Student Notes

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Ethics and Law

Session Name: Assisted Dying

Session Format: SGW

Aim
To introduce current law and professional guidance on assisted dying

Learning outcomes
By the end of this session you should be able to:
State current Egyptian law on brain death, organ donation, euthanasia and assisted suicide
Explain the Doctrine of Double Effect
Outline two arguments for and two arguments against the legalisation of assisted dying

Task 1: Quiz

1. What is the meaning of brain death and brain stem death?

A-Brain death is defined as Permanent cessation of cerebral hemispheres and brain stem
functions

2. How you diagnose brain death?

A- The patient is unresponsive to any stimulus (deep coma).
No motor responses within the cranial nerve distribution can be elicited by painful or other
sensory stimuli.
No reflex responses indicative of continued brain stem function:
Absence of corneal, occulo-cephalic and occulo-vestibular reflexes.
Absence of pupillary response of bright light.
Absence of gag reflex, spontaneous swallowing, tongue or facial movements
Apnoea test

3. Does diagnosis of brain death regulated by law in Egypt?

A-Egyptian law no.5 / 2010 regulating diagnosis of brain death and organ donation and
transplantation.

4. What is the meaning of PVS?

A-The term was coined to describe the patient who loses the higher cerebral powers of the
brain but the functions of the brainstem remains relatively intact.

5. What is the meaning of suspended animation?

A-It is the slowing of life processes without termination.
Breathing, heartbeat, and other involuntary functions may still occur, but they can only be
detected by artificial means.

6. What is the meaning of the term euthanasia? (1)

A - Euthanasia literally means "good death

An act of euthanasia has the intention of bringing about a good death for the person who dies

7. Euthanasia and murder are legally different in the Egypt. True or false? (1)
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A - False
Euthanasia and murder are legally equivalent in the Egypt
Mercy killing by active means is murder that the doctors motives are kindly makes no
difference in law.
The benevolence or otherwise of the intention is irrelevant in law

8. What does active euthanasia mean? (2)

A - Active euthanasia (killing) means deliberately hastening death (1) with a benevolent intention (1)

9. What does passive euthanasia mean? (2)

A - Passive euthanasia is taken to mean withholding or withdrawing treatment that is postponing or

could postpone death. The intention is for the person to die with the death viewed as a good thing
by the perpetrator.

Passive euthanasia is distinct from simply withholding/withdrawing treatment, although many

people do struggle with the distinction. The intention in passive euthanasia is to hasten death
whereas withholding/withdrawing treatment occurs when the treatment is not considered to be in the
best interests of the patient, or in line with their wishes/ refusal of consent. (death is a foreseen
consequence rather than the intention).

10. What is voluntary euthanasia? (1)

A - Voluntary euthanasia Intentionally causing / hastening a death for someone who is competent
and wants to die (with a benevolent intention)

11. What is non-voluntary euthanasia? (1)

A Non-voluntary euthanasia Intentionally causing / hastening a death for someone who lacks
capacity to make that decision (with a benevolent intention)
(i.e. who is unable to give consent/ express their will)

12. What is involuntary euthanasia? (1)

A - Involuntary euthanasia Intentionally causing / hastening death against the will of the person who
dies (with a benevolent intention)

13. How did Dr Cox attempt to kill his patient, Lillian Boyes (as in the case R v Cox [1992])?
(1)

A - He gave her an injection of potassium chloride

14. What offence was Dr Cox charged with? (1)

A - He was charged with attempted murder, since it would have been impossible to conclusively
prove that the injection he gave killed her and he was given a 12-month suspended sentence
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15. What did the Cox case confirm (legally)? (1)

A - That it is illegal to deliberately hasten death in order to relieve suffering (that the doctors motive
kindness, compassion - is irrelevant in law). Therefore, euthanasia is legally equivalent to murder.

16. How did Dr Adams patient die, (as in the case R v Adams [1957])? (1)

A She died of an overdose of large quantities of opioid painkillers (morphine) administered by Dr

Adams

17. Why wasnt Dr Adams convicted of murder? (1)

A- Because his intention was to relieve the patients suffering, not kill her.

18. What do you understand the Doctrine of Double Effect to mean? (2)

A - This says that there is a morally significant distinction between:

what you intend to do
and
the consequences that you foresee

Intending to bring about death (illegal) is different from intending to relieve the patients pain,
foreseeing that death will result (legally permissible).

19. What is the maximum prison sentence for aiding the suicide of another? (1)

A - Fourteen years imprisonment.

20. Whats the difference between physician-assisted suicide and euthanasia? (1)

A - PAS can be simply defined as the doctor assisting the patient to commit suicide (eg by prescribing
drugs which the patient takes him/herself). This is different from euthanasia, which means that death
is deliberately caused or hastened without the assistance/active involvement of the patient.

21. List three places where physician assisted suicide is legal (3)

A - USA states, Oregon (since 1994) and Washington (since Nov 2008)
Netherlands (1993), Belgium (2002), Switzerland

Task 2: Should assisted dying be legalised?

The statements below relate to a particular argument regarding the legalisation of assisted dying. For
each statement, please answer the following questions:

1. Is the argument in favour of or against the legalisation of assisted dying?

2. How convincing do you find the argument, on a scale of 1-5?
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Ethics and Law

3. Can you think of a good response to the argument?

Group 1
1. We should focus on providing good end of life and palliative care instead of talking about killing
people. This would relieve the suffering of the vast majority of patients

2. If assisted suicide were legalised, it wouldnt be long before euthanasia was legalised too. Its
inevitable

3. Most doctors wouldnt want to take part in helping patients to die. You cant force us to do
something like that if we dont want to

Group 2
1. Patients who are at the end of their lives might take a long time to die, even though they want
things to be over quickly. If we were being compassionate, we would help them to die more quickly

2. It is not our place to judge when our lives are at an end; all human life is sacred

3. The general public seems to be in favour of some sort of assisted dying, so it should be legalised

Group 3
1. If assisted dying were legalised, some patients would feel under pressure to die when they dont
want to

2. The public trust doctors more than any other profession. If we helped people to die, we would
lose this trust

3. There is already evidence that some doctors help their patients to die. If we legalised this, it
would bring the practice out into the open and we could regulate it

Group 4
1. Respect for patient autonomy is a fundamental value in healthcare, so we should extend this to
allow people to choose when to end their lives

2. Assisted dying should never be legalised because it is incompatible with the aims and ethos of
healthcare

3. Most doctors do not want assisted dying to be legalised, and theyre the experts. We should listen
to them

Further Reading

Chapter 12, pp 179-181 and pp 184-191 of End of life in Hope T., Savulescu J. & Hendrick J. Medical Ethics
and Law: the core curriculum, 2nd edition, Churchill Livingstone, 2008