Ethics Questions Asked at Medical Interviews - Euthanasia

Euthanasia is a hotly contested topic and is frequently discussed in the media. As part of your medical school interview, questions will likely be asked on ethical principles. Euthanasia is the termination of an ill person’s life, but in the UK laws mean that assisted suicide gives you 14 years imprisonment.

In your medical school interview, be that panel format or multiple mini interview (MMI) circuits, you should expect at least part of the interview to be concerned with ethical issues. Euthanasia is one of the most popular ethical scenarios to come up. As part of your interview preparation, you should read up on a number of ethical issues and NHS Hot Topics, to the level that you would feel comfortable discussing them during the interview. In this blog post, we provide you with some of the information so you can begin forming your own views. 

What is Euthanasia? Where does the law stand?

Euthanasia is the act of deliberately ending someone’s life, in order to relieve their suffering. This is typically done by giving a patient an overdose of sedatives or muscle relaxant, with the aim of ending their life. Assisted suicide is the act of assisting another to kill themselves, for example by obtaining, but not administering, the drugs which end someone’s life. 

In the UK, assisted suicide is illegal under the terms of the suicide act, and will get someone 14 years imprisonment. Euthanasia is regarded as murder, so imprisonment for life is the maximum penalty. Suicide itself is not illegal, and 10% of suicides in England involve those who are chronically ill. When someone knows they are going to die, they most often opt for hospice care. People also have the right to refuse treatment, so long as they have the capacity to consent.

Tony Nicklinson is a man who campaigned tirelessly for the right to die, following his paralysis due to a stroke. After being refused by the High Court to end his life, he refused food. He died of pneumonia surrounded by his family and friends. He bought the case of euthanasia and the assisted dying to the headlines. In 2015, MPs rejected plans for a 'right to die bill', where people with less than six months to live would have been allowed a legal dose of drugs, to take themselves when they would ready. 72% of MPs rejected the ‘assisted dying bill’, but campaign groups suggest that 82% of the British public support assisted dying. It is important to consider the legal aspects when thinking about how you view the topic of euthanasia. The proposed bill would have meant that a person had the right to die if approved by two doctors and high court judge. 

What are the different types of euthanasia?

Voluntary euthanasia is when a person makes a conscious decision to die. Non-voluntary euthanasia is when someone is unable to give their consent to treatment, so someone else must make the decision on their behalf. In most cases, this is because the ill person has previously expressed a wish for their life to be ended. Involuntary euthanasia is when someone wants to live but someone else decides that it would be in their best interest to die.

Active euthanasia is when a deliberate intervention is made to end someone’s life, for example through lethal injection. Passive euthanasia is the removal or withholding of treatment which is required for someone to live. Passive euthanasia is legally allowed in the UK, as it may be in the patient’s best interest. This could be by removing a feeding tube or switching off a life support machine.

How do we approach this issue?

As a prospective medical student, it may be worth considering the four principles of medical ethics when drawing conclusions. Remember that in your interview, there is no right or wrong answer. Although euthanasia is illegal in the UK, a doctor can still support it. They can simply not act upon it.

The four principles of medical ethics

• Autonomy - respect for the patient’s right to self-determination. Patient autonomy is really important as this is their life. It refers to their capacity to think, decide, and act on one’s own free initiative. However, in the case of assisted dying, much consideration must be taken to the thought process of the doctor. Consent. Confidentiality. Access to records. Doctors can recommend treatments but cannot force a patient to follow their advice. From this perspective, the act of euthanasia should be allowed.
• Beneficence - the duty to ‘do good’. A doctor should do their utmost to care for their patient, within reason. If a doctor was to only do good, they should do what is in the interest of the patient, but ultimately allowing them to die is not doing good. 
• Non-maleficence - the duty to ‘not do bad’. A doctor should not intentionally harm their patient. Doctors can refuse to give treatment if it is in the patient’s best interest. Assisted suicide is deliberately harming a patient, and thus a doctor helping a patient to die would not be acting ethically. 
• Justice - to treat all people equally and equitably. A doctor should not discriminate, and the quality of care must be the same for all patients, irrespective of gender, race, sexuality, socio-economic status and more.

Arguments for euthanasia

Autonomy - Many people believe that allowing someone to die with dignity is really important, and the state should not interfere with such a private matter. It is that person’s own life, and it should be their choice what to do with it.

Beneficence/Non-maleficence - By not allowing the person to die it is prolonging their suffering and therefore goes against the principle of beneficence.

Justice - Keeping someone alive can ultimately be very expensive. Allowing euthanasia would certainly free up some money which could be injected into preventing the diseases causing the problems in the first place. Animals are allowed to be put down when they are suffering, so people who consider all living things as equal argue it is only fair that the same treatment is available to humans. 

Arguments against euthanasia

Autonomy - Some people are concerned that allowing euthanasia could be a step onto a slippery slope leading to involuntary euthanasia. It may also be hard for some people to consent to euthanasia if in a compromised situation, for example, terminally ill patients may feel the pressure to choose euthanasia so as not to be a burden if it is legalised.