Medical journal puts forward case for euthanasia

Euthanasia and physician-assisted suicide should be legalised, according to an editorial published this morning in the British Medical Journal. If death is in a patient's best interests, then death constitutes a moral good, according to the report.

The editorial, written by two British medical professors, is highly controversial, coming so soon after the right-to-euthanasia case taken by Ms Diane Pretty. The British courts ruled last month that Ms Pretty, who suffers from incurable motor neurone disease, may not be assisted to die by her husband. "This decision may be consistent with legal precedent but is morally wrong. That is why the law should be changed," the editorial states.

It was written by Prof Len Doyal, professor of medical ethics at the University of London, and Prof Lesley Doyal, professor of health and social care at the University of Bristol.

If Ms Pretty had become permanently incompetent as a result of brain damage and was being kept alive by medical technology, then legally her doctors could withdraw life-saving treatments resulting in her death, the authors write. This same discretion is not available to doctors in most other circumstances.

"Against the background of the duty to care, the moral and legal status of not saving a life through failing to treat can be the same as actively taking that life," the authors suggest.

If it is sometimes acceptable for doctors to stop sustaining life when this is in the best interests of severely incompetent patients, and cause death through inaction, then action and inaction "may be deemed morally and legally equivalent", they say.

"Thus parliament and the courts should take the next step of recognising that this same equivalence should hold when there is clinical agreement that it is in the best interests of some severely incompetent patients to end their life."

If taking away life-sustaining treatment can be said to be of benefit to some patients, "then death constitutes a moral good for these patients. And if this is so, why is it wrong to intend to bring about this moral good?" they ask.

"Returning to Ms Pretty, why should we not also legalise voluntary active euthanasia in light of these arguments? Were she permanently and severely incompetent, we have seen the circumstances in which her doctors would be allowed to end her life passively and should be allowed to do so actively. Therefore, should she not be able to invite them actively to end her life and to advise them about how this should be done?"

Doctor-assisted suicide or euthanasia is directly contrary to the ethical rules laid down for doctors here by the Medical Council. Its Guide to Ethical Conduct & Behaviour Section E points out: "Deliberately causing the death of a patient is professional misconduct."

The guide indicates that where a patient is unable to communicate or consent to treatment, then the doctor should discuss patient management with next-of-kin.

It adds: "The council reiterates its view that access to nutrition and hydration remains one of the basic needs of human beings, and all reasonable and practical efforts should be made to maintain both of them."