EMERITUS BRITISH PROFESSOR OF MEDICAL ETHICS PLEADS FOR LEGALISATION OF EUTHANASIA OF INCOMPETENT PATIENTS

Pr. Len Doyal, emeritus (i.e. retired from teaching) professor of medical ethics at the Queen Mary University of London published an article in the review Medical Ethics. In the British newspaper The Guardian of Thursday 8 June, a front-page coverage is devolved to the thesis of Doyal. Doyal has been a supporter of the “assisted dying bill” of Lord Joffe which is also covered elsewhere in an earlier post on this blog. The bill has been postponed for further examination – i.e. sent back to an undetermined period – thanks to the efforts of opponents of the bill.

In fact, for Pr. Doyal, what is problematic are the instances where life-sustaining care is removed from an patient whose “quality of life” is not deemed acceptable. The UK, just as the USA, allow in fact the withdrawal of artificial feeding of life-supporting artefacts in some circumstances. For Doyal, doctors should recognise that they are “already killing patients” when they remove feeding tubes from those “whose lives are judged to be no longer worth living”.

The article of the Guardian goes on quoting Doyal:

Withdrawing life saving treatments for incompetent patients is “believed to be morally appropriate because it constitutes doing nothing. It is disease that does the dirty work, not the clinician. Yet this argument cannot wash away the foreseeable suffering of severely incompetent patients sometimes forced to die avoidably slow and distressing deaths…”

Doyal then draws a parallel with a father who might be condemned for letting his baby die in its bath without acting to save it (and is thus criminally responsible) and continues:

“Clinicians who starve morally incompetent patients to death are not deemed by law to have killed them actively even if they begin the process by the removal of feeding tubes. The legal fiction is that such starvation is not active killing is no more than the clumsy judicial camouflage of the euthanasia that is actually occurring”.

For Doyal, and in that he rejoins proponents of euthanasia for incompetent patients in Belgium,

“the category of patients that concerns me most are the patients where we are not sure. There is still some brain functions but they will never have any brain awareness or cognitive functions, but they seem to be suffering”.

While Peter Saunders, a representative of Care Not Killing, an anti-euthanasia organization, stresses that Doyal is using medical paternalism at its utmost extent, it is also worth critically considering the arguments of Doyal.

Firstly, Doyal is right in questioning the practice of withdrawing feeding or life-sustaining care to patients who are incompetent, but not in danger of immediate death. Such an intervention might be morally sustainable only when the situation is irreversible, medically, and when the care requested for the patient is too important for him to be living without heavy medical assistance. Otherwise, starving to death a person who could still live otherwise can be deemed morally as taking a positive action to shorten its life. The Catholic church has some ambiguity in that respect, since it will be recalled that it took positive action to help maintain Terri Schiavo alive even though she was severely brain damaged. In other occurrences, Catholic thinkers consider that care may become futile (disproportionate in regards to the ends researched).

However, there is another distinction which Doyal surprisingly neglects: that is that between an active intervention and the abstention of doing anything negative. When feeding or life-sustaining treatment is withdrawn, this means simply that the physician is abstaining from prolonging artificially a life that is near to its “natural” conclusion. A lethal injection is a positive action which puts the physician in the guise of cutting short the life of the individual.

However, what is even more serious, is the confession by Doyal that end-of-life decisions are made by physicians on the basis of a normative appreciation of what is a life that is “worth living”. We are not very far now from giving physicians the ultimate authority on who will live and who will die.

In addition, Doyal cleverly does not quote sufferings, when he talks of incompetent patients: the reason is that the withdrawal of life-supporting treatment does not mean withdrawing palliative medications that may ensure a painless death, while as Doyal himself confesses not to be sure whether the patients still can be feeling pain…

Nowhere maybe as in the UK have the proponents of euthanasia been so outspoken and articulate in their desire to put an end to life of incompetent patients. This ultimate goal, precedes only one which has not yet been spoken out: a socially biased medicine, where poor and “useless” patients would be directly sent to death, while financially proficient patients would be allowed to live and be cured.