Hostname: page-component-745bb68f8f-grxwn Total loading time: 0 Render date: 2025-01-24T13:09:31.124Z Has data issue: false hasContentIssue false
  • English
  • Français

“A Special Defence”: A Psychiatric Approach to Formalising Euthanasia

Published online by Cambridge University Press:  02 January 2018

Tim Helme
Tim Helme*
Affiliation:
UMDS/SETRHA
*
6 Rivermill, 151 Grosvenor Road, London SW1V 3JN
Get access Rights & Permissions [Opens in a new window]

Abstract

Domestic and world opinion is gradually changing towards the idea of tolerating or even legalising active euthanasia. The implications of this are examined using Foulke's concept of the ‘levels' in group discussions. Psychiatrists have a unique experience in using the statutory mental health legislation, in addition to the ordinary law, to regulate medical care. A new ‘special defence’ is suggested, to be enacted by Parliament, intended to justify, but also designed to control, deliberate acts of medical euthanasia.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 163 , Issue 4 , October 1993 , pp. 456 - 466
Copyright
Copyright © Royal College of Psychiatrists, 1993 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Age Concern (1988) The Living Will: Consent to Treatment at the End of Life. London: Edward Arnold.Google Scholar
Alexander, L. (1949) Medical science under dictatorship. New England Journal of Medicine, 241, 39–47.CrossRefGoogle ScholarPubMed
American Board of Family Practice (1991) Press release. ABFP, Lexington, Kentucky 40505, USA.Google Scholar
Journal of the American Medical Association (1988) “It's over, Debbie.” Journal of the American Medical Association, 259, 272.Google Scholar
Angell, M. (1988) Euthanasia. New England Journal of Medicine, 319, 1348–1350.Google Scholar
Baker, A. A. (1976) Slow euthanasia - or “she will be better off in hospital”. British Medical Journal, ii, 571–572.Google Scholar
Barraclough, B., Bunch, J., Nelson, B., et al (1974) A hundred cases of suicide: clinical aspects. British Journal of Psychiatry, 125, 355–373.Google Scholar
Berrios, G. E. & Mohanna, M. (1990) Durkheim and French psychiatric views on suicide during the 19th century. A conceptual history. British Journal of Psychiatry, 156, 1–9.Google Scholar
Black, D. & Jolley, D. (1990) Slow euthanasia? The deaths of psychogeriatric patients. British Medical Journal, 300, 1321–1323.CrossRefGoogle ScholarPubMed
Black, D. & Jolley, D. (1991) Deaths in psychiatric care. International Journal of Geriatric Psychiatry, 6, 489–495.Google Scholar
Bliss, M. R. (1990) Resources, the family and voluntary euthanasia. British Journal of General Practice, 40, 117–122.Google Scholar
Bliss, M. R. (1991) Should we encourage survival against the odds? Care of the Elderly, November, 475–478.Google Scholar
Bluglass, R. (1983) A Guide to the Mental Health Act 1983. London: Churchill Livingstone.Google Scholar
Borst-Eilers, E., Leenen, H. J. J. & Admiraal, P. V. (1991) Medical aspects of euthanasia (Letter). Medical Journal of Australia, 155, 645–646.Google Scholar
Bowlby, J. (1979) The Making and Breaking of Affectional Bonds. London: Tavistock.Google Scholar
Brahams, D. (1990) Euthanasia in the Netherlands. Lancet, i, 591–592.Google Scholar
Breo, D. L. (1991) MD-aided suicide voted down; both sides say debate to continue. Journal of the American Medical Association, 266, 2895–2900.Google Scholar
Brewin, T. B. (1986) Voluntary euthanasia. Lancet, i, 1085–1086.Google Scholar
British Medical Association (1988) Euthanasia: Report of the Working Party to Review the British Medical Association's Guidance on Euthanasia. London: BMA.Google Scholar
British Medical Journal (1971) Termination of life. British Medical Journal, i, 187–188.Google Scholar
British Medical Journal (1992) Euthanasia around the world. British Medical Journal, 304, 7–10.Google Scholar
Brody, B. A. (1988) Life and Death Decision Making. Oxford: Oxford University Press.Google Scholar
Byrne, P., (ed.) (1990) Medicine, Medical Ethics and the Value of Life. Chichester: Wiley.Google Scholar
Carton, R. W. (1990) The road to euthanasia. Journal of the American Medical Association, 263, 2221.Google Scholar
Cassel, C. K. & Meier, D. E. (1990) Morals and moralism in the debate over euthanasia and assisted suicide. New England Journal of Medicine, 323, 750–752.CrossRefGoogle ScholarPubMed
Church Information Office (1975) On Dying Well. An Anglican Contribution to the Debate on Euthanasia. CIO, Church House, Dean's Yard, London SW1P 3NZ.Google Scholar
Dawson of Penn (1936) Official Report, House of Lords, 1 December 1936, col. 465—506. London: HMSO.Google Scholar
De Beauvoir, S. (1970) La Viellesse (transl. 1972 as Old Age). Harmondsworth: Penguin.Google Scholar
Devlin, P. (1985) Easing the Passing: The Trial of Dr. John Bodkin Adams. London: Bodley Head.Google Scholar
De Wachter, M. A. M. (1989) Active euthanasia in the Netherlands. Journal of the American Medical Association, 262, 3316–3319.Google Scholar
Drain, G. (Chair) (1990) Institute of Medical Ethics Working Party on the Ethics of Prolonging Life and Assisting Death. Assisted death. Lancet, ii, 610–613.Google Scholar
Durkheim, E. (1897) Le Suicide (trans 1952 as Suicide: A Study in Sociology). London: Routledge & Kegan Paul.Google Scholar
Dyer, C. (1992) Rheumatologist convicted of attempted murder. British Medical Journal, 305, 731.Google Scholar
Fenigsen, R. A. (1988) A case against Dutch euthanasia. Hastings Centre Report, 19 (suppl.), 22–30.Google Scholar
Foulkes, S. H. (1964) Therapeutic Group Analysis. London: Karnac.Google Scholar
Gaylin, W., Kass, L. R., Pellegrino, E. D., et al (1988) ‘Doctors must not kill’. Journal of the American Medical Association, 259, 2139–2140.Google Scholar
Gillett, G. (1988) Euthanasia, letting die and the pause. Journal of Medical Ethics, 14, 61–68.Google Scholar
Gillon, R. (1988) Euthanasia, withholding life-prolonging treatment, and moral differences between killing and letting die. Journal of Medical Ethics, 14, 115–117.CrossRefGoogle ScholarPubMed
Glover, J. (1977) Causing Death and Saving Lives. Harmondsworth: Penguin Books.Google Scholar
Goodwin, J. S. (1991) Mercy killing: Mercy for whom? Journal of the American Medical Association, 265, 326.Google Scholar
Health Advisory Service (1982) The Rising Tide: Developing Services for Mental Illness in Old Age. HAS, Sutherland House, Sutton, Surrey SM2 5AN.Google Scholar
Heilig, S. (1988) The SFMS euthanasia survey: results and analyses. San Francisco Medicine, May, 24–26, 34.Google Scholar
Helme, T. M. (1991a) Stances towards euthanasia. Psychiatric Bulletin, 15, 1–3.Google Scholar
Helme, T. M. (1991b) The Voluntary Euthanasia (Legalisation) Bill (1936) revisited. Journal of Medical Ethics, 17, 25–29.Google Scholar
Helme, T. M. (1992) Euthanasia around the world. British Medical Journal, 304, 717.Google Scholar
Helme, T. M. & Padfield, N. (1993) Setting euthanasia on the level. Liverpool Law Review, 15, 75–92.Google Scholar
Higgs, R. (1988) Not the last word on euthanasia. British Medical Journal, 296, 1348.CrossRefGoogle ScholarPubMed
Hinshelwood, R. D. (1989) A Dictionary of Kleinian Thought. London: Free Association Books.Google Scholar
Hinton, J. (1967) Dying. Harmondsworth: Penguin Books.Google Scholar
Hope, T. (1992) Advance directives about medical treatment. British Medical Journal, 304, 398.Google Scholar
Horder, (1936) Official Report, House of Lords, 1 December 1936, col. 489—490. London: HMSO.Google Scholar
Humphry, D. & Wickett, A. (1986) The Right to Die: Understanding Euthanasia. London: Bodley Head.Google Scholar
Hunterian Society (1936) “That the practice of voluntary euthanasia would be unjustifiable”. Lancet, ii, 1215–1216.Google Scholar
Ineichen, B. (1987) Measuring the rising tide. How many dementia cases will there be by 2001? British Journal of Psychiatry, 150, 193–200.CrossRefGoogle ScholarPubMed
Isaacs, B., Gunn, J., McKechan, A., et al (1971) The concept of pre-death. Lancet, i, 1115–1118.Google Scholar
Jennett, B. (1991) Euthanasia 1990 - attitudes in Britain, USA and the Netherlands. Health Bulletin, 49, 176–183.Google ScholarPubMed
Jennett, B. (1992) Letting vegetative patients die: ethical and lawful and brings Britain into line. British Medical Journal, 305, 1305–1306.CrossRefGoogle Scholar
Kennedy, I. & Grubb, A. (1989) Medical Law: Text and Materials. London: Butterworths.Google Scholar
Kennedy, L. (1990) Euthanasia: The Good Death. Counterblasts No. 13. London: Chatto.Google Scholar
Keown, J. (1992) The law and practice of euthanasia in the Netherlands. Law Quarterly Review, 108, 51–78.Google Scholar
Kohl, M. (1974) The Morality of Killing: Sanctity of Life, Abortion and Euthanasia. London: Peter Owen.Google Scholar
Kreitman, N. (1977) Parasuicide. London: Wiley.Google Scholar
Kuhse, H. (1987) The Sanctity of Life Doctrine in Medicine: A Critique. Oxford: Clarendon Press.Google Scholar
Kuhse, H. & Singer, P. (1988) Doctors' practices and attitudes regarding voluntary euthanasia. Medical Journal of Australia, 148, 623–627.Google Scholar
Lancet (1927) Medicine and the law. Euthanasia. Lancet, ii, 986.Google Scholar
Lancet (1931) Society of Medical Officers of Health. Lancet, 905–906.Google Scholar
Lancet (1935) Voluntary euthanasia. Lancet, ii, 1385–1387.Google Scholar
Lancet (1980) In cancer, honesty is here to stay. Lancet, ii, 245.Google Scholar
Law Commission (1991) Mentally Incapacitated Adults and Decision-Making: An Overview. Consultation Paper No. 119. London: HMSO.Google Scholar
Leenan, H. J. J. (1990) Euthanasia in the Netherlands. In Medicine, Medical Ethics and the Value of Life (ed. Byrne, P.). Chichester: Wiley.Google Scholar
Leng, R. (1990) Mens rea and the defences to a criminal charge. In Principles and Practice of Forensic Psychiatry (eds Bluglass, R. & Bowden, P.). London: Churchill Livingstone.Google Scholar
Lundberg, G. D. (1988) ‘It's Over, Debbie’ and the euthanasia debate. Journal of the American Medical Association, 259, 2142–2143.Google Scholar
Malan, D. H. (1979) Individual Psychotherapy and the Science of Psychodynamics. London: Butterworths.Google Scholar
Menzies Lyth, I. (1988) Containing Anxiety in Institutions. London: Free Association Books.Google Scholar
Miller, E. J. & Gwynne, G. V. (1972) A Life Apart. A Pilot Study of Residential Institutions for the Physically Handicapped and the Young Chronic Sick. London: Tavistock.Google Scholar
Misbin, R. I. (1991) Physicians aid in dying. New England Journal of Medicine, 325, 1307–1311.Google Scholar
Müller-Hill, B. (1988) Murderous Science: Elimination by Scientific Selection of Jews, Gypsies and Others, Germany 1933—1945. Oxford: Oxford University Press.Google Scholar
Nature (1991) Final exit: euthanasia guide sells out. Nature, 352, 553.Google Scholar
Nelson, A. (1990) Official Report, House of Commons, 8 May 1990, cols 43—48. London: HMSO.Google Scholar
Novack, D. H., Plumer, R., Smith, R. L., et al (1979) Change in physicians' attitudes towards telling the cancer patient. Journal of the American Medical Association, 241, 897–900.Google Scholar
Nowell-Smith, P. (1989) Euthanasia and the doctors: a rejection of the BMA's report. Journal of Medical Ethics, 15, 124–128.Google Scholar
Oken, D. (1961) What to tell cancer patients. A study of medical attitudes. Journal of the American Medical Association, 175, 1120–1128.Google Scholar
Oliver, J. (1991) Voluntary euthanasia in Britain today. Care of the Eldery, June, 304.Google Scholar
Orentlicher, D. (1989) Physician participation in assisted suicide. Journal of the American Medical Association, 262, 1844–1855.Google Scholar
Pabst Battin, M. (1982) Ethical Issues in Suicide. London: Prentice Hall.Google Scholar
Parkes, C. M. (1972) Bereavement: Studies of Grief in Adult Life. Harmondsworth: Pelican.Google Scholar
Pence, G. E. (1988) Do not go slowly into that dark night: mercy killing in Holland. American Journal of Medicine, 84, 139–141.Google Scholar
Pollard, B. J. (1991) Medical aspects of euthanasia. Medical Journal of Australia, 154, 613–616.Google Scholar
Post, S. G. (1990) Severely demented elderly people. A case against senicide. Journal of the American Geriatric Society, 38, 715–718.Google Scholar
Post, S. G. (1991) Euthanasia and other medical decisions about the end of life (Letter). Lancet, 338, 952–953.Google Scholar
Purcell, W. (1985) Euthanasia. Enquirer's Library. London: Mowbray.Google Scholar
Rachels, J. (1975) Active and passive euthanasia. New England Journal of Medicine, 292, 78–80.Google Scholar
Rachels, J. (1986) The End of Life: Euthanasia and Morality. Oxford: Oxford University Press.Google Scholar
Rapin, M. (1987) The ethics of intensive care. Intensive Care Medicine, 13, 300–303.Google Scholar
Reichel, W. & Dyck, A. J. (1989) Euthanasia: a contemporary moral quandary. Lancet, ii, 1321–1323.Google Scholar
Remmelink, J. (1991) Report of Commission of Inquiry into Medical Practice with Regard to Euthanasia. Information Department, Ministry of Justice, Postbus 20301, 2500 EH 's-Gravenhage, Holland.Google Scholar
Rhein, R. (1992) California says no to euthanasia. British Medical Journal, 305, 1175.Google Scholar
Rigter, H., Borst-Eilers, E. & Leenan, H. J. J. (1988) Euthanasia across the North Sea. British Medical Journal, 297, 1593–1595.Google Scholar
Roberts, H. (1936) Euthanasia and Other Aspects of Life and Death. London: Constable.Google Scholar
Sacred Congregation for the Doctrine of the Faith (1980) Declaration on Euthanasia. Rome: SCDF.Google Scholar
Saunders, C. & Baines, M. (1989) Living with Dying. The Management of Terminal Disease. Oxford: Oxford Medical.Google Scholar
Seguin, M. (1990) Polls, polls and more polls. World Right-to-Die Newsletter, Issue No. 17, Winter.Google Scholar
Sereny, G. (1974) Into That Darkness. From Mercy Killing to Mass Murder. London: Andre Deutsch.Google Scholar
Singer, P. A. & Siegler, M. (1990) Euthanasia - a critique. New England Journal of Medicine, 322, 1881–1883.Google Scholar
Smith, R. (1992) Euthanasia: time for a royal commission. British Medical Journal, 305, 728–729.Google Scholar
Sprung, C. L. (1990) Changing attitudes and practices in forgoing life-sustaining treatments. Journal of the American Medical Association, 263, 2211–2215.Google Scholar
Stanley, J. (1992) The Appleton International Conference: Developing guidelines for decisions to forego life-prolonging medical treatment. Journal of Medical Ethics, 18 (suppl.).Google Scholar
Stanley, J. (1989) Appleton consensus: suggested international guidelines for decisions to forego medical treatment. Journal of Medical Ethics, 15, 129–136.CrossRefGoogle ScholarPubMed
Stehbens, W. E. (1986) Euthanasia. New Zealand Medical Journal, March, 190–193.Google Scholar
Stone, L. (1990) Road to Divorce: England 1530—1987. Oxford: Oxford University Press.Google Scholar
Twycross, R. G. (1990) Assisted death: a reply. Lancet, ii, 796–798.Google Scholar
Usandivaras, R. J. (1986) Foulkes' primordial level in clinical practice. Group Analysis, 19, 113–124.Google Scholar
van der Maas, P. J., van Delden, J. J. M., Pijnenborg, L., et al (1991) Euthanasia and other medical decision concerning the end of life. Lancet, 338, 669–674.Google Scholar
Vaux, K. L. (1988) Debbie's dying: mercy killing and the good death. Journal of the American Medical Association, 259, 2140–2141.Google Scholar
Wanzer, S. H., Federman, D. D., Adelstein, S. J., et al (1989) The physician's responsibility towards hopelessly ill patients: a second look. New England Journal of Medicine, 320, 844–849.Google Scholar
Weddington, W. W. (1981) Euthanasia: clinical issues behind the request. Journal of the American Medical Association, 246, 1949–1950.Google Scholar
Wennberg, R. N. (1989) Terminal Choices: Euthanasia, Suicide and the Right to Die. Grand Rapids, Michigan: Eerdmans.Google Scholar
Wilkes, E. (1991) Thoughts around euthanasia. Care of the Elderly, May, 256.Google Scholar
Williams, G. (1958a) The Sanctity of Life and the Criminal Law. London: Faber & Faber.Google Scholar
Williams, G. (1958b) Euthanasia legislation: a rejoinder to the nonreligious objections. In Voluntary Euthanasia: Experts Debate the Right to Die (eds Downing, A. B. & Smoker, B.). London: Peter Owen.Google Scholar
Williams, G. (1969) Euthanasia report of meeting of library section of Royal Society of Medicine. British Medical Journal, iv, 229–230.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.