Euthanasia - Medical Ethics and Law at the end of life

hey guys welcome back to the channel and Happy New Year if you're new here my name is Ali I'm a final year medical student at Cambridge University and this is the third video in our series about medical ethics and today we're going to be talking about euthanasia and medical ethics at the end of life we're going to be talking about these topics in two videos in this video we're gonna be focusing on what is arguably the most well known case in the UK we're going to be introducing some terms like elective euthanasia a passive euthanasia operation assisted suicide and explaining what those terms are and more importantly how to use them appropriately because I think there is a lot of confusion surrounding those terms and a lot of medicine applicants seem to be using them in kind of the wrong context and we're going to be explaining the law in the UK as it stands at the moment so the legal status of euthanasia and physician assisted suicide and we're going to be talking about the doctrine of double effect if you haven't heard of these terms before that's absolutely fine all of it should hopefully make sense by the end of the video and then in part 2 in the next video which should be out at some point next week we're going to be talking about assisted suicide and cases where people have tried to change the law surrounding assisted suicide and the ethics associated with that so let's just jump right into it we're now going to cut to a video of Charla and Molly who you might know from the last two videos and they're going to be introducing to us the case of Lillian Boyd's here we go so I want you to imagine that you're a consultant at the hospital you've been treating this patient is called Lillian for many years and she's suffering terribly with arthritis and she's she's a palliative patient she's someone who is never gonna get better and all we're trying to do is relieve her symptoms so one day on ward round Lillian says to you as her consultant I am in so much pain and I am suffering so much that I just don't want to live anymore I want you to do something that will end my life today what do you do as a doctor in that situation you know this patient really well you can see that they're really suffering that their symptoms aren't being managed and they're desperate that their life would end to relieve them of the suffering what would you do in that scenario so this is actually a real case from 1992 and this was dr. Nigel Cox and he was asked by Lillian to do this thing to end her life to relieve her suffering and it's become one of those seminal cases that we talk about a lot in discussions around euthanasia and end-of-life care for patients so we'll be going back and forth to this case as we go through explaining end-of-life care and ethics around euthanasia and assisted dying and we'll tell you what happened as we go along so that's the case have a think about it think about what you might do in that scenario a little bit more information that might help you this is the most severe case of rheumatoid arthritis you've ever seen in your life and you really admire Lillian's resilience in the face of her condition previously she was always kind of taking things rather well being good humoured about the whole thing but now it's sort of gotten to the point where she really can't take the suffering anymore and it's an unbearable agony on top of her rheumatoid arthritis she's got internal bleeding he's got septicemia she's got vasculitis which is causing her internal organs to become gangrenous and is further contributing to her suffering and her two sons Patrick and John are by her bedside and they and all three of them are begging you to expediently and her life to relieve her suffering what would you do so if you were asked this or something similar in an interview you could go with the four principles approach you know the structure that we always recommend for answering medical ethics and Oreos that we mentioned in the first video so in this scenario we've got kind of the four principles adults as one another the principle of non-maleficence not doing harm and the principle of beneficence doing good they're sort of in conflict because ending someone's life isn't really doing good and you could argue that ending someone's life is not doing harm because you're relieving their suffering but you could also argue that you know ending someone's life is precisely the definition of doing harm and then autonomy and justice come into it autonomy the patient wants this physically or the patient once the patient's family want this so in terms of autonomy we should surely be helping her under life but in terms of justice we can ask about you know fair allocation of resources and just kind of fairness in general is it fair for us to take the life of another human being regardless of what the intention is so this is a really tricky case and this is the case that's gonna hopefully form the undercurrent of this video and we're gonna be kind of referring back to it as we explain things in a bit more detail so in your interview if you're are something like this yeah you could go with the four principles approach but everyone is going to be doing that so if you know a little bit more if you can give a little bit more about arguments surrounding euthanasia and assisted suicide then you're definitely going to be standing out so to that end let's introduce some terms now and Charlotte and Molly are now going to explain what active euthanasia or passive euthanasia and physician assisted suicide what those terms actually mean and how you should use them here we go so euthanasia literally means a good death and there are some some terms that people use and that we just want to clarify so you'll hear people talking about bracket of euthanasia and active euthanasia is when you actually do something with the intent of ending someone's life so that would be for example injecting a drug that does nothing else but kill someone so that's active euthanasia now you'll hear people talking about passive euthanasia but we don't think that's a particularly helpful term to use because passive euthanasia people mean that you're doing something like withdrawing or withholding treatment that results in someone dying but calling it euthanasia is not helpful at all because euthanasia is illegal but withdrawing or withholding treatment in a patient's best interest is good clinical practice and so what we'd advise you to say is active euthanasia is definitely illegal but withdrawing or withholding treatment in accordance with the patient's best interests is good clinical practice and is what happens up and down the country in every hospital every day okay so there's also a third term called physician assisted suicides and in this instance it involves a physician so a doctor providing a patient with a treatment which is going to end there but the doctor does not actually physically give them the treatment the patient actually takes it themselves so this is a physician assisted suicide and this is also illegal in the UK so so active euthanasia passive euthanasia and physician assisted suicide all of those things are illegal in the UK because the intent is to end someone's life and intending to end someone's life constitutes murder so all illegal in the UK but as we've said withdrawing or withholding treatment is good medical practice and is not illegal if it's done in accordance with the best best interests of the patient okay so we have to find some terms and I just want to reiterate please don't use the phrase passive euthanasia passive euthanasia is so confusing because as they said passive euthanasia we think of it as you know unplugging unplugging a life-support machine but something is only ever defined as euthanasia if your intent is to end their life and if your intent is to end someone's life then that is murder and that is illegal in the UK with the drawing treatment is not the same thing as passive euthanasia so please don't get the stupid terms confused and in fact what we all suggest is just never ever use the term passive euthanasia because it's just hugely confusing with drone treatment is good medical practice in some circumstances it's not illegal it is a good thing to do the thing about where the during treatment is that and the reason why it's so confusing is that often withdrawing treatment will result in someone's life ending but your intent when you're withdrawing the treatment must be that you think clinically that the the treatment itself is no longer in the best interest of the patient so there's an important distinction here you're not saying that continuing to live is no longer in the patient's best interests you're saying that the treatment in particular that you are currently giving them is not is no longer in their best interests so if they're plugged up to a load of machines then you can make the argument that you know the suffering caused by being plugged up the loads of these machines is no longer in your best interests yes if you unplug those machines the patient will probably die but your intent is to relieve their suffering because the treatment is not in their best interest your intent is not to end their life and yeah a lot of people say that this distinction is just arguing over the semantics like what difference is there between me saying that I'm gonna unplug the lives of one machine to end their life versus I'm gonna unplug the lives of what machine because I think the life person because I think the lives of what machine is no longer in their best interests and kind of we can we can argue about this all day the point is at the moment in the UK your intent cannot be to end their life your intent must be that you are withdrawing treatment because you think the treatment is no longer in their best interests so we've defined some terms we've said that please never ever used the phrase passive euthanasia when talking about this whole topic now let's go back to dr. Cox and his Charlotte and Molly again I hated going back to dr. Cox and what actually ended up happening was he injected a drug and Lilian died shortly afterwards it couldn't be determined necessarily whether she definitely died because of the drug he injected or not because she was so poorly at the time and but that is what happened um so thinking about dr. Cox's defense legally how might he defended himself doing what he did because it sounds like what he did was active euthanasia which we've just said is completely illegal in the UK and he gave her a drug and she subsequently died but actually there is one example where this this might be a loophole and it's called the doctrine of double effect and what it means is that it's based on your intentions essentially so a lot of patients nearing the end of their life around quite high doses of some quite serious drugs and those drugs could if we give them in high enough quantities actually shorten the patient's life but it's worth noting that actually we need to give sufficient amounts of drugs to make sure that a patient is comfortable at this time it's paramount that we don't let patients die in distress and in an undignified and so it should be allowed legally it is allowed for doctors to give quite high amounts of these drugs so the point of the doctrine of double effect is that even if a doctor gives a drug knowing that it may shorten a patient's life if their intent is to give that drug in order to improve their symptoms and to make them more comfortable and their intent is not to shorten their life then that is considered legal in the UK you hear this quite a lot in relation to morphine a very strong painkiller and actually all the research has suggested that if we use morphine properly it doesn't shorten people's lives and so in reality this this isn't really used as a defense but if we think about going back to - Nigel Cox again it would it would absolutely not have been a defense for him even if he tried so what Nigel Cox actually did was used a drug called potassium chloride potassium chloride is good for one thing and one thing only and that's stopping someone's heart there is no other symptomatic relief to be gained from injecting potassium chloride and so by using that substance dr. Cox was never going to be able to use the doctrine of double effect as any sort of defense so that's the doctrine of double effect and that's an important concept to understand in this whole debate about euthanasia and assisted suicide the thing with the doctrine of double effect though is that it's it is mostly a theoretical argument these days palliative care has gotten to the point where we're very rarely prescribing drugs that have the side effect of shortening someone's life there is very little evidence that morphine in particular shortens people's lives that's the most famous one that people think of there is a small amount of evidence maybe that benzodiazepines are drugs that reduce people's agitation towards the end of life there is some evidence that maybe those might reduce their life and maybe in those cases you might apply the doctrine of double effect but in general the vast majority of palliative care patients we don't need to shorten their life in order to relieve their suffering so the doctrine of double effect is as we said mostly a theoretical concept in these cases so we've defined the doctrine double effect let's not talk about what happened to dr. Cox say we'll tell you a bit more about what actually happened in the case of dr. Cox and so although we've said that he couldn't use the doctrine of double effect as a legal argument in this case and it was eventually found that he was not he was guilty okay it was eventually found that he was guilty of manslaughter but not murder and that's because as we said earlier on it wasn't clear whether lilian would have died with or without his injection because she was so ill anyway and so he was found guilty of manslaughter he was actually given a suspended sentence so he didn't go to prison for this and he wasn't actually struck off from the GMC so he's still mainly practicing now he has definitely been practicing since this happened in the 1990s and so what we can learn from this is that this is a particularly difficult ethical case and sometimes in the law although things like active euthanasia are strictly illegal in certain instances we can start to appeal to what other doctors would have done and other doctors might actually sympathize with how horrific lis difficult this decision was for dr. Cox and and therefore his sentence has been slightly more lenient so what we're saying is that none of these situations are clear-cut and they can all be fought differently in the courts and all come out differently depending on the specific situation that you find yourself in so yeah that was the case and let's be clear about this we're not advocating what dr. Cox did we're not saying what he did was right we're saying what he did was strictly is strictly illegal but we're conceding that yeah this was a terribly difficult position to be put in and a position that you know us as clinicians we would never want to be put in that position it was a very difficult decision he had to make and he did what he thought was right at the time and you know you can form your own personal opinion as to whether you think it was a good thing he did or a bad thing he did the fact of the matter was it was illegal maybe should the law be changed I don't know that's that's topic of debate and that's kind of all we're gonna be talking about in the next video incidentally at dr. Cox's trial they called up two eminent rheumatologists who were given the facts of the case and they were asked what they would have done in that circumstance one of them got too distressed and wasn't able to answer the question and the second one said that he wished he would have had the courage to do what dr. Cox did in that circumstance so I just leave it at that you can form your own conclusions from from all the facts that we know we've told you so far and we'll put a link to the Wikipedia article you can read more about this I think it's hugely interesting and if you're interested then yeah you can follow that link so this concludes our first admittedly quite heavy video about end-of-life and euthanasia we've talked about the current legal status of euthanasia in the UK it is illegal 100 percent definitively there is like there are pretty much no two ways about it we've talked about the doctrine of double effect we've defined some terms we've said that passive euthanasia is not the same thing as withdrawing treatment with the drawing treatment is good medical practice in some circumstances passive euthanasia is always illegal and throughout the video we've been referencing the case of dr. Cox and the really really difficult dilemma associated with it and if you get asked something about euthanasia in your interviews you can reference the four principles of medical ethics as you should because it's a great way of structuring your answer but now you can draw on a little bit more about what you know about the legal status of euthanasia and a little bit more about maybe referencing the doctor case if you feel like it if it kind of goes in with the flow of your interview and that would really help you stand out I think one MMI scenario that I've heard some some universities ask it's quite mean because it you really shouldn't be expected to have this level of knowledge at your stage with the application but one MMI scenario that I heard was there was a patient you were a doctor and he had to kind of explain to a patient who asked you that he wanted to end his life so the scenario was kind of what would you do in that circumstance and a way to answer that is I think I think well they want you to say is firstly you would you would want to kind of explore the patient's concerns like ask them why they're feeling that way really trying to get to the bottom of here ultimately if they press you you do have to say that you're bound by the law that you know ending someone's life is illegal in the UK and you can kind of explain that palliative care is really good these days a lot of patients are afraid of maybe dying in pain dying and suffering dying unable to breathe and generally palliative care is really really good we can generally deal with most of these symptoms so that's how our tackle one of these MMI scenarios but to be honest if you get something like that that's really mean that's more like finally a medical student what they would get in their final loss Keys rather than what you should really get as a medicine applicant but hey you've got the information now if you do get hit with a quite mean scenario so that brings us to the end of this video thank you very much for watching we've said that euthanasia is strictly illegal in the UK but people have tried over the last few years to change the law in the UK I personally think the law should be changed in the UK in favour of maybe allowing a little bit more leeway for for euthanasia or for a physician assisted suicide and that's going to be the subject of the next video we're going to be introducing these cases of people who've tried to change the laws we were going to be talking about why they tried to change the law we're gonna be talking about the ethics of assisted suicide so yeah I hope you found this video useful if you did please give it a thumbs up if you haven't subscribed to the channel please consider doing so have a lovely day and I'll see you next time bye

Channel: Ali Abdaal

Views: 75,019

Rating: 4.9337959 out of 5

Keywords: medical ethics, medicine interview ethics, medicine interview questions, medicine interview, medicine interview preparation, how to prepare for medicine interviews, medical school interviews, med school interviews, medical school interview prep, tips for medicine interview, medicine interview tips, interview tips, euthanasia, assisted suicide, physician assisted suicide, medical ethics euthanasia, euthenasia, dignitas, active euthanasia, passive euthanasia, dr cox

Id: 1dIU1YhZX94

Length: 17min 38sec (1058 seconds)

Published: Wed Jan 10 2018