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Crime or care? The problem of cause of death and 'intention to kill' in end-of-life care

Posted Oct 14 2010 5:13am
When is 'allowing a person to die' classified as killing them?  When can patients choose to end their life by refusing life-saving medical care?  How much pain relief can be given legally when a side-effect of palliative medication is to shorten a patient's life?  These legal and ethical problems faced by doctors the world over will be examined in a symposium at the University of Sydney on Thursday 28 October.

Leading legal academics, Dr Andrew McGee from Queensland University of Technology, Associate Professor Cameron Stewart from Sydney Law School, and cancer surgeon Dr Charles Douglas, will each discuss the complex problems that arise when the law of homicide is applied to end-of-life-care.

Organiser Sascha Callaghan from the Centre for Values, Ethics and the Law in Medicine said that occasionally a doctor may feel it necessary to give large doses of sedatives, foreseeing that death may be hastened as a result.  "But they would not be guilty of homicide if their intention was only to relieve suffering," she said.  "This defence seems to be peculiar to the medical setting, and is arguably at odds with general criminal law principles."

Dr McGee believes that the existing law draws reasonable boundaries between unlawful killing and what we all recognise as legitimate palliative care, but Associate Professor Stewart argues that the law would do better to acknowledge that sometimes the best palliative care treatments involve a technical homicide and that a better approach would be to develop a new defence to a criminal charge for doctors, based on the doctrine of "necessity".

Finally, noted cancer surgeon Dr Charles Douglas will be presenting new empirical findings about doctors' self-reported intentions in end of life care, and consider whether the current law works in practice. While intentions are undoubtedly more complex than the law allows, and while many are skeptical about the Principle of Double Effect as a moral principle, Dr Douglas will argue that the intention - foresight distinction remains important in end of life care, and will stay that way regardless of the legal status of euthanasia or assisted suicide.

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