The Supreme Court of the Republic

The central ethical argument for voluntary euthanasia for example, is that respect for persons consequently demands respect for their autonomous choices because autonomy presupposes competence. In exercising autonomy or self-determination people take responsibility for their lives and, since dying is a part of life, choices about the manner of their dying and the timing of their death are, for many people, part of what is involved in taking responsibility for their lives.

Advocates of voluntary euthanasia contend that if a person is suffering from a terminal illness; as a direct result of the illness, either suffering intolerable pain, or only has available a life that is unacceptably burdensome (because the illness has to be treated in ways which lead to her being unacceptably dependent on others or on technological means of life support; has an enduring, voluntary and competent wish to die (or has, prior to losing the competence to do so), expressed a wish to die in the event that conditions unable without assistance to commit suicide, then there should be legal and medical provision to enable her to be allowed to die or assisted to die.

Dr Stephen Lodwig's23 case however, suggested that if voluntary euthanasia is to be legally permitted it must be against a backdrop of respect for professional autonomy. Thus, if a doctor's view of her moral or professional responsibilities is at odds with the request of her patient for euthanasia, provision must be made for the transfer of the patient's care to another who faces no such conflict. However, these conditions are somewhat restrictive in their scope. In particular, the conditions concern 24access to voluntary euthanasia for those who are terminally ill. While that expression is not free of all ambiguity, for present purposes it can be agreed that it does not include the bringing about of the death of, victims of quadraplegic paralysis or those who suffer from alzeheimers disease.

The onus of establishing lack of voluntariness or lack of competence should subsequently be on those who refuse to accept the person's choice, for example R v Z 2004. In Passive Euthanasia the issue of consent becomes somewhat blurred. Passive euthanasia involves the withdrawal or withholding of treatment, the non-treatment of a treatable condition and the refusal of treatment. This is based on a morally significant difference between inactivity and action. Lord Mustill stated in the case of Bland that "the English criminal law… draws a sharp distinction between acts and omissions. If an act resulting in death is done without lawful excuse and with intent to kill, it is murder. But an omission to act with the same result and the same intent is in general no offence at all"25.

In Re a Ward of Court heard in the Supreme Court of the Republic of Ireland it was held that "As the process of dying was a part and ultimate consequence of life, the right to life necessarily implied the right to have nature take its course and to die a natural death and not to have life artificially maintained by the provision of nourishment by abnormal, artificial means which had no curative effect and which were intended merely to prolong life. The right to life, as so defined, did not include a right to have life terminated or death accelerated"26. Non voluntary Euthanasia – when the patient is competent but has not consented to euthanasia suggests the ending of life of paternalistic grounds. This is certainly not lawful as it overrides the patient's own autonomy and in that respect amounts to murder. The Remmelink Committee found that 45% of 1,000 non voluntary euthanasia cases the treatment of pain was no longer adequate to help suffering.

The impossibility of treating pain adequately was the reason for killing 30% of patients while 70% of patients were killed for reasons such as low quality of life, futility of life and also influenced by family and friends rather than inadequate pain control27. Assisted Suicide Suicide can be distinguished from euthanasia by the person who brings about the final act from which subsequently death occurs. Whatever the motive of the person assisting, by definition "suicide" cannot occur without the patient's cooperation. If the patient does not actively consent to the act, it becomes either non-voluntary euthanasia or murder. It could be argued, therefore, that assisted suicide may be less open to potential abuse than euthanasia because the patient's cooperation must be verified by witnesses at various stages which can be separated in time.

The 1994 Oregon legislation, for example, permitted doctors to prescribe a lethal dose for competent patients with a life expectancy lower than 6 months. In the UK however, Section 2 of the Suicide Act 1961 remains uncompromising in its terms: "A person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term not exceeding 14 years. "28 Terminal Sedation Terminal Sedation is generally known as "sedation for intractable suffering in the dying patient,"29 whereby a terminally ill person with irremediable suffering is sedated to unconsciousness. If fluids are not provided to such an unconscious patient, death soon ensues.

Orentlicher30 has equated terminal sedation with euthanasia because the withdrawal of food and water "does nothing to relieve the patient's suffering but only serves to bring about the patient's death. " Nevertheless, under Quill, a state may allow terminal sedation if it is "based on informed consent and the double effect. Just as a state may prohibit assisting suicide while permitting patients to refuse unwanted lifesaving treatment, it may permit palliative care related to that refusal, which may have the foreseen but unintended double `effect' of hastening the patient's death"31. When looking to the medical sphere in the case of terminal sedation, terminally ill patients may have intolerable pain, shortness of breath, delirium, or persistent vomiting that is refractory to the usual therapies.

Intolerable pain may be caused by several conditions while intolerable shortness of breath can result from several conditions, too, including lung and other cancers, chronic obstructive lung disease, and congestive heart failure32 Terminal sedation is then maintained until the patient dies which is usually within a few days either from the illness itself or from the withholding of nutrition and hydration. On closer examination, however, terminal sedation at times is tantamount to passive euthanasia. However, the difference between terminal sedation and passive euthanasia is that (it is argued) the patient dies from the induced stupor or coma. It is the medically created state of diminished consciousness that renders the patient unable to eat and not the patient's underlying disease. In an article by John Luce and Ann Alpers, they cite Quill and associates and argue that terminal sedation does not conform with the rule of double effect because "life-prolonging therapies are withdrawn with the intent of hastening death.