Progressive development of human rights together with medical science brings continuously discussible question of euthanasia. There are various opinions how euthanasia should be practice. Each of those opinions is supported by considerable arguments but right now it’s hard to say if there is more followers or opponents and to choose which way is the right one.
The progress in modern medicine allowed us to live longer and healthier lives. But new health problems are still developing. However, by prolonging live this way does not mean a better or more acceptable death. Even there are people who would argue that modern medicine provides the means for extending the process of dying, which can be painful and meaningless for patients, and torturous and financially burdensome for their families.
The question of euthanasia is being discussed mainly in circles of doctors and religion communities, then less by lawyers. Even lawyers are the main part for finding the key definition of euthanasia. How we can see today, each country has its own approach to euthanasia which is reflected on its legislature.
This paper reflects the comparison of euthanasia law in Netherlands and UK. Comparing these two states of Europe is mainly because just in one of them the euthanasia is legalized which will clearly show the legal differences. But are the differences so distinct in practice as well? However, first chapter focus on general definition of concepts of euthanasia for better understanding the whole concept of euthanasia law. The analysis of both jurisdiction approaches towards this concept is mentioned in the second chapter. The comparative view of those countries and whether they are really so different? This is analyzed in chapter 3. The fourth chapter just determine a position of international law towards problematic of euthanasia.
Definition of the Concepts of “Euthanasia”
The word Euthanasia originated from the Greek language: eu means “good” and thanatos means “death”. One meaning given to the word is “the intentional termination of life by another at the explicit request of the person who dies.” However, there are some more classifications of this term as active or passive, and as either voluntary or involuntary. Similar or even one form of euthanasia is considered assisted suicide. The result of this division is an issue of great confusion and absence of common definition of the term of “Euthanasia”.
Active VS Passive
Active euthanasia might be defined as intentionally bringing death of an ill patient on his express request by active means such as injecting the patient with poison. This type used to be called `mercy killing`, but this term was soon avoid because its connected with Nazis in World Word II and their killing Jews, Gypsis,etc.
On the other hand, there is passive euthanasia which is usually defined as refusal of medical treatment with the intention of causing the patient’s death. It means that the patient with incurable illness, no chance to get better and where the death is irrevocable has right to refuse all treatment innervations. By this act the patient is taking all responsibility from his step. It means if the patient has any sudden interruption in life functions, the doctors just don‚t do anything to save him and just leave him die.
Voluntary VS Involuntary
Another division is between Voluntary and Involuntary euthanasia. These two types are not so much relevant for this paper but just to mention them for better understanding of whole concept of euthanasia. Voluntary euthanasia means when the patient‚s life is end up on his behalf or that he refuses his treatment with knowing that the act will lead to his death.
The opposite of voluntary is involuntary euthanasia which occurs when a patient’s life is ended without the patient’s knowledge. This may be a case when a patient is unconscious or in vegetative state and somebody makes a decision for him. This type does not follow so many obstructions and is pretty clear from the legal point of view than the previous one.
Somewhere between active and passive euthanasia is considered assisted suicide. This type is seen when a doctor gives to a patient an advice how to end his own life, but the doctor does not perform the act by himself. For example, if a doctor gives you a pill sufficient to cause your death, explains to you what it is and you later on take it by yourself, this is considered assisted suicide.
The Regulation of Euthanasia by Criminal Law
Pain and Symptom Relief Approaches
If patient is seriously ill or has great pain there exists general agreement which can help him out of his suffering. There are two special approaches which can be practice even though they may shorten a patient‚s life and without any violation of the terms of criminal law causing bodily harm. The first is called Double Effect which is based on doctor‚s intention. Another way is Medical Exception. These concepts are more described below.
In general, the medical exception means that doctors are allowed to do things which are for others forbidden, as long as there is a medical reason for that. The medical treatment falls outside the criminal law. It means that things which are done by doctors would be very serious crimes for others.
This provision should help doctors as well as patients. An example where a doctor is afraid of prosecution by his patient would not be contribution neither for doctors nor patients. On the other hand, this concept has also its disadvantages. Doctors are losing almost all liability for their acts so they don‚t might not feel such responsibility towards patient even though it is very difficult to prove doctors negligence or mistake.
. “Double Effect”
“The principle of double effect is doctrine that distinguishes between the consequences a person intends and those that are unintended but foreseen and may be applicable in various situations where an action has two effects, one good and one bad.” This means, if the doctor‚s primary intention is to relieve suffering, he may prescribe pain relief even though he knows it may cause the patient‚s death. The doctor will not be guilty of murder unless his purpose was to cause patients death.
However, this raises an issue of intention since in most jurisdictions, there is not permit the fine distinctions between primary and secondary intention that the doctrine of double effect requires. The intention is intended even if is foreseen by the actor. Nevertheless, the approach in medical cases is taken with provision even though the legal grounds on which this can be done are not clear.
On November 28, 2000, the Dutch Lower House of parliament, by a vote, approved the legalization of euthanasia [104 for and 40 against]. Then, on April 10, 2001 the Dutch Upper House of parliament followed and voted to legalize euthanasia [46 for, 28 against and one member was not present].
On April 1st 2002, Termination of Life on Request and Assisted Suicide Act came into effect and euthanasia became legal in the Netherlands. By this step, the Netherlands became the first and at that time only country in the world where euthanasia is formally legalized [Is not punishable]. Even though, already at the beginning of 90‚s Royal Dutch Medical Association and the Ministry of Justice agreed that when a physician followed prescribes guidelines for non-prosecution agreement, there was practiced euthanasia.
Big part in approving of the Act played at that time proceeding case called Brongersma. This case is considered as one of the landmark in development of Dutch euthanasia law. The reason was also because parliamentary debate was closely interwoven. During parliamentary debates many question about the new Act was connected with this case.
The doctor Philip Suntorius helped an 86 year old patient, who was ex-senator Brongersma very well known to the public, to die in belief that he was suffering because of his hopeless existence. That simply meant that the doctor helped him because of the reason being “tired of life”. The case ended after 2 years  where the Supreme Court rejected all of Sutorius defenses and he was convicted of murder (article 40, Penal Code), but the court used discretion to not impose any punishment.
The most important about the case of Brongersma is that it raised the debates in parliament and forced all members to focus on issue of euthanasia. Its part has also that the actor who died was former senator of the Labor Party. Right before the end of the proceedings the Termination of Life on Request and Assisted Suicide Act was approved by member of parliaments.
Active Euthanasia and Assisted Suicide
In big number of other countries the term of `euthanasia‚ is including most of all behaviors concluding the death, as is euthanasia active, passive, voluntary, etc. But in the Netherlands only the `active euthanasia‚ is legally considered as effective.
Since 2002, the conditions of euthanasia are governed by the Termination of Life on Request and Assisted Suicide Act [Review Procedures]. The law is made out of three parts. The first regulate `requirements of due care‚ and talks about responsibilities of reviewing reported cases. The second amends articles 293 and 294 of the penal code. And the third amends the Burial and Cremation Law.
The statutory `requirements of due care‚ is consisted of six points:
- The patients request was voluntary and well-considered
- The conviction that the patient’s suffering was unbearable and without improvement
- The doctor informed the patient about the situation he was in and about his prospects
- The patient has to be informed that there was no other reasonable solution for the situation he was in
- The doctor has consulted at least one other, independent physician who has seen the patient and has given his written opinion on the requirements of due care, referred to in parts 1 – 4, and
- The doctor has terminated a life or assisted in a suicide with due care
The illegality of euthanasia was ended by coming of article 293. Article 293 provides: ” Any person who terminates another person’s life at that person’s express and earnest request shall be liable to a term of imprisonment not exceeding twelve years or a fifth-category fine.”
But article 293 adds:” The act referred to in the first paragraph shall not be an offence if it committed by a physician who fulfils the due care criteria of the Termination of Life on Request and Assisted Suicide Act, and if the physician notifies the municipal pathologist of this act in accordance with the provisions of Burial and Cremation Act.”
It means that behavior usually punishable is not recognized as criminal offence if the act is committed by physician who fulfils the set requirements and notifies pathologist.
Since the only type of which is legally recognized as `euthanasia‚ is active one then assisted suicide falls out of this group in the Netherlands. Assistance with suicide would never be considered as a crime before the article 294 of Penal Code.
Article 294 states:” Any person who intentionally assist another to commit suicide or provides him with the means to do shall, if suicide follows, be liable to a term of imprisonment not exceeding three years or a fourth-category fine”.
Nevertheless, both of those types are treated differently by Penal Code, but Dutch law does not make any differences between active euthanasia and assisted suicide in practice as far as they are justifiable. It means that in practice both of these approaches are considered as `euthanasia‚ in the Netherlands.
Refusal of Treatment
Refusal of treatment is considered as passive euthanasia. In the Netherlands this action is covered by the Law on Contracts for Medical Treatment which is part of Dutch penal code. According to article 11 of the Constitution which states the right of all persons to the inviolability of the body, the doctor has to follow a wish of a patient in refusing a treatment.
The right to refuse begins at age o12. In case where a child is 12-16 years old there is need consent of both the child and his parents. In a case when a child is younger than 12 or between12-18 and is not competent, the he or she is represented by parents or his guardian. But for people 18 years old or older who are not competent, the decision has to make a representative [Court-appointed representative, spouse or partner and a parent, child, brother or sister].
Another possibility to refuse treatment is through written treatment directive. Article 450.3 of Law on Contracts for Medical Treatment says: “In a case patient sixteen years of age or older cannot be considered capable of reasonable assessment of his relevant interests, the health care provider and [the personal representative] shall follow the patients apparent views laid down in writing when he was still capable of such reasonable assessment and containing a refusal of consent. The health care provider may depart herefrom if he considers that there are well-founded reasons for doing so. ”
There are almost no formal requirements such as witness or signature, but these instruments might increase chance of a valid treatment directive. The only issue which may occur is while a doctor departs from the written document if he considers that there are `well-founded reasons‚ to do so. This formulation is vague; there is an agreement that the personal view of a doctor cannot amount `well founded reason‚. A professional opinion that it will cause death of a patient is irrelevant. In effect, `well founded reason‚ refers to authenticity of the document.
. The United Kingdom
In the United Kingdom, differently from the Netherlands, is Euthanasia and assisted suicide illegal. Even though over couple of years, there have been number of debates if they should be legalized, but all failed because lack of support.
Active Euthanasia and Assisted Suicide
Since there is no any provision for legal euthanasia then euthanasia is considered as murder under English law where a convicted is charged of life sentence. The motive of offender or consent of the victim is relevant to the case and this is presented in case of Bland .
Then another part is assisted suicide which is prohibited by Suicide Act 1961 section 2 which states: A person who aids, abets, counsels or procures the suicide of another, or attempt by another to commit suicide shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years.
The issue raises if somebody assists to another person to obtain assisted suicide in other country [where the act is considered as legal], is he then going to be prosecuted under the Suicide Act 1961 section 2? One of the favorite destinations where people wish to receive assisted suicide is Switzerland. As far as I know there are around 150 cases every year and nobody has been prosecuted yet.
The view how strictly is the law followed is seen in a case Pretty v. The United Kingdom. The plaintiff Dianne Pretty came with opinion that the criminal prohibition on assisted suicide is in contradiction with European Convention on Human Rights, but she was not successful. This case is analyzed in more details in section four “Approach of International law towards “Euthanasia”.
A mentally competent adult has an absolute right to refuse any medical treatment which is considered as passive euthanasia even though it leads to death of a patient. In case of a competent child, he or she does not need parental permission to do so. But the decision has to be in the best interest of the patients, where a court can overrule any of those refusals.
When an adult is mentally incompetent, the treatment decision is made on behalf of his representative, who is by the individual by himself [when competent] or judicially appointed. This decision maker has to use the `best interest‚ test. The action of prolonging life is usually considered to be in the best interest of the patient. The Mental Capacity Act 2005 section 4 states the requirements which must be considered:
A, the person‚s past and present wishes and feelings,
, the beliefs and values that would be likely to influence his decisions if he had f capacity,and
C, the other factors that he would be likely to consider if he were able to do so.
The case Airedale NHS Trust v. Bland  is the landmark case in passive euthanasia [withdrawal]. Antony Bland was a victim of a disaster at Hillsborough stadium. He was found in the crush. Unfortunately after the accident he was diagnosed as a being in persistent vegetative state. He was fed through a tube. The conclusion by doctors was that Antony
would never get out of this state. Since he was not a competent then his family and doctors agreed that it was in his best interest to withdraw artificial nutrition, but against this decision was Official Solicitor who represented incapable people as Antony. Lord Lowry said:
“There is no duty, or indeed right to feed, when feeding is not in the best interests of the patient. But the real reason for withdrawing feeding is that the doctors consider that it would be in the patients best interests for him to be allowed to die.”
The House of Lords agreed with opposing solicitor that if the doctors‚ intention is to deny any food and fluids to Antony then it would be considered as murder. But the Lords held that they would not commit murder because the offence requires an act not an omission. Where, stopping feeding is considered as an omission not an act. The Law Lords dismiss the appeal against withdrawing feeding of Anthony Bland, the feeding was stopped and he died couple of days later. Lord Mustill said:
The conclusion that the declarations can be upheld depends crucially on a distinction drawn by the criminal law between acts and omissions, and carries with it inescapably a distinction between, on the one hand what is often called “mercy-killing”, where active steps are taken in a medical context to terminate the life of a suffering patient, and a situation such as the present where the proposed conduct has the aim for equally humane reasons of terminating the life of Anthony Bland by withholding from him the basic necessities of life
Approach of International Law Towards “EUTHANASIA”
- Mental Capacity Act 2005[http://www.opsi.gov.uk/Acts/acts2005/pdf/ukpga_20050009_en.pdf]
- Criminal Justice Act 2003
- The Suicide Act 1961
- The Law Commission
- Termination of Life on Request and Assisted Suicide, Act of 2002[http://www.eutanasia.ws/leyes/lEYHOLANDESA2002.pdf]
- Dutch Criminal [Penal] Code, ss 293 (euthanasia), 294 (assistance with suicide), 287 (murder)
- Law on Contracts for Medical Care of 1995
- Burial and Cremation Law
- Netherlands State Commission on Euthanasia
- The Universal Declaration of Human Rights
- European Convention on Human Rights
- Covenant on Civil and Political RightsCases:
- Airedale NHS Trust v Bland  AC 789
- Pretty v. United Kingdom  ECHR 423
- Re (Wardship: Medical Treatment)  1 WLR
- Attorney-General v Able  QB 795
- Wyatt v Porsmouth NHS Trust  EWHC 693
- Sutorius Case, District Court at Haarlem, 30 October 2000
. Secondary Sources
- Friedlander, Henry, The Origins of Nazi Genocide: From Euthanasia to the Final Solution
- Tulloch, Gail, Euthanasia-choice and death, 2005
- Gerald A. Larue, Humanism Today, Euthanasia
- Williams, Glenys, The Principle of Double Effect and Terminal Sedation, Med Law Rev.2001
- The Free Legal Dictionary by Farlex [http://www.thefreedictionary.com/]
- Gonzaga Journal of International Law- Legalization of Euthanasia in the Netherlands Jonathan, T. Smies
- Treatment Directives in The Nehtherlands, [http://dissertations.ub.rug.nl/FILES/faculties/jur/2005/c.vezzoni/04_c4.pdf]
- Holland Legalizes Voluntary Euthanasia, 2000, TheVoluntary Euthanasia Society News, [http:// www.ves.org.uk/cgi-bin/]
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