www.mddus.com


If the principle of autonomy allows a


competent individual to refuse treatment even if the refusal of the treatment is likely to lead to death, it follows that there is a right to be allowed to die (it is now common to ask patients if they wish to be resuscitated). Whilst it can be acknowledged, albeit uneasily, that competent adults are at liberty to commit suicide, does autonomy also confer a right to commit suicide and, to go even further, does it confer a duty on doctors or others to assist when an autonomous individual wishes but is unable to end their own life? Tony Nicklinson – one of the appellants


mentioned above – had sought a change in the law so his wife would not face prosecution for assisting his suicide. His case was unsuccessful; however, he did end his life but only after several days of refusing food and water rather than by being helped to take a fatal overdose. As we have seen, as an


autonomous individual he had the right to refuse treatment, and for others to have tried to keep him alive against his wishes would have been illegal. Yet it also would have been, and remains, illegal for his wife to have assisted him as he wished. It is not surprising that, whilst


acknowledging the importance of respecting autonomy, many will have great difficulty in accepting that the same principle that underpins confidentiality and informed consent should inevitably lead to endorsement of a right to assisted suicide. There is a recognised unease with


accepting the over-arching primacy of autonomy and how this has been translated into the culture of individual rights and the duties placed on others as a result. It can be argued that this approach has become associated with a consumerist, libertarian approach to medical care that compromises the


autonomy of other individuals and not only trumps the other principles but appears to disregard them completely.


Do no harm The reality is that we already restrict the autonomy of individuals when it conflicts with other ethical principles; we do not prescribe antibiotics to everyone who requests them nor do we permit smoking in public places. Supporters of assisted suicide will argue


that the principle of non maleficence – first do no harm (primum non nocere) – also supports their case. On initial examination the concept of not doing harm seems intuitively correct, readily acceptable and appears to fit easily and consistently with the other prima facie duties and reflects current examples of best practice. However, what if there are competing


harms? How should we behave when the harm of being kept alive and prolonging dying


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16