Refusing treatment and mercy killing

A number of recent legal cases originating from the UK have highlighted the confusion that exists in the minds of most people over what should and should not be done when a patient who believes that life has nothing more to offer decides to opt out. Such highly emotional decisions raise fundamental ethical questions to which we may not have clear answers.

We have heard about the case of `Miss B` (as it turned out, a Maltese patient in a London hospital) who suffered permanent damage to her nervous system when an artery in her neck burst about a year ago. This resulted in paralysis from the neck down, and she required mechanical ventilation to maintain breathing. When she decided that she did not want to live any longer harnessed onto this apparatus, she asked her doctors to switch the machine off - which they refused to do - and the case ended up in the High Court.

In this case, the judge, Dame Elizabeth Butler-Sloss, had no hesitation in deciding that the patient had every right to demand that treatment be ceased.

The patient was mentally fully competent, capable of making her own decisions, and therefore had every right to refuse treatment. Failure of the doctors to comply with the patient`s wishes would have constituted "unlawful trespass" which is punishable by law.

The medical profession has published guidelines in the past in relation to withdrawing life-prolonging treatments. If the medical team have conscientious objections to this process, they should ask another team to take over.

They cannot impose what they believe is the best treatment on an unwilling patient. This is also the view of the Catholic Church. Pope Pius XII, while making a distinction between `ordinary` and `extraordinary` means of maintaining life, considered the ventilator as an `extraordinary" means of treatment.

There is a world of difference between the above case and euthanasia. A more recent case, also from the UK, illustrates this: Diane Pretty, a woman who suffered from motor neurone disease which paralysed her for several years, requested that her husband be legally permitted to give her a lethal injection. The courts, both the House of Lords and European Court of Human Rights, held this was not acceptable and declared it to be a case of euthanasia.

Euthanasia involves helping a patient to die peacefully, usually through the administration of an overdose of sedative drugs. When such a drug is given by another person, this is called "active" euthanasia, a process which is illegal in virtually every country (with the exception of Colombia).

In the Netherlands it is also illegal, but each case is considered on its own merits, and no doctor has been prosecuted in recent years for helping sick patients terminate their life.

On the other hand, euthanasia is said to be "passive" when the doctor or another person merely helps provide the wherewithal for the patient to achieve his or her aims without actually being involved in actively administering the drugs.

For a doctor to provide an overdose of barbiturates, for instance, would constitute passive euthanasia. Views as to the legality of this process vary considerably worldwide, and seem to be getting softer all the time. In this case the decision as well as the action involved in taking an overdose are made by the patient.

However, the third party is aiding and abetting the process, and therefore shares responsibility.

It should be quite clear that the cases described above illustrate two very different situations, and the courts rightly ruled that the first case was to be allowed while the second was to be rejected. Mercy killing is considered morally wrong and unacceptable by the law of most countries.

Issues of this nature are bound to increase as patients clamour for their perceived rights to control their body and, eventually, the right of where and when to take the final plunge and opt out.

It is therefore becoming more and more important for ethical principles to be clearly understood, particularly by the medical and paramedical professions, who are most often involved in these issues.

The fact that religion has become less and less meaningful as a normative code to an increasing number of young graduates makes it more difficult for them to understand the basis of moral action and a void has appeared in relation to our ability to deal with ethical issues.

At the very least, the university should ensure that professional courses supply the necessary ethical programmes to prepare students for this maze of ethical issues that will one day overcome them.