Letters

Withdrawing life sustaining treatment and euthanasia debate

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7323.1248 (Published 24 November 2001) Cite this as: BMJ 2001;323:1248

Euthanasia may be ethical, but it is not legal

  1. Tom Woodcock, consultant, critical care directorate ([email protected])
  1. Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton SO16 6YD
  2. Sandringham Hospital, Sandringham, Victoria 3191, Australia
  3. University of Edinburgh, Edinburgh EH9 1UW
  4. General Infirmary, Leeds LS1 3EX
  5. Department of Anaesthesia, Royal Hospital for Sick Children, Edinburgh EH9 1LF

    EDITOR—Street and Henderson invite debate about an accepted medical practice (withdrawing life sustaining treatment under the influence of paralysing agents) that is approved by an authoritative ethical advisory committee and yet is of questionable legality.1 It should be no surprise that a course of action that is ethically justifiable may be illegal, for the law of England on care at the end of life is both morally and intellectually misshapen.2

    In their commentary Inwald and Vandyck submit that the advice of the ethical committee is not compatible with the common law of England, and that to cause respiratory muscle paralysis in a patient without providing ventilatory support is a form of euthanasia. I agree with their view, but I am not confident that their proposed solution of discontinuing the administration of the paralysing drug shortly before the abrupt discontinuation of ventilation, omitting to allow the drug to be eliminated or reversed, would be accepted by a court.

    Edwards tries to reconcile the practice of ventilator withdrawal under pharmacological paralysis with the legal doctrine of double effect, but she misses or avoids the point that we cannot claim that muscle relaxants are drugs necessary to alleviate suffering and primarily used for such palliation. Their lethal pharmacological effect on unventilated patients is therefore not secondary, and the practice constitutes euthanasia. Outside of its narrow legal standing, double effect is not universally accepted as a morally relevant concept. 3 4 In both these commentaries the only submitted justification for not waiting the hour or two it would take to clear the drug from the system (if it has been administered in a therapeutic dose) is to claim that the delay harms the patient who is lingering on a ventilator. Given that patients given curare ought normally to be sedated or anaesthetised …

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