“Dr. Death” was just realeased from prison

Jack Kevorkian is the American doctor who helped, by his own count, 130 people end their own lives. He was found guilty of second-degree homicide in 1999 and just released from prison on parole.

Questions:

1. Do you think Jack Kevorkian is in some way a good example or he just went too far and his actions are from the medical point of view absolutely unacceptable?

2. Is euthanasia first of all a legal problem or more problem of ethics or it is not possible to separate this?

Answers:

Richard Huxtable, Senior Lecturer and Deputy Director of the Centre for Ethics in Medicine, University of Bristol

1. Some people argue that euthanasia ought to be lawful, at least where this is what the suffering patient really wants. However, these people will usually insist that any new law would need to be very carefully regulated. Jack Kevorkian, of course, practised assisted suicide illegally – and so his actions were not regulated.

2. Euthanasia is clearly a legal problem, since – by definition – it involves ending a person’s life. But the law in this area must also be based on sound ethical principles, and here we find that people genuinely disagree over which principle is most important. Should the law rest on the idea of self-determination, meaning that people who wish to die ought to be offered help in doing so? How far should a patient’s poor quality of life influence our decisions about whether or not to treat them? Is life itself too valuable to risk allowing any exceptions to the rule that we should not kill? These, and many other questions, are often answered in different ways by different people across the world. These debates will undoubtedly continue and it is essential that we hear everyone’s opinions, so that we can arrive at laws that are ethical, honest and safe.

Alasdair Maclean, Senior Lecturer, Dundee Law School, University of Dundee

1. The answer to your first question depends somewhat on perspective. There are two aspects to it. First, Dr Kevorkian was breaking the law. This raises the question of whether it is ever acceptable to break the law. I think that prima facie it is legally, ethically and professionally wrong for a doctor to break the law. However, it may be justified where the law itself is unjust or unethical and people are suffering as a result. In other words, Dr Kevorkian’s actions, while prima facie wrong, may nevertheless be justified or excused by the consequences of his actions. In helping people to die it is arguable that he was acting in a caring way to ease suffering. As far as I’m aware he only helped people die at their request. Thus, he is respecting their autonomy and their dignity and is acting beneficently. However, there are dangers attached with a maverick acting outside the law. First, there are none of the procedural safeguards to protect vulnerable persons. Second, othe r more unscrupulous people may follow suit. Third, it undermines the authority of the law. One might also question whether his motives were entirely selfless. For these reasons, I would argue that, while I think that assisted dying should be lawful, his actions were unacceptable. He should rather have campaigned for change.

2. I don’t think the legal and ethical issues can be separated. The law should be ethically defensible and it should be consistent in its approach. In  both Scotland and England the law allows doctors to withdraw treatment, including nutrition and hydration from patients in a permanent vegetative state, with the intention that the patient will die. However, positively assisting dying is unlawful. The basis for this is the distinction between acts and omissions. A close analysis of the distinction in this context will reveal that there is no moral difference between withdrawing treatment from a patient with the intention that he or she dies and giving them an injection to cause their life to end. The law here is out of step with ethics. If the law is to be consistent it should do one of two things. It should either make withholding treatment unlawful or make assisted dying lawful. There are risks to vulnerable people whatever approach the law takes and these risks need to be weighed up in deciding which of the two courses to adopt.

That said, the law in Scotland and the law in England are unlikely to change given that both recent proposals to allow assisted dying, based on the Oregon model, failed (Jeremy Purvis MSP’s proposal in Scotland and Lord Joffe’s Bill in England).

My own view is that, with suitable regulatory control, assisted dying should be allowed. While palliative care can deal with much of the suffering, and terminal sedation is an option, there are some people for whom it is not an adequate solution. Providing that the decision is made autonomously then helping that person to die may be the kindest way of easing their suffering.

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