Pressure is growing in Europe for some form of legalised euthanasia but few governments have gone as far as the Benelux countries in allowing assisted suicide in clearly defined cases. The mix of growing public support for ending lives of the terminally ill or brain dead but continued prohibitions on it in the law has led to some long and hard-fought legal battles in Italy (Eluana Englaro) and in France (Vincent Humbert).

(Photo: Multiple sclerosis sufferer Debbie Purdy, whose case prompted Britain’s new guidelines, 2 June 2009/Stephen Hird)

It has also created a legal and ethical twilight zone where for compassionate reasons the law did not really punish the doctors, nurses or relatives who helped someone die. In France, this became clear in a number of court cases where the person accused of assisted suicide were convicted but got only a short suspended sentence. In Britain, a frequently used way to get around the law has been the so-called “suicide tourism” route to the Dignitas suicide group in Zurich.

Pressed by the Law Lords to clarify British policy, the Director of Public Prosecutions in London has issued guidelines indicating when someone who helps another person to commit suicide might face legal action. At first glace, this may seem like a clarification. But it still leaves enough questions out there to leave the issue shrouded in uncertainty. The reception in London has been mixed. Some commentators say this strikes a sensible balance but others think it’s not enough and parliament has to debate and legislate on it.

The guidelines are listed below and here is our news report explaining the story.

Do you think governments such as Britain’s should take a clear decision to keep the euthanasia ban or scrap it? Or do you think they should leave some leeway, as in the case of these guidelines, to let families make the final decision for relatives who suffer from  terminal illnesses or want to end their lives because of severe and incurable physical disabilities?

(Photo: Undertakers remove body of assisted suicide from Dignitas office in Zurich, 20 Jan 2003/Sebastian Derungs)

Among factors weighing against a prosecution are:

• The victim expressed a clear wish to commit suicide
• The victim asked for assistance in killing themselves
• The victim had a terminal illness or a severe and incurable physical disability; or a severe degenerative physical condition
• Those assisting were wholly motivated by compassion
• The victim was physically unable to undertake the act that constituted assistance
• The act of assistance or influence was judged to be relatively minor

Among factors weighing in favour of prosecution:

• The suicide victim was under 18 years old
• The victim’s capacity to make an informed decision on suicide was affected by illness or learning difficulties
• The victim did not have a terminal illness, nor a severe and incurable physical disability nor a severe degenerative physical condition
• The victim had not unequivocally indicated a wish to kill themselves
• The victim had not personally asked for assistance

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It used to be an issue just for the terminally ill. Now as populations around the world age, governments are increasingly being confronted with the taboo idea of dying as something people can volunteer to do.

“The demand for the option, if not the practice, is growing rapidly,” said Dr. Philip Nitschke, 61, founder and director of the pro-euthanasia group Exit International.

(Photo: Dr. Nitschke shows his ’suicide kit,’ 7 May 2009/Stefan Wermuth)

The Australian doctor — nicknamed Dr Death for his work on suicide — is traveling the world to teach people how to end their lives safely with a suicide drug-testing kit.

Nitschke’s is an extreme view, but as the proportion of older people increases rapidly in countries such as the United States, Australia, Japan, Germany and Britain, the suggestion of an option to escape indignity could spur political tremors. Calls for reform and a legal decision in July forced the British government to promise to clarify the law. Draft guidelines are due this month with a final version by next spring.

While assisted suicide is legal in Switzerland and physician-assisted suicide — where a doctor prescribes a lethal dose the patient may choose to drink — is legal in the State of Washington, Luxembourg, the Netherlands and Oregon, in Britain helping someone commit suicide is a crime that carries a maximum sentence of 14 years in prison.

Read the whole story here.

See also Belgium has significant hike in euthanasia after law.

Here’s a Reuters video about the death of a quadriplegic Australian man who was granted the legal right to refuse food and water in his nursing home.

What do you think? Is there a “right to die?” Should assisted suicide be legal?

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Pope Benedict’s encyclical “Charity in Truth” proposed a sweeping reform of the world economic system from one based on the profit motive to one based on solidarity and concern for the common good. Like other such documents in the Roman Catholic Church’s social teaching tradition, the encyclical delivers a strong critique of unbridled capitalism. This can be uncomfortable for Catholics who champion free enterprise and some conservative Catholic writers reacted quickly and critically. One of them, George Weigel, wrote the encyclical “resembles a duck-billed platypus.”

(Image: Charity in Truth/Ignatius Press)

We wanted to hear the views of a Catholic executive, one who’s involved in business rather than reacting from the sidelines. So I called Frank Keating, president and chief executive officer of the American Council of Life Insurers (ACLI). The former Republican governor of Oklahoma (1995-2003) is a former chairman of the National Catholic Review Board, which he said “sought to identify and correct the horror of sexual abuse on the part of the clergy.” He is a Knight of Malta and a Knight of the Holy Sepulchre.

DB: What’s your overall reaction to the encyclical?

FK:“I haven’t read the 30,000 words but I think what the pope is proposing is not inconsistent with other papal messages. The common denominator to all of them is the worth of the individual, the dignity of every human person. So Benedict XVI focuses on the right to life, he speaks against euthanasia, he speaks against the evil of abortion, he speaks against cloning. But at the same time he talks about duties and responsibilities to the vulnerable because the vulnerable are dignified human beings as well as those who are rich and powerful.

(Photo: Frank Keating, 11 Feb 2002/Adrees Latif)

“So to exploit someone in a capitalist society is, according to Benedict, inapropriate and contrary to Catholic moral teaching. But for me as a free market capitalist, I see in this statement also the right for me to determine my destiny. In other words, if I wish to work for the state I should be able to do so. If I wish to found a small business, I should be able to do so. A dignified, independent mortal soul, a caring individual should be able to determine their own destiny.

“There is a little bit for the left, support for unions, support for protection of the globe against waste, but there is also something I think for the free market advocates in the Church, because if you are an independent creature with a unique personality based upon, obviously, the immortality of your soul, you should be able to work or not work as your decision. I think there is a little bit for everyone.”

DB: What do you think about Benedict’s call for a “world political authority” to manage the global economy?

FK: “I think it is impractical to suggest that sovereign nations will surrender on the one hand a free market economy or on the other hand a socialist economy or completely managed or disintigrating economy as you would have for example in a place like Zimbabwe, or places like that which are utterly dysfunctional. I don’t think he would suggest that those economies that work surrender what works to those that don’t work and be managed by some supernational group that would impoverish everybody. I think what he’s talking about.

“As a result of the impoverishment of reckless lending, the impoverishment of a number of individuals throughout the globe, you are going to have far more coordination, and that is good. There is a difference between coordination and mandate. Look at Solvency II or (the Bank for International Settlements in) Basel. All that stuff, coordinating banks, coordinating insurance companies and the practices, lending standards and the like. I think you’ll see more coordination and, to the extent that that can be done, it will be healthy for everyone. A reckless loan in the United States can and did impoverish people in Latvia. So obviously coordination is important as long as it is not mandated.

(Photo: Bank for International Settlements, 8 July 1997/stringer)

“I see ‘world political authority’ … (and) ‘manage the global economy’ (in the Reuters report). If it said to coordinate decision making in the global economy, I think there would be less concern. But again it was probably written in Latin.

“Here’s a quote: ‘The conviction that the economy must be autonomous, that it must be shielded from ‘influences’ of a moral character, has led man to abuse the economic process in a thoroughly destructive way.” Well, some men certainly have done that. I don’t think there is any question about that. I think his comments are not inappropriate.

“I think this is also for any of us, whether we are Catholics or not, to have the pope say ‘Once profit becomes the exclusive goal, if it is produced by improper means and without the risks destroying wealth and creating poverty.’ Well, I don’t disagree with that. I think to raise this crisis to an international debate and emphasise the moral issues involved, and the ethical issues involved, is totally appropriate.”

DB: Will this encyclical change the way you run the ACLI?

FK: “Our products are protection products against calamity. Whether your house burns down and you have inadequate resources to rebuild it, property/casualty insurance saves you. Or your business partner dies or your spouse dies, life insurance provides the money to get back on your feet. I would argue there is a moral purpose there in pooling risk to help other people.

“But in the pope’s case, to talk about moral responsibility, duties to others, I think Bernard Madoff is the poster boy for that. Because here is a man, as you know, who betrayed and destroyed his own faith community, those within his own faith community. So I think for men and women in business and finance and government for that matter, I think the Pope’s message is one to listen to and to listen to carefully.”

(Photo: Bernard Madoff, 17 Dec 2008/Shannon Stapleton)

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Former Health Secretary Patricia Hewitt is calling for a change in the law, to allow people to take terminally ill patients abroad for assisted suicide without fear of prosecution.

The law may say it is illegal but in practice, those who do assist suicide abroad are not being prosecuted in practice.

The anomaly has been highlighted lately by the case of multiple sclerosis sufferer Debbie Purdy, who lost a legal bid to force the government to clarify the law on assisted suicide to protect her husband from any future action.

Opponents of any change in the law, like Care not Killing say it would open the floodgates and soon lead to a more general euthanasia law. How long would it be before old and terminally ill people might find themselves being encouraged or even forced to take their own lives?

Hewitt's bid to change the law is not likely to be successful, despite cross-party support in the House of Commons. Do you think she is right?

UPDATE: Eluana Englaro died on Monday Feb. 9.

What’s been called “Italy’s Terry Schiavo case” is starting to resemble its U.S. precedent in more ways than one. Prime Minister Silvio Berlusconi ordered doctors on Friday not to disconnect the feeding tubes that the country’s top appeals court had ruled could be removed. Doctors had began withdrawing them on Friday before the order came from Rome.

Eluana Englaro, 38, has been in a vegetative state since a car crash in 1992. Her  case has looked much like that of Schiavo, the American who spent 15 years in a vegetative state and was allowed to die in 2005 after a long court battle.

(Photo:Eluana Englaro in an undated family photo)

“Until we have a law about end-of-life issues, nutrition and hydration, because they are a form of vital life sustenance, cannot be suspended under any circumstances by those who are care-givers of people who are not self-sufficient,” Berlusconi said after making the case resemble the Schiavo drama even more by intervening to stop Englaro’s tubes from being removed. In the Schiavo case, President George Bush also stepped in at a late stage to try to block a court decision to disconnect her.

The cabinet acted in defiance of Italy’s President Giorgio Napolitano, who was opposed to dealing with the issue through a decree and has the power to block it. But Berlusconi said that if that happened he would call an emergency session of parliament, where he has a comfortable majority, to enact a law.

Catholic politicians, mostly in the centre right, have said that not feeding Englaro amounts to euthanasia, which is illegal in Italy, and had urged the government to intervene.

As in the Schiavo case, the Milan court that ruled on Englaro back in November said it was convinced that her condition was irreversible and that she would prefer to die rather than be kept alive artificially. Do you think those criteria are enough to allow doctors to remove the nutrition and hydration tubes?

(Photo: Prime Minister Silvio Berlusconi, 20 Dec 2008/Remo Casilli)

Imagine you go to a conference on major bioethical questions — controversial issues like abortion, embryonic stem cells, assisted reproduction and euthanasia — and a keynote speaker uses all his allotted time warning about global warming. Is this the wrong issue to discuss — or the only one worth talking about?

The question arose at the annual conference of the European Association of Centres of Medical Ethics (EACME) that ended at the weekend in Prague. Dr. Richard Nicholson, editor of the Bulletin of Medical Ethics, told the assembled bioethicists they had to look beyond their usual issues to consider the far larger ecological threat he said could soon end up destroying mankind.

The issue is urgent for bioethicists, he said, because the healthcare industry in the rich OECD countries is a major source of carbon dioxide emissions. It also spends vast amounts to prolong patients’ lives, about half of it in the final months before death. “The more effort we put into saving individual lives, the more likely we are to doom the human race to extinction,” he said.

“Just being a little bit more green isn’t the answer,” he insisted. Rich countries will have to find ways to cut their carbon emissions almost completely within the next few years. His outlook for the healthcare industry was summarised in a bleak PowerPoint slide:

Possible changes in medicine

• close most hospitals and concentrate on good-quality primary care
• reverse the brain drain and send redundant health workers to developing countries
• outlaw assisted reproduction
• stop medical research undertaken for utopian or financial reasons.

If western countries closed all their hospitals, he said, life expectancy there would drop by only eight months.

“What is more important,” he asked, “maintaining our wealth and economies for 20-30 years until climate change wipes them out, or trying to ensure that as much as possible of the human race survives?”

“The Good Death,” a play about euthanasia, has brought the issue of “mercy killing” to Dutch theatres at a time when such deaths are falling. They dropped to 2,325, or 1.7 percent of all deaths in 2005, from 2.6 percent in 2001. Playing to packed houses throughout the Netherlands, which legalised euthanasia in 2002, the play shows the law has not removed the moral dilemma for many involved.

In fact, part of the reason for the drop in euthanasia deaths could be that agonised doctors are opting to give patients heavy sedation until they die, rather than putting an end to their lives. Even some patients who have asked for euthanasia are given continuous deep sedation instead. This feature by our Netherlands chief correspondent Emma Thomasson looks at the issues involved.

This raises the question of whether deep sedation, while being presented as palliative care that is ethically acceptable for many faiths, is not in fact “euthanasia lite.” Or at least whether it is being used as such. The British Medical Journal has suggested this in a report that prompted an editorial and a lively reader discussion. “Although the exact cause of this trend is unclear, there are indications that continuous deep sedation may in some cases be being used as a substitute for euthanasia,” a report in Science Daily said.

The fall in Dutch euthanasia deaths is sometimes cited by “death in dignity” campaigners in other European countries as a sign that legalisation is not a slippery slope towards the easy disposal of ailing patients. This suggests it might lead in another direction that could undermine the palliative care option often presented as the alternative to legalised euthanasia.

Where do you think the line should be drawn in end-of-life care?