Ethics Update - 2006
A number of ethical issues in healthcare have come to the fore again in the last year, and will remain matters for payer, action and support for health professionals who have to deal with these issues at the 'coalface' over the coming years.
Assisted Dying for the Terminally Ill
Lord Joffe sought in 2006 to bring a private members bill before Parliament that would have legalised physician assisted suicide for terminally ill patients. It had many safeguards, and its supporters argued that it was a compassionate response to terminal illness. However, great concern was raised that this would open the door to full blown euthanasia. The concern was that sooner or later this would be extended from the terminally ill to others who wanted assistance with ending their lives.
Furthermore, there were fears that government could use this as a cost saving exercise, avoiding investment in palliative care services such as hospices and specialist palliative care teams of doctors and nurses in general hospitals and the community. And the evidence is strong that where palliative care is provided, few if any patients express a consistent wish to be assisted to end their own lives. Finally, many health professionals were anxious that introducing such a piece of legislation would have a seriously detrimental impact on the relationship with their patients.
These arguments formed the basis of a broad campaign of disability rights groups, health professionals and faith-based organisations against the Joffe Bill. With a large letter writing campaign and lobbying of the House of Lords the Bill was defeated in May of this year.
However, Lord Joffe and his supporters are keen to bring this legislation back to Parliament in the current session (2006/2007), albeit in a revised form. You can read more about the campaign for more and better palliative care and against the weakening of existing laws against euthanasia and assisted suicide at www.carenotkilling.org.uk
Department of Health's Review of the Human Fertilisation and Embryology Act
The Human Fertilisation and Embryology Authority (HFEA) have undertaken an extensive review of the various aspects of the law governing medical technologies used to assist human reproduction. One particular area is issue of inheritable diseases, and the use of IVF technology to screen out embryos carrying heritable diseases such as haemophilia. This means that any embryos found to carry certain genetic traits that will or might lead to a serious health problem in later life would be destroyed.
Many families with history of these diseases want access to this technology to ensure that their children do not inherit or pass on these conditions to future generations. However, this raises a lot questions, including the severity of the illnesses that should be so screened.
For instance, haemophilia is now a very manageable condition and does not mean years of incarcerated dependence caused by joint damage after sever, uncontrolled bleeding as it did just a couple of decades ago. Other genetic disorders, such as susceptibility to breast cancer, do not necessarily manifest themselves in every individual who carries the gene. In short, at what point do we decide which conditions should be screened out? Should we not be investing more in to treating and curing such illnesses rather than eliminating individuals who have inherited them from our population?
It should be stressed that the current legislation puts severe restrictions on such screening and elimination of embryos to only those carrying immediately life-threatening illnesses. However, if it were widened to other, less severe conditions there could be a danger that this could be a first step towards eugenics, whereby certain genetic traits are systematically eliminated from the population by destroying those individuals who carry genes deemed unhealthy or undesirable by the medical profession or society as a whole.
Mental Capacity Act
The Act, which comes into force on 1 April 2007, contains much that is good and necessary both to support mentally incapacitated people in making decisions, and to protect them from abuse and exploitation.
However, the Act gives statutory force to 'advance refusals' and 'proxy decisions', meaning that doctors and nurses could be legally required to withhold food and fluids in some situations where they believe such action clinically inappropriate.
The Terri Schiavo case in the United Sates in 2005 illustrates the issue. Mrs Schiavo, young woman who had severe brain damage, but who was otherwise physically healthy, was allowed to starve and dehydrate to death because her husband, with power of attorney, claimed she had expressed a desire not to go on living if she ever ended up in such a state. She was not terminally ill, but neither could she live without prolonged care - care which was withdrawn allowing her to die.
There are loopholes in the Act whereby non-dying mentally incapacitated patients can be starved and dehydrated to death in their 'best interests' either on the say so of those given power of attorney, or according to a legally binding advance directive. In other words, once again health professionals might be required to assist in the death of a patient.
All three of these legal/ethical developments need us to ask three questions as Christians:
1. What value does God place on human life - from the newly conceived embryo to the dying, or the person in a persistent coma?
2. Does the Christian ethic of care and compassion involve actively ending the life of a suffering, vulnerable individual, or are there other ways in which we can alleviate that suffering?
3. How can we support Christian health professionals who must deal with these issues practically day-to-day?
Prayer
- For all those working day-to-day with vulnerable people - that they might have compassion and wisdom to know how to deal with the very real ethical dilemmas that they face.
- For those in positions of influence to act justly and wisely as they work on legislation that affects the lives of many vulnerable people
- For those campaigning on behalf of vulnerable people - for wisdom, courage and sensitivity in how they seek to change opinions and make a stand for what is right and just.
For more detailed information on these and other medical ethical issues, see www.cmf.org.uk/ethics/
