Euthanasia - Medical Ethics and Law at the end of life

2018-01-10 · Long video (solo, talking head or whiteboard) · Ali, Charlotte, Molly Hunt, a guest · recording, 17:38 · watch on YouTube

Topic: Medicine and his doctor years · mode: Explanation and tutorial · tags: Aimed at students

In the third video of his medical ethics series for medicine interviews, Ali and his friends Charlotte and Molly use the 1992 case of Dr Nigel Cox and Lillian Boyes to explain that euthanasia and physician-assisted suicide are illegal in the UK, why the term "passive euthanasia" should be avoided, withdrawing treatment and the doctrine of double effect.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — Ali introduces the euthanasia video, the third of his medical ethics series, and part two to come

★ Ali, a final-year Cambridge medical student, presents the third video of his medical ethics series, on euthanasia and medical ethics at the end of life. — 00:00:00 · Medical ethics, Euthanasia, University of Cambridge
★★ Ali says there is a lot of confusion around the terms active euthanasia, passive euthanasia and physician-assisted suicide, and many medicine applicants use them in the wrong context. — 00:00:00 · Euthanasia, Assisted suicide, Medicine interview
★★ Ali says part two of his euthanasia videos, which should be out at some point the following week, will cover assisted suicide, attempts to change the law on it, and its ethics. (hedged) — 00:00:29 · Assisted suicide

00:00:58 — Charlotte and Molly introduce the case of Dr Nigel Cox and Lillian Boyes

★★ a guest: In the case Charlotte and Molly present, Lillian, a long-term patient of her consultant, suffers terribly with arthritis and is a palliative patient who will never get better. — 00:00:58 · Charlotte, Molly Hunt
★★ a guest: The case is real: in 1992 Lillian Boyes asked Dr Nigel Cox to end her life to relieve her suffering, and it became a seminal case in discussions of euthanasia. — 00:01:39 · Euthanasia
★★ a guest: Besides severe rheumatoid arthritis, Lillian Boyes had internal bleeding, septicaemia and vasculitis making her organs gangrenous; she and her sons Patrick and John begged for her life to be ended. — 00:02:23

00:03:02 — The four principles applied to the case, and how to stand out

★★ Ali applies the four principles to the Lillian Boyes case: non-maleficence and beneficence conflict, since ending a life can be argued to relieve suffering or to be the very definition of harm. — 00:03:02 · Four principles of medical ethics
★★ Ali says autonomy favours helping Lillian Boyes end her life, as she and her family want it, while justice asks whether it is fair to take another human life whatever the intention. — 00:03:40 · Four principles of medical ethics

00:04:26 — Active euthanasia, passive euthanasia and physician-assisted suicide

★★ a guest: Euthanasia literally means a good death; active euthanasia is doing something with the intent of ending someone's life, such as injecting a drug that does nothing but kill. — 00:04:26 · Euthanasia
★★★ a guest: Charlotte and Molly call "passive euthanasia", meaning withdrawing or withholding treatment so that someone dies, an unhelpful term: euthanasia is illegal, while withdrawing treatment in a patient's best interests is good clinical practice. — 00:05:00 · Best interests, Charlotte, Molly Hunt
★★ a guest: In physician-assisted suicide a doctor provides a treatment that will end the patient's life, but the patient takes it themselves. — 00:05:40 · Assisted suicide
★★★ a guest: Active euthanasia, passive euthanasia and physician-assisted suicide are all illegal in the UK, because intending to end someone's life constitutes murder. — 00:06:10 · Euthanasia, Assisted suicide, United Kingdom

00:06:39 — Don't use the phrase passive euthanasia: withdrawing treatment and intent

★★★ Ali urges applicants never to use the term "passive euthanasia", which is hugely confusing; withdrawing treatment is not the same thing and is good medical practice in some circumstances. — 00:07:06
★★★ Ali says withdrawing treatment means judging that the particular treatment, not continuing to live, is no longer in the patient's best interests, even if the patient will probably die. — 00:07:36 · Best interests
★★ Ali grants that many call the line between unplugging life support to end a life and because it no longer serves the patient mere semantics, but in UK law the intent cannot be to end life. — 00:08:03 · United Kingdom

00:08:36 — The doctrine of double effect and Dr Cox's potassium chloride

★★ a guest: Dr Nigel Cox injected a drug and Lillian Boyes died shortly afterwards; it could not be determined whether the drug caused her death, as she was so ill. — 00:08:36
★★ a guest: Doctors must give end-of-life patients enough drugs to keep them comfortable: letting patients die in distress and without dignity must not happen. — 00:09:25
★★★ a guest: Under the doctrine of double effect, a doctor who gives a drug knowing it may shorten a patient's life acts legally in the UK if the intent is to relieve symptoms, not to shorten life. — 00:10:08 · United Kingdom
★★ a guest: The doctrine of double effect is often discussed in relation to morphine, but research suggests morphine used properly does not shorten people's lives. — 00:10:08
★★★ a guest: The doctrine of double effect could not have defended Dr Nigel Cox: he used potassium chloride, which only stops the heart and gives no symptomatic relief. — 00:10:48
★★ Ali says the doctrine of double effect is now mostly theoretical: for the vast majority of palliative care patients, relieving suffering does not require shortening life. — 00:11:46

00:12:20 — Dr Cox: the verdict

★★ a guest: Dr Nigel Cox was given a suspended sentence, so he did not go to prison, and he was not struck off by the GMC. — 00:12:42

00:13:42 — Ali's closing remarks on the Cox case and on interview answers

★★ a guest: Charlotte and Molly say end-of-life cases like Dr Cox's are never clear-cut and can be fought and decided differently in the courts depending on the situation. — 00:13:42 · Charlotte, Molly Hunt
★★★ Ali stresses he does not advocate what Dr Nigel Cox did, which was strictly illegal, but concedes it was a terribly difficult position no clinician would want to be in. — 00:13:42
★★ At Dr Nigel Cox's trial two eminent rheumatologists were asked what they would have done: one was too distressed to answer, the other wished he had had the courage to do what Cox did. — 00:14:19
★★★ Ali says applicants asked about euthanasia should structure their answer with the four principles, then add the legal status of euthanasia and perhaps the Dr Cox case, which would help them stand out. — 00:15:27 · Four principles of medical ethics, Euthanasia, Medicine interview

00:15:55 — A possible MMI scenario: a patient asks you to end his life

★★ Ali calls an MMI scenario some universities ask, a patient asking the doctor to end his life, mean: it suits final-year students' OSCEs more than medicine applicants. — 00:15:56 · Multiple mini interview
★★★ In an MMI where a patient asks to end his life, Ali would first explore the patient's concerns, then if pressed say he is bound by the law, and explain that palliative care is very good these days. — 00:16:22 · Multiple mini interview

00:16:51 — Ali's view on changing the law and a preview of the next video

★ Ali says that euthanasia is strictly illegal in the UK, but people have tried over the last few years to change the law. — 00:16:51 · Euthanasia, United Kingdom
★★★ Ali personally thinks UK law should be changed to allow a little more leeway for euthanasia and physician-assisted suicide. — 00:16:51 · Euthanasia, Assisted suicide, United Kingdom

In the description and comments

★★ Ali Abdaal (channel): The channel corrects the verdict given in the video: Nigel Cox was found guilty of attempted murder, not of manslaughter, as Dr Fistein of the Cambridge Clinical School faculty pointed out. — video description
★ Ali Abdaal (channel): The channel corrects the previous video: in Re T it was the refusal that was deemed invalid, not the original consent, as Molly had said. — video description · Re T, Molly Hunt

Threads in this video

kept · Ali promises a video on euthanasia, assisted suicide and do-not-resuscitate decisions (2017) — Ali, a final-year Cambridge medical student, presents the third video of his medical ethics series, on euthanasia and medical ethics at the end of life. (00:00:00)
kept · Ali promises more videos on the BMAT, interviews and personal statements (2017) — Ali, a final-year Cambridge medical student, presents the third video of his medical ethics series, on euthanasia and medical ethics at the end of life. (00:00:00)
promised · Ali says part two of his euthanasia videos, which should be out at some point the following week, will cover assisted suicide, attempts to change the law on it, and its ethics. — Ali says part two of his euthanasia videos, which should be out at some point the following week, will cover assisted suicide, attempts to change the law on it, and its ethics. (00:00:29)
refine · How do you answer medical ethics questions in interviews? — Ali says applicants asked about euthanasia should structure their answer with the four principles, then add the legal status of euthanasia and perhaps the Dr Cox case, which would help them stand out. (00:15:27)

Where the stories that moved here went next

Mentioned

Central: Assisted suicide · Euthanasia · Medical ethics

Also: Best interests · Charlotte · Four principles of medical ethics · Medicine interview · Molly Hunt · Multiple mini interview · United Kingdom · University of Cambridge

Only in the description or credits: Re T

Replies to

continues · How to answer Medical Ethics interview questions
continues · Consent, Capacity and Jehovah's Witnesses - Medical Ethics & Law for interviews

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