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Euthanasia: Medicine Interview Ethics

Euthanasia: Medicine Interview Ethics

Updated on: December 3, 2023
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Written By Dr Ollie

Every article is fact-checked by a medical professional. However, inaccuracies may still persist.

Euthanasia is a highly controversial topic but one that medical school interviewers are not afraid to challenge applicants with.

Whether or not euthanasia can be an ethical course of action for doctors to take is an area of debate that can push even the brightest candidates to their limits.

In this article, I’m going to give you everything you’ll need to know about the topic before taking on even the meanest euthanasia questions at your medical school interview.

Learn how to deal with more of the most common topics in medical ethics here.

What Is Euthanasia?

Euthanasia is defined by the NHS as “the act of deliberately ending a person’s life to relieve suffering.”

The word itself actually comes from a combination of two Greek words meaning ‘good’ and ‘death.’

It’s essentially a term to describe the mercy killing of someone- normally because they’re suffering from an incurable, painful and fatal disease.

Euthanasia aims to put a patient out of their misery- essentially ending their life earlier than it otherwise would have in order to stop them suffering.

This might be a cancer patient who’s in severe chronic pain as a result of their incurable cancer or it could be a patient with locked-in syndrome, unable to participate in life other than move their eyes.

Euthanasia can be categorised according to how it’s carried out as well as how the patient is able to consent to the procedure…

Voluntary, Non-Voluntary & Involuntary Euthanasia

Whether euthanasia is voluntary, non-voluntary or involuntary all comes down to how the patient consents to having their life ended.

  • Voluntary euthanasia is where the patient is able to actively consent. An example of this would be a patient in severe chronic pain because of diabetic neuropathy asking you to end their life.
  • Non-voluntary euthanasia is where the patient isn’t able to actively communicate their consent. An example of this would be someone in an irreversible coma who you know would have wanted to die rather than continue living that way.
  • Involuntary euthanasia is the killing of patients without their consent. This was practised by the Nazis and is otherwise known as murder!

Active Or Passive Euthanasia

Whether euthanasia is active or passive depends on how the act itself is carried out.

  • Active euthanasia involves a definite action or deed that ends the life of a patient. For example, injecting them with a lethal dose of a drug.
  • Passive euthanasia involved the removal or omittance of something that was otherwise keeping the patient alive. For example, turning off their life support machine or removing their feeding tube.

An example of active voluntary euthanasia would be a doctor giving a patient a lethal injection after the patient asked to be put out of their misery.

An example of non-voluntary passive euthanasia would be switching off the life support machine of a patient who was in an irreversible coma following a brainstem stroke.

UK Law On Euthanasia

Active euthanasia is illegal in the United Kingdom. That’s irrespective of whether it’s voluntary or non-voluntary.

Anyone who actively assists in the death of another person can be tried for either manslaughter or murder- doctors included.

Even if a patient specifically asks for a doctor to give them a fatal injection to prevent them from suffering in their final days of life, the doctor cannot legally comply.

Passive euthanasia is, however, legal in the UK.

A doctor can legally withhold treatment that would otherwise artificially extend someone’s life if the doctor thinks that it’s in the patient’s best interests.

This can translate to ‘pulling the plug’ on a patient in intensive care with no hope of recovery.

Euthanasia Medical Ethics Pixel Infographic

This could also be a cancer patient not going through another round of chemotherapy despite the fact it would likely increase the number of days they had left- due to the severely unpleasant side effects the medication would have on the patient.

When used colloquially, the term ‘euthanasia’ is generally referring to active euthanasia- which is illegal.

However, passive euthanasia is permitted and practised every day in the NHS.

What Is Assisted Suicide?

Assisted suicide, or physician assisted suicide, is a very similar concept to euthanasia and is also illegal in the UK.

The only difference between active euthanasia and assisted suicide is that with physician assisted suicide it’s the patient that administers the final lethal injection (as an example) to themselves rather than the doctor.

The doctor is assisting them in committing suicide by providing them with all the tools they need to perform the act (in this case a syringe with a lethal dose of medication in it).

Assisted suicide is illegal under the terms of the Suicide Act (1961) and is punishable by up to 14 in prison.

Trying to kill yourself, however, in itself is not a criminal act.

Euthanasia Laws Around The World

Countries around the world all have varying stances on euthanasia and physician assisted suicide- many of which are significantly different from the UK’s.

One of the most famous examples is that of Switzerland.

Active euthanasia is still illegal in Switzerland but assisted suicide is legal- as long as the final action that directly causes the person to die is done by themselves.

Every year a small number of people travel from the UK to a Dignitas clinic in Switzerland where they’re able to safely and legally end their own lives.

Dignitas is a Swiss non-profit organisation that provides physician assisted suicide services to people with terminal illnesses or severe physical or mental diseases.

A patient on the intensive care unit

Countries where active voluntary euthanasia is legal include Belgium, Canada, Colombia, Luxembourg, the Netherlands, New Zealand, Spain and Australia.

Taking Belgium as an example, their parliament legalised euthanasia in 2002.

Since becoming legal, just under 1,500 people a year choose to be euthanised under the legislation.

In 2013, the Belgium Senate voted in favour of extending its euthanasia law to encompass children as well.

Terminally ill children must understand what they’re asking for, be in severe pain with no available treatment, and the request must be approved by both their parents and medical team.

The first child to be euthanised under these regulations occurred in 2016.

Ethical Arguments For Euthanasia

Euthanasia is an emotive and convoluted subject that can undoubtedly be argued both ways.

In order to lay out some of the ethical arguments for euthanasia, I’ve used the framework of the four pillars of medical ethics:

AutonomyPatients have the right to choose how they live so they should also have the right to choose how they die. If someone actively wants to have their suffering ended why should this compassion be denied to them?

Physicians, family members or friends should not be prosecuted for simply respecting the wishes of a dying person by helping to end their life.
BeneficenceIn some cases, putting someone out of their misery may be the best thing you can do for them. It’s naive to think that prolonging life with further medical care is always in a patient’’s best interests.

Euthanasia can allow a patient to die with dignity on their own terms. This is much more preferable for many patients suffering from chronic, deteriorating, incurable diseases.
Non-maleficenceWhen euthanasia is illegal, there will still be some people who attempt it in an unregulated manner. These suicide attempts are often botched and simply lead to more suffering in the long term.

UK citizens who want assistance in committing suicide currently have to travel abroad. It is likely they would much rather be able to die at home, surrounded by friends and family, rather than in a foreign medical clinic.
JusticeThe act of euthanasia does not harm anyone else or indeed society. With this being the case, why aren’t people allowed to choose to end their life?

The public are increasingly in support of legalising euthanasia and in countries where it is legal, popular opinion is generally strongly in favour of it. These sentiments should be reflected in law.

Ethical Arguments Against Euthanasia

Although there are many convincing arguments for euthanasia to be legalised, it’s important not to lose perspective of the other side of the argument.

Here are some of the main arguments against changing the law as it stands:

AutonomyIf euthanasia is legalised patients may feel pressured into dying by family or friends even if that’s not what they truly want. It could be seen as a way to stop being a burden despite the fact they’d actually like to continue living.

By definition, in non-voluntary euthanasia the patient is unable to consent. With euthanasia being irreversible, this is not an act that should be carried out without a clear request from the patient.
BeneficenceEffective palliative care can offer a better alternative to euthanasia. With good palliative care the patient can be relatively symptom free and spend their last few days with family and friends without unnaturally shortening their life.

Euthanasia being illegal guards against the tiny minority of doctors who may not have their patient’s best interests at heart. Legal euthanasia would be open to abuse from criminal doctors with disastrous consequences.
Non-maleficenceEuthanising patients turns doctors from healers into executioners. Many people believe in the sanctity of life- that human life is sacred and should not be taken. This means that ending a life, even to end suffering, is never the right thing to do.

Allowing ill people to be euthanised devalues the life of others living with disease or disabilities. Society’s view of what a life worth living is will change, to the detriment of those with existing conditions.
JusticeLegalising some forms of euthanasia is a slippery slope towards increasingly dangerous and hard to police acts becoming legal. For example, Belgium now allows children to be euthanised.

Some would argue legal euthanasia puts too much power in the hands of the doctor. They’re in many ways playing God- having the power to decide who should live and who should die.

The Principle Of Double Effect

The principle of double effect (or doctrine of double effect) is a part of UK law that can be a bit confusing to get your head around at first.

The principle of double effect says that a doctor can legally administer treatment that hastens death so long as the primary intention of that treatment isn’t to kill the patient.

So, as an example, a patient with terminal blood cancer may be in severe pain as a result of the cancer having spread throughout their body.

In order to help treat the pain and palliate the patient, a doctor is able to give this patient large doses of morphine as a very strong painkiller.

A doctor drawing up IV morphine for a patient

However, at such doses as to effectively combat the patient’s pain, the morphine is arguably shortening the patient’s life- as it depresses breathing and consciousness.

But, this is completely allowed under UK law as long as the intention behind the treatment is to help the patient- rather than actively shorten their life.

What a doctor can’t do is give a patient a large dose of morphine explicitly to suppress their breathing so that they pass away.

The intention here would have been to euthanise the patient and so is illegal.

The principle of double effect being legal is a cornerstone to effective palliative care being possible.

Lots of the strong drugs doctors can use to ease suffering at the end of a patient’s life may also slightly shorten their life.

But, as long as the intention is to relieve suffering and not kill, it’s allowed.

Alternatives To Euthanasia In The UK

With euthanasia currently being illegal in the UK, there are a number of alternatives available- to which many against its legalisation will point to as adequate substitutes.

One of these alternatives is an advanced decision to refuse treatment (or ADRT).

This is a form of advanced directive, essentially a legal document setting out a patient’s wishes for a point in time in which they can’t clearly communicate them.

For example, Jehovah’s Witnesses may sign one to refuse blood transfusions.

Or, a patient with dementia may sign an ADRT stating that under no circumstances would they want to be fed through a feeding tube.

As their dementia progresses, and they lose the ability to verbally communicate, their wishes can still be respected despite not being able to actively refuse treatment when it would otherwise have been used.

If this patient were to get to the point of needing a feeding tube, their ADRT would be in place and legally allow doctors to respect the patient’s autonomy- even if this meant the patient ultimately starved to death.

Another aspect of clinical care that people point to as an alternative to euthanasia is effective palliative care.

Palliative medicine is medical care focussed on making a patient as comfortable as possible towards the end of their life.

Doctors can use very strong painkillers, anti-anxiety medications and sleeping agents in order to make the process of dying as peaceful as possible.

When a patient and their family is well cared for in such a manner, death can be experienced as more of a natural phenomenon rather than a traumatic experience for everyone involved.

However, unfortunately the reality is there will always be patients and cases for which these medications are inadequate.

A very small minority of patients will still suffer up until the point they pass away despite the best palliative care modern medicine has to offer.

High-Profile Cases In The Media

When preparing to discuss euthanasia at your medicine interview, it’s worth arming yourself with a couple of case studies from the media that you can use to illustrate your points.

I’m going to briefly describe two below- but you can easily research others online.

Diane Pretty

Diane Pretty was diagnosed with motor neurone disease in her late 30s. The disease left her mind intact but gradually weakened her muscles to the point that she could not move or care for herself in any way.

She was looked after round the clock by her husband and a team of nurses- she was catheterised and fed through a tube.

Diane Pretty wasn’t able to commit suicide herself but would have done so if she was physically able. She however wanted assurance that her husband or doctor wouldn’t be prosecuted if they helped her die.

Pretty ultimately lost her fight in the courts, with the European Court of Human Rights turning down her appeal after a lengthy series of trials in UK courts.

Diane Pretty died aged 43 in 2002 from a series of lung and chest problems resulting from her condition.

Tony Nicklinson

Tony Nicklinson was a civil engineer who suffered a severe stroke in 2005 that left him with ‘locked-in’ syndrome.

He went from an active man in his early 50s to someone completely unable to move, talk or feed himself.

Having been cared for in every aspect of his life for 7 years, he took his case to a panel of High Court judges, asking that he be assisted in committing suicide.

Only able to communicate with the outside world by blinking his eyes, the former rugby player asked to be released from his “living nightmare” by having a doctor administer a lethal injection.

The High Court ruled in 2012 against Mr Nicklinson and he died 6 days after the judgement from pneumonia following a hunger strike that began after the verdict was announced.

Final Thoughts

Discussing euthanasia at a medical school interview can be a bit of a minefield if you don’t know your way around the facts.

But, after digesting the content in this article, you should be feeling a lot more confident about the prospect of it coming up.

Medical ethics is almost certain to come up in a medicine interview in some form or another and the arguments discussed above regarding euthanasia can easily be applied to many other hot topics.

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.