John Keown

Voluntary euthanasia under control? Further empirical evidence from The Netherlands.

Nineteen ninety-six saw the publication of a major Dutch survey into euthanasia in the Netherlands. This paper outlines the main statistical findings of this survey and considers whether it shows that voluntary euthanasia is under effective control in the Netherlands. The paper concludes that although there has been some improvement in compliance with procedural requirements, the practice of voluntary euthanasia remains beyond effective control.

The Polkinghorne Report on Fetal Research: nice recommendations, shame about the reasoning.

In 1989, in the wake of the first operations to transplant fetal tissue into the brains of sufferers from Parkinsons Disease, the UK Code of Practice governing the use of the fetus for research was overhauled by an eminent committee under the chairmanship of the Reverend Dr John Polkinghorne. The Polkinghorne Report has, however, attracted remarkably little comment or analysis. This paper is believed to be the first to subject it to sustained ethical and legal scrutiny. The author concludes that, although the committees recommendations meet the major objections to the Code of Practice, the report is nevertheless vulnerable to criticism in its treatment of at least three issues: the moral status of the fetus; paternal consent to fetal use, and the ethical inter-relation of fetal use and abortion.

SURVEYING THE FOUNDATIONS OF MEDICAL LAW: A REASSESSMENT OF GLANVILLE WILLIAMS'S THE SANCTITY OF LIFE AND THE CRIMINAL LAW

Much of the confusion in the current debate about embryonic stem-cell research is generated by the advocates of stem-cell research who use controversial and misleading terminology about what it involves and who evade or misrepresent the central moral argument against such research, namely, that it involves the destruction of innocent human beings. This essay points out that such failings are not new to bioethical debate and exposes them in one of the earliest and most influential books on the law and ethics of medicine: The Sanctity of Life and the Criminal Law by Professor Glanville Williams.

Reason, Morality, and Law: The Philosophy of John Finnis

REASONS, GOODS, AND PRINCIPLES INTENTIONS IN ACTION JUSTICE, RIGHTS, AND WRONGDOING PHILOSOPHY OF LAW PHILOSOPHY, RELIGION, AND PUBLIC REASONS REFLECTIONS AND RESPONSES

Mr Marty’s muddle: a superficial and selective case for euthanasia in Europe

In April 2004 the Parliamentary Assembly of the Council of Europe debated a report from its Social, Health and Family Affairs Committee (the Marty Report), which questioned the Council of Europe’s opposition to legalising euthanasia. This article exposes the Report’s flaws, not least its superficiality and selectivity.

‘Palliative Sedation’, Ethics and the Law: An Overview of the ‘Sanctity of Life’, ‘Best Interests’ and ‘Autonomy’

‘Palliative sedation’ raises several profound ethical and legal questions. Is it compatible with the ‘sanctity of life’? When is it in a patient’s ‘best interests’? To what extent should a patient’s autonomous wishes determine when it is or is not carried out? This chapter does not attempt to resolve these questions directly. This is in no small measure because ‘palliative sedation’ is protean concept with no universally agreed definition. For example, it may involve sedation which is or is not ‘deep’; which is or is not administered with the consent of the patient; which is or is not associated with the withdrawal of tube-feeding; which involves or does not involve the ‘terminally ill’; and which is or is not administered with intent to shorten life. In short, ‘palliative sedation’ can embrace many, many distinct scenarios.

A reply to McLachlan.

In an earlier article in this journal, I advanced five ethical arguments in favour of a voluntary, unpaid system of blood donation. In his reply to my article, Hugh McLachlan criticised one of those arguments, namely, the argument that an unpaid system promotes altruism and social solidarity. In this reply to Dr. McLachlan, I maintain that his criticism is misguided, and that he appears unclear not only about my own argument, but also about his own.

Tallis's slippery slope.

Tallis’s argument about changing the law on assisted dying invites at least three comments.1 He claims that being able to “determine what is in your own best interest when you are of sound mind” is a fundamental principle of medicine and that “Nobody else’s views should be able to over-ride this right.” …

Euthanasia, Ethics and Public Policy: The Dutch experience: controlling VAE? condoning NVAE?

To many, the slippery slope arguments are obviously persuasive. To others, however, they remain unconvincing, and no basis for resisting the decriminalisation of VAE in certain ‘hard cases’. Why, it is asked, should the possibility of future abuse trump the certainty of present suffering? As VAE has historically been illegal around the world, the empirical argument has, inevitably, lacked evidential support. (The logical argument, being philosophical rather than practical, does not rely on empirical evidence, though evidence of a shift in practice from condonation of VAE to condonation of NVAE would certainly illustrate its cogency.) More recently, that situation has changed. In 1984, the Supreme Court in one jurisdiction – the Netherlands – declared that doctors could lawfully carry out VAE in certain circumstances. Since that time a substantial body of evidence has accumulated which allows the empirical version of the slippery slope argument to be tested. Given the cardinal importance of the Dutch experience to the debate, the following chapters consider whether the evidence from the Netherlands indicates that VAE is, as the Dutch claim, effectively controlled, and whether there has been a shift towards condonation of NVAE. By way of preamble, it is worth noting that the Dutch experience is a matter of some dispute. Its defenders (who are usually but not exclusively Dutch) claim that VAE has been successfully ‘brought out into the open’ and effectively controlled. Its critics (usually but not exclusively outside the Netherlands) dispute this and maintain that VAE remains beyond effective control.

No right to assisted suicide.

T ERMINALLY ill with motor neurone disease, Mrs. Diane Pretty wanted her husband to assist her commit suicide. She asked the DPP for an assurance that he would not prosecute her husband. The DPP refused. In proceedings for judicial review she sought an order that the DPP give the undertaking or a declaration that the prohibition on assisted suicide was incompatible with the European Convention on Human Rights.