britain. To kill another person deliberately is murder or manslaughter, even if the other person asks you to kill them. Anyone doing so could potentially face 14 years in prison. Under the 1961 Suicide Act, it is also a criminal offence in Britain, punishable by 14 years' imprisonment, to assist, aid or counsel somebody in relation to taking their own life. Nevertheless, the authorities may decide not to prosecute in cases of euthanasia after taking into account the circumstances of the death. In September 2009 the Director of Public Prosecutions was forced by an appeal to the House of Lords to make public the criteria that influence whether a person is prosecuted. The factors put a large emphasis on the suspect knowing the person who died and on the death being a one-off occurrence in order to avoid a prosecution. (Legal position stated at September 2009) Changing attitudes The Times (24 January 2007) reported that, according to the 2007 British Social Attitudes survey, 80% of the public said they wanted the law changed to give terminally ill patients the right to die with a doctor's help. In the same survey, 45% supported giving patients with non-terminal illnesses the option of euthanasia. "A majority" was opposed to relatives being involved in a patient's death.

Key terms and definitions

Active euthanasia In active euthanasia a person directly and deliberately causes the patient's death. Assisted suicide This is when the person who wants to die needs help to kill themselves, asks for it and receives it. Competence A competent patient is one who understands his or her medical condition, what the likely future course of the disease is, and the risks and benefits associated with the treatment of the condition; and who can communicate their wishes. Dignity The value that a human being has simply by existing, not because of any property or action of an individual. DNR Abbreviation for Do Not Resuscitate. Instruction telling medical staff not to attempt to resuscitate the patient if the patient has a heart attack. Doctrine of Double Effect Ethical theory that allows the use of drugs that will shorten life, if the primary aim is only to reduce pain. Futile treatment Treatment that the health care team think will be completely ineffective. Indirect euthanasia This means providing treatment (usually to reduce pain) that has the foreseeable side effect of causing the patient to die sooner. Involuntary euthanasia This occurs when the person who dies wants to live but is killed anyway. It is usually the same thing as murder. Living will A document prepared by an individual in which they state what they want in regard to medical treatment and euthanasia.

Non-voluntary euthanasia This is where the person is unable to ask for euthanasia (perhaps they are unconscious or otherwise unable to communicate), or to make a meaningful choice between living and dying and an appropriate person takes the decision on their behalf, perhaps in accordance with their living will, or previously expressed wishes. Palliative care Medical, emotional, psychosocial, or spiritual care given to a person who is terminally ill and which is aimed at reducing suffering rather than curing. Passive euthanasia In passive euthanasia death is brought about by an omission - i.e. by withdrawing or withholding treatment in order to let the person die. PAS Abbreviation for Physician Assisted Suicide. Voluntary euthanasia This is where euthanasia is carried out at the request of the person who dies.

Forms of euthanasia
Euthanasia comes in several different forms, each of which brings a different set of rights and wrongs. Active and passive euthanasia In active euthanasia a person directly and deliberately causes the patient's death. In passive euthanasia they don't directly take the patient's life, they just allow them to die. This is a morally unsatisfactory distinction, since even though a person doesn't 'actively kill' the patient, they are aware that the result of their inaction will be the death of the patient. Active euthanasia is when death is brought about by an act - for example when a person is killed by being given an overdose of pain-killers. Passive euthanasia is when death is brought about by anomission - i.e. when someone lets the person die. This can be by withdrawing or withholding treatment: y Withdrawing treatment: for example, switching off a machine that is keeping a person alive, so that they die of their disease.

Withholding treatment: for example, not carrying out surgery that will extend life for a short time. Traditionally, passive euthanasia is thought of as less bad than active euthanasia. But some people think active euthanasia is morally better. Read more about the ethics of passive and active euthanasia Voluntary and involuntary euthanasia Voluntary euthanasia occurs at the request of the person who dies. Non-voluntary euthanasia occurs when the person is unconscious or otherwise unable (for example, a very young baby or a person of extremely low intelligence) to make a meaningful choice between living and dying, and an appropriate person takes the decision on their behalf. Non-voluntary euthanasia also includes cases where the person is a child who is mentally and emotionally able to take the decision, but is not regarded in law as old enough to take such a decision, so someone else must take it on their behalf in the eyes of the law. Involuntary euthanasia occurs when the person who dies chooses life and is killed anyway. This is usually called murder, but it is possible to imagine cases where the killing would count as being for the benefit of the person who dies. Read more about the ethics of voluntary and involuntary euthanasia Indirect euthanasia This means providing treatment (usually to reduce pain) that has the side effect of speeding the patient's death. Since the primary intention is not to kill, this is seen by some people (but not all) as morally acceptable. A justification along these lines is formally called the doctrine of double effect. Assisted suicide This usually refers to cases where the person who is going to die needs help to kill themselves and asks for it. It may be something as simple as getting drugs for the person and putting those drugs within their reach.

Voluntary and involuntary euthanasia

Voluntary euthanasia

The person wants to die and says so. This includes cases of: y y y y y asking for help with dying refusing burdensome medical treatment asking for medical treatment to be stopped, or life support machines to be switched off refusing to eat simply deciding to die Non-voluntary euthanasia The person cannot make a decision or cannot make their wishes known. This includes cases where: y y y y y y the person is in a coma the person is too young (eg a very young baby) the person is senile the person is mentally retarded to a very severe extent the person is severely brain damaged the person is mentally disturbed in such a way that they should be protected from themselves Involuntary euthanasia The person wants to live but is killed anyway.This is usually murder but not always. Consider the following examples: y A soldier has their stomach blown open by a shell burst. They are in great pain and screaming in agony. They beg the army doctor to save their life. The doctor knows that they will die in ten minutes whatever happens. As he has no painkilling drugs with him he decides to spare the soldier further pain and shoots them dead. y A person is seen at a 10th floor window of a burning building. Their clothes are on fire and fire brigade has not yet arrived. The person is screaming for help. A passer by nearby realises that within seconds the person will suffer an agonising death from burns. He has a rifle with him and shoots the screaming person dead. y A man and a woman are fleeing from a horde of alien monsters notorious for torturing human beings that they capture. They fall into a pit dug to catch them. As the monsters lower their tentacles into the pit to drag the man out he begs the woman to do something to save him. She shoots him, and then kills herself. The morality of these and similar cases is left for the reader to think about.

Active and passive euthanasia

Active euthanasia Active euthanasia occurs when the medical professionals, or another person, deliberately do something that causes the patient to die. Passive euthanasia Passive euthanasia occurs when the patient dies because the medical professionals either don't do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive. y y y y switch off life-support machines disconnect a feeding tube don't carry out a life-extending operation don't give life-extending drugs The moral difference between killing and letting die Many people make a moral distinction between active and passive euthanasia. They think that it is acceptable to withhold treatment and allow a patient to die, but that it is never acceptable to kill a patient by a deliberate act. Some medical people like this idea. They think it allows them to provide a patient with the death they want without having to deal with the difficult moral problems they would face if they deliberately killed that person. Thou shalt not kill but needst not strive, officiously, to keep alive. Arthur Hugh Clough (1819-1861) There is no real difference But some people think this distinction is nonsense, since stopping treatment is a deliberate act, and so is deciding not to carry out a particular treatment. Switching off a respirator requires someone to carry out the action of throwing the switch. If the patient dies as a result of the doctor switching off the respirator then although it's certainly true that the patient dies from lung cancer (or whatever), it's also true that the immediate cause of their death is the switching off of the breathing machine. y in active euthanasia the doctor takes an action with the intention that it will cause the patient's death y in passive euthanasia the doctor lets the patient die

when a doctor lets someone die, they carry out an action with the intention that it will cause the patient's death

so there is no real difference between passive and active euthanasia, since both have the same result: the death of the patient on humanitarian grounds

thus the act of removing life-support is just as much an act of killing as giving a lethal injection Is active euthanasia morally better? Some (mostly philosophers) go even further and say that active euthanasia is morally better because it can be quicker and cleaner, and it may be less painful for the patient.
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Acts and omissions

This is one of the classic ideas in ethics. It says that there is a moral difference between carrying out an action, and merely omitting to carry out an action. Simon Blackburn explains it like this in the Oxford Dictionary of Philosophy: The doctrine that it makes an ethical difference whether an agent actively intervenes to bring about a result, or omits to act in circumstances in which it is foreseen that as a result of the omission the same result occurs. Thus suppose I wish you dead, if I act to bring about your death I am a murderer, but if I happily discover you in danger of death, and fail to act to save you, I am not acting, and therefore, according to the doctrine, not a murderer. Simon Blackburn, Oxford Dictionary of Philosophy But the acts and omissions doctrine doesn't always work... The killings in the bath The philosopher James Rachels has an argument that shows that the distinction between acts and omissions is not as helpful as it looks. Consider these two cases: y y Smith will inherit a fortune if his 6 year old cousin dies. One evening Smith sneaks into the bathroom where the child is having his bath and drowns the boy. y y y Smith then arranges the evidence so that it looks like an accident. Jones will inherit a fortune if his 6 year old cousin dies. One evening Jones sneaks into the bathroom where the child is having his bath.

As he enters the bathroom he sees the boy fall over, hit his head on the side of the bath, and slide face-down under the water.

Jones is delighted; he doesn't rescue the child but stands by the bath, and watches as the child drowns. According to the doctrine of acts and omissions Smith is morally guiltier than Jones, since he actively killed the child, while Jones just allowed the boy to die. In law Smith is guilty of murder and Jones isn't guilty of anything. However, most people would regard any distinction between their moral guilt as splitting hairs. Suppose Jones defends himself by saying: I didn't do anything except just stand there and watch the child drown. I didn't kill him; I only let him die. Would we be impressed? An objection to this analogy

for their patient with Smith and Jones who are obvious villains. Of course you can't. But if you don't find the difference between killing and letting die persuasive in the Smith/Jones case, you shouldn't find it effective in the case of the wellmeaning doctor and euthanasia. The importance of intention The Smith/Jones case partly depends on us paying no attention to the intentions of Smith and Jones. But in most cases of right and wrong we do think that intention matters, and if we were asked, we would probably say that Smith was a worse person than Jones, because he intended to kill. Consider this case (and yes, it's a fantasy, doctors don't behave like this): y y y Brown is rushed into hospital after being stabbed. He arrives in casualty. Although he is bleeding heavily, he could be saved. The only doctor on duty wants to go home, and knows that saving Brown will take him an hour. y y He decides to let Brown bleed to death. Brown dies a few minutes later.

ou might argue that we can't compare the case of a doctor who is trying to do their best

Brown's mother arrives, and on learning what has happened screams at the doctor, "You killed my son!"

The doctor replies, "No I didn't. I just let him die." No-one would think that the doctor's reply excused him in any way. In this case letting someone die is morally very bad indeed. And if the lazy doctor defended himself to Brown's mother by saying, "I didn't kill him. The dagger in his heart killed him," we wouldn't think this an adequate moral argument either. You can probably invent many similar examples. But there are cases where letting someone die might not be morally bad. Suppose that the reason the doctor didn't save Brown was that he was already in the middle of saving Green, and if he left Green to save Brown, Green would die. In that case, we might think that the doctor had a good defence against accusations of unethical behaviour. Further reading James Rachels, 'Active and Passive Euthanasia'. The New England Journal of Medicine, Vol. 292, pp 78-80, 1975
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Preferring active to passive euthanasia

This section is written from the presumption that there are occasions when euthanasia is morally OK. If you believe that euthanasia is always wrong, then this section is not worth reading. Active euthanasia is morally better because it can be quicker and cleaner, and it may be less painful for the patient. Doctors faced with the problem of an incurable patient who wants to die have often felt it was morally better to withdraw treatment from a patient and let the patient die than to kill the patient (perhaps with a lethal injection). But some philosophers think that active euthanasia is in fact the morally better course of action. Here's a case to consider: y y A is dying of incurable cancer. A will die in about 7 days.

y y y y

A is in great pain, despite high doses of painkilling drugs. A asks his doctor to end it all. If the doctor agrees, she has two choices about what to do:
The doctor stops giving A the drugs that are keeping him alive, but continues pain killers - A dies 3 days later, after having been in pain despite the doctor's best efforts.

The doctor gives A a lethal injection - A becomes unconscious within seconds and dies within an hour.

Let's suppose that the reason A wants to die is because he wants to stop suffering pain, and that that's the reason the doctor is willing to allow euthanasia in each case. Active euthanasia reduces the total amount of pain A suffers, and so active euthanasia should be preferred in this case. To accept this argument we have to agree that the best action is one the which causes the greatest happiness (or perhaps the least unhappiness) for the patient (and perhaps for the patient's relatives and carers too). Not everyone would agree that this is the right way to argue. We can look at this situation is another way: y y y Causing death is a great evil if death is a great evil. A lesser evil should always be preferred to a greater evil. If passive euthanasia would be right in this case then the continued existence of the patient in a state of great pain must be a greater evil than their death. y So allowing the patient to continue to live in this state is a greater evil than causing their death. y y Causing their death swiftly is a lesser evil than allowing them to live in pain. Active euthanasia is a lesser evil than passive euthanasia. But this still won't satisfy some people. James Rachels has offered some other arguments that work differently. Do as you would be done by The rule that we should treat other people as we would like them to treat us also seems to support euthanasia, if we would want to be put out of our misery if we were in A's position. But this isn't necessarily so: y A person might well not want to be killed even in this situation, if their beliefs or opinions were not against active euthanasia. y There are many examples of people who have accepted appalling pain for their beliefs.

Only rules that apply to everyone can be accepted One well-known ethical principle says that we should only be guided by moral principles that we would accept should be followed by everyone. If we accept that active euthanasia is wrong, then we accept as a universal rule that people should be permitted to suffer severe pain before death if that is the consequence of their disease.

DNR - Do Not Resuscitate

DNRs are Do Not Resuscitate orders. A DNR order on a patient's file means that a doctor is not required to resuscitate a patient if their heart stops and is designed to prevent unnecessary suffering. The usual circumstances in which it is appropriate not to resuscitate are: y y y when it will not restart the heart or breathing when there is no benefit to the patient when the benefits are outweighed by the burdens Although DNRs can be regarded as a form of passive euthanasia, they are not controversial unless they are abused, since they are intended to prevent patients suffering pointlessly from the bad effects that resuscitation can cause: broken ribs, other fractures, ruptured spleen, brain damage. Proper use of DNRs Guidelines issued by the British Medical Association and the Royal College of Nursing say that DNR orders should only be issued after discussion with patients or their family. Although it may be difficult to have discussions with patients and their relatives about whether to revive or not, doctors accept that this is no reason why discussions should not take place. The most difficult cases for discussion are usually those involving patients who know they were going to die, are suffering a lot of pain, but who could live for several months. Dr Robin Loveday, a consultant says, "that is the situation where you really need a lot of discussion with the patient and their relatives to help them make a decision as to whether, if they do suffer a cardiac arrest, it is appropriate to have another go to give them a few more months of life." Guidelines

The UK medical profession has quite wide guidelines for circumstances in which a DNR may be issued: y y if a patient's condition is such that resuscitation is unlikely to succeed if a mentally competent patient has consistently stated or recorded the fact that he or she does not want to be resuscitated y if there is advanced notice or a living will which says the patient does not want to be resuscitated y if successful resuscitation would not be in the patient's best interest because it would lead to a poor quality of life In the UK, NHS Trusts must ensure: y y y y an agreed resuscitation policy that respects patients' rights is in place a non-executive director is identified to oversee implementation of policy the policy is readily available to patients, families and carers the policy is put under audit and regularly monitored Abuse of DNRs The clear guidelines on DNRs had to be firmly restated in 2000, after a number of seemingly healthy patients discovered they had 'do not resuscitate' or DNR orders written in their medical notes without consultation with them or their relatives. There was further concern when it emerged that junior doctors had sometimes made DNR decisions because senior doctors were unavailable. 67 year-old Jill Baker found she had had a DNR order written on her medical notes without her consent. "She was understandably distressed by this as no discussion had taken place with her or her next of kin," said a doctor. BBC News 27 June, 2000 Age Concern warned that the UK's elderly feared they were at risk of not being revived simply because of their age. Arguing that DNRs might be a form of ageism in the NHS, a spokeseman said "Age Concern will not rest until the 'writing off' of patients' lives on the basis of their age has been stamped out."

The doctrine of double effect

This doctrine says that if doing something morally good has a morally bad side-effect it's ethically OK to do it providing the bad side-effect wasn't intended. This is true even if you foresaw that the bad effect would probably happen.

The principle is used to justify the case where a doctor gives drugs to a patient to relieve distressing symptoms even though he knows doing this may shorten the patient's life. This is because the doctor is not aiming directly at killing the patient - the bad result of the patient's death is a side-effect of the good result of reducing the patient's pain. Many doctors use this doctrine to justify the use of high doses of drugs such as morphine for the purpose of relieving suffering in terminally-ill patients even though they know the drugs are likely to cause the patient to die sooner. Factors involved in the doctrine of double effect y The good result must be achieved independently of the bad one: For the doctrine to apply, the bad result must not be the means of achieving the good one. So if the only way the drug relieves the patient's pain is by killing him, the doctrine of double effect doesn't apply. y The action must be proportional to the cause: If I give a patient a dose of drugs so large that it is certain to kill them, and that is also far greater than the dose needed to control their pain, I can't use the Doctrine of Double Effect to say that what I did was right. y The action must be appropriate (a): I also have to give the patient the right medicine. If I give the patient a fatal dose of pain-killing drugs, it's no use saying that my intention was to relieve their symptoms of vomiting if the drug doesn't have any effect on vomiting. y The action must be appropriate (b): I also have to give the patient the right medicine for their symptoms. If I give the patient a fatal dose of pain-killing drugs, it's no use saying that my intention was to relieve their symptoms of pain if the patient wasn't suffering from pain but from breathlessness. y The patient must be in a terminal condition: If I give the patient a fatal dose of painkilling drugs and they would have recovered from their disease or injury if I hadn't given them the drugs, it's no use saying that my intention was to relieve their pain. And that applies even if there was no other way of controlling their pain. Problems with the doctrine of double effect Some philosophers think this argument is too clever for its own good. y We are responsible for all the anticipated consequences of our actions: If we can foresee the two effects of our action we have to take the moral responsibility for both effects - we can't get out of trouble by deciding to intend only the effect that suits us. y Intention is irrelevant: Some people take the view that it's sloppy morality to decide the rightness or wrongness of an act by looking at the intention of the doctor. They think

that some acts are objectively right or wrong, and that the intention of the person who does them is irrelevant. But most legal systems regard the intention of a person as a vital element in deciding whether they have committed a crime, and how serious a crime, in cases of causing death. y Death is not always bad - so double effect is irrelevant:Other philosophers say that the Doctrine of Double Effect assumes that we think that death is always bad. They say that if continued life holds nothing for the patient but the negative things of pain and suffering, then death is a good thing, and we don't need to use the doctrine of double effect. y Double effect can produce an unexpected moral result: If you do think that a quicker death is better than a slower one then the Doctrine of Double Effect shows that a doctor who intended to kill the patient is morally superior to a doctor who merely intended to relieve pain. The Sulmasy test Daniel P. Sulmasy has put forward a way for a doctor to check what their intention really is. The doctor should ask himself, "If the patient were not to die after my actions, would I feel that I had failed to accomplish what I had set out to do?"

Religion and euthanasia

Religions and death Death is one of the most important things that religions deal with. All faiths offer meaning and explanations for death and dying; all faiths try to find a place for death and dying within human experience. For those left behind when someone dies religions provide rituals to mark death, and ceremonies to remember those who have died. Religions provide understanding and comfort for those who are facing death. Religions regard understanding death and dying as vital to finding meaning in human life. Dying is often seen as an occasion for getting powerful spiritual insights as well as for preparing for whatever afterlife may be to come. So it's not surprising that all faiths have strong views on euthanasia. Religious views on euthanasia: y y Buddhism Christian

y y y y y

Roman Catholic Hindu Islam Judaism Sikhism Religions and euthanasia Most religions disapprove of euthanasia. Some of them absolutely forbid it. The Roman Catholic church, for example, is one of the most active organisations in opposing euthanasia. Virtually all religions state that those who become vulnerable through illness or disability deserve special care and protection, and that proper end of life care is a much better thing than euthanasia. Religions are opposed to euthanasia for a number of reasons. God has forbidden it

virtually all religions with a supreme God have a command from God in their scriptures that says 'you must not kill'

y y

this is usually interpreted as meaning 'you must not kill innocent human beings' this rules out euthanasia (and suicide) as well as murder, as carrying out any of these would be against God's orders, and would be an attack on the sovereignity of God Human life is sacred

y y y

human lives are special because God created them therefore human life should be protected and preserved, whatever happens therefore we shouldn't interfere with God's plans by shortening human lives Human life is special

y y y y y y

human beings are made in God's image therefore they have a special value and dignity this value doesn't depend on the quality of a particular life taking a life violates that special value and dignity
even if it's one's own life even if that life is full of pain and suffering

Eastern religions

Some Eastern religions take a different approach. The key ideas in their attitudes to death are achieving freedom from mortal life, and not-harming living beings. Euthanasia clearly conflicts with the second of these, and it interferes with the first. Freedom from mortal life y Hinduism and Buddhism see mortal life as part of a continuing cycle in which we are born, live, die, and are reborn over and over again y the ultimate aim of each being is to get free of this cycle, and so be completely liberated from the material world y during each cycle of life and death human beings make progress towards their ultimate liberation y how they live and how they die play a vital part in deciding what their next life will be, and so in shaping their journey to liberation y shortening life interferes with the working out of the laws that govern this process (the laws of karma), and so interferes with a human being's journey to liberation Warning: this 'explanation' is very over-simplified; there's much more to these religious ideas than is written here. Non-harm - the principle of ahimsa y Hinduism and Buddhism regard all life (not just human life) as involved in the process above y y therefore they say that we should try to avoid harming living things this rules out killing people, even if they want to die The sanctity of life Religious people often refer to the sanctity of life, or say that human life is sacred. They usually mean something like this: God gives people life, so only God has the right to take it away. You can look at that sentence in several ways. Here are three: y y y y y y God gave us our lives we owe our lives to God God is the final authority over our lives we must not interfere in the ending of our lives God is intimately involved in our lives God was intimately involved in our births

y y y y y y y

God will be intimately involved in our deaths it would be wrong to try and shut God out of our dying we should not interfere in the way God has chosen for our lives to end God gave us our lives we are only stewards of our bodies, and are responsible to God for them we must use our bodies as God intended us to we must allow our lives (our stewardship) to end at the time and in the way God wants

General Christian view

Christians are mostly against euthanasia. The arguments are usually based on the beliefs that life is given by God, and that human beings are made in God's image. Some churches also emphasise the importance of not interfering with the natural process of death. Life is a gift from God y y all life is God-given birth and death are part of the life processes which God has created, so we should respect them y therefore no human being has the authority to take the life of any innocent person, even if that person wants to die Human beings are valuable because they are made in God's image y human life possesses an intrinsic dignity and value because it is created by God in his own image for the distinctive destiny of sharing in God's own life y
saying that God created humankind in his own image doesn't mean that people actually look like God, but that people have a unique capacity for rational existence that enables them to see what is good and to want what is good

y y y

as people develop these abilities they live a life that is as close as possible to God's life of love this is a good thing, and life should be preserved so that people can go on doing this

to propose euthanasia for an individual is to judge that the current life of that individual is not worthwhile

such a judgement is incompatible with recognising the worth and dignity of the person to be killed

y y

therefore arguements based on the quality of life are completely irrelevant nor should anyone ask for euthanasia for themselves because no-one has the right to value anyone, even themselves, as worthless

The process of dying is spiritually important, and should not be disrupted y y Many churches believe that the period just before death is a profoundly spiritual time They think it is wrong to interfere with the process of dying, as this would interrupt the process of the spirit moving towards God All human lives are equally valuable Christians believe that the intrinsic dignity and value of human lives means that the value of each human life is identical. They don't think that human dignity and value are measured by mobility, intelligence, or any achievements in life. Valuing human beings as equal just because they are human beings has clear implications for thinking about euthanasia: y patients in a persistent vegetative state, although seriously damaged, remain living human beings, and so their intrinsic value remains the same as anyone else's y so it would be wrong to treat their lives as worthless and to conclude that they 'would be better off dead' y patients who are old or sick, and who are near the end of earthly life have the same value as any other human being y people who have mental or physical handicaps have the same value as any other human being Exceptions and omissions Some features of Christianity suggest that there are some obligations that go against the general view that euthanasia is a bad thing: y y y y Christianity requires us to respect every human being If we respect a person we should respect their decisions about the end of their life We should accept their rational decisions to refuse burdensome and futile treatment Perhaps we should accept their rational decision to refuse excessively burdensome treatment even if it may provide several weeks more of life End of life care The Christian faith leads those who follow it to some clear-cut views about the way terminally ill patients should be treated: y y y the community should care for people who are dying, and for those who are close to them the community should provide the best possible palliative care the community should face death and dying with honesty and support

the community should recognise that when people suffer death on earth they entrust their future to the risen Christ

religious people, both lay and professional, should help the terminally ill to prepare for death

y y

they should be open to their hopes and fears they should be open to discussion
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The Roman Catholic view

Euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. Pope John Paul II, Evangelium Vitae, 1995 The Roman Catholic church regards euthanasia as morally wrong. It has always taught the absolute and unchanging value of the commandment "You shall not kill". The church has said that: nothing and no one can in any way permit the killing of an innocent human being, whether a foetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. Pope John Paul II has spoken out against what he calls a 'culture of death' in modern society, and said that human beings should always prefer the way of life to the way of death. The church regards any law permitting euthanasia as an intrinsically unjust law. The value of life Life is a thing of value in itself; it's value doesn't depend on the extent that it brings pleasure and well-being. This means that suffering and pain do not stop life being valuable, and are not a reason for ending life. The church believes that each person should enter the dying process with all its mysteries with trust in God and in solidarity with their fellow human beings; they should die with the dignity of letting themselves be loved unconditionally. As Catholic leaders and moral teachers, we believe that life is the most basic gift of a loving God--a gift over which we have stewardship but not absolute dominion. National Conference of Catholic Bishops (USA), 1991

The right to die The Roman Catholic church does not accept that human beings have a right to die. Human beings are free agents, but their freedom does not extend to the ending of their own lives. Euthanasia and suicide are both a rejection of God's absolute sovereignty over life and death. The church believes that each human life is a manifestation of God in the world, a sign of his presence, a trace of his glory. "The life which God offers to man is a gift by which God shares something of himself with his creature." A human being who insists that they have the 'right to die' is denying the truth of their fundamental relationship with God. Refusing aggressive medical treatment The church regards it as morally acceptable to refuse extraordinary and aggressive medical means to preserve life. Refusing such treatment is not euthanasia but a proper acceptance of the human condition in the face of death. Assisting suicide Since it is morally wrong to commit suicide it is morally wrong to help someone commit suicide. True compassion leads to sharing another's pain; it does not kill the person whose suffering we cannot bear. Pope John Paul II, Evangelium Vitae, 1995

Euthanasia and suicide in Islam Muslims are against euthanasia. They believe that all human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this. Life is sacred Euthanasia and suicide are not included among the reasons allowed for killing in Islam. Do not take life, which Allah made sacred, other than in the course of justice. Qur'an 17:33 Allah decides how long each of us will live

When their time comes they cannot delay it for a single hour nor can they bring it forward by a single hour. Qur'an 16:61 And no person can ever die except by Allah's leave and at an appointed term. Qur'an 3:145 Suicide and euthanasia are explicitly forbidden Destroy not yourselves. Surely Allah is ever merciful to you. Qur'an 4:29 The Prophet said: "Amongst the nations before you there was a man who got a wound, and growing impatient (with its pain), he took a knife and cut his hand with it and the blood did not stop till he died. Allah said, 'My Slave hurried to bring death upon himself so I have forbidden him (to enter) Paradise.' " Sahih Bukhari 4.56.669

Is there a duty to die?

Is there a duty to die? It sounds an odd question - most of us would say 'no', except perhaps for military and similar personnel in certain circumstances. After all, when we say someone did their duty when they gave up their life to save others, we often mean that they did an act of heroism, well beyond the call of duty. But some cultures, and some modern thinkers, think that there is a duty on a person to die in certain circumstances. The ideas of John Hardwig The philosopher John Hardwig re-opened this debate with an article in 1997. He says that an individual is not the only person who will be affected by decisions over whether they live or die. So, when deciding whether to live or die, a person should not consider only themselves; they should also consider their family and the people who love them. What produces a duty to die? Hardwig thinks that we may have a duty to die when the burden of caring for us seriously compromises the lives of those who love us: y y y they may be physically exhausted by caring for us they may be emotionally exhausted by caring for us they may be financially destroyed by the cost of our healthcare

y y y

they may be financially destroyed by having to give up work to care for us their home may become a place of grief and sickness other family members may be neglected as all attention is focussed on us Hardwig says that there are no general rules - each case will be different, and he openly admits I can readily imagine that, through cowardice, rationalisation, or failure of resolve, I will fail in this obligation to protect my loved ones. If so, I think I would need to be excused or forgiven for what I did. John Hardwig Nor does Hardwig think that a person should make their final decision without consulting their family - although he points out the difficulties in doing this. What makes a duty to die more likely? He goes on to list various features of a person's situation that make it more likely that they have a duty to die:

a duty to die is more likely when continuing to live will impose significant burdens on our family and loved ones

y y y

a duty to die becomes greater as we grow older, because we will sacrifice less of our life a duty to die is more likely if we have already lived a full life there is a greater duty to die if our loved ones' lives have already been difficult or impoverished

a duty to die is more likely if our loved ones have already made great contributions or sacrifices to make our life a good one

y y

the duty to die is reduced if we can adapt well to our disease or disability the duty to die is reduced if we still make significant contributions (not just money) to the lives of others

a duty to die is more likely when the part of us that is loved will soon be gone or seriously compromised

there is a greater duty to die to the extent that we have lived a relatively lavish lifestyle instead of saving for illness or old age It is one of the tragedies of our lives that someone who wants very much to live can nevertheless have a duty to die. John Hardwig

Futile, extraordinary or burdensome medical treatment

Futile, extraordinary or burdensome medical treatment Euthanasia is not the same thing as refusing burdensome medical treatment. Refusing such treatment can be seen as allowing the dying to die in an appropriate way, which is not the same thing as causing the death of the living. But what is burdensome medical treatment? There is no standard answer; each case should be looked at separately, balancing the amount of pain and suffering involved against the amount of good to be done. The issue is not the value of the life of the person concerned, but the value of the treatment to that person. The sorts of treatment that can be stopped or refused because it's burdensome would include: y y experimental treatment treatment where the unpleasant side-effects are completely out of proportion to any possible benefit y
In 1980 the Sacred Congregation for the Doctrine of the Faith suggested that treatment for a dying patient should be proportionate to the therapeutic effect to be expected, and should not be disproportionately painful, intrusive, risky, or costly, in the circumstances.

futile treatment that doesn't have any reasonable chance of doing good - other than keeping the patient from dying

treatment that causes great suffering to the patient - and makes their overall situation worse

y y

treatment that causes great suffering to those who love the patient heroic treatment - which the medics carry out for their own sakes Objections to this sort of treatment are much more common when the patient is close to death, and are also raised when a patient is in a persistent vegetative state and could continue to live in a coma for many years with treatment. This latter case is always controversial. Experimental procedures These are always extraordinary, but what is experimental in one year is standard a year or two later.

So in 2002 accepting an artificial heart would be be extraordinary and probably burdensome - because it would be a highly experimental procedure - but using a ventilator would be a standard procedure, and would only be burdensome if there were other factors involved.

What is a good death?

What is a good death? In a Gallup poll in America, more than 70% of individuals surveyed feared dying in pain or alone without the chance to say good-bye. Twelve principles The authors of The future of health and care of older people: the best is yet to come [London: Age Concern, 1999] set down 12 principles of a good death: y y y y y y y y y y y y to know when death is coming, and to understand what can be expected to be able to retain control of what happens to be afforded dignity and privacy to have control over pain relief and other symptom control to have choice and control over where death occurs (at home or elsewhere) to have access to information and expertise of whatever kind is necessary to have access to any spiritual or emotional support required to have access to hospice care in any location, not only in hospital to have control over who is present and who shares the end to be able to issue advance directives which ensure wishes are respected to have time to say goodbye, and control over other aspects of timing to be able to leave when it is time to go, and not to have life prolonged pointlessly Nine key issues An article in the Journal of the American Medical Association (Vol. 284 No. 19, November 15, 2000) found that there is no one definition of a good death; quality end-of-life care is a dynamic process that is negotiated and renegotiated among patients, families, and health care professionals. The article ranked the key issues for patients like this (most important at the top): y y y freedom from pain at peace with God presence of family

y y y y y y

mentally aware treatment choices followed finances in order feel life was meaningful resolve conflicts die at home The article showed that patients highly valued attention to spirituality; in particular, the importance of coming to peace with God and praying. Achieving peace with God and pain control were nearly identical in importance for patients and bereaved family members. However the survey found that for some patients it was more important to resolve faith issues with themselves rather than to take part in social or interpersonal expressions of spirituality.

Assisted Dying Bill: Clarification

Latest: Clarification on assisted suicide law and Scottish Parliament bill, 2009 After a number of legal challenges by Debbie Purdy, a multiple sclerosis sufferer who wanted to know if her husband would be prosecuted for helping her to die, the law on assisted suicide in England and Wales was clarified in September 2009. The decision to prosecute will be based on factors including the nature of the victims illness. All cases will be investigated by the police but discretion will still be used, said the Director of Public Prosecutions. Assisting suicide remains illegal and carries a jail term of up to 14 years. In December 2009, the MSP Margo Macdonald, who has Parkinsons Disease, put forward a bill in the Scottish Parliament to legalise assisted suicide. MSPs may be given a free vote on The End Of Life Choices Bill which will be published after it undergoes legal scrutiny in early 2010.
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Assisted Dying Bill

2006: Assisted Dying Bill The House of Lords has blocked a bill that would allow terminally ill people to be helped to die.

Lord Joffe's bill, which had its second reading on Friday 12th May 2006, proposed that after signing a legal declaration that they wanted to die, a patient's doctor could prescribe a lethal dose of medication that the patient could take themselves. Only people with less than six months to live, who are suffering unbearably and deemed to be of sound mind and not depressed would be able to end their life under Lord Joffe's proposal. Peers spent the day in a passionate debate on whether or not it was right to allow a person who was terminally ill to be given drugs they could then use to end their own life. Lord Joffe said: "We must find a solution to the unbearable suffering of patients whose needs cannot be met by palliative care." Peers backed an amendment to delay the bill for six months by 48 votes. (148 were in favour and 100 opposed.) Lord Joffe said the move was intended to end the debate, but pledged to reintroduce his bill at a later date. The government has said it will not block a further hearing of the bill. The debate highlighted divisions between supporters of the right to die and those who want better palliative care. Amongst those Lords against the bill were the Archbishop of Canterbury Dr Rowan Williams, Lady Finlay, a professor in palliative care and Cardinal Cormac Murphy O'Connor, Archbishop of Westminster. They urged more to be done instead to improve palliative care for terminally ill patients. These Lords were also supported by disability campaigners. Opponents to the bill demonstrated outside Parliament and submitted a petition to Downing Street which was signed by 100,000 people. The bill's supporters said doctors should be able to prescribe drugs so a terminally ill person suffering terrible pain could choose to end his or her life. These included Labour's Baroness David aged 92. She said: If I were terminally ill, I believe I would be the only person with the right to decide how I died, and whether I preferred palliative care to assisted dying. It would provide me with an additional option on how to end my life, which I would find tremendously reassuring. Baroness David, Labour peer

Mark Slattery, of the charity Dignity in Dying, formerly the Voluntary Euthanasia Society, said the campaign to introduce an assisted dying bill would continue. Julia Millington of the ProLife Alliance welcomed the Lords' decision and stated they would continue to resist any change in the law.
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Religious leaders
2005: Religious leaders made a strong stand Britain's faith leaders joined forces to protest against plans to revive the controversial rightto-die Bill in Parliament. Nine leading figures representing the major faith groups spoke out against Lord Joffe's proposals. Under the proposed legislation the terminally ill would be able to choose to die and then receive help to commit suicide. But in an open letter to both Houses of Parliament, the religious leaders condemned the bill, saying: Assisted suicide and euthanasia will radically change the social air we all breathe by severely undermining respect for life. ... We, the undersigned, hold all human life to be sacred and worthy of the utmost respect and note with concern that repeated attempts are being made to persuade Parliament to change the law on intentional killing so as to allow assisted suicide and voluntary euthanasia for those who are terminally ill. 2005 open letter to the Houses of Parlliament from Britain's religious leaders Right to die The letter was published after Lord Joffe announced plans to re-introduce his private member's bill which would give terminally ill people the right to die. The 73-year-old peer planned to revamp the legislation and bring it back to Parliament in early November. This was the third time he has introduced a bill to allow voluntary euthanasia or assisted suicide since 2003. His previous legislation - the Assisted Dying for the Terminally Ill bill - ran out of parliamentary time before the General Election. But it prompted a House of Lords select committee review of the law on assisted suicide. The committee's report was debated in the Lords on October 10, 2005. Providing alternatives

Representatives of Britain's faith groups argued that the suffering of the terminally ill and dying could be minimised through rapid advances in palliative care. Providing good care does not require any change in the law but a reprioritisation of NHS resources in order to ensure that adequate training is given to doctors and nurses and that centres of palliative care exist where they can be accessed by those who need them. The argument that assisted suicide or euthanasia is necessary to deal with the suffering of terminal illness is false. 2005 open letter to the Houses of Parlliament from Britain's religious leaders
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Other countries
Euthanasia in other countries The letter also pointed to studies from Holland where euthanasia has been legal since 2001. The Netherlands has the most liberal assisted suicide laws in the world. Under Dutch law, doctors can administer a lethal dose of muscle relaxants and sedatives to terminally ill patients at a patient's request. Britain's religious leaders claim that one in every 32 deaths in the Netherlands is a result of legal or illegal euthanasia. In January 2005, a report in the Dutch Journal of Medicine alleged there had been 22 cases of illegal euthanasia involving infants born with spina bifida. "A similar law here could lead to some 13,000 deaths a year and Dutch pro-euthanasia groups are now, moreover, campaigning for further relaxations of the law - for example, to encompass people with dementia," said the faith leaders. They also claimed that many doctors in Oregon in the US, where the Death with Dignity Act of 1994 legalised assisted suicide, were reluctant to help patients to die. In the UK, the religious leaders maintain that the largest most recent surveys show that most British doctors do not favour a change in the law. Amending the bill After the debate in the House of Lords in early October, Lord Joffe indicated that he might be prepared to amend his proposals so doctors would not be required to administer a lethal injection. Instead, the bill would allow doctors to indirectly help people die by prescribing drugs for patients to take themselves. This procedure is known as physician-assisted suicide.

The British Government is neutral on the issue of voluntary euthanasia but has indicated that Lord Joffe's revised bill may be given parliamentary time when it is introduced in November. The bill is unlikely to become law but an amended version could win support from the medical community. In another unprecedented move, the British Medical Association dropped its historic opposition to euthanasia during 2005, adopting a neutral stance on the issue.

Q&A: Assisted suicide

The director of public prosecutions has set out new guidelines on assisted suicide. Keir Starmer has already published draft advice, but has now updated that following a public consultation. He has said he hopes his intervention will bring greater clarity to the thorny issue of prosecution. Why has he taken action?
Assisted suicide is still illegal in England and Wales

Law Lords ruled last summer that there was a need for greater clarity after hearing an appeal from someone with multiple sclerosis. Debbie Purdy, from Bradford, had gone to the House of Lords after losing her court case seeking clarification on whether her husband would be prosecuted if he helped her go abroad to die. Her legal team argued that the DPP had acted illegally by not providing guidance on how decisions over prosecutions were made. They agreed, saying she deserved to have some information about what was taken into account in such cases. However, Mr Starmer was not asked to change the law - indeed he does not have the power to do that. What does the current law say? The 1961 Suicide Act makes it an offence to encourage or assist a suicide or a suicide attempt in England and Wales. Anyone doing so could face up to 14 years in prison. The law is almost identical in Northern Ireland. There is no specific law on assisted suicide in Scotland, creating some uncertainty although in theory someone could be prosecuted under homicide legislation.

To date, more than 100 UK citizens have travelled to Dignitas in Switzerland to end their lives. Although some cases have been considered by the DPP, no relative has yet been prosecuted. What has the DPP published? He published draft guidance in September, although it came into affect immediately. Mr Starmer set out a range of factors that might influence whether or not a person would face prosecution. This has now been updated following a consultation which got nearly 5,000 submissions. The advice lists a range of factors that will be taken into account when deciding if a prosecution is appropriate or not. These include whether the victim reached a "voluntary, clear, settled and informed" decision. There is also particular emphasis on the motivation of the suspect. They would be expected to have acted "wholly compassionately" and not for financial reasons. The idea is it will give people who were asking their loved ones to help them die an indication of whether they would then face charges. However, Mr Starmer stopped short of saying he would offer guarantees as the individual circumstances of each case would still need to be investigated. Did this change anything? Not the law. The legislation on assisted suicide remains the same. And Mr Starmer was also quick to point out that this does not affect the legality of euthanasia - whereby someone kills an individual who wants to die but is not able to take their own life. Such actions are considered to be acts of murder or manslaughter. However, the DPP said he hoped it would bring greater clarity for people in situations such as those Britons who have travelled to Dignitas. Campaigners believe it does but, at the end of the day, prosecutors will still be exercising discretion. All individuals who help someone to die still face a police investigation during which the factors spelt out by Mr Starmer will be taken into account. Will this lead to a Dignitas-style clinic being set up here? It seems inconceivable that it will. The factors set out by the DPP put a strong emphasis on a suspect having to know the person and for it to be a one-off occurrence in order to avoid a prosecution. This would seem to exclude an organisation or business like Dignitas offering a suicide service.

That organisation is only allowed to operate because of Switzerland's liberal laws on assisted suicide, which suggest that a person can be prosecuted only if they are acting out of self-interest. In theory someone could help someone buy a drug to commit suicide in this country - a barbiturate solution is used in Switzerland - but this is far from easy to obtain. Is it possible there could be a change in the law? There have already been several attempts to legalise assisted suicide, but these have been rejected. The most recent, in 2006, was defeated in the House of Lords by 148 votes to 100. It is likely the issue will come before parliament again in the future. However, public opinion is not easy to gauge. Surveys show mixed results, depending on who is asking the question and how it is asked - although there is certainly an appetite for more debate.

Assisted suicide law 'clarified'

By Nick Triggle Health reporter, BBC News

Debbie Purdy and Dr Andrew Ferguson offer differing views on the guidance

New guidance has been issued to clarify the law on assisted suicide in England and Wales - but it offers no guarantees against prosecution. Instead the director of public prosecutions has spelled out the range of factors that will be taken

into account when deciding on cases. These include whether there was a financial motive, and looking into how the decision to die was made. The guidance does not represent a change in the law. Assisting suicide is illegal and carries a jail term of up to 14 years. However, more than 100 Britons with terminal or incurable illnesses have gone to the Swiss centre Dignitas to die and none of the relatives and friends involved in the cases has been prosecuted. This is because the authorities have the power to use their discretion under the terms of the act. Keir Starmer QC, the director of public prosecutions, was forced to publish the guidance after a long-running legal fight by Debbie Purdy, a multiple sclerosis sufferer from Bradford. In July, Law Lords ruled she had the right to know under what circumstances her husband would be prosecuted if he helped her travel abroad to die. Mr Starmer said he hoped his guidance would now bring greater clarity to the issue, although he added all cases would still be investigated by the police. He said: "There are no guarantees against prosecution. "It is my job to ensure that the most vulnerable people are protected while at the same time giving enough information to those people, like Ms Purdy, who want to be able to make informed decisions about what actions they choose to take." Among the factors which would determine a prosecution are: Whether a person stands to benefit financially from assisting a suicide or if they were acting out of compassion If the individual wanting to die was deemed competent enough and had a "clear and settled" wish to make such a decision. Particular attention would be paid to issues such as being under 18, and having a mental illness Whether the person was persuaded or pressured into committing suicide, or if it was their own decision The new framework will come into force immediately - although a consultation is also being launched with the final policy not expected to be published until the spring. Ms Purdy welcomed the intervention by the DPP.
There must be a real danger that this will be seen as giving the green light to assistance from close relatives or friends Q&A: Assisted suicide Pillinger on the dying debate Send us your comments Keir Starmer QC, Director of Public Prosecutions There are no guarantees against prosecution

She said it was important to underline that people considering suicide had a duty first to carefully consider all possible options. "People will know what they must make sure of before they assist, and hopefully that will give

Dr Peter Saunders Care Not Killing What the prosecution consider Assisted suicide worldwide

people confidence not to make such a decision until the last possible minute." And Sarah Wootton, chief executive of the Dignity in Dying campaign group, agreed, saying the guidance represented a "significant breakthrough". But Dr Peter Saunders, of Care Not Killing, an umbrella group of doctors, religious organisations and charities, said there were some features that were "disturbing". He claimed having details spelt out like this could make prosecutions less likely.

Pratchett on why he wants to die at home with a brandy

"There must be a real danger that this will be seen as giving the green light to assistance from close relatives or friends, who in many cases might be those who would stand personally to gain from the death of the deceased." The law is similar in Northern Ireland and new guidance being issued sets out an almost identical framework. In Scotland there is some uncertainty as there is no specific law on assisted suicide, although in theory someone could be prosecuted under homicide law. A bill is expected to come before the Scottish parliament soon in a bid to legalise assisted suicide.

Terry Shiavo was a young female, who became sick after she had an accident in which left her brain dead for the rest of her life. Her husband, Michael Shiavo was her caretaker and was later appointed as her legal guardian on June 18, 1990. (http://www.cbc.ca/news/background/schiavo/). This was a struggle for Mr. Shiavo, as it would have been for me and many others. From this point on, Mr. Shiavo knew that he had a hard and long struggle dealing with the fact that his wife, whom he loved, is now brain dead, and he is the one left to care for her and make medical decision on her behalf. Her family was there for her also, and this is how all of this became a problem between Mr. Shiavo, and Terry's' parents Mr. and Mrs. Schindler. Mr. Shiavo was doing his job as a caretaker for his wife, taking her to get the necessary treatment that she needed and required, and really and truly sticking by his wife in such a rough circumstance. He stated that "my wife had said she would never want to be kept alive if she were in a vegetative state". (http://www.cbc.ca/news/background/schiavo/). He was just honoring what she had wanted to do if this type of situation would ever happen, and he was obeying what she wanted. I have to totally agree with him, and how he tried and did take care of Terry. It gets hard on families and also it can take a toll of them when there is a sick family member who is in need of 24 hour care. Ethically, I see that Michael was right; however I am also in limbo to where I think he could have turned Terry's custody over to her parents, even though he did honor what she wanted. Sometimes families find themselves in a comfort zone by trying to come to peace with there loved ones by sitting there with there loved ones while they are on the machine. I couldn't imagine this struggle between Terry's family and Michael. The main fight was about Michael removing the feeding tube in May 1998, which would result in allowing Terry to go on and pass away. That fight went on for many of years. On "July 29, 1993", Terry's parents wanted to take custody of there daughter. After so long, being in a vegetated state, there was only so much that her family, doctors and her husband could do for her. The way I feel that Michael felt, was that he has done just about everything in his power that he could do to keep his wife alive. I believe this situation took a toll on his life, and that pulling the feeding tube was the last resort for him, being that he had also been suffering all of those years trying to do the right thing and go above and beyond to care for Terry, even though her family wanted custody of Terry, and did not agree with Michaels decisions. Being that what Terry Shiavo apparently would have wanted to be kept alive by a machine/feeding tube, there was nothing written down on paper and there was no proof that she actually said that, but the say so lied in the hands of Michael, also known as "advanced directives" (pg. 402) . This is where the courts got involved. Legally when there is no proof, there has to be legal actions taken to help resolve the problem between two parties. Guardianship is a big responsibility for anyone who is appointed to that position. There are many struggles that come behind it. In my findings, I have read so much up on the Terry Shiavo story. From what I understand from reading, their marriage was on the brinks already. When this accident occurred, it was mentioned that she was talking to one of her co-workers and also her brother about how her marriage was in trouble. This is where a light goes off in my mind, and this is why I am in agreement with her husband but then again I find myself in limbo about his decisions, because of what I have read up on doing this report. I ask myself is this really why he wanted to take the feeding tube out? Then on the other hand, I find myself thinking, why would he have went this long to let her live with the feeding tube if he didn't love her. Then again he had won two lawsuits for Terry for malpractice, in which he won $250,000 and another which was "more than one million dollars", so is that why he stayed by her side for that long, or was he just physically and mentally emotionally tired, and that is why he carried this out that long? I really do wonder. Michael was once accepted in the Schindler's family and sooner than he probably though he was up against his worst enemies, you might say. I feel that he was in the worst position between all of the parties. To me disability rights entail choices, self-direction, opportunities unfettered by discrimination and an equal place in society to give, as well as to take. Terri's case doesn't even come close to fitting into what I consider to be the disability rights movement. For starters she will never, can never, choose to do anything ever again in her life. Will she be ever moving anywhere, accessible or not? Will she be looking for an attendant who gives her great care? Will she be taking a bus, or learning to drive a van? Will she look for a job? Will she have a say in her survival benefits? Will she ever be voting? Will she ever have any communication whatever about her needs or desires? Again, the answer is "no." She had no way, in my eyes of even getting better at all.