The Traditional Account of Ethics and Law at the End of Life—and its Discontents
For the past 30 years, the Melbourne urologist Dr Rodney Syme has quietly—and more recently, not-so-quietly—assisted terminally and permanently ill people to die. This paper draws on Syme’s recent book, A Good Death: An Argument for Voluntary Euthanasia, to identify and to reflect on some important challenges to what I outline as the traditional account of law, ethics, and end of life decisions. Among the challenges Syme makes to the traditional view is his argument that physicians’ intentions are frail and unfairly expose physicians to moral and legal censure. Secondly, Syme argues that physician-assisted dying (PAD) should be framed as a form of palliative care, not as a kind of safety-chute for when palliative care fails. Thirdly, Syme himself is a rare breed: a dissident doctor who has opened himself up for scrutiny and criticism, by reflecting publicly on his experiences at the edge of the law. Syme’s career illustrates that prohibition, just like legalization, is a social policy that carries social consequences. The paper acknowledges the variability and idiosyncratic nature of extra-legal physician-assisted dying, and argues that the best way forward is to attempt to weigh the social consequences of both policies. Advocates and opponents of PAD should recognize that both prohibition and legalization involve trade-offs and impose possible costs on patients and on society.
KeywordsEuthanasia Physician-assisted suicide Palliative sedation Criminal law Personal autonomy Withdrawing treatment Law and ethics
The author would like to thank the reviewers for their helpful comments.
- Airedale NHS Trust v Bland (1993) AC 789–899.Google Scholar
- Alcorn, G. 1998. Right to die row returns. Age. 2 November, p 1.Google Scholar
- Assisted Dying for the Terminally Ill Bill. 2004. (House of Lords) (HL Bill 17).Google Scholar
- Beauchamp, T. and F. James. 1994. Principles of biomedical ethics, 4th ed. New York: Oxford University Press.Google Scholar
- Butcher, S. and L. Pryor. 2003. Justice tempered with mercy for husband who helped his wife die. Sydney Morning Herald. 25 July 2003.Google Scholar
- Campbell, S. 2008. Ten years of “death with dignity”. The New Atlantis 22: 33–46.Google Scholar
- Consent to Medical Treatment and Palliative Care Act. 1995. (SA) s. 17.Google Scholar
- Cox. 1992. 12 BMLR 38.Google Scholar
- Crimes Act. 1900. (NSW) s 18 (defining murder and manslaughter).Google Scholar
- Criminal Code Amendment Suicide Related Material Offences Act. 2005.Google Scholar
- Cruzan v Director, Missouri Department of Health 497 US 261. 1990.Google Scholar
- Davies, N. 1995. Helping patients to die. Age. 25 March, p 1.Google Scholar
- Davies, J. 2007. Terminal answer. Bulletin. 6 November, pp 28–31.Google Scholar
- Davies, J. 2009. Suicide drug of choice in mail; death drug ordered by internet, sourced by friends in underground trade. Weekend Australian. 14–15 March 2009, pp 1, 4.Google Scholar
- Fitzgerald, J. 1999. Bioethics, disability and death: Uncovering cultural bias in the euthanasia debate. In Disability, divers-ability and legal change, ed. M. Jones and L. Marks, 267–281. The Hague: Nijhoff.Google Scholar
- Gardner; re BWV. 2003. VSC 173 (29 May 2003).Google Scholar
- Gonzales v Oregon. 2006. 126 S. Ct. 904; 546 U.S. 243.Google Scholar
- Gunderman, R. 2002. Is suffering the enemy? Hastings Center Report March-April: 40–44.Google Scholar
- Herranz, G. 2004. Euthanasia: An uncontrollable power over death. (Translated from the Spanish by Lilia Ceballos; published in Spanish as La Metamorfosis del Activismo Pro-eutanasia. Persona y Bioética 8: 16–21. English-language version published 2006. The National Catholic Bioethics Quarterly 6: 263–270. Available at: http://www.lifeissues.net/writers/her/her_01euthanasia.html (accessed 27 February 2009).
- House of Lords, Select Committee on the Assisted Dying for the Terminally Ill Bill. Final Report. 2005. (HL Paper 86–1, 4 April, at: http://www.publications.parliament.uk/pa/ld/ldasdy.htm) (accessed 12 March 2009).
- Hutchings, B. 1997. Andrews won’t stop me, doctor vows. Australian. 26 March, p 2.Google Scholar
- Kaldjian, L.C., J.F. Jekel, J.L. Bernene, G.E. Rosenthal, M. Vaughan-Sarrazin, and T.P. Duffy. 2004. Internists’ attitudes towards terminal sedation in end of life care. Journal of Medical Ethics 30: 499–503.Google Scholar
- Keizer, B. 1997. In search of a decent death. Guardian Weekly. 13 April 1997: 24.Google Scholar
- LaFrance, A.B. 2008. Physician assisted death: From rhetoric to reality in Oregon. Wyoming Law Review 8: 333–346.Google Scholar
- McStay, R. 2003. Terminal sedation: Palliative care for intractable pain, post Glucksberg and Quill. American Journal of Law & Medicine 29: 45–76.Google Scholar
- Magnusson, R. 2002. Angels of death: Exploring the euthanasia underground. Melbourne: Melbourne University Press. New Haven, Connecticut: Yale University Press.Google Scholar
- Name withheld. 1998. It’s over Debbie. Journal of the American Medical Association 259: 272.Google Scholar
- O’Connor, M., D. Kissane, and O. Spruyt. 1999. Sedation in the terminally ill—A clinical perspective. Monash Bioethics Review 18: 17–27.Google Scholar
- O’Reilly, K. 2008. Montana court OKs doctor-assisted suicide. American Medical News, at: http://www.ama-assn.org/amednews/2008/12/29/prsa1229.htm (posted 29 December) (accessed 5 June 2009).
- O’Reilly, K. 2009. Montana judge rejects stay of physician-assisted suicide ruling. American Medical News, at: http://www.ama-assn.org/amednews/2009/01/26/prsd0129.htm (posted 29 January) (accessed 5 June 2009).
- Palmer, H. 1957. Dr Adams’ trial for murder. Criminal Law Review: 365–377.Google Scholar
- Pollard, B. and R. Winton. 1993. Why doctors and nurses must not kill patients. Medical Journal of Australia 128: 426–429.Google Scholar
- Pretty v The United Kingdom. 2002. 2346/02  ECHR 427 (20 April 2002).Google Scholar
- R v Woollin. 1999. 1 AC 82.Google Scholar
- R (Pretty) v DPP. 2002. 1 AC 800.Google Scholar
- R v Maxwell. 2003. VSC 278 (24 July 2003).Google Scholar
- Re A (children)(conjoined twins). 2000. 4 All ER 961–1070.Google Scholar
- Re B (adult: refusal of medical treatment). 2002. 2 All ER 449.Google Scholar
- R v Shirley Justins. 2008. NSWSC 1194 (12 November 2008).Google Scholar
- Re T. 1992. 4 All ER 649.Google Scholar
- Rodriguez v British Columbia (Attorney General). 1993. 3 S.C.R. 519.Google Scholar
- St George’s Healthcare NHS Trust v S; R v Collins & Ors, ex parte S. 1998. 3 All ER 673.Google Scholar
- Shipman Inquiry, The. 2005. Shipman: The final report. London: UK Home Office, at: http://www.the-shipman-inquiry.org.uk/reports.asp (accessed 29 August 2008).
- Souter, F. 2008. His life in her hands. Good Weekend. (The Sydney Morning Herald Magazine). 2 August 2008, pp. 18–26.Google Scholar
- Syme, R. 1998a. Ending the pain of dying. Age. 2 November, p 15.Google Scholar
- Syme, R. 1998b. The father, son and euthanasia. Age. 13 April.Google Scholar
- Syme, R. 1999. Reply from Rodney Syme. Monash Bioethics Review: 34–40.Google Scholar
- Syme, R. 2008. A good death: An argument for voluntary euthanasia. Melbourne: Melbourne University Press.Google Scholar
- Tallis, R. 1996. Is there a slippery slope? Times Literary Supplememt. 12 January, p. 3.Google Scholar
- Vacco v. Quill 521 U.S. 793. 1997.Google Scholar
- van der Heide, A., L. Deliens, K. Faisst, T. Nilstun, M. Norup, E. Paci, et al. 2003. End-of-life decision-making in six European countries: Descriptive study. Lancet 361: 345–350.Google Scholar
- Washington v. Glucksberg 521 U.S. 702. 1997.Google Scholar