Practical Ethics

Ending It, in Paternia

In the Republic of Paternia there has, of late, been a vigorous debate on the question of whether the law should change to permit marital separation in some circumstances. Some desperate Paternian couples have been illegally travelling abroad to engage in marital separations in Switterland (where they are permitted for now, though the Switts are becoming uncomfortable with their country’s renown for so-called “separation tourism”). Some of these couples have been dragged through the Paternian courts on their return. Sympathetic juries have often chosen to acquit, recognizing that their situations had become unbearable, that they had separated consensually, and that legal enforcement of their cohabiting marital relationship would only have prolonged their suffering. Moreover, prosecutors in Paternia have for a long time only selectively prosecuted cases of marital separation that illegally took place abroad.

Easing the passing: Death booths, misrepresentations and the 'Ugh factor'

Death is in the air. To stop us being engulfed by the ‘silver tsunami’,  Martin Amis urges the construction of euthanasia booths, and encourages the elderly to go to them for a martini, a medal and a pharmaceutical nudge into the void. Terry Pratchett talks cosily about ‘shaking death by the hand’ as he sits on his lawn, Tallis on his IPod, drinking some modern Socratic hemlock washed down with vintage brandy. He and his backers in the euthanasia industry shrewdly propose death tribunals who, having heard evidence about individual cases, would sign or withhold a death warrant. Such tribunals, they say, would obviate the risk that vulnerable people might opt unacceptably for euthanasia. The opinion polls consistently indicate considerable public support for a change in the law against assisted suicide. The opponents of assisted dying are caricatured as reactionary bigots, probably fuelled by otiose, antediluvian religious prejudice: people who care more about some dogma of the sanctity of life than about pain, fear, despair and autonomy. The crusade for assisted dying is a campaign by the modern and enlightened against the mediaeval  and  benighted.

Is the brain half full - or half empty?

There have been dramatic headlines in the media ('Coma Man. I think…I’m alive') following the publication yesterday of a new study using brain scans to detect consciousness in profoundly brain damaged patients. For the first time scientists and doctors have demonstrated that some patients diagnosed with persistent vegetative state may be able to communicate using functional magnetic resonance imaging (fMRI).

Killing is killing - or is it?

In the headlines this week is the tragic story of Frances Inglis, whom a jury at the Old Bailey found guilty of murdering her disabled son Tom and sentenced to nine years in jail. Tom Inglis had been left severely braindamaged after falling from a moving ambulance in 2007, throwing his mother in a state of deep distress. She refused to believe an (apparently isolated) encouraging prognosis from one of the doctors at the hospital, and concluded that it was her duty to release her son from the “living hell” in which he found himself. Horrified on learning that the only legal way of allowing her son to die was an application to the High Court for Tom’s food and water to be withdrawn, Frances Inglis decided to take action on her own. After a first unsuccessful attempt 14 months earlier, she took her son’s life by injecting him with a lethal dose of heroin in November 2008.

 

Should parents decide? The case of RB

In the Family Court yesterday, a controversial case that has been widely reported in the media came to a premature close. The father of baby RB, a severely physically disabled 13 month-old infant, withdrew his opposition to the plan by RB’s mother and doctors to take him off life support. It is believed that in the near future doctors will stop breathing machines and allow RB to die. The court did not, in the end, make a judgement about this case, though a statement of endorsement by Justice Macfarlane yesterday suggests that it would have reached the same conclusion.

Switzerland gets tough on suicide clinics

The Swiss government (the Federal Council) has recently announced its intention to crack down on “suicide tourism” and to severely restrict the activities of suicide clinics like Dignitas and Exit, which have regularly made the headlines outside Switzerland in the last few years (particularly Dignitas), as foreigners make up a large proportion of the hundreds of people they help to die every year. The government is proposing two draft Bills for public deliberation until March. The first option is an outright ban on suicide clinics; were it to become law, clinics like Dignitas and Exit would simply have to close down. Such an extreme measure, however, doesn’t have the favors of most members of the Federal Council, and probably won’t have those of the Parliament either. The second option is more likely to prove popular, and I will thus focus on it: it would involve much stricter regulations – rather than a ban – being imposed on the activities of these clinics. Violations of those regulations would involve sanctions of up to five years in prison.

Non-resisted suicide and depression

In late 2007 a young woman with a history of depression and several previous suicide attempts presented to an emergency department following an overdose. She gave doctors a copy of her living will, written 3 days previously, in which she made it clear that she wanted no measures to be taken to save her life. Earlier this week Roger Crisp and Julian Savulescu argued separately in this blog that the wishes of competent patients to end their lives should be respected. But if we believe that suicide can be rationally sought, and should sometimes not be resisted, should this include those who have been diagnosed with depression?

Living Wills and Assisted Suicide

Kerrie Wooltorton is believed to have been the first person to use a living will as part of a successful attempt to commit suicide: http://www.guardian.co.uk/society/2009/oct/01/living-will-suicide-legal . The 26-year-old wrote her will, and then three days later took poison and called an ambulance. The will said that no steps were to be taken to prolong her life, and that she desired only to be made as comfortable as possible and not to die alone.

If doctors had kept her alive, they may have been open to legal action. Indeed any interference with Wooltorton against her wishes could have been interpreted as an assault. But might there nevertheless be a moral case for ignoring a living will in such circumstances?

T-illegal actions and the case for legal ambiguity

Question: When is a crime not a crime? Answer: when it will never be prosecuted.

The release this week by the Director of Public Prosecutions of his interim policy on prosecution of assisted suicide raises a number of questions – as discussed yesterday in this blog by Simon Rippon. The new policy formalises what has been informal for some time, that family members of patients with terminal illnesses (or other serious conditions) who help the patients to travel overseas to access assisted suicide are unlikely to be prosecuted for their actions. But their actions will still be technically criminal. Should there be a class of ambiguous actions that are neither legal, nor illegal?

Assisted Suicide and Accusations

As a result of a court ruling requiring clarification of the law, the UK's Director of Public Prosecutions (DPP), Keir Starmer, yesterday issued some guidelines concerning the legal grey area of assisted suicide. The DPP published a list of factors that will weigh in favour of and against prosecutions for assisted suicide.

Care Not Killing (CNK), a UK umbrella group for organisations and individuals that oppose legalising assisted suicide and euthanasia, says that under the new guidelines:

it is envisaged that prosecutions for assisted suicide will be less likely where the deceased was terminally ill or suffering from a severe and incurable physical disability or a severe degenerative physical condition from which there is no possibility of recovery. [T]his classification ... implies that the lives of a whole group of people ... are less deserving of the law's protection than are others.

This kind of objection crops up frequently to laws that make special provision for some groups of people and not others. But does it hold up to scrutiny here? The guidelines do not state that the terminally ill, severely and incurably disabled, and those suffering a severe degenerative physical condition (hereafter, for brevity: The Unfortunate) are less deserving of anything than others, so if they do indeed imply that The Unfortunate are less deserving of the law's protection than others, it must be because the DPP's justification for the guidelines presupposes this judgment.