Intended for healthcare professionals

Why I will not support assisted dying: it will affect every doctor and every patient

I read with interest the thoughtful essay by Dr Sandy Buchman, explaining why accepting patient’s autonomy led him to provide lethal injection. His questions have been mine. What are the goals and values of medicine? What does it mean to truly respect patient autonomy?

Consent to treatment is fundamental to the integrity of the doctor-patient relationship. Its ethical basis is the respect for the autonomy of the individual. The respect for autonomy has enormous value as a principle, derived from a high opinion of the patient’s value and worth and should grace each interaction with a patient. However, should autonomy be the pinnacle of modern medical ethics? I do what I want for me. I choose for me. What about the effects on my friend, my neighbour, my doctor if I always do what I want? Is unrestrained individual autonomy good for society? Is not society the very expression of the inter-dependent relationships we have with each other? I stop at the red light because waiting for you to go first makes sense for us both.

What limitations then, if any, should be placed on autonomy?

The problem with ‘The Four Principles’ of Beauchamp and Childress in Medical Ethics is the pre-eminent principle. Is it ‘do no harm’ or justice or beneficence or autonomy? And what trumps what? Does autonomy trump justice if a terminally ill patient wants the last ICU bed? Does patient autonomy trump doctor autonomy if a dying patient wants CPR? What if these are not the most important principles at all? What about compassion or human dignity or the inherent value of human life?

Does the introduction of euthanasia affect more than those concerned? Dr Buchman is right that it represents ‘a fundamental shift in the medical profession’s role.’ The shift from preserving life to taking life is enormous and should not be minimised. The prohibition of taking life is present in almost all civilised societies due to a high view of the worth of human life. Everyone has a right to life under Article 1 of The Human Rights Act 1998 such that no one should be deprived of that life intentionally. This is in accordance with the UN Universal Declaration of Human Rights which affirms, ‘the inherent dignity and the equal and inalienable rights of all members of the human family.’ For the state to sanction the taking an individual’s life is a solemn and significant action. It reverberates across the values and shakes the very basis of our society.

Far from one person’s decision affecting no one but himself, it affects us all. Some patients may never consider assisted suicide unless it was suggested to them. The terrible irony is that legislation introduced with the intention of enhancing individual autonomy may diminish the autonomy of the most vulnerable.

Dr Buchman described the case of Professor Froggatt whose suffering was undeniable. We must face such suffering squarely- as physicians we cannot make everything better. How do we move forward? Beauchamp and Walters conclude that moral dilemmas are “a need to balance rival claims in untidy circumstances”. Do we need a different matrix for analysis? Or simply to strengthen the matrix to involve more dimensions to each claim? We need to consider the intrinsic nature of the act of state sanctioned-taking of life by a doctor. We must outline the unintended consequences of diminishing the autonomy of others. We must consider that the underlying principle of inherent human dignity is core to both these values- is it compromised more by the state permitting the intentional taking of life or by restraint on individual autonomy?

We must stop to reflect because some patient suffering is terrible, but human value and worth restrain us from taking life. Responsibility to the vulnerable is the very stuff of friendship and family, of society, of the doctor-patient relationship itself.

I do not want to take patients’ lives. Even if they ask me to.

References
1.Beauchamp TL, Childress J. Principles of biomedical ethics. 1st ed. New York: Oxford University Press, 1979; 5th ed, 2001
2. https://www.legislation.gov.uk/ukpga/1998/42/schedule
3. http://www.un.org/en/universal-declaration-human-rights/
4. Beauchamp and Walters Contemporary Issues In Bioethics, 6th Ed. (New York: Wadsworth, 2003).

Competing interests: I am a Christian.

18 February 2019
Gillian R Wright
Senior Researcher in Medical Ethics
Scottish Council for Human Bioethics
15 North Bank Street, The Mound, Edinburgh EH1 2LS