DNR: The Backdoor to Legalised Euthanasia?
- Meg Kelly
- Jan 29, 2021
- 4 min read
What is DNR and euthanasia?
DNRs, or Do Not Resuscitate orders, are a note on a patient’s file which means that a doctor shouldn’t attempt to resuscitate the patient if their heart stops.
There are a few reasons why such a note may be present, and it will be inappropriate to resuscitate someone if resuscitation attempts will not restart the heart, where resuscitation attempts will not present a benefit to the patient and where the burden of resuscitation outweighs the benefit of it. Although DNRs are generally regarded as a form of passive euthanasia, they are generally uncontroversial as they act on the balance of evils - DNRs are intended to prevent the unnecessary suffering of patients through potential effects of resuscitation attempts such as fractures, ruptures and brain damage.
Euthanasia is a broad term for the quickening of death of a patient, generally for the purposes of shortening the suffering they experience. There are four types of euthanasia: voluntary, involuntary, active, and passive. DNRs are an example of passive euthanasia, similarly to withdrawing treatments that lengthen or continue life such as a ventilator.
What is the law?
Euthanasia is illegal in the UK, and the majority of the law in this area can be found in the Suicide Act 1961. The Act specifically criminalises euthanasia, setting out that ‘a person who aids, abets, counsels or procures the suicide of another or attempts by another to commit suicide shall be liable in a conviction on indictment’. This is the offence of complicity in suicide. In addition, the Act states that ‘if an individual incapable of committing suicide for himself/herself enlists the aid of an outside party in performing the act, that party may be charged with conspiracy’.
Expanding on the European Convention of Human Rights (ECHR), the Human Rights Act 1998 explains that each human has a right to life, and that this right should be protected by law. However, a number of questions can be raised here as to what parts of ‘life’ ought to be protected. Many people would argue that their freedom and right to self-determination should also be protected. For example, in Pretty v UK, the court was asked to decide whether an individual should have the right to determine whether they wish to live as a terminally ill person.
DNR orders are legal in the UK, and numerous other jurisdictions, provided they exist for the right reasons. The General Medical Council (GMC) has, on a number occasions, explained the necessity of DNR orders. In particular, the GMC makes reference to the ‘brutal’ and ‘traumatic’ effects of CPR and other techniques for resuscitation. Article 3 ECHR provides that no human shall be subjected to torture or inhumane or degrading treatment. Here then, it is clear that in certain cases, CPR could be torturous for a patient and so may be considered to be in breach of Article 3.
Although euthanasia is illegal in the UK, it is permitted in a few other nations, primarily in Europe. The most well-known of these include Switzerland, the Netherlands, and Belgium. In some cases, British patients can travel to these states for euthanasia, but must of course meet any criteria that the state requires for euthanasia to be carried out.
Why is this so controversial?
There is arguably no clear line between DNR and euthanasia. In fact, even large medical bodies such as the GMC regard DNR as a form of euthanasia. The current distinctions drawn seem therefore to be made on technicalities. The first is that the death must be passive; active euthanasia is not legal. In Re B (Adult: Refusal of Medical Treatment) for example, the court ruled that a terminally ill patient could refuse certain treatment, knowing that such refusal would result in their death. The omission to provide the treatment was therefore legal as it was a passive allowance of death.
The case of Re B also raised further questions, especially in the area of capacity. The court found that, for a person to refuse treatment or have a DNR order, they must have sufficient knowledge and understanding that this will lead to their death as well as the ability to make a calculated decision on this basis. The question then is whether a person, of sound mind, should be given the autonomy to make a decision that would end their life: euthanasia. In some sense this would act perfectly in line with Article 3 ECHR as the person would no longer be subject to the potential torture of living with a debilitating condition.
DNRs have, for many years, been labelled as a ‘slippery slope’ towards the legalisation of all forms of euthanasia. Those against euthanasia make the case that legalising euthanasia would lead to more cases of voluntary euthanasia, and so would lead to demand for new methods and the development of more drugs so that euthanasia could be carried out more freely. This would potentially make euthanasia less regulated and so could lead to abuses by medical staff and family members. In particular, as has been seen in the coronavirus pandemic, care might be prioritised for the younger and healthier and so terminally ill patients may then be coerced into signing away their life.
Conclusion
Is DNR the backdoor to euthanasia? It certainly could be. Whilst there are any number of conflicting reasons for and against the legalisation of other forms of euthanasia, there is no doubt that the current law acts on the technicality of an omission when failing to provide treatment as opposed to administering life-ending treatment has no difference in outcome. The individual’s right to autonomy over their body and life, although a key element of human rights law, can only truly extend so far as public morals and interests will allow. For now, then, it seems that in the UK euthanasia is not close to becoming legalised, given that the public moral value put on life is incredibly high. However, this does lead to concerns of increased cases of assisted suicide or ‘mercy killings’ in the future. In addition, some may decide to seek euthanasia in other countries, which could bring a high emotional and monetary cost on families of terminally ill patients. Euthanasia will likely be, for a long time, a moral and legal battlefield.
Comments