Helga Kuhse

Why Terminal Sedation is no Solution to the Voluntary Euthanasia Debate
  • Helga Kuhse
Chapter

Abstract

In an interesting and provocative article, Professor Tännsjö has suggested that terminal sedation at the patient’s request might function as an alternative to voluntary euthanasia and resolve the deadlock between those who support voluntary euthanasia, and those who oppose it on the grounds that it infringes the Sanctity-of-Life Doctrine1. I disagree.

While terminal sedation would be an acceptable alternative to some supporters of voluntary euthanasia, it would be opposed by traditional supporters of the Sanctityof-Life Doctrine. As I shall attempt to show, terminal sedation involves the intentional termination of life or killing and would thus constitute euthanasia.

Substantially, I shall argue that the Sanctity-of-Life Doctrine, in its reliance on the Doctrine of Double Effect, is not an appropriate basis for clinical decisionmaking and the law. In the absence of convincing reasons to the contrary, doctors should be allowed to provide both terminal sedation and euthanasia to terminally or incurably ill patients, at the patients’ request.

Keywords

Palliative Care Double Effect Monash Bioethic Review Competent Patient Terminal Sedation 
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Notes

  1. 1.
    ”Terminal Sedation — A Compromise in the Euthanasia Debate?”, Bulletin of Medical Ethics, No. 163, November 2000, pp. 13–22. He has developed his argument further in Chapter 2 of this book, and all my cuhsenuent references are to this chapter.Google Scholar
  2. 2.
    Rights of the Terminally Ill Act 1995, Northern Territory of Australia. Darwin: Government Printer, 1995.Google Scholar
  3. 3.
    Commonwealth Euthanasia Laws Act 1997.Google Scholar
  4. 4.
    Terminal sedation is practised in Australia, but the moral and legal status of various regimes described by the term remains contentious. For some backgrouund on the case of Ester Wild and the Northern Territory Legislation, see David W. Kissane, Annette Street, Philip Nitschke: ‘Seven deaths in Darwin: case studies under the Rights of the Terminally Ill Act, Northern Territory, Australia’, The Lancet, Vol. 352, October 3, 1988, pp. 1097–1102.CrossRefGoogle Scholar
  5. 4a.
    See also Helga Kuhse: ‘Voluntary euthanasia, politics and the law’, Monash Bioethics Review, Vol. 16, No.1, January 1997, pp. 1–4Google Scholar
  6. 4b.
    See also Helga Kuhse: also ‘Death of the NT Rights of the Terminally Ill Act’. Monash Bioethics Review, Vol. 16, No. 3, July 1997, pp. 3.Google Scholar
  7. 5.
    Professor Tännsjö does not define voluntary euthanasia in this way, but I take it that this is the understanding he has in mind when, on p. 17, he refers to the Dutch practice of voluntary euthanasia as ‘the active and intentional killing of patients ... at the request of these patients ...’Google Scholar
  8. 6.
    Professor Tännsjö’s initial definition of ‘terminal sedation’ covers only terminally ill patients, but is then extended to cover incurably ill patients as well (p. 26).Google Scholar
  9. 7.
    For a detailed discussion and critique of the Sanctity-of-Life Doctrine in Medicine, see Helga Kuhse: The Sanctity-of-Life Doctrine in Medicine — A Critique, Oxford: Oxford University Press, 1987.Google Scholar
  10. 8.
    Paul Ramsey, as quoted by Daniel Callahan: ‘The Sanctity of Life’ in Dr. R. Cutler (ed.): Updating Life and Death, Boston: Beacon Press, 1969, pp. 181–223Google Scholar
  11. 8a.
    see also Paul Ramsey: Ethics at the Edges of Life, New Haven and London: Yale University Press, 1978, p. 147.Google Scholar
  12. 9.
    Sacred Congregation for the Doctrine of the Faith: Declaration on Euthanasia, Vatican City, 1980, p. 6; in the Appendix of this book, p. 136.Google Scholar
  13. 10.
    Crinminal Code of Western Australia, Section 273. See also the New South Wales (Australia) Crimes Act 1900, S.19(1)(a) which states: ‘Murder shall be taken to have been committed where the act of the accused or the thing omitted by him to be done, causing the death charged, was done or omitted with reckless indifference to human life, or with intent to kill or inflict grievous bodily harm upon some person.’ (my emphasis) For a general discussion of the sanctity of life view in law, see E.W. Keyserlingk: Sanctity of Life or Quality of Life (in the context of ethics, medicine, and law). Study written for the Law Reform Commission of Canada, Ottawa: Law Reform Commission, 1979.Google Scholar
  14. 11.
    Sacred Congregation for the Doctrine of the Faith, op. cit., p. 10; reprinted in the Appendix of this book, p. 138.Google Scholar
  15. 12.
    Sacred Congregation for the Doctrine of the Faith, op. cit., pp. 8–9; reprinted in the Appendix of this book, p. 139. For a critical analysis of these assumptions, see Helga Kuhse: The Sanctity-of-Life Doctrine in Medicine — A Critique, op. cit.Google Scholar
  16. 13.
    See Chapter 2, Helga Kuhse: The Sanctity-of-Life Doctrine in Medicine — A Critique, op. cit.Google Scholar
  17. 14.
    For a statement of the Doctrine, see Catholic University of America: New Catholic Encyclopedia, Vol. 4, New York: McGraw Hill, 1976, pp. 1020–22.Google Scholar
  18. 15.
    Jonathan Glover: Causing Death and Saving Lives, Harmondworth: Penguin Books, 1977, p. 90.Google Scholar
  19. 16.
    Sacred Congregation: Declaration on Euthanasia, op. cit., p. 10; reprinted in the Appendix of this book, p. 137..Google Scholar
  20. 17.
    Hedonistic utilitarians would fall into this group.Google Scholar
  21. 18.
    Preference utilitarians and various rights or autonomy-based ethical theories would take this kind of view.Google Scholar
  22. 19.
    For two such views, see, for example, Max Charlesworth: Bioethics in a Liberal Society (Cambridge: Cambridge University Press, 1993)CrossRefGoogle Scholar
  23. 19a.
    Ronald Dworkin: Life’s Dominion: An argument about abortion, euthanasia and individual freedom, New York: Knopf, 1993.Google Scholar
  24. 20.
    The Sanctity-of-Life Doctrine in Medicine, op.cit.Google Scholar
  25. 21.
    See, for example, Helga Kuhse: Chapter 8, Helga Kuhse: Caring: Nurses, Women and Ethics, Oxford: Blackwell, 1997Google Scholar
  26. 21a.
    and Helga Kuhse: ‘From Intention to Consent’ in (eds.) Margaret P. Battin, Rosamond Rhodes, and Anita Silvers: Physician-Assisted Suicide — Expanding the Debate, New York and London: Routledge, 1998, pp. 252–266.Google Scholar
  27. 22.
    See H.T. Engelhardt: The Foundations of Bioethics, second edition, Oxford: Oxford University Press, 1995.Google Scholar
  28. 23.
    The investigation was subsequently dropped.Google Scholar
  29. 24.
    See Chapter 3, Helga Kuhse: The Sanctity-of-Life Doctrine in Medicine, op. cit.Google Scholar
  30. 25.
    See, for example, Roger Hunt: ‘Palliative Care: The Rhetoric-Reality Gap’, In Helga Kuhse (ed.): Willing to Listen — Wanting to Die, Ringwood, Vic.: Penguin Books, 1994, pp. 115–136Google Scholar
  31. 25a.
    and T.E. Quill, R. Dresser, D.W. Brock: ‘The Rule of Double Effect — A Critique of its Role in End-of-Life Decision Making’, New England Journal of Medicine, Vol. 327(24), 11 December 1997, pp. 1768–1771.CrossRefGoogle Scholar
  32. 26.
    Roger Hunt: ‘Palliative Care: The Rhetoric-Reality Gap’, In Helga Kuhse (ed.): Willing to Listen — Wanting to Die, 1968 op.cit., pp. 115–136.Google Scholar
  33. 27.
  34. 28.
    The Netherlands, Belgium, and Oregon are exceptions. In the US State of Oregon, physician-assisted suicide is lawful, and doctors in the Netherlands and Belgium can lawfully practise both voluntary euthanasia and medically assisted suicide.Google Scholar
  35. 29.
    P.J. van der Maas, J.J.M. Delden, L. Pijnenborg: ‘Euthanasia and Other Decisions Concerning the End of Life’, Lancet, Vol. 338, 1991, pp. 669–74CrossRefGoogle Scholar
  36. 29a.
    P.J. van der Maas, G. van der Wal, I. Haverkate, et al.: ‘Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands 1990–1995’, New England Journal of Medicine, Vol. 335, 1996, pp. 1699–1705CrossRefGoogle Scholar
  37. 29b.
    Helga Kuhse, Peter Singer, Peter Baume, et al: ‘End-of-Life Decisions in Australian Medical Practice’, Medical Journal ofAustralia, Vol. 166, 1997, pp. 191–96Google Scholar
  38. 29c.
    Luc Deliens, Freddy Mortier, Johan Bilsen, et al: ‘End-of-Life Decisions in Medical Practice in Flanders, Belgium: A Nationwide Survey’, Lancet, Vol. 356, 2000, pp. 1806–1811.CrossRefGoogle Scholar
  39. 30.
    Vacco v. Quill, 80f, 3rd. 716 (2nd Circ) 1966. This case of discrimination was upheld by the Appeals Court, but not subsequently by the United States Supreme Court (Vacco v. Quill, 117 S.Ct. 2293. 1997).Google Scholar
  40. 31.
    See endnote 2.Google Scholar
  41. 32.
    P.J. van der Maas, J.J.M. Delden, L. Pijnenborg: ‘Euthanasia and Other Decisions Concerning the End of Life’, Lancet, Vol. 338, 1991, pp. 669–74CrossRefGoogle Scholar
  42. 32a.
    P.J. van der Maas, G. van der Wal, I. Haverkate, et al.: ‘Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands 1990–1995’, New England Journal of Medicine, Vol. 335, 1996, pp. 1699–1705CrossRefGoogle Scholar
  43. 32b.
    Helga Kuhse, Peter Singer, Peter Baume, et al: ‘End-of-Life Decisions in Australian Medical Practice’, Medical Journal ofAustralia, Vol. 166, 1997, pp. 191–96Google Scholar
  44. 32c.
    Luc Deliens, Freddy Mortier, Johan Bilsen, et al: ‘End-of-Life Decisions in Medical Practice in Flanders, Belgium: A Nationwide Survey’, Lancet, Vol. 356, 2000, pp. 1806–1811.CrossRefGoogle Scholar
  45. 33.
    John Griffiths: ‘The Regulation of Euthanasia and Related Medical Procedures that Shorten Life in the Netherlands’, Medical Law International, Vol. 1, 1994, pp. 137–58.CrossRefGoogle Scholar
  46. 34.
    See Helga Kuhse, Peter Singer, Peter Baume, et al: ‘End-of-Life Decisions in Australian Medical Practice’, op.cit.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2004

Authors and Affiliations

  • Helga Kuhse
    • 1
  1. 1.Monash Centre for Human BioethicsMonash UniversityAustralia

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