by John Carey Last week Dr D. Garrow put his medical career at risk by publicly stating that he had allowed a spina bifida baby to die from starvation and dehydration. Whatever else may be said about his admission, he deserves credit for saying that -matters like this ought to be discussed."
They raise in an acute form some particularly difficult and unresolved moral problems. Two questions especially need answering: what is the difference between killing and letting die, and should the medical profession be involved in helping people to die when they indicate clearly that that is their wish?
Several other issues are closely connected. of which perhaps the most tricky is that concerning the allocation of medical resources.
Some valuable insights into the moral criteria involved in "the prolongation of life" are con tamed in the two pamphlets issued today by the Linacre Centre, which was set up in 1977 to advise Catholics on medical ethics.
The pamphlets stress the importance of "intention" in judging the morality of an action. Thus, referring_ to a celebrated case in which a child suffering from Down's syndrome (mongolism) was allowed to die. they say: "Win withholding treatment one intends the death of' another, this is as morally reprehensible as actively bringing about death."
However, they also say that it is not a doctor's responsibility to maintain "just any level of biological existence." If, for example, there is absolutely no sign of the brain functioning, it is possible to say that "there are no grounds for attributing distinctive human abilities to a particular body."
The crucial factor in the deci sion, according to the pamphlets, is that there must be "a radical capacity for human flourishing." Sister Janey Milne Home, of the Linacre Centre, explained that in practice this meant that the right to continued life was absolute whenever there was even the tiniest indications that the patient was able to respond to another person, in however slight a way.
She gave as an example an actual instance where a child on a respirator who was incapable of any movement at all reacted to the approach of his mother by a slight watering of the eyes.
She added that because of the uncertainties which surrounded virtually every case, whenever there was any doubt at all the patient must be given the "benefit of the doubt."
'Any new moves to introduce legislation for voluntary euthanasia would meet strong opposition from the medical profession.'
The problems of defining death have arisen only because of the enormous advances in medical technology and expertise. Whereas before, if both breathing and heart had ceased to function, a person could be said to be dead, now machines can be used to pump air in and blood round. Consequently death is now defined more and more in terms of -brain death".
In theory, this increasing reliance on machine is fine, and has brought unquestioned benefits. But in practice it has also produced serious problems which have not yet received sufficient attention either from the medical profession or from moral theologians.
For example, is it justifiable to devote large sums of hospital money to highly specialised equipment which will benefit comparatively few people? Or should that money be spent instead on increasing the number of machines in more general use?
Again, within the National Health Service as a whole. how is it decided what things should take priority? Should it be more specialised units, like coronary care units, more general hospitals, more clinics in areas now chronically short of general practitioners, more nursing staff. or what?
All these are quite distinct from the more general issue of yoluntary euthanasia. What if the patient actively wants to die? Supporters of voluntary euthanasia say that if that is the case, the law should be changed to allow doctors to help them secure what they desire. They say that a doctor's duty to preserve life often conflicts with his other duty to relieve pain. and that in such instances the patient has a "right to die" with which the doctor should comply.
A partial answer to this lies in the fact that places such as Dr Cicely Saunders' St Christopher's Hospice have clearly
demonstrated that pain can almost always be brought completely under control.
The Voluntary Euthanasia Society has admitted this but has said that hospice care is very costly, that it has an unusually high staff to patient ration, and that staff are trained in methods of pain control to a degree not found elsewhere.
On the medical side, the British Medical Association unanimously condemned euthanasia in a report in 1971, and Dr Hugh Trowell who chaired the committee which wrote that report, has since written that any legislation would in practice mean "death on demand at the hands of the medical profession."
In particular, Dr Trowell stressed that "Doctors . . . must be completely excluded from the role of the person who terminates life." Among other things, to play any such role would completely undermine the "covenant of trust" between doctor and patient, he said.
That view still holds good for the vast majority of doctors. As a result it is likely that any new moves to introduce legislation for voluntary euthanasia would meet strong opposition from the medical profession. Legalised euthanasia thus seems to be a threat that is still a long way in the future.
But if the practice of euthanasia is not to gain more ground in our hospitals, and if the care of the whole community is to improve, two things need to be made a matter of top priority for those working in health care, economic planners and moral theologians alike.
First, all doctors and nurses must receive far more training than they do at present in modern techniques of pain control and in the personal, psychological and social aspects of dying and death. Here the hospice movement has shown the way and deserves closer study.
Second, the criteria for deciding how human and financial resources are allocated must be examined in more detail and more critically before it is too late.
For new knowledge and technology, rightly used, can be a blessing, as the hospices have shown. But there is a serious danger that what is technically possible will increasingly ride roughshod over what is humanly desirable. simply because it has acquired a momentum of its own which cannot be checked.