Why active euthanasia and physician assisted suicide should be legalisedBMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7321.1079 (Published 10 November 2001) Cite this as: BMJ 2001;323:1079
If death is in a patient's best interest then death constitutes a moral good
- Len Doyal, professor of medical ethics,
- Lesley Doyal, professor of health and social care
- St Bartholomew's and Royal London School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AD
- University of Bristol, School for Policy Studies, Bristol BS8 1T2
Last month Diane Pretty was refused the legal right to choose the circumstances of her own death.1 She suffers from motor neurone disease and is experiencing the disintegration of her body. She faces a death that she believes will entail indignity and suffering and physically cannot kill herself. The court has denied her request that her husband be allowed to help her. This decision may be consistent with legal precedent but is morally wrong. That is why the law should be changed.
Suppose that Mrs Pretty became permanently and severely incompetent as a result of brain damage and that her life was being sustained by medical technology. If her doctors believed that medical treatment could provide no benefit because of her inability ever to engage in any self directed activity, then legally they could withdraw life sustaining treatments, including hydration and nutrition.2 In such circumstances they would foresee that she would die as a result of their failure to perform what would ordinarily be their duty to protect life and health. In most other circumstances clinicians are not allowed this discretion to accelerate foreseeable deaths through inaction.
Against the background of the duty to care, the moral and legal status of not saving a life through failing to treat can be the same as actively taking that life. 3 4 For example, a doctor who knowingly allows a patient who could be saved to bleed to death in emergency care might be accused of murder. What is deemed to be morally and legally important here …
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