1. ASSISTED DYING Some medico-scientific and ethical aspects John Bryant Plymouth CiS, Feb 2013

2. WHEN MAY I DIE AND WHEN AM I DEAD? Ethical frameworks Medical ethics Science, Medicine and Demographics Issues and Implications

3. A THOUGHT WITH WHICH TO BEGIN There are two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle. Albert Einstein

5. ETHICAL FRAMEWORKS Deontology (Duty-based; Kantian Ethics) Consequentialism (Results-based) Virtue (Character-based -Aristotle, Aquinas) [Natural Law – Aristotle, Aquinas] Communitarian Aspects –Michael Sandel, Stanley Hauerwas

6. David Sharp Died, May 2006 300m below summit Thanks to Dr Donal O’Mathuna for this example

7. MEDICAL ETHICS  Beneficence, Do good  Non-malificence Don’t do harm  Justice Treat people fairly  Autonomy Respect individual rights Beauchamp & Childress, Principles of Biomedical Ethics  What type of ethical system is this?  What about wisdom and compassion?

8. THE STATE OF PLAY Life expectancy Medical progress Defining death Difficult dying

9. LIFE EXPECTANCY Life-spans are increasing each day by an average of two hours. Great Britain, averages 1930, Men – 60 1970, Men – 68, Women - 71 2012, Men – 79, Women – 83 But note huge differences, even within one city, eg Glasgow

10. CountryAverage life expectancy, years Monaco89.7 Singapore83.8 Switzerland81.2 Denmark78.8 USA78.5 Sri Lanka75.9 Jamaica73.4 India67.1 Kenya63.1 Botswana55.7 Zambia52.6 Swaziland49.4 Republic of South Africa 49.4 Note: In Africa, averages are lowered by childhood deaths and by HIV/AIDS Data from CIA World Fact Book

13. THE DOWNSIDE Frequencies of dementia in the UK, 2012 Age 40–64 1 in 1400 Age 65-69 1 in 100 Age 70-79 1 in 25 Over 80 1 in 6

14. HEART LUNGSBRAIN It used to be easy: when the heart had stopped beating and breathing had ceased, the person had died. Since 1976 in the UK, cessation of brain stem function has also been taken as an indication of death. However, with our increased understanding of the relationship between heart, lung and brain function and our technological ability to provide replacements for at least some of those functions, defining death has become more difficult and this has led in turn to cases in which deciding about continuing or stopping treatment is very problematic.

15. Dúirt mé leat go raibh mé breoite Spike Milligan

16. THE ISSUES Voluntary euthanasia Involuntary euthanasia Assisted suicide Withdrawing or withholding treatment

17. IMPORTANT QUESTIONS Can euthanasia ever be justified? Can killing ever be caring? When should medical treatment be withdrawn or withheld? Is there a difference between killing a person and letting them die? Is there a moral difference between euthanasia and assisted suicide?

18. IMPORTANT QUESTIONS Why shouldn’t I decide when I want to die? Isn’t it my right to make decisions about my own life?

19. IMPORTANT QUESTIONS What about the doctor’s part in all this? How does euthanasia / assisted suicide relate to the commandment ‘You shall not kill’? Is there a ‘Christian view’?

20. LEGAL EUTHANASIA Belgium Netherlands Luxembourg In Belgium and Netherlands, teenagers as young as 13-years old may opt for euthanasia

21. OTHER LEGAL ASPECTS Assisted suicide is legal in Switzerland, and in three US states But withdrawing or with-holding treatment, where further treatment is deemed ‘futile’, is legal in most countries. Some call this ‘passive euthanasia.’

22. MEDICAL ETHICS  Beneficence, Do good  Non-malificence Don’t do harm  Justice Treat people fairly  Autonomy Respect individual rights  What about wisdom and compassion?

23. HOW DO WE APPLY MEDICAL ETHICS? Compassion – ‘condemned to life’ (does beneficence exclude ‘mercy killing’?) Autonomy – it’s my life Openness – it happens anyway But... Is ending someone’s life the only way to show compassion? Does my exercise of autonomy affect other people?

24. A SLIPPERY SLOPE? What ‘form’ might a slippery slope take in this instance?

25. Coming out in March Publisher: Lion A bargain at £9.99! Chapter 7 is entitled Medical Technology: from Gamete to Grave