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Euthanasia and physician assisted suicide: do the moral arguments differ?

A discussion paper from the BMA’s Medical Ethics Department
April 1998

Introduction
Euthanasia and physician assisted suicide are controversial, emotive issues which are often at the forefront of public debate.

For many years, the BMA has opposed any change in the current UK legislation which prohibits euthanasia. Physician assisted suicide is also legally prohibited but has not generated the same level of intense debate. Frequently both acts are perceived as identical. Some commentators, however, suggest that euthanasia debates are more concerned with interpretations of "beneficence" whereas discussions of assisted suicide rely on "autonomy" arguments.Go to reference 1 It is said, for example that this is one of the main distinctions between the Australian Northern Territories Rights of the Terminally Ill Act (passed 1995 but subsequently annulled) and the Oregon Death with Dignity Act (passed in 1994 but not implemented until 1998). The Oregon legislation allows doctors to provide the means for ending life but not to administer it whereas the Australian law permitted more extensive medical participation.

This discussion paper has been drawn up to stimulate wider debate within the profession about euthanasia and assisted suicide.

While the BMA opposes euthanasia primarily on the grounds that it is alien to the traditional ethos and moral focus of medicine, some of the most convincing arguments have been purely practical. The difficulties of effectively monitoring euthanasia to ensure against abuse are acknowledged even in the Netherlands where experts estimated that, contrary to the regulations, six out of ten cases of euthanasia were going unreported.Go to reference 2 From a practical perspective, the BMA considers that acceptance of euthanasia as an option could exercise a detrimental effect on societal attitudes and on the doctor-patient relationship, jeopardising in particular, the fate of vulnerable individuals. Some of these arguments apply equally to physician assisted suicide. Nevertheless, a 1996 nationwide survey of doctors appeared to indicate attitudinal differences to the two acts Go to reference 3. The BMA's Medical Ethics Committee is anxious to know whether doctors consider that these apparently differing intuitive responses to euthanasia and assisted suicide are supported by convincing moral arguments.

References

1. La France A.B. Physician Assisted Death: A comparison of the Oregon and Northern Territory Statutes, quoted by McLean S A, Britton A, in Sometimes a Small Victory, Glasgow University (1996)(commissioned by the Scottish Voluntary Euthanasia Society but carried out by an independent agency
2. Interview with Professor van der Wal, author of the 1995 study* into medical decisions at the end of life, reported in Newsletter 60 of the Voluntary Euthanasia Society, May 1997.
   *Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. New England Journal of Medicine 1996; 335:1699-705.
3. McLean S, Britton A, Sometimes A Small Victory, Glasgow University (1996) (commissioned by the Scottish Voluntary Euthanasia Society but carried out by an independent agency).