Euthanasia News Review

2004 - current

Death decisions given legal clearance (July 2004)
Euthanasia campaigner jailed (July 2004)
GMC challenged on feeding and hydration (April 2004)

2000 - 2003

Euthanasia at home and abroad (July 2003)
Will doctors assist death? (July 2003)
Backdoor euthanasia by nurses? (April 2003)
Assisted death proposals (April 2003)
Belgium's euthanasia law claims its first victim (January 2003)
Assisted suicide for visitors to Switzerland (October 2002)
Diane Pretty dies (July 2002)
Peaceful end for Ms B (July 2002)
Dutch legalise euthanasia (July 2002)
Australian family may face jail for watching suicide (July 2002)
Diane Pretty latest (April 2002)
Belgium set to decriminalise euthanasia (January 2002)
French health minister admits to mercy killing (October 2001)
Woman moves forward in quest for 'right to die' (October 2001)
New guidance issues on resuscitation (July 2001)
Holland decriminalises voluntary euthanasia (July 2001)
Belgium may legalise euthanasia (July 2001)
MEPs lobby against extension of euthanasia (July 2001)
Euthanasia ship docks in Australia (July 2001)
Dutch vote to 'legalise' euthanasia (April 2001)
Shipman faces public enquiry (April 2001)
PVS Patients allowed to die (January 2001)
DNR orders and living wills (October 2000)
Euthanasia investigation (October 2000)
Winterton bill update (July 2000)
French support euthanasia (July 2000)
GP found guilty of 15 counts of murder (April 2000)
Belgium considers legalising euthanasia (April 2000)
Physician Assisted Suicide (April 2000)
UK concerns that elderly patients are endangered (April 2000)
The Winterton Bill (April 2000)

1997 - 1999

David Moor cleared of murder (July 1999)
Euthanasia control ineffective in Holland (July 1999)
Jack Kevorkian convicted and sentenced (July 1999)
Oregon data on physician assisted suicide (July 1999)
High Court rules on withdrawal of treatment (July 1999)
BMA guidelines on withdrawal of treatment (July 1999)
Abuse of Dutch Euthanasia Legislation (April 1999)
Doctor starve patients in Sussex (April 1999)
Euthanasia Fears (January 1999)
Physician Assisted Suicide (October 1998)
Living Wills pave the wat for euthanasia (July 1998)
Legalised Physician Assisted Suicide in the US (July 1998)
Euthanasia by the back door? (April 1998)
Euthanasia in Canada (April 1998)
Euthanasia update (January 1998)
Dutch non-treatment decisions (January 1998)
Latest attempts to legalise euthanasia (October 1997)
Japanese Parliament recognises concept of 'Brain Death' (July 1997)
Hillsborough survivor emerges from persistent vegetative state (July 1997)
Northern Territory euthanasia law overturned (July 1997)
Second patient dies by euthanasia under New Act (April 1997)
US supreme court ruling on euthanasia (April 1997)
Dutch cabinet relaxes euthanasia legislation (April 1997)
Kevorkian acquitted again (January 1997)
Moves to legalise physician assisted suicide in US (January 1997)
Northern Territory euthanasia bill comes into force (January 1997)
Euthanasia further decriminalised in Netherlands (January 1997)
Tube feeding withdrawn in Scottish right-to-die case (January 1997)
Scottish court shows leniency in euthanasia case (January 1997)
Over a third of British doctors would practice euthanasia (January 1997)

July 2004

Death decisions given legal clearance

A multiple sclerosis (MS) sufferer has won the ‘right’ to be left to choke to death. The former teacher made a living will to ensure that carers will not intervene if she starts to choke on her food, a situation that often arises in the later stages of MS due to eating difficulties. Durham County Council has made a decision to uphold the living will and instructed carers not to intervene personally in the case of an emergency, although they will be expected to call the emergency services. Mark Slattery of the Voluntary Euthanasia Society said that the woman was, ‘expressing the will that it would actually be more painful for her to be revived or to be given this treatment than it would be for her to choke and to die’.

This is thought to be the first decision of its kind, and the council now plans to introduce a policy on living wills. It is likely that other local councils will follow suit. Previously, medical staff have been legally bound by living wills, but it was not clear whether this extended to social carers. Anyone who physically handles the patient in a way that has been refused in advance could be liable to charges of assault.

The Mental Capacity Bill, currently under discussion in the House of Lords, will seek to clarify the legal situation regarding living wills. It will state that the treatments being refused must be specified and that doctors must be satisfied that there has been no change in mind or circumstances to negate the living will. Additionally, if there is any doubt, this should be resolved in favour of preserving life.

A report from the University of Michigan published in the Hastings Center Report has indicated that living wills don’t work. The authors reviewed hundreds of studies of living wills, end-of-life decisions and the psychology of decision making. They recommend that Durable Powers of Attorney (DPA), allowing people to name someone to make decisions on their behalf, be used instead. DPAs are also cheaper than living wills. Starting up the administration of living wills in America cost an estimated $101.5m, and demands countless hours from hospital staff annually.

The UK equivalent, Lasting Powers of Attorney, are also covered in the Mental Capacity Bill. (Hastings Center Report 2004;34:2, BMJ 2004;328:1035, bbc.co.uk 2004; 24 May, Guardian 2004; 26 May)

Euthanasia campaigner jailed

One of New Zealand’s leading euthanasia campaigners has been sentenced to 15 months in jail for the attempted murder of her mother. Lesley Martin wrote a book in which she described injecting her 69 year old mother with morphine. Joy Martin had been suffering from colorectal cancer and died the following day.

Police decided to investigate the case on reading the book, entitled To Die Like a Dog, in which Martin also described trying to suffocate her mother with a pillow in an attempt to relieve her suffering. She is a former intensive care nurse and cared for her mother in the five months prior to her death in 1999.

Lesley Martin helped found Exit New Zealand, a lobby group fighting to see voluntary euthanasia legalised. Following the trial she insisted that she would go to jail. ‘Not a single day’ went by when she felt guilty about her actions, she declared. However, her lawyer has said he will appeal the sentence, as a conviction would prevent her from travelling overseas to promote euthanasia. (bbc.co.uk 2004; 30 April, New Zealand Herald 2004; 30 April, Sydney Morning Herald; 30 April)

April 2004

GMC challenged on feeding and hydration

July 2003

Euthanasia at home and abroad

The Patient Assisted Dying Bill was the subject of seven hours of debate when it underwent its second reading in the House of Lords on 6 June.

Since the bill was introduced to the House of Lords by retired human rights lawyer Lord Joffe in February this year, it has received much media attention, with voices on both sides of the argument straining to be heard. More than 50 peers took part in the debate, and many commented on the overwhelming public correspondence they had received on the issue.

The bill has already been examined by the parliamentary Joint Committee on Human Rights, which concluded that the safeguards were adequate to 'protect the interests and rights of vulnerable patients. They would ensure that nobody could lawfully be subjected to assisted dying without his or her fully informed consent.' In his opening speech Lord Joffe referred to examples of other countries where 'we see assisted dying laws working well' as support for his bill, as well as a supposed 81% of the public favouring change.

Another key issue in the debate has been the recent spate of 'suicide tourism'. Swiss based organisation Dignitas provides medical assistance for terminally ill patients to kill themselves. Since Reginald Crew became the second Briton to make use of these services in January this year, a number of other people have followed suit.

In April Robert and Jennifer Stokes both received assistance to die, yet neither was terminally ill. Mrs Stokes' family knew nothing of the couple's plans and were devastated by the news. They have called for Dignitas to be shut down. The case brings into question the effectiveness of a 'terminal illness' clause in euthanasia legislation. Vivienne Nathanson, of the British Medical Association said, 'It certainly strengthens my view that it is very difficult to write the law so tightly that you don't get unexpected consequences. That has to give everyone cause for concern, whether they are for or against.'

Most recently John Close, a 54 year old motor neurone disease sufferer, flew to Zurich to die at the Dignitas clinic with his family at his bedside.

'Aiding and abetting' a suicide is officially illegal in the UK under the 1961 Suicide Act, and families who travel abroad with their dying relatives could be liable to prosecution. However, since the Merseyside police decided against prosecuting Reginald Crew's widow for accompanying him to the Dignitas clinic, other families of terminally ill patients may pursue this route with greater confidence. The Swiss authorities are currently investigating ways of making it harder for foreigners to travel there for assisted suicide, but it may be some time before the new rules are in place. (Guardian 2003; 15 April, 6,7 June, bbc.co.uk 2003; 27 May, Guardian 2003; 10 April, Sunday Times 2003; 20 April, telegraph.co.uk 2002; 14 September)

Will doctors assist death?

An internet survey commissioned by the pro-life charity Right to Life indicates that 74% of doctors would refuse to perform assisted suicide if it were legalised.

986 doctors responded to the survey, which was carried out by the independent Opinion Research Business using a random selection of 9,000 members from doctors.net.uk, the foremost medical internet company in the UK. 56% of respondents agreed with the House of Lords Select Committee on Medical Ethics statement, which said that it would be impossible to set safe boundaries on euthanasia. However, the survey showed sharp divisions depending on whether doctors are prepared to assist death; those who are tended to disagree with the Lords' statement (86%). Major concerns were also raised about the clinicians' ability to separate a patient's true wish to die from pressure from families and friends.

This survey contrasts with one carried out by the Voluntary Euthanasia Society in January this year, which indicated that 55% of 1,002 doctors of all specialities supported physician assisted suicide where a terminally ill patient requested it. This survey was carried out through medix-uk.com, and it is not clear what sampling methods were used to obtain responses. (bbc.co.uk 2003; 13 May, opinion.co.uk/news.htm, ves.org.uk/resources.html)

April 2003

Backdoor euthanasia by nurses?

Five percent of nurses believe colleagues are helping terminally ill patients to die, according to a survey for Nursing Times magazine.

Of the 1,173 nurses questioned, 55 agreed that, 'Health professionals already quietly help patients to die', while 50% feel that the law on assisted suicide should be changed. Many expressed confusion about whether the administration of 'the last dose' of morphine constitutes assisting the patient to die.

A spokeswoman for the Royal College of Nursing (RCN) responded that the poll represents a small sample. She told the BBC, 'We don't think it's the right time for a change in the euthanasia laws' and highlighted the RCN's support for increased investment in palliative care.

A different study, covering nearly 1,000 elderly people in Thames region nursing homes, found that patients are often prescribed strong tranquilisers without therapeutic justification. Of the 25% of patients given neuroleptic drugs, the therapy was inappropriate for 82.8%. The drugs are given to 'quieten' patients with 'behavioural problems', but are likely to exacerbate patients' dementia and increase their risk of falling. The research team rejected 'aggression' as sufficient medical justification, but accepted 'biting and hitting others'. The Alzheimer's Society said that the same statistics could be applied to up to 100,000 of the 500,000 in residential care across the country, and hope that this report will help put an end to such indiscriminate prescribing. (bbc.co.uk 2003;5 February, Guardian 2003;10 February)

Assisted death proposals

A bill to legalise euthanasia has been introduced to the House of Lords by Lord Joel Joffe, a prominent retired human rights lawyer, with further debate expected in early May.

The 'Patient Assisted Dying Bill' would allow a terminally ill adult who remains competent to receive medical help to die at his own considered and persistent request; it also gives them a legal right to maximum pain control. The recommended safeguards are that two doctors must confirm the diagnosis and ensure that all alternatives have been fully considered, a written declaration must be made in the presence of a solicitor, a 'waiting time' between the request and final act is enforced, and each death must be reported to a monitoring commission. Additionally, if there is doubt about the patient's competence, a psychiatric assessment must be sought. There is a conscientious objection clause for doctors who feel unable to participate.

Lord Joffe commented, 'The Diane Pretty and Reginald Crew cases highlighted the pressing need to allow terminally ill competent adults greater choice in the manner of their death'; he cited media polls indicating that 80% of the public favour a change in the law. (www.ves.org.uk/nw_press.html,)

January 2003

Belgium's euthanasia law claims its first victim

Belgium has followed its neighbour, the Netherlands, by legalising euthanasia on 23 September 2002. The first official case followed only a week later, and provoked an outcry after claims that it was an illegal publicity stunt.

39 year old Mario Verstraete, who suffered from multiple sclerosis, died from lethal injection on 30 September despite the legal requirement that a patient must request euthanasia at least a month ahead. Belgium's professional medical organisation has complained that the killing was illegal and is considering whether to take legal action. (Times 2002;23 September, Guardian 2002;9 October)

October 2002

Assisted suicide for visitors to Switzerland

A Swiss euthanasia charity, Dignitas, has begun to accept foreigners into its membership and offers physician-assisted suicide (PAS) to those that can travel to Switzerland.

A television report detailed the journey of Sigrid Casey from Germany to Zurich, where she received the assistance necessary to end her own life. The prescribing doctor had received the patient's medical notes prior to their first meeting in order to aid his assessment of her capacity to make such a decision. After spending an hour with her he provided the necessary dose of an agent similar to that used by vets when 'putting down' animals.

Dignitas owns a flat where foreign patients spend their last hours, and a hospice nurse is present with the patient throughout. The nurse was tearful as she described how she sat with patients in their final moments. She is not paid a salary for her work since Swiss law does not allow anyone to profit from PAS. Additionally she cannot actually help the patient take the drug, or she could be found guilty of murder under Swiss law - the final act must be the patient's alone.

Dignitas was set up by Ludwig Minelli, a lawyer who believes that the terminally ill have a right to die when they choose. 'To live with dignity, to die with dignity. That is our motto' he said. The group has not yet fallen foul of the law. They inform the local authorities of each death and ensure that there are two witnesses present. So far they have assisted 109 people to end their lives, and accept the mentally ill and clinically depressed into their program.

Dignitas currently purports to have four British members, for a membership cost of £10 each. Anyone travelling from this country to Switzerland as a companion to someone seeking assisted suicide there, risks being detained on their return. Under the Suicide Act 1961, the companion may be guilty of aiding and abetting a suicide, which carries a maximum sentence of 14 years. (Newsnight, BBC2, 11 August 2002)

July 2002

Diane Pretty dies

Diane Pretty has died less than a fortnight after losing her final court appeal, seeking her husband's help to end her life. She passed away at a hospice near her home in Bedfordshire. Her husband was at her side.

Mrs Pretty, 43, had suffered from motor neurone disease for three years and had been fighting a long legal battle which finally ended in the European Court of Human Rights. She had been seeking the right to her husband's help in dying before the onset of the choking and asphyxia which mark the final stages of her condition.

Suicide is not a crime in the UK but Mrs Pretty was physically unable to take her own life. Without a court sanction, her husband could have faced a possible prosecution for aiding and abetting suicide, which carries a prison term of up to 14 years. However, the European Court of Human Rights ruled that the state was not obliged to sanction steps to avoid the inhuman and degrading effects of a disease. Afterwards she said: 'The law has taken all my rights away.'

However, speaking to the Guardian, Rachel Hurst, director of Disability Awareness in Action, said her organisation stood by its support of the European court's decision. 'The issue about Diane Pretty is that she wanted to kill herself, but I am afraid it would be very wrong for justice to say in certain circumstances people can die. It would be a slippery slope and many people who did not want to die could be affected. Palliative care does take away a great deal of the problem and was her death any worse than someone in the Potters Bar crash?' (Guardian 2002; 13 May. See also report in Triple Helix 2002; Summer)

Peaceful end for Ms B

A woman paralysed from the neck down who won a legal battle to allow her to have medical treatment withdrawn has died peacefully in her sleep. A High Court judge ruled that the 43 year old, known as Ms B, had the 'necessary mental capacity to give consent or to refuse consent to life-sustaining medical treatment', granting her the right to be transferred to another hospital and have her ventilator switched off, after her original hospital refused to do so. The former social worker was also to be treated in accordance with her wishes and be given the medication and care necessary to ease her suffering and allow her to die in dignity.

Following her death, the Department of Health issued a statement saying: 'Ms B has chosen to have all artificial ventilation which she is receiving as part of her medical treatment withdrawn. She has died peacefully in her sleep after being taken off the ventilator at her request.'

In the wake of the case, the General Medical Council has published provisional guidelines to help doctors decide when it might be appropriate to withhold or withdraw a patient's treatment. Professor David Hatch, who chaired the working group that drew up the guidelines, said they had consulted widely on the proposals, receiving more than 700 responses. 'I think that the overriding principle, which was confirmed in the Miss B case, is that one must respect the wishes of the patient and make sure they are fully informed about all the options and free to make their own decisions,' he said. (Guardian 2002; 29, 30 April)

Dutch legalise euthanasia

The Netherlands has become the first country in the world to officially legalise euthanasia. After considerable debate, the change to the law was agreed at the end of last year. However, it has only now come into force.

For the past two decades, the authorities have turned a blind eye to the practice but doctors still risked prosecution, even when they had obtained the consent of the dying patient.

The new legislation will permit doctors to administer euthanasia only to those patients who are in a state of continuous, unbearable and incurable suffering. However, they must obtain a second opinion, the patient must be judged to be of sound mind and their request to die must be entirely voluntary and independent.

There are already thought to be between 2,000 and 3,000 recorded cases of euthanasia in the country each year and more than 90% of the Dutch population support it. However, the new law has inevitably provoked controversy. The UN Human Rights Committee has warned that mercy killing in the Netherlands risks becoming routine and insensitive. Concerns have also been raised that the initiative will trigger a wave of 'euthanasia tourism' but a clause insisting on a well established relationship between the doctor and patient is designed to prevent this.(Guardian 2002; 1 April)

Australian family may face jail for watching suicide

The family of Australian woman Nancy Crick face possible prosecution after watching her commit suicide. Mrs Crick, 69, who had allegedly been suffering from colorectal cancer for three years swallowed an overdose of drugs, washed it down with Bailey's liquer and lit a final cigarette, having decided she could no longer go on with life. Her friends and relatives who were with her at her home in Queensland are now faced with the possibility of life imprisonment.

Mrs Crick had made no secret of her desire to end her life but did not want to die alone. However, she knew that assisting a suicide was illegal so prior to her death she recorded a video statement aimed at protecting those with her in which she declared, 'It's my death, I'm doing it and no-one else.'

The local police declared her house a crime scene and sealed it off shortly after her body was carried out to an ambulance. It is believed that she had obtained the necessary drugs after an appeal on the internet.

Mrs Crick had campaigned vociferously for a change in the country's euthanasia laws and her death has re-ignited the whole debate. Australia's Northern Territory became the first place in the world to legalise voluntary euthanasia in 1996 but the law was overturned just nine months later.

In a bizarre twist a post mortem examination revealed that Mrs Crick did not have any visual signs of cancer at the time of her death, despite her claim to have been suffering from the complications of colorectal cancer for three years. (Independent 2002; 24 May, Sydney Morning Herald 2002; 27 May)

April 2002

Diane Pretty latest

The European Court of Human Rights in Strasbourg has said it will expedite an application for a hearing from Diane Pretty, the 43 year-old woman with motor neurone disease who has been refused a guarantee by the British Appeal Court that her husband would not be prosecuted if he assisted her suicide. Guardian 2002; 24 January

January 2002

Belgium set to decriminalise euthanasia

The Belgian Senate has strongly approved draft legislation to give terminally ill people the right to die making it the second country in the world to do so, after the Netherlands. The proposal is expected to be passed by the lower chamber before the end of the year. The large majority in the vote was attributed to the legal opinion of the country's Council of State that it was 'the right to life' and not 'life' itself that was at stake, and that this should be seen in the context of self-determination. Conscious patients over 18 with an incurable illness will be allowed to receive euthanasia if they have made voluntary and repeated requests to die. Each request will have to be registered with a committee of doctors and lay people. Parallel legislation will be introduced to provide for improved palliative care. Even the legislation's supporters acknowledge, however, that planned cuts in next year's health spending, in particular on nursing homes, will make this difficult. 72% of Belgians taking part in a newspaper survey earlier this year approved of decriminalising euthanasia. In a second survey, 42% of doctors said they would be prepared to honour a request for assisted suicide. BMJ 2001;322:1024

October 2001

French health minister admits to mercy killing

Bernard Kouchner, the French Health Minister, has admitted to administering lethal doses of morphine to war casualties while working as a doctor in Lebanon and Vietnam.

The co-founder of medical aid charity Medicins Sans Frontiers said that ending someone's life was 'a delicate matter', in the revelations made to Dutch magazine Vrij Nederland. Asked what form of euthanasia he had administered, he replied: 'Both passive and active euthanasia...I have been in so many wars and also in hospitals. It happens on a daily basis that life-prolonging equipment is being switched off.'

When legalisation of euthanasia came into effect in the Netherlands Mr Kouchner said he would press for it to be legalised in France too. He says now that he does not favour euthanasia legislation in France. In 1998, a survey of British doctors by the British Medical Journal claimed that half the GPs in the country had in some way assisted terminally ill patients to die. Euthanasia is illegal in all forms in Britain. Guardian 2001;25 July; Times 2001;25 July

Woman moves forward in quest for 'right to die'

A terminally ill woman who wants assistance to end her own life, won the right to have her case reviewed in the high court on 31 August. Diane Pretty, 42, was diagnosed with motor neurone disease in 1999. She is now paralysed from the neck down, but is fully mentally competent. She wishes to take her own life but is physically unable to do so. The director of public prosecution had previously refused to guarantee that her husband would not be prosecuted under the 1961 Suicide Act if he helped to end his wife's life. After the ruling, Brian Pretty said that his wife was 'very pleased' with the outcome.

The Voluntary Euthanasia Society and the civil rights group Liberty are supporting her case. They claim that the exceptional circumstances mean that Mr Pretty should be exempt from the Suicide Act.

The judge, who described the case as 'tragic', said he wanted the full hearing to be held as soon as possible. It will almost certainly be held in front of a senior judge because of the ramifications for other seriously disabled people. It is expected to come to court on 10 October. Mrs Pretty's counsel, Philip Havers QC, said: 'if ever there was an individual who can demonstrate a well-settled wish on wholly rational grounds to terminate her life we suggest it is this claimant.'

The Netherlands and the state of Oregon in the USA are currently the only two places in the world that allow voluntary euthanasia. Guardian 2001;31 August; BMJ 2001;323:531, 8 September

July 2001

New guidance issued on resuscitation

According to new guidelines, decisions about whether or not to attempt resuscitation should be reached in consultation, where possible, with the patient and close relatives. Decisions Relating to Cardiopulmonary Resuscitation, a joint statement from the BMA, the Resuscitation Council (UK), and the Royal College of Nursing, comes after public concern about 'do not resuscitate' (DNR) orders which were previously written in notes without patients' or their relatives' knowledge. The statement emphasises that a patient's informed decision should be respected and that 'all reasonable efforts' should be made to attempt to revive a patient if their wishes cannot be ascertained. It also recommends a change to the term 'do not attempt resuscitation' (DNAR), to highlight the fact that cardiopulmonary resuscitation is frequently unsuccessful. The guidance recommends that resuscitation should not be attempted in all cases of cardiac or respiratory failure, for example it may be considered inappropriate for patients in whom cardiopulmonary arrest clearly represents a terminal event in their illness. BMJ 2001;322:509, 3 March

Holland decriminalises voluntary euthanasia

The Netherlands has become the first country in the world to pass a law decriminalising voluntary euthanasia. Dutch doctors carrying out the practice under strict conditions will no longer be judged automatically as criminals when the law comes into force this autumn.

The new law liberalises the existing legislation, in particular allowing children aged 12 to 16 years to request euthanasia with the consent of their parents and for those aged 16-18 to do so without requiring parental consent.

The legislation states that doctors must be 'convinced' that the patient's request is voluntary and well-considered and that he or she faces 'unremitting and unbearable' suffering. Doctors must also have advised patients of their prospects and reached a firm conclusion that there is 'no reasonable alternative solution'.

Senators have been inundated by 60,000 letters on the topic from the public. The spokeswoman for the opposition Christian Democratic party expressed fears that unless doctors were given legal rights not to co-operate on moral grounds, euthanasia could become a 'viable treatment option', creating a culture in which 'doctors have to defend their choices not to commit euthanasia'. BMJ 2001;322:947, 21 April

Belgium may legalise euthanasia

Belgium is to be the next country to consider legalising euthanasia. In some areas it is planning to go even further than its Dutch neighbours. Whereas in the Netherlands a second doctor must review any decision, in Belgium he or she would only need to consider the diagnosis that had been made. BMJ 2001;322:947, 21 April

MEPs lobby against extension of euthanasia

Two German MEPs are now trying to mobilise European public opinion against the new Dutch legislation. Dr Peter Liese, the chairman of the Christian Democratic working group for bioethics in the European parliament, and his compatriot, Hiltrud Breyer, the Green party's spokeswoman on the temporary committee for human genetics, are calling for alternative treatment for people at the end of their lives.

They support each patient's right to reject life prolonging measures such as artificial respiration. However they insist that this is totally different from active euthanasia. 'If the state starts to allow medical doctors to give pills or an injection to their patients with the sole aim of killing the patients, the misuse of this method is inevitable,' they pointed out. Instead, they want increased EU and national funds for research into effective pain relief and improved palliative care as well as political support from the European Parliament to put pressure on national authorities to provide more hospices. BMJ 2001;322:638, 17 March

Euthanasia ship docks in Australia

Meanwhile, an Australian euthanasia campaigner has seized on Holland's decision to legalise the practice by proposing a mercy-killing clinic on board a Dutch-registered ship. Dr Philip Nitschke who gained international notoriety by helping four cancer patients to die when euthanasia was briefly legalised in the Northern Territory in 1996, hopes to supervise suicides legally by mooring a boat outside territorial waters and operating under Dutch law. Dr Nitschke, a GP based in Darwin Australia, said: 'We're looking at how the change in Dutch law impacts on the international law of the sea.'

Although Australia's federal parliament overturned the Northern Territory's euthanasia law less than a year after it was introduced, following a public outcry, Dr Nitschke still runs clinics across the country where he advises terminally ill patients how to commit suicide. Telegraph 2001; 12 April

April 2001

Dutch vote to 'legalise' euthanasia

Dutch MPs have voted to end 20 years of uncertainty for doctors by effectively legalising euthanasia, making Holland the first democratic country to do so. The practice has been decriminalised since a landmark court case in the early 1980's. A doctor currently performing euthanasia must first report what is still an illegal act to a regional review committee, who only drop the case if they believe he has followed the criteria established through case law. Under the new bill the doctors' actions will 'not be treated as a criminal offence if the criteria are followed'.

The decision split the country with strong opposition from the Dutch Church and the hospice movement, who fear that choosing to die will become a 'normal' practice. This decision follows an earlier example in Australia's Northern Territory when 'physician assisted suicide' was temporarily allowed in 1996-7.

Opposition MPs were appalled at the Dutch verdict, fearing that the bill would 'open the floodgates'. They cited examples whereby families might use this law to get rid of ailing relatives. Also under the new bill, children as young as twelve will be eligible for euthanasia if they receive parental permission. Currently less than 50% of an estimated 3,600 cases of physician assisted suicide are reported each year in Holland. Telegraph 2000; 4 December; BMJ 2000; 321:1433, 9 December

Shipman faces public inquiry

A public inquiry is to be held into the serial killer Harold Shipman. The families of Shipman's victims won a legal battle to overturn an earlier decision by Alan Milburn, the Health Secretary, to hold the investigation in private. Dame Janet Smith, a High Court judge was appointed to chair the inquiry that started in January. Telegraph 2001; 9 January

January 2001

PVS patients allowed to die

In the first right to life case to go to the High Court since the introduction of the Human Rights Act, doctors were given the go-ahead to withdraw artificial feeding from two patients in a state of 'living death'. The landmark case was mounted by the families and doctors of the two unrelated women. It involved two women from the North of England who, as the court heard from John Grace QC, were in a 'twilight zone of suspended animation where death commences though some form of life continues'. He was seeking consent on behalf of two unnamed health authorities to cease life-sustaining treatment. The plea was opposed on the grounds that stopping tube feeding would breach the patients' right to life, guaranteed by article 2 of the new act which makes the European Convention on Human Rights part of UK law. The test case was tried before Britain's most senior family judge, Dame Elizabeth Butler-Sloss, who decided that the termination of feeding would not infringe the patients' rights, clearing the way for courts to continue sanctioning such decisions in the future.

The first of the two women who have since died peacefully, was a 49 year old known only as Mrs M, who had been in a persistent vegetative state (PVS) since an anaesthetic mishap during a gynaecological operation overseas. The other, a 36 year old severe epileptic, Ms H, had been in near PVS since last January after her brain was deprived of oxygen following a heart attack in hospital. Since the case of Hillsborough survivor Tony Bland in 1993, the courts have sanctioned the withdrawal of feeding from around twenty patients in PVS and two in near PVS. In justifying her decision Dame Butler-Sloss said that the removal of a feeding tube was not 'a deliberate act'. Guardian 2000; 17 September, 7 October; Times 2000; 26 October

October 2000

DNR Orders and Living Wills

The row sparked when Jill Baker, a 67-year-old patient with stomach cancer discovered a do-not-resuscitate (DNR) order on her notes without having been consulted by doctors, has lead to an investigation by the BMA ethics committee. It will look at how some form of compulsory written consent could be obtained in the future before any DNR orders are made. Many of the speakers at the BMA national conference in June told of how junior doctors, only months out of training were being 'cajoled and coerced' into making DNR orders for hospital patients contrary to national guidelines.

In a separate study performed at the Imperial College School of Medicine, it was found that although at first many elderly did not know about the existence of living wills, once made aware, seven out of ten elderly people wanted to let doctors know their wishes in the event of a terminal illness. The first study of its kind in Britain found that most patients over 66 want to relieve doctors and families of the burden of having to decide whether to prolong their life. Most would refuse life prolonging treatment once they were bedridden and suffering advanced dementia. Telegraph 2000; 16 June; Telegraph 2000; 28 June; BMJ 2000; 320:1618-1619, 17 June

Euthanasia Investigation

A preliminary murder investigation has been opened into the deaths of more than 20 elderly patients in a clinic in Saclay, south-west of Paris, after staff complained that they had been forced to carry out euthanasia. Police raided the clinic to investigate suspicious deaths of patients in the past five years. Times 2000; 10 July

July 2000

Winterton Bill update

Ann Winterton's Medical Treatment (Prevention of Euthanasia) Bill is currently at report stage in the House of Commons. The bill would outlaw the withdrawal of medical treatment, nutrition or hydration from a patient with the intention of hastening a patient's death. On 8 May Ann Winterton put down an early day motion, noting with concern various recent developments towards euthanasia. The motion, signed by 41 other members of Parliament, invites the Government to reconsider its position and honour its stated opposition to euthanasia, as well as to allow her bill adequate time to complete its stages. BMJ 2000;320:1094, 22 April; SPUC News Digest 2000; 17 May

French support euthanasia

France's National Ethics Committee has released a report which states that euthanasia may be permissible in certain circumstances, and admits that it is already practised in the country's hospitals. The carefully worded document, which took three years to complete, avoids demanding any change in legislation and calls for a loophole in the law to save physicians from possible prosecution. A 1995 survey of 140 French anaesthetists found that 26% of them had deliberately injected patients with lethal drugs when they felt that the patients had no chance of recovery.

In 1999 a young nurse, Christine Malevre was charged with manslaughter after telling police that she had helped 30 patients to die at their request. In response to the case, then Health Minister Bernard Kouchner (now the United Nations administrator in Kosovo) called euphemistically for a 'different approach' to how one dies. Psychiatric reports found that Malevre had no true compassion but had a 'megalomaniacal desire' to be in a position of power. The charge against her was upgraded to murder. Reuters Health 2000; 6 March

April 2000

GP found guilty of 15 counts of murder

Harold Shipman, a Manchester GP, has been found guilty of the murder of 15 elderly women and sentenced to life in prison. Police have evidence for the possibility of many more murders and some reports suggest that his total death toll could be over 150. He was also found guilty of forging the £400,000 will of Mrs Grundy, one of his victims who died of 'old age'. Later exhumation revealed large quantities of morphine in her body.

The local Health Authority has urged the government to tighten up the system and make GPs more accountable. The General Medical Council will be encouraging the government to introduce many reforms.

Health authorities are to be made aware of any previous convictions for offences such as Shipman's (for stockpiling of pethidine), and will require any deaths in GPs' surgeries to be reported to the coroner. GPs who countersign death certificates will have to examine the body, check the medical notes and speak to the families themselves. More auditing of GPs' surgeries will be introduced and their computers will be configured so that backdating and falsification of reports is much harder. A new whistle-blowing hotline will be set up and the availability of controlled drugs will be tightened.

An independent inquiry has been set up, chaired by Lord Laming of Tewin. The main aim of the inquiry, which will report to the government in September, is to examine how patients can be safeguarded in the future. BMJ 1999; 319:1026, 16 October; Telegraph 2000; 1 February; Telegraph 2000; 2 February

Belgium considers legalising euthanasia

Proposals to decriminalise euthanasia in Belgium have been met with anger from the medical community who feel they have not been properly consulted. Senators propose that doctors should be allowed to carry out voluntary euthanasia under certain conditions; the patient must be aware of his serious and incurable condition and of the alternative possibilities of palliative care, the patient must be a competent adult and make an explicit and repeated request. He must be in continuous and intolerable suffering that is not alleviated by medical care, with his condition confirmed by another doctor.

The Christian Democrat party is opposed to these proposals, saying they fear increasing liberality, even more than in Holland, and that there would be no effective control. BMJ 2000;320:137, 15 January

Physician Assisted Suicide

Oregon's 1997 Death With Dignity Act allowed voluntary self-administration of lethal drugs prescribed by a doctor. But now, under the Pain Relief Promotion Act, federally controlled substances can no longer be used for physician assisted suicide in the US. If a doctor prescribes a drug with the purpose of ending life, he is now subject to criminal penalties which can be as high as 20 years in prison. BMJ 1999;319:1312, 13 November

UK concerns that elderly patients are endangered

In the UK, Age Concern has called for a Government enquiry into recent claims that elderly patients are being starved to death and into increasing allegations of involuntary euthanasia (withholding of food and drink from the not-terminally ill). The charity reports an increasing loss of confidence in the NHS among senior citizens and has received more than 1,000 complaints that the elderly are being fobbed off, undervalued or abused. A pressure group of concerned relatives called SOS-NHS Patients in Danger is considering going to the European Court of Human Rights with 50 examples of suspicious deaths under NHS care. The BMA says that tube-feeding is a medical treatment and can be withdrawn, but does not advocate the removal of oral feeding. Independent 1999, 7 December

The Winterton Bill

Ann Winterton's Medical Treatment (Prevention of Euthanasia) Bill, seeking to prevent doctors from taking any action which could be interpreted as deliberately shortening life, has passed its second reading in the House of Commons. The BMA, which is firmly opposed to euthanasia, is campaigning against the Bill, saying that it would override patient autonomy and would prevent patients from refusing further treatment. Current BMA guidelines allow doctors to agree to a request to withhold/withdraw treatment, and if the patient is incompetent, doctors are expected to act 'in the patient's best interests'. However, Ms Winterton says her bill does not require doctors to strive officiously to keep dying patients alive. BMJ 2000;320;319, 29 January; Independent 2000; 24 January; Telegraph 2000; 27 January

July 1999

David Moor cleared of murder

Dr David Moor, the Newcastle GP charged with murdering an elderly patient, was unanimously cleared by a jury in May. Dr Moor gave Joseph Liddell a lethal dose of diamorphine under the double effect law. This states that doctors may give medication that they know will shorten life if their primary intention is to relieve suffering and not to kill. BMJ 1999;318:1306, 15 May

There is much discussion over whether this marks a legal watershed similar to cases in Holland that led to the decriminalisation of euthanasia in the 1980s. Dr Andrew Fergusson, CMF General Secretary and chairman of Healthcare Opposed to Euthanasia (HOPE) was concerned that this would add to the considerable confusion about what is acceptable medical practice in the grey area between life and death. Anti-euthanasia groups, such as Alert, led by Dr Peggy Norris, see this verdict as the beginning of a slippery slope to the routine dispatching of terminally-ill patients that allegedly now occurs in Holland. Daily Telegraph 1999; 12 May

Euthanasia control ineffective in Holland

A British and a Dutch doctor have claimed that the practice of euthanasia is not being effectively controlled in Holland. If all cases of 'explicit intention to end a life' are taken into account, there were 24,500 deaths in 1995, far more than the official figure of 3,200. A clear majority of cases is going unreported and unchecked. Daily Telegraph 1999; 17 February

Jack Kevorkian convicted and sentenced

In the US, Jack Kevorkian, 'Dr Death', who helped an elderly man commit suicide and then broadcast the event on national television, was convicted of second degree murder and sentenced to 10 to 25 years in prison in March. Kevorkian claims to have assisted in over 130 deaths and has already stood trial three times. He had challenged the authorities to convict him, hoping to prove that euthanasia 'is not a crime, ever'. BMJ 1999;318:1094, 24 April; Daily Telegraph 1999; 14 April

Oregon data on physician assisted suicide

Data are now available from Oregon, where there has been one year of legally permissible physician-assisted suicide. Proponents claim that the data show excellent adherence to all required safeguards and a very limited use of assisted suicide by a small group of terminally ill patients whose suffering could be relieved no other way. Opponents claim that the Oregon law is powerless to police or detect cases falling outside legal guidelines and that many deaths may have occurred where the guidelines were ignored. BMJ 1999;318:953-954, 10 April

High Court rules on withdrawal of treatment

A woman has failed in her attempt to win a High Court ruling that doctors cannot give or refuse treatment against a parent's wishes without first getting a court's permission. Mrs Glass's severely ill son was admitted to a Portsmouth hospital with a recurrent attack of breathing problems, and doctors decided not to intervene but gave him a low dose of diamorphine. However, his mother accused the doctors of unlawful conduct in giving diamorphine (which she believed could depress the child's breathing and hasten his death) against her will. The BMA medical ethics committee said that every effort should be made to reach a consensus between everyone involved in difficult situations, and if this proves impossible, then further advice, possibly involving the courts, should be sought. BMJ 1999;318:1167, 1 May

BMA guidelines on withdrawal of treatment

The BMA is drawing up guidelines on when doctors can withhold or withdraw treatment from patients who are not in the process of dying. None of these patients will have given any indication of whether or not they want treatment to be withheld (eg those with Alzheimer's, those suffering severe strokes and babies with multiple handicaps). Daily Telegraph 1999; 17 February

April 1999

Abuse of Dutch Euthanasia Legislation

Dutch law allows euthanasia when the patient is undergoing intractable suffering and makes a voluntary request provided that the doctor reports each case to the local medical examiner. However, it has emerged that the regulation is being abused widely, with many cases of non-voluntary euthanasia coming to light. In 1995, 900 cases were recorded including many fully or partly competent patients who were killed without making any request for euthanasia. The problem may stem from the lack of palliative care facilities available, and many GP's feel that they have no solution other than euthanasia for patients in great pain.BMJ 1998;317:1613, 12 December

Doctors starve patients in Sussex

In England, the police are investigating the deaths of at least 50 patients in Derby, Surrey, Kent and Sussex. There have been accusations that the patients' deaths were hastened by denying them intravenous fluids. The BMA's ethics committee said that it seems that doctors have responded to the guidelines on withdrawing and withholding treatment by removing artificial hydration and nutrition even from patients who are not terminally ill, (eg those with dementia or serious strokes). BMJ 1999;318:143, 16 January

January 1999

Euthanasia Fears

More than 10,000 Dutchmen now carry anti-euthanasia passports because of fears that they may be killed prematurely by over-enthusiastic doctors if they become ill. The cards say 'I request that no medical treatment be withheld on the grounds that the future quality of my life will be diminished, because I believe this is not something human beings can judge. I request that under no circumstances a life-ending treatment be administered because I am of the opinion that people do not have the right to end life.' These cards are being distributed by pro-life groups throughout Holland as the Dutch government pushes through a bill which will legalise physician-assisted suicide. Doctors in Holland are increasingly practising non-voluntary euthanasia and are ending patients' lives without their approval. Every year, up to 25,000 people die when their treatment is terminated on medical grounds. An official survey shows that 23% of doctors have ended a patient's life without his or her explicit request. Although euthanasia of any kind is currently illegal in Holland, these doctors rarely face prosecution. A group of predominantly Christian members of the Dutch Physicians' Association are afraid to speak out against euthanasia for fear of losing their jobs, and members are being encouraged not to mention their views when applying for jobs.

In England however, a new campaign against any relaxation of the euthanasia laws was recently launched by doctors. There are fears that any change in the law would lead to a slippery slope where many thousands of people would be at risk if doctors were legally allowed to hasten death by administering or withholding drugs, food and drink. One doctor said he was frightened by the attitude of younger doctors who seem to be losing their sense of the sanctity of human life. Telegraph 1998; 15 October

October 1998

Physician Assisted Suicide

At its annual conference the BMA has called for a full and frank debate into physician-assisted suicide (PAS). Most doctors opposed the concept, saying that better palliative care was more important. Yet, some junior doctors now see a greater moral acceptability in PAS compared with euthanasia, which are both illegal. The conference also rejected a motion that doctors are 'obliged to accede to clear requests by patients that their life should be allowed to end'. It said that this is too broad and dangerous a statement, which would be open to misunderstanding and place doctors in jeopardy. BMJ 1998;317:214, 18 July; Telegraph 1998; 8 July; BMJ 1998;317:217, 18 July

July 1998

Living Wills pave the way for Euthanasia

Two out of three Britons favour making living wills legally binding on doctors, according to a recent MORI poll. The government is proposing to legislate to set up a statutory framework for living wills and submissions on its consultation document Who decides? closed at the end of March.

CMF is opposed to legally binding living wills, which we see as the beginning of a slippery slope. Although living wills could not force doctors to do anything unlawful (such as performing euthanasia), they would open the door to starvation of incompetent patients through withholding of food and fluids.
Advance directives (patients' advance refusal of treatment) are already binding on doctors under common law following a ruling by the High Court in 1993. The case concerned a schizophrenic man with a gangrenous leg living in Broadmoor Special Hospital who obtained an injunction banning doctors from amputating his limb at any time in the future. BMJ 1998;316:959, 28 March

Legalised Physician Assisted Suicide in the US

An 85 year old woman with metastatic breast cancer has become the first person to die under Oregon's Death with Dignity Act. Oregon is the only state in which physician assisted suicide is legal although Jack Kevorkian, a Michigan doctor, has made a career out of carrying out the procedure illegally.

In a recent survey of 3,102 doctors in the New England Journal of Medicine, a third of respondents said they would comply if physician assisted suicide were legal, and a quarter said they would perform euthanasia.

The US Supreme Court ruled last year that there was no constitutional right to physician assisted suicide, but the Oregon law, which had been held in abeyance by legal challenges, may well pave the way for similar legislation in other states. BMJ 1998;316:1037, 4 April; BMJ 1998;316:1334, 2 May

April 1998

Euthanasia by the back door?

New government proposals for taking decisions on behalf of mentally incompetent people would put living wills on a statutory footing. The new consultation paper, issued along lines originally recommended in 1995 by the Law Commission, would also allow 'substitute decision makers' to make judgements about medical interventions when patients cease to be competent. The consultation period finishes on 31 March.

On the day Lord Irvine unveiled the paper, MPs voted against Joe Ashton's Doctor Assisted Dying Bill by 234 votes to 89. The bill would have allowed 'incurably ill patients' to be killed by a doctor.

Oregon's decision to allow assisted suicide for terminally ill people has been threatened by a warning from the US Federal Drug Enforcement Administration. It stated that a doctor who writes a prescription for suicide would be violating the Controlled Substances Act. BMJ 1998;316:9, 3 January; BMJ 1997;315:1398, 29 November

Euthanasia in Canada

A Canadian court has ruled that a mandatory life sentence would be a cruel and unusual punishment for a farmer convicted of killing his child, a twelve year old girl with cerebral palsy. He apparently did it to relieve her of a lifetime of unremitting pain. Spokesmen for disabled groups said that the ruling was essentially 'open season' on the disabled, but the case judge said that the homicide was committed for 'caring and altruistic reasons'. The defendant received a one year jail sentence plus one year house arrest.

An AIDS specialist from Toronto, Canada, has been convicted on two counts of physician-assisted suicide. He pleaded guilty to supplying lethal doses of barbiturates to two patients, one of whom survived after spending days in a coma. Maurice Genereux was portrayed by the surviving patient as a doctor who freely dispensed tranquilisers to suicidal patients without making efforts to dissuade them. He was suspended from practising medicine in 1994 on charges of sexual harassment but reinstated early due to a shortage of AIDS doctors. Lancet 1997;350:1758, 13 December; Lancet 1998;351:121, 10 January

January 1998

Euthanasia Update

The Liberal Democrats (at their Eastbourne party conference) voted for a review to look at the implications of changing the law to 'permit doctors to accede openly to repeated requests from suffering and terminally ill patients to die instead of having to help them secretly as at present'. The British government apparently has no plans to introduce legislation to legalise euthanasia.

The state of Oregon has just decided by referendum to uphold a 1994 Act making physician-assisted suicide legal.

Annie Lindsell, a sufferer of motor neurone disease, died on 2 December after being told that her GP would not be prosecuted for administering strong painkillers should her condition deteriorate. The court was satisfied that the principle purpose of treatment would be to relieve pain and not to shorten life. Ironically in the event no drugs were necessary. It seems a little confusing as to why the case went so far in the courts. The principle of 'double effect' is well accepted. BMJ 1997;315:832, 4 October; Hansard 1997; Col 147, 1 July; BMJ 1997;315:1253, 15 November; Lancet 1997;350:1376, 8 November

Dutch non-treatment decisions

The Dutch Public Prosecutors Office has dropped a murder charge against staff at a nursing home who allegedly allowed a patient with Alzheimer's disease to dehydrate. When relatives asked why Mr R Mulder, aged 62, was not being given fluids through a drip, they claimed to have been told that it was in line with the home's 'dehydration policy'. He regained consciousness hours later after transfer to a hospital. Since then claims have emerged that about 50% of deaths in Dutch nursing homes could be as a result of starvation.

The Royal College of Paediatrics and Child Health has recently defined five situations when it is appropriate to withhold or withdraw life saving treatment in children: brain death, PVS, no chance, no purpose and 'unbearable situation'. BMJ 1997;315:624, 13 September; BMJ 1997;315:327, 9 August; BMJ 1997;315:834, 4 October

October 1997

Latest attempts to legalise euthanasia

The Supreme Court of the United States made unanimous rulings in June that there is no fundamental right to assistance in committing suicide. The rulings invalidated the decisions in March and April 1996 of the Ninth and Second Circuit Appeals Courts which had effectively lifted bans on physician- assisted suicide in 16 US states. In making his ruling Chief Justice Rehnquist said that there was an 'important and logical' distinction between refusal of unwanted treatment by a competent patient and receiving assistance in actively terminating life.

So far Oregon is the only state to succeed in making physician-assisted suicide legal but the Act, which was passed by public referendum in 1994, is still held in abeyance by legal challenges.

In the Netherlands, although euthanasia remains a criminal act, doctors are not prosecuted provided they follow established guidelines. The July 1996 Rights of the Terminally Ill Act of the Northern Territory of Australia, which permitted the practice, was overturned by the Australian Senate on 24 March this year. Colombia, however, passed a law allowing euthanasia in late May and the Philippines and South Africa have also been considering legislation.

Recently the UK debate blew up again when two doctors confessed to giving lethal doses of drugs to hasten the deaths of terminally ill patients. Michael Irwin, chairman of the Voluntary Euthanasia Society, and David Moor, a Newcastle GP, have not been prosecuted. The British Medical Association overwhelmingly rejected calls to legalise euthanasia at its summer conference, as did the House of Lords Select Committee on Medical Ethics, which reported in 1994. BMJ 1997; 315:137-8
BMJ 1997; 314:1852; BMJ 1997; 314:1644; Daily Dispatch, 11 April 1997; Student BMJ 1997; 5:272

July 1997

Japanese Parliament recognises concept of 'Brain Death'

The lower house of the Japanese Parliament has voted to recognise the concept of brain death, thus paving the way for heart transplants to occur in the country for the first time. In the past there has been cultural resistance to organ donation but the Health and Welfare Ministry now estimate that more than 8,000 'brain dead' patients could become potential donors and be taken off artificial support.

If approved by the upper house, the ruling would leave only Poland and Pakistan among major countries not designating brain death as actual death in law or practice. The Declaration of Sydney (1968), to which most World Medical Association members adhere, makes it possible to cease resuscitation and to remove organs once the process of death 'has become irreversible'. BMJ 1997; 314:1298

Hillsborough survivor emerges from persistent vegetative state

A survivor of the Hillsborough football ground disaster has emerged from the persistent vegetative state (PVS) to the extent of being able to signal yes and no using a touch sensitive pad. Andrew Devine sustained his injuries in the crush which lead to the deaths of 95 soccer fans including fellow PVS victim Tony Bland. Tony died after a House of Lords ruling to stop feeding him in 1993. Since then, at least ten further patients have died in similar circumstances in England and Wales, following High Court decisions to sanction the withdrawal of artificial nutrition and hydration.

The news has fuelled calls for review of the BMA guidelines which stipulate a waiting time of only 12 months before treatment withdrawal decisions can be made. A recent paper by Dr Keith Andrews, consultant in disability medicine at the Royal Hospital for Neurodisability in London, showed that over half of 40 patients admitted to his unit with the PVS label were misdiagnosed. There are estimated to be over 1,000 patients in the UK with PVS. Daily Telegraph 27 March 1997; BMJ 1996; 313:13-16

Northern Territory euthanasia law overturned

The Australian Federal Parliament has overturned the Northern Territory's controversial euthanasia legislation. The Rights of the Terminally Ill Act, under which four patients have died since it was enacted last year, was defeated by a 88-35 vote in the House of Representatives and finally by a 38-33 vote in the Senate on March 25.

Doctors on both sides of the ethical divide have joined forces to call for an increase in government funding for palliative care; the Australian Medical Association has welcomed the passing of the new bill. The Prime Minister John Howard -who supported the anti-euthanasia bill - last year cut funding for palliative care.

Dr Philip Nitschke, who developed a 'computer death machine' for use under the defunct Act, has accused the Australian Senate of betraying the terminally ill and has symbolically burnt copies of the new bill in the streets. In a similar vein, Rodney Syme, Melbourne urologist and Voluntary Euthanasia Society president, has said that he will continue to 'help patients to die', even if it means going to jail. BMJ 1997; 314:994; Humanity, April 1997

April 1997

Second patient dies by euthanasia under New Act

Mrs Janet Mills, a 52 year old suffering from the rare skin cancer mycosis fungoides, has become the second Australian to die under the Rights of the Terminally Ill Act'.

Mrs Mills died in Darwin on 2 January after receiving a lethal injection from the death machine' developed by a GP, Dr Philip Nitschke. The first patient, Bob Dent, died in September 1996.

A survey carried out in the Northern Territory of Australia found that 47% of the public strongly approved of the Act which legalises euthanasia. This compares with only 14% of doctors and 34% of nurses. BMJ 1997;314:92; Lancet 1997;349:577

US supreme court ruling on euthanasia

The United States Supreme Court is expected to rule this summer on two federal decisions attempting to make state prohibition of physician-assisted suicide unconstitutional.

The Second and Ninth Circuit Courts of Appeal had each used parts of the 14th amendment to justify the practice. The 14th amendment says, in part, that states shall not deprive any person of life, liberty, or property without due process of law'. The federal courts contend that people should have a liberty interest in choosing the time and manner of their deaths'.

The Supreme Court ruling Roe vs Wade' effectively legalised abortion on demand throughout the US in 1973. It is possible that another liberal judgement in this case could open the floodgates for euthanasia. BMJ 1997;314:165

Dutch cabinet relaxes euthanasia legislation

The Dutch Cabinet has further relaxed euthanasia legislation. Euthanasia remains a criminal offence in the Netherlands although, since 1983, courts have acquitted doctors acting within strict guidelines. These include explicit, informed and voluntary requests on the grounds of unbearable suffering'.

Regional committees of doctors, lawyers and ethicists, rather than the courts, will now decide whether the guidelines have been followed. A separate national committee to be established in 1998 will rule on cases involving coma patients and handicapped children.

According to the Remmelink Report nearly 2% of all deaths in the Netherlands result from euthanasia, and of the estimated 3,300 cases per year over 1,000 are involuntary. BMJ 1997;314:325; Lancet 1991;338:669-74

January 1997

Kevorkian acquitted again

Dr Jack Kevorkian of Michigan in the US was acquitted for the sixth time in May on charges of assisting suicide. It is unlikely he will be charged again. Even during his last prosecution, he aided the carbon monoxide suicide of a Canadian multiple sclerosis sufferer. A BMJ editorial was entitled 'Jack Kevorkian: a medical hero'. BMJ 1996;312:1434

Moves to legalise physician assisted suicide in US

On 25th June the American Medical Association reaffirmed its opposition to physician-assisted suicide. However, two US federal courts of appeal have decided that state laws in Washington and New York prohibiting physician-assisted suicide, are unconstitutional. They held that citizens had a liberty interest in receiving help to choose the time of their death. Both states have now appealed to the Supreme Court. Christians believe God is the sovereign author of life and death (Job 1:21). Bull Med Ethics May 1996

Northern Territory Euthanasia bill comes into force

The Rights of the Terminally Ill Act in Australia's Northern Territory came into force on 1st July 1996. Three doctors are required to examine a patient who has requested help in dying. Its legality has been challenged in the territory's Supreme Court.
Bull Med Ethics May 1996

Euthanasia further decriminalised in Netherlands

The Royal Dutch Medical Association has argued that individual doctors performing euthanasia should no longer face criminal investigation, if they have kept to agreed guidelines. This may remove one of the last safeguards protecting patients. At the same time, according to the Dutch Voluntary Euthanasia Society, patients are still complaining of poor access to euthanasia. Lancet 1996, 347,188

Tube feeding withdrawn in Scottish right-to-die case

In the first Scottish right-to-die case, tube feeding was withdrawn after the court ruled it was no longer in Janet Johnston's interests to keep her alive. She had been in persistent vegetative state (PVS) for four years. BMJ 1996;312:1115

Scottish court shows leniency in euthanasia case

In October, a man who admitted killing his terminally-ill brother, was shown leniency by a Scottish court. It was Scotland's first criminal case involving euthanasia. Mr Paul Brady smothered his brother James, suffering from Huntington's disease, after administering a drug overdose. The murder charge was reduced to culpable homicide. This may be seen as condoning the act; and goes against the principle 'thou shalt not kill' (Dt 5:17).

Over a third of British doctors would practice euthanasia

A recent BMA News Review (Sept 1996) survey of 750 hospital doctors and GP's found that 46% would support a change in the law, allowing doctors to comply with terminally ill patients requests for euthanasia. 44% support the status quo. One in five doctors have at some stage been asked to intervene actively to end the life of a patient; while over a third would practise euthanasia if it was legalised. The British House of Lords Select Committee on Medical Ethics unanimously ruled in February 1994 that there should be no change in the law to allow euthanasia. CMF along with the Department of Health, the Home Office, the British Medical Association and the Royal College of Nursing had all argued against any change.

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