Euthanasia is the action of intentionally ending an individual’s life to relieve their suffering.

Consequentialist considerations

• Egoism
  • A person’s continued existence may bring them more pain than pleasure. However, some argue that given proper expert care, few truly die in pain and distress.
  • Legalising euthanasia may normalise it in a way that ill people feel obliged to ask for euthanasia even if they do not want it.
• Utilitarian
  • A person’s continued existence may more bring pain than pleasure to those who are distressed by their suffering. Yet a person may also want euthanasia against the desires of friends and family.
  • Resources being spent on keeping them alive may produce more happiness if used in other ways.

Deontological considerations

• Duty not to kill: Do doctors have a duty not to kill, as killing is inherently wrong? What if a patient relinquishes the right to live? If you can kill in self-protection against an unwilling victim why can’t you kill a willing victim? What about situations without consent? Refer to cases R v Cox (1992) and State of Louisiana v. Anna M. Pou (2006) below.
• Right to die/liberty: Do individuals have the right to do what they want with their life, including dying? If so, does that mean doctors have have a duty to perform euthanasia even if they may be against euthanasia? What about the state’s competing interests to prevent suicide? Refer to cases Ms B v An NHS Hospital Trust (2002), Pretty v UK (2002) and Washington v. Glucksberg (1997) below.
• Principle of double effect (associated with Thomas Aquinas): Some argue that an action may be morally permissible if intentions were good even if there is a foreseeable bad effect, provided that the action itself was moral and the bad effect unintended. Refer to case David Moore (1999) below.
• Natural law: Are we exercising human nature to preserve dignity and autonomy? Or does euthanasia goes against the inherent self-protective nature of humans?

Other considerations

• Action vs omission: Some distinguish between active euthanasia where death results from an act (e.g. painkiller overdose) and passive euthanasia which results from an omission (e.g. withholding treatment such as life support). While consequentialists generally see no difference, deontologists might differentiate between the intention to bring about death versus halting treatment that is no longer beneficial. Refer to cases Airedale NHS Trust v. Bland (1993) and Burke v the GMC (2005) & Burke v the UK (2006) below.
• A relevant issue is assisted suicide where the professional aids an individual who wishes to end their own life. Is this different from euthanasia? Is killing yourself an exercise of personal autonomy, or is killing inherently bad and therefore should not be performed? In the House of Lords debate on Assisted Dying for the Terminally Ill (2005), Dr. Raymond Hoffenberg argued that if people can deny treatment and die slow distressing deaths, why deny them the means to end their life quicker. On the other hand, Jane Campbell argued that even the terminally ill can have meaningful lives. However, due only to the government’s limited provision of quality palliative and social care, individuals may choose euthanasia. Refer to cases Pretty v UK, 2002, R (Nicklinson) v Ministry of Justice (2014) and Washington v. Glucksberg (1997) below.

Case studies

• Airedale NHS Trust v Bland (1993), UK: Tony Bland was in a vegetative state. The House of Lords ruled that withdrawing life-sustaining treatment may be lawful if that decision made is ‘not against the patient’s best interests’.
• Burke v the GMC (2005) & Burke v the UK (2006), UK: Leslie Burke suffered from a degenerative brain condition which which meant he would eventually require life support. He was concerned that his doctors might decide to withdraw treatment but wanted to be kept alive and die of natural causes, regardless of pain and suffering. The court ruled that patients do not have the right to demand treatments.
• David Moor (1999), UK: Dr. Moor gave terminally ill patients large doses of diamorphine which hastened their death. His defence was doctrine of double effect – intention was to control pain. Moor was acquitted.
• Ms B v An NHS Hospital Trust (2002), UK: The High Court ruled that patients have the right to refuse treatments even if it would result in their death. Legally, doctors must comply with a competent patient’s request to end life support; if they feel unable to do so, they must find a colleague who can.
• R v Cox (1992), UK: Dr. Nigel Cox was found guilty of attempted murder for administering a lethal dose of potassium chloride to Lillian Boyes, who suffered from extreme pain due to rheumatoid arthritis which could not be relieved by analgesics. Boyes was expected to die within days/weeks.
• R (Nicklinson) v Ministry of Justice (2014), UK: Tony Nicklinson had a stroke and was paralysed from the neck down, describing his life as a “living nightmare”. He desired to take his life, but required assistance to do so. He applied to the High Court to declare a doctor-assisted suicide was legal or that current laws were incompatible with Article 8 of the European Convention on Human Rights (Right to respect for private and family life). This ruling was refused and he died of pneumonia after refusing food.
• Pretty v UK (2002), UK: Diane Pretty suffered from Motor Neurone Disease. She wished her husband could assist her in ending her life, but assisted suicide is illegal under the Suicide Act 1961. She argued the Suicide Act was inconsistent with the Human Rights Act 1998, Articles 3 (prohibition of inhuman and degrading treatment) and 8 (right to a private and family life). British courts ruled that the Human Rights Act 1998 does not confer a right to die nor to assisted suicide and interests of the state came before her right to a private life.
• State of Louisiana v. Anna M. Pou (2006), USA: During Hurricane Katrina. Dr. Anna Pou and others were thought to have administered illegal lethal injections to at least four severely ill or disabled patients they judged could not be evacuated. Altogether, 45 patients died at the hospital in the storm. Charges were expunged after cause of death was found to be “undetermined” despite elevated blood drug levels in the deceased.
• Washington v. Glucksberg (1997), USA: Dr Harold Glucksberg, with other physicians, terminally ill patients and the charity Dying with Dignity argued for the right to die. The Supreme court ruled that the constitution did not guarantee such provisions.