BRITAIN: One of Britain's leading experts on medical ethics yesterday called for doctors to be able to end the lives of terminally ill patients, even if they have not given consent.
Len Doyal, emeritus professor of medical ethics at the Queen Mary Hospital, University of London, took the euthanasia debate into new and highly contentious territory. He said 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. Some will suffer a "slow and distressing death" as a result.
It would be better if their lives were ended "more quickly, more humanely and without guilt", Prof Doyal argues in an article in Clinical Ethics, published by the Royal Society of Medicine.
Critics said that the views of Prof Doyal, a member of the British Medical Association's medical ethics committee for nine years, were the "very worst form of medical paternalism".
Prof Doyal was a supporter of a Bill in the House of Lords on "assisted dying" that would have allowed terminally-ill patients to request a cocktail of drugs to end their lives early. Opponents of the Bill shelved it by voting for a postponement for further debate. But Prof Doyal is now taking the debate a stage further.
He argues that doctors are already effectively practising euthanasia on patients who have no consciousness beyond the capacity to suffer pain, by withdrawing life-saving treatment, which may involve turning off a ventilator, ending antibiotics or withdrawing a feeding tube.
He draws a parallel with a father who sees his baby drowning in the bath and fails to do anything to save it. He foresaw the certainty of the death and did nothing and would, therefore, be morally considered to have killed the child.
"Clinicians who starve severely 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 that such starvation is not active killing is no more than clumsy judicial camouflage of the euthanasia that is actually occurring," Prof Doyal writes.
His concern, he says, is not just with patients who are in a permanent vegetative state and who, therefore, feel nothing at all. "The category of patients that concerns me most are the patients where we are not sure. There is still some brain function, but they will never have any brain awareness or cognitive function, but they seem to be suffering," he said.
He does not believe that legalising non-voluntary euthanasia for such patients would lead to more or inappropriate deaths.
"We have a situation where these decisions are being made all the time and yet we have no coherent system of regulation for them . . . We really don't know what is going on out there, as you do in Holland where all this is legal or in Oregon where they have physician-assisted suicide."
Peter Saunders, campaign director of Care Not Killing, an alliance of healthcare professionals and others opposed to euthanasia and the House of Lords Bill, said Prof Doyal was confusing the withdrawal of treatment that was more of a burden than a benefit to a dying patient, with actively ending life.
"Doyal is advocating the very worst form of medical paternalism whereby doctors can end the lives of patients after making a judgment their lives are of no value and claim they are simply acting in their patients' best interests," he said. "The clear lesson from the Netherlands, where over 1,000 patients are killed by doctors every year without their consent and where babies with special needs are killed . . . is that when voluntary euthanasia is legalised, involuntary euthanasia inevitably follows," he said.- (Guardian service)