A random human
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Hi

Simple question.

Is passive euthenasia illegal in the UK?

That is to withhold treatment where the patient is no longer recovering, or if there is no other treatment available.

I understand that ethics is a very vague subject and there is really no right and wrong, it all depends on the circumstances and intentions.

Lets give some scenarios

1) Patient A is terminally ill and nothing is working. Infact treatment may be making the person worse off by putting them through unneeded stress and pain (surgery, drugs etc...). You can keep him alive but he decides that he wishes to have treatment stopped so he can die, but wishes to have drugs to reduce or eliminate all and any pain. He is not depressed and is completely competent to make this decision. You withold treatment and allow him to die peacefully.

2) Patient B is also terminally ill, treatments will work but it will put the patient under a lot of stress and pain, the patient would rather not go through this and says they want to stop treatment and just die. They are also showing signs of severe depression which may be altering the reality meaning they see the problem far worse than it actually is. They are most likely not competent to make their own decision and it may not be in their best interests.

3) Patient C comes into the hospital from a car accident and needs blood transfusion immediately. The patient is 25 years old, and is a Jehovah witness. Blood transfusions are illegal in their religion. The person is competent and mature, understands the situation completely and accepts that he will die if not given the blood transfusion. He is to his word and does not want to have a blood transfusion, rather he would die. You withold treatment and allow him to die.

All of these are a type of passive euthanasia. In my opinion 1 and 3 are fine to do but 2 is wrong.

However is there a clear cut law that any euthenasia, even if scenario 1 or 3 is present, is illegal?

Because with scenario 3, you have to resepct the patients autonomy, but you cannot harm a patient and must do what is in their best interest. They may feel their best interest is to die as they believe they will go to heaven, but then you are not saving them.

Cheers
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Revenged
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if someone has medical capacity they can decide what they like so 1 and 3. it is very clear cut.

why would 2 be wrong ? terminal patients are going to be depressed and it is reasonable to refuse further palliative chemo or radiotherapy. i doubt you will get a psych to label someone non-competent on the basis of depression and even if you think someone lacks capacity how are you going to be able to force someone to have palliative chemo or radiotherapy ? in real life it wont happen mate.

HTH
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Beska
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(Original post by A random human)
Hi

Simple question.

Is passive euthenasia illegal in the UK?

That is to withhold treatment where the patient is no longer recovering, or if there is no other treatment available.

I understand that ethics is a very vague subject and there is really no right and wrong, it all depends on the circumstances and intentions.

Lets give some scenarios

1) Patient A is terminally ill and nothing is working. Infact treatment may be making the person worse off by putting them through unneeded stress and pain (surgery, drugs etc...). You can keep him alive but he decides that he wishes to have treatment stopped so he can die, but wishes to have drugs to reduce or eliminate all and any pain. He is not depressed and is completely competent to make this decision. You withold treatment and allow him to die peacefully.

2) Patient B is also terminally ill, treatments will work but it will put the patient under a lot of stress and pain, the patient would rather not go through this and says they want to stop treatment and just die. They are also showing signs of severe depression which may be altering the reality meaning they see the problem far worse than it actually is. They are most likely not competent to make their own decision and it may not be in their best interests.

3) Patient C comes into the hospital from a car accident and needs blood transfusion immediately. The patient is 25 years old, and is a Jehovah witness. Blood transfusions are illegal in their religion. The person is competent and mature, understands the situation completely and accepts that he will die if not given the blood transfusion. He is to his word and does not want to have a blood transfusion, rather he would die. You withold treatment and allow him to die.

All of these are a type of passive euthanasia. In my opinion 1 and 3 are fine to do but 2 is wrong.

However is there a clear cut law that any euthenasia, even if scenario 1 or 3 is present, is illegal?

Because with scenario 3, you have to resepct the patients autonomy, but you cannot harm a patient and must do what is in their best interest. They may feel their best interest is to die as they believe they will go to heaven, but then you are not saving them.

Cheers
It's important with these things to remember that treatment at the end of life is just like treatment, on a basic level, at any point in that patient's care. The basics of patient choice, patient autonomy, the indication for medication, etc. is just the same.

In 1) the patient is declining treatment and indeed from the sounds of it the treatment is having no effect but lots of side effects so from the doctor's point of view I don't really see why they'd keep treating. The patient has the right to decline treatment.

In 2), it's important that their depression is not clouding their ability to make an informed decision. Without the depression, it's similar to 1) in terms of it's the patient declining treatment and you can't force treatment on someone that doesn't want it (that's assault). However, throwing depression and altered capacity to consent to treatment (or decline treatment) into the mix makes it more difficult. The GMC say:

66. A patient’s ability to make decisions may depend on the nature and severity of their condition, or the difficulty or complexity of the decision. Some patients will always be able to make simple decisions, but may have difficulty if the decision is complex or involves a number of options. Other patients may be able to make decisions at certain times but not others, because fluctuations in their condition impair their ability to understand, retain or weigh up information, or communicate their wishes.
Plus:

73. If your assessment leaves you in doubt about the patient’s capacity to make a decision, you should seek advice from:
a. nursing staff or others involved in the patient’s care, or those close to the patient, who may be aware of the patient’s usual ability to make decisions and their particular communication needs
b. colleagues with relevant specialist experience, such as psychiatrists, neurologists, or speech and language therapists.
74. If you are still unsure about the patient’s capacity to make a decision, you must seek legal advice with a view to asking a court to determine capacity.
It is important to bear in mind how the mental health act says competency should be assessed (http://www.patient.co.uk/doctor/mental-capacity-act):

i) A presumption of capacity: every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise.

ii) The right for individuals to be supported to make their own decisions: people must be given all appropriate help before anyone concludes that they cannot make their own decisions.

iii) That individuals must retain the right to make what might be seen as eccentric or unwise decisions.

iv) Best interests: anything done for or on behalf of people without capacity must be in their best interests.

v) Least restrictive intervention: anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.
i) and iii) are important to remember. In addition, it is important that the person should be able to understand, retain and weigh the information provided and communicate their decision. However, depression does not automatically mean a person lacks capacity and it's unfair to say that but it's important to assess if capacity has been impaired. It's all very complicated and covered in detail on the above link - it's worth a read. Not come across this problem in practice so not sure about pragmatic matters.

In c), the patient has the right to decline treatment, provided that they are competent to do so. It is important to make sure that 1) they have the capacity to make that decision, 2) they have not been coerced. In your example it seems that both those conditions are met. In that situation you would treat as much as you could. It does not necessarily mean they they will die (though, even if they do it doesn't change anything).
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nexttime
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For adults, yes it is legal.

Treating 1) or 3) would most likely land the doctor in court on a battery charge. You've deliberately worded 2) to be less clear cut - what happens in reality would probably mostly depend on the prognosis of the terminal illness.
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