Baroness Mary Warnock is a philosopher renowned for her writing on moral issues. Previously a Fellow and Tutor in Philosophy at St Hugh’s College, Oxford, and Mistress of Girton College, Cambridge, she is now an Independent Life Peer in the House of Lords, and a writer and broadcaster. Elisabeth Macdonald has spent her career working in cancer medicine in the UK as well as periods as a Consultant Oncologist in France and in research at Stanford University, California. Their book, Easeful Death: Is There a Case for Assisted Dying?, is publishing in paperback in March, and you can read their previous blog post here. The following is an excerpt about the medical perspective of assisted death.
Doctors in general are of a conservative turn of mind when contemplating decisions involving their patients. Medicine is a discipline in which taking risks with patient welfare is almost never justified and doctors, even those trained to model their care on the latest evidence-based research, are not easily persuaded to change a long established policy. It is not surprising that the contemplation of such profoundly serious changes of practice as assisted suicide and euthanasia has led to controversy, disagreement, and fierce professional debate. Doctors are currently forbidden, like every other citizen, to end human life. There is no legal indulgence conferred by a medical or nursing qualification.
So what attitudes do these professionals express when discussing the interests of patients in grave distress who seek medical aid to end their lives? In medical ethics much discussion centres on the difference between ‘killing’ and ‘letting die’. For many people it seems important to distinguish between killing and letting die and to prohibit the former while authorizing the latter in certain cases. In the past the distinction was sometimes, not very helpfully, referred to as that between ‘active’ and ‘passive’ euthanasia. In recent years, however, the distinction between killing and letting die has become blurred. For example, switching off a respiratory-support machine could be interpreted as actively terminating a patient’s life. Alternatively this act may be seen as withdrawing the artificial means maintaining a life which is already unsustainable by the individual alone. In other words this act discontinues an artificial circulation in a patient who is actually already dead (letting die).
We would contend that there is no morally relevant difference between killing someone and allowing him to die. A well-known example cited in medical ethics describes two young men, each of whom want their 6-year-old cousin to die in order that they can gain a large inheritance. Smith drowns his cousin while the boy is taking a bath. Jones plans to drown his cousin, but as he enters the bathroom he sees the boy slip and hit his head: Jones stands by doing nothing while the boy drowns.
Smith killed his cousin: Jones merely allowed his cousin to die. Both of these acts are clearly reprehensible but do demonstrate that the distinction between killing and letting die is morally irrelevant. Moreover, someone who starves another person to death is as guilty of murder as someone who poisons that person. The person who allows a fellow human being to die of hunger is as morally guilty as someone who acts to poison him. The difference lies in the more obvious and direct causal implications of the verb ‘to kill’. Killing, like pushing or pulling, kicking or smashing, is manifestly doing something to produce a certain effect. John Stuart Mill insisted that a cause is not necessarily an ‘active intervention’. The failure of the guards to patrol the walls may cause the fall of the city. Yet people may still instinctively feel that failing to do something is less causal than killing them. It is less ‘hands on’. It is after all doing nothing, and may therefore seem to be incapable of producing any effect. Ex nihilo nihil fit. Moreover, ‘to kill’ is a verb that contains a record of its own success. If I kill you, you are dead; whereas if I, say, fail to feed you, there is room for another event to come along either to save or to dispatch you. There is space for what the lawyers call novus actus interveniens.
A case that illustrates the medical abhorrence of active intervention to bring about death was that of a 40-year-old woman known only as Ms B. In 2001 she suffered a burst blood vessel in her neck and became totally paralysed. She was kept alive on a ventilator for a year, her brain unaffected. When the year was up, she asked that she might get someone to switch off the ventilator at a time of her choice, when she felt she had had enough. The hospital authorities refused, and one of the doctors involved was reported as saying: ‘She is asking us to kill her, and this we would not like to do’. Ms B appealed to the courts, and a court was convened round her bed. The judge, Lady Butler-Sloss found that she was suffering from no mental incapacity, and that it would be lawful for the hospital to grant her request. They still repeated that they could not kill her, even if it would be a lawful act. So Ms B was moved to another, less squeamish hospital, where in due course she asked for the ventilator to be switched off and she died.
Thus, doctors are profoundly suspicious of any action which may be classified as killing; and this is partly, we believe, because of the emotive violence contained within the very word ‘killing’. This word carries with it images of battlefields or grisly car accidents. These images are far removed from the scene of calm, caring, easeful, and timely death that is the ideal we would all wish eventually for ourselves.