The Traditional Account of Ethics and Law at the End of Life - And Its Discontents

Abstract:     
For the past thirty years, the Melbourne urologist Dr Rodney Syme has quietly - and more recently, not-so-quietly - assisted terminally and permanently ill people to die. This paper draws on Syme's recent book, A Good Death: An Argument for Voluntary Euthanasia, to identify and to reflect on some important challenges to what I outline as the traditional account of law, ethics, and end-of-life decisions. Among the challenges Syme makes to the traditional view is his argument that physicians' intentions are frail and unfairly expose physicians to moral and legal censure. Secondly, Syme argues that physician-assisted dying (PAD) should be framed as a form of palliative care, not as a kind of safety-chute for when palliative care fails. Thirdly, Syme himself is a rare breed: a dissident doctor who has opened himself up for scrutiny and criticism, by reflecting publicly on his experiences at the edge of the law. Syme's career illustrates that prohibition, just like legalization, is a social policy that carries social consequences. The paper acknowledges the variability and idiosyncratic nature of extra-legal physician-assisted dying, and argues that the best way forward is to attempt to weigh the social consequences of both policies. Advocates and opponents of PAD should recognize that both prohibition and legalization involve trade-offs and impose possible costs on patients and on society.

Number of Pages in PDF File: 47

Keywords: euthanasia, physician-assisted suicide, palliative sedation, criminal law, personal autonomy, withdrawing treatment, law and ethics

JEL Classification: K10, K14, K30, K32

Accepted Paper Series