What are some problems and benefits of the UK Law?

1. What are some problems and benefits of the UK Law?

2. Some problems of UK Law • It is vague. It neither denies nor permits euthanasia and allows euthanasia by the back door. It forces euthanasia underground. • Each case is taken on its own merits though this causes problems of consistency. • It does not protect the right to life of the dying and allows people to take the law and morality into their own hands. • It prolongs the agony of the dying and fails to take account of high quality palliative care.

3. Some benefits of UK Law • Each case is dealt with on its own merits. • Responsibility lies with the courts not with the individual or medical staff thus it does not place medical or political organizations in a difficult position. • It sets clear precedents and it does not make it easy to give euthanasia. • It works- it is a halfway house between legalization and an outright ban.

4. UK Law: Summary • Illegal • Treatment can be withdrawn or refused • Double effect is legal • Goes on all the time • Benefits and drawbacks of present law

5. UK Law and Law in Holland Euthanasia

6. The Law in Holland • Since 1973 the Dutch government had been aware that euthanasia was being practiced by medical staff. During the following years the practice became more widespread and more accepted by the public and politicians alike. • By 2001 the Dutch parliament comfortably passed the Termination of Life on Request and Assisted Suicide (Review Procedures) Act which became law on April 1, 2002. The law basically made legal what had been common practice for about 20 years. • Here is the situation…

7. The Law in Holland (1) • Euthanasia must be performed in accordance with careful medical practice, that is, the official guidelines are to be observed. • All cases will be discussed by a regional review committee, made up of a lawyer, a doctor, an ethicist and others. • Euthanasia and assisted suicide will not be a crime if carried out by a doctor who has followed the guidelines, and reported it to a local medical examiner. • The local medical examiner has to satisfy himself that procedures have been carried out properly and then sends a report to the regional committee and the prosecutor.

8. The Law in Holland (2) • Children between 12 and 16 must normally have their parents' consent before they may request euthanasia. In exceptional cases a doctor may agree to a child's request even without parental consent. • Requests by children aged 16 -17 do not require parental consent, but parents should be involved in decision making. • Patients who are able may request euthanasia through an advance directive. • The patient's suffering must be unbearable with no prospect of improvement.

9. The Law in Holland (3) • The patient's request for euthanasia must be voluntary and persist over time (the request can not be granted when under the influence of others, psychological illness or drugs). • The patient must be fully aware of his/her condition, prospects and options and there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above- the independent doctor must have no previous knowledge of the patient.

10. The Death • The death must be carried out in a medically proper fashion. It is preferred that the patient takes the fatal medication themselves but often this is not possible. • Medication usually involves a drug that makes the patient unconscious followed by a drug that stops the heart. The drugs are taken intravenously or orally and the doctor must be present throughout the procedure. • If these conditions are not met then the doctor will be subject to prosecution. • It is possible for non-Dutch nationals to receive euthanasia. It is strongly discouraged but euthanasia tourism remains an issue. • Assisted Suicide

11. In practice… • In 2003 just over 1% of deaths in Holland were through requests for euthanasia. The bulk of them were for cancer patients and the most of the patients opted to die at home. • It is very likely that these figures are artificially low because many deaths from euthanasia will not have been recorded or reported. The Dutch government is very self-conscious of the need to be clear on its euthanasia legislation and have an excellent guide on the web at: http://www.minbuza.nl/default.asp?CMS_ITEM=MBZ413077 • Interestingly enough the Dutch government has palliative care as an entitlement in their National Health Service unlike the UK where there is a dependence on charitable organisations to provide palliative care. • Euthanasia debate flares up in Europe

12. What are some criticisms and positive reactions of the Law in Holland?

13. Some criticisms of Dutch Law • It does not prevent illegal euthanasia and euthanasia can go unreported. It permits involuntary euthanasia in some cases. This violates the principle that government’s duty is to protect lives of innocent. • It goes against the fundamental purpose of a doctor as a healer and changes the patient-doctor relationship. • It increases pressure on doctors from families and patients and also on patients to request euthanasia. Furthermore Doctors against euthanasia are under pressure to go against their conscience. • It may overestimate maturity in minors and an Advance Directive risks uninformed changes of mind. 66% of requests are turned down thus patient doesn’t really have the right to choose, it is up to others.

14. Positive reactions to Dutch Law • It reduces incidences of underground euthanasia and it has safeguards against abuse through its procedures. Better to have laws about euthanasia than none at all. Euthanasia laws allow it to be regulated. • It is compassionate and it allows people to die with dignity at a time of their choosing. The policy seeks to ensure that those thinking about euthanasia are fully informed and it gives people a choice. • Palliative care is given equal importance in the law. • Doctors and nurses can never be disciplined or prosecuted for not carrying out euthanasia and it takes moral burden off doctors.

15. Summary: Dutch Law • Legal since 2002 • Available for 12+ only • Referred to committee • Referred to medical examiner • Preferred that patients do it themselves • Most requests are refused – (66%) • Small percentage officially recorded • Benefits and drawbacks

16. Should the UK adopt Laws similar to those in Holland concerning euthanasia?

17. To Do • Read Section on the BMA and Palliative Care – summarise the main info. • Read the Religious Leaders responses – Christian and Muslim views – try all questions • Read views independent (secular) or religion, Humanist, Utilitarian.

18. Homework • For Tuesday 31st • Complete all 4 exam questions