Terminology and Definitions
Some useful terms and definitions to be aware of when engaging with issues concerning the end of life are listed below.
The word ‘euthanasia’ comes from the Greek roots eu (well) and thanatos (death), but currently means much more than ‘good-death’.
Euthanasia has been usefully defined as ‘the intentional killing, by act or omission, of a person whose life is felt not to be worth living‘.
Oxford English Dictionary:
“The action of inducing a gentle and easy death. Used [especially] with reference to a proposal that the law should sanction the putting painlessly to death of those suffering from incurable and extremely painful diseases.”
House of Lords select committee on medical ethics
“A deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering.”
[report, HL paper 21-1, session 1993-1994, 20]
Clearly taking steps to end the life of a person can be taken either with or without the patient’s consent or against the patient’s will. Consequently the following distinctions can be made:
a) Voluntary euthanasia
Where a competent patient consents
b) Involuntary euthanasia
Where a competent patient does not consent.
c) Non-voluntary euthanasia
Where the patient lacks the competence to make an end-of-life decision.
Any act which intentionally helps another to commit suicide
(Lewis, P. (2007) Assisted dying and legal change (Oxford: Oxford University Press), p.5)
Physician Assisted Suicide (PAS)
A procedure where the doctor prescribes a lethal medication to enable a patient to commit suicide, but the person administers the dose, not the doctor.
Permanent Vegetative State (PVS)
A neurological condition found in patients with severe brain damage who are in an apparent state of wakefulness but without detectable conscious awareness.
Withdrawing and withholding treatment
According to the law, both the act of withdrawing and act of withholding treatment are omissions. Committing an omission is not legally wrong unless there is a legal obligation to act which there will not be should a patient validly refuses treatment or where it is not in the patient’s best interests to receive the treatment.
Two key areas of controversy arise surrounding this question.
a) Whether the distinction between an act or omission is morally sufficient to justify the conclusions drawn by the law.
b) Whether withdrawing (as opposed to withholding) life-sustaining treatment or care is properly characterised as simply an omission.
Medical and nursing care for terminally ill patients which has the aim of relieving symptoms rather than achieving a cure.
This is a short-hand term for something known as an advance decision or advance directive. The term ‘living will’ can be misleading and the Mental Capacity Act 2005 uses advance decision instead.
It is a declaration of a patient’s wishes concerning the provision or withholding of future medical treatment which may be legally binding in certain circumstances.