Assisted dying: a doctor’s poisoned chalice?
The question of whether assisted suicide (often known as assisted dying) is morally defensible, or should be legally permitted, is a familiar issue of medical ethics. Polls suggest that most people in Britain support a change in the law to allow it (as well as euthanasia). But the British medical establishment has a longstanding record of opposition to such a change. The official position of the British Medical Association is that assisted suicide and euthanasia should not be legalised, although the Royal College of Physicians has recently adopted a neutral stance.
The prevailing medical view is that a change in the law would put vulnerable people at risk and that all deliberate killing or facilitation of killing goes against the traditional ethos of medicine. This view is firmly opposed to the policy adopted in Belgium, the Netherlands and Switzerland – the home of the Dignitas clinic. In Belgium, euthanasia has been legal since 2002, if the patient who requests it is in constant and unbearable physical or mental suffering.
These new laws reflect the fact that many people, including some members of the medical profession, believe that doctors should be allowed to assist competent adult patients to end their own lives, at their patients’ request. But many opponents of assisted dying believe that a compelling moral argument against assisted dying is founded both on the sanctity of human life and on the fear that allowing this practice would lead to a disregard for human life in general, or perhaps for the lives of the sick or disabled in particular. Critics reject this argument, with some prominent philosophers arguing that there is nothing morally special about human beings and that the paramount ethical concern should be the relief of extreme suffering – by ending life at a competent patient’s repeated request, if necessary.
However, even if there is a sound ethical basis for assisted dying, what should the role of doctors be? Some people argue that legally allowing doctors to be involved would place an undue burden on them, even if they were protected by a ‘conscience clause’. Among the treatment options before a doctor would be that of helping patients end their lives, and doctors might feel bound to consider it even if their heavy workload prevents due reflection.
If doctors continue to be banned from assisting patients to take their own lives, should the law look leniently on relatives who take on the task, with all the attendant risks? Traditionally, doctors have understood the Hippocratic oath – ‘first, do no harm’ – as giving a strict prohibition on killing. But what if the patient suffers more ‘harm’ by staying alive? Are we seeing the idea of ‘harm’ being redefined and, if so, what does that mean for our understanding of the role of medicine?