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The Case Against Assisted Dying (2008)

Helen Watt considers the central question to discussions of euthanasia. A pdf is available here.


Worthless lives?


Non-voluntary euthanasia

Non-voluntary euthanasia is, in fact, a natural sequel to voluntary euthanasia: if death is seen as a benefit urgently needed by some, this benefit is likely to be extended to a wider pool of patients. In the Netherlands, euthanasia has been legally available for decades, and a series of government-ordered surveys have been carried out to track the results. These results are very much more alarming than the optimistic gloss they receive from the survey authors and the Dutch Government might suggest. 2 3 By no means all of those killed without request are non-competent at the time. The survey authors candidly acknowledge that non-voluntary life-termination seems rather difficult to prevent; they suggest that if patients want to live, they should say so clearly, orally and in writing, well in advance. 4

It is, of course, true that some killing by doctors goes on in countries where this is illegal. However, covert voluntary euthanasia is no more a reason to make this practice legal than covert non-voluntary euthanasia is a reason to legalise non-voluntary killing. In fact, the legalisation of voluntary killing is likely to cause other forms of killing by doctors to be taken less seriously. In the Netherlands, very few doctors have been prosecuted for breaking the law on euthanasia and assisted suicide, and those few convicted have been treated with remarkable leniency.


Oregon, whose law permitting assisted suicide (though not euthanasia) came into force in 1997 is often presented as a model for other legislatures to follow. In fact, Oregon polices assisted suicide even less than does the Netherlands: self-reporting by doctors is followed by no investigation, but merely a passive reporting by the relevant authority. 5 And although nothing like the official Dutch surveys has been carried out in Oregon, there is anectodal evidence of patients being pressured to die or undertreated on the grounds that they have a suicide prescription and need nothing more. 6 It is worth pointing out that reported pain in Oregon has worsened since assisted suicide was legalized, 7 and that the State, which funds assisted suicide, is less ready to fund essential medical services for those who want and need them.

Complicity in suicide

8 In particular, advance directives will sometimes, though not always, have a suicidal motive, 9 10 Such a motive is sadly not unknown among health professionals, perhaps especially those who find their own mortality and fragility psychologically troubling.


An edited form of this paper was published in Geriatric Medicine.


1. Davis A. Patients need medical help to live with dignity until they die naturally. BMJ 2002; 324: 846.

2. Keown J. Euthanasia, Ethics and Public Policy. 2002; Cambridge University Press, Cambridge.

3. Keown J. . 2006; Care Not Killing Alliance, London: 10.

4. Van der Wal G, van der Heide A et al. Medische Besluitvorming aan het einde van het leven: De prektijk en de toetsing procedure [Medical Decisionmaking at the End of Life: The Practice and the Review and Verification Procedure]. 2003; De Tijdstroom, Utrecht: 201.

5. Keown J. Considering Physician-Assisted Suicide: An evaluation of Lord Joffe's Assisted Dying for the Terminally Ill Bill. 2006; Care Not Killing Alliance, London: 11.

6. Keown J. 2006; Care Not Killing Alliance, London: 13-14.

7. Fromme EK, Tilden VP, Drach LL, Tolle SW. Increased Family Reports of Pain or Distress in Dying Oregonians. J of Palliative Med. 2004; 7:431-442.

8. Gormally L, ed. Euthanasia, Clinical Practice and the Law. 1994; The Linacre Centre, London.

9. Watt H. Cooperation problems in care of suicidal patients. In: Watt H, ed. Cooperation, Complicity and Conscience: Problems in Healthcare, Science, Law and Public Policy. 2005; The Linacre Centre, London: 139-147.

10. Mental Capacity Act.