Ethics - Life, death, dying and killing

From CambridgeNotes

Decision making with patients with advanced progressive illnesses who may be dying is complex and is underpinned by the four principles of medical ethics: beneficence, non-maleficence, justice and respect for autonomy.


  • Law
    • Active euthanasia (X performs an action resulting in Y's death) is illegal in UK, even if the patient requests it or if it is in the patient's best interests.
    • Passive euthanasia (X allows Y to die by withdrawing/withholding life-prolonging treatment) is not necessarily illegal, if it is the patient's best interests for them to be allowed to die as a result of the natural course of the illness. For example, withdrawing ventilation and withholding hydration and nutrition may be legal.
    • Intending relief of distress despite foreseeing death is usually legal. As the doctor's legal duty is to act in the patient's interests, it is legal to inject morphine with the intention of relieving a patient's distress but with the foreseen complication that it causes death.
    • Intentionally assisting suicide is illegal. However, if the doctor had prescribed drugs for therapeutic purposes that the patient overdosed on, the doctor is not guilty. This doctor maybe negligent.
    • Competent patient: can refuse any life-saving treatment and this is not suicide. The doctor must comply with the patients wishes or else they would be committing a battery.
    • Incompetent patient: the doctor has a duty of care to treat in the patient's best interests, even if this means allowing the patient to die.
  • Ethics:
    • FOR euthanasia: patient autonomy, relief of suffering, suicide is accepted
    • AGAINST euthanasia: advances in palliative care reduces suffering, medicine aims to promote life so euthanasia may cause distrust of doctors, pressure on an ill/vulnerable person to opt for euthanasia as they may want to relieve the burden they place on others

Do Not Resuscitate (DNR): A limitation of treatment.

  • BMA/RCN/UK Resuscitation Council guidelines 2001 suggest considering DNR when:
    • CPR is likely to be futile
    • mentally competent patient refuses CPR (recorded, sustained wishes, valid advance directive)
    • incompetent patient: CPR is likely to lead to a quality of life not in the patient's best interests. Family members can neither refuse nor demand a DNR order.

Organ Transplantation There are 2 important statutes:

  • The Human Tissue Act (1961)
    • Allows people to donate their organs for therapeutic purposes after death
    • Allows surviving relatives to veto a patient's request
  • The Human Organ Transplants Act 1989
    • For transplants involving living donors:
      • No payment for organs
      • Transplant must be between genetically related individuals, or else approved by a special authority (ULTRA)
  • UK Transplant guidelines for the allocation of organs for donation is based on the chance of success of the transplant: donor age and the geographical proximity of the donor and the transplant centre.