A Matter of Life or Death

Diane Pretty is left with no option.

The European Court of Human Rights today turned down the 43-year-old terminally-ill British citizen’s plea to die with her husband’s help.

Suffering from an incurable motor neurone disease, paralysed from the neck down, confined to a wheelchair, fed through a tube and unable to speak and swallow on her own, the ruling of the European Court marks the end of the legal road for Mrs. Pretty.

Britain is right, says European Court

After her husband Brian Pretty was denied immunity from prosecution by Britain’s highest court if he helped his wife to die, Diane Pretty decided that the British authorities’ refusal amounted to a violation of the Human Rights Convention by forcing her to endure medical treatment that’s both inhuman and degrading.

With the help of lawyers and a human rights group, Liberty, Diane Pretty took her case to Europe’s highest court.

Her lawyers argued that British courts’ refusal to free her husband from the fear of legal action infringed the couple’s rights under five articles of the European Convention on Human Rights.

But seven judges at the European Court in Strasbourg, France, ruled that Britain had violated none of her rights. Assisting in a suicide is illegal under English law and carries a maximum 14-year jail term.

Diane Pretty’s case has fuelled the long-standing debate over euthanasia and divided legal and moral opinion.

Netherlands the only country to legalise euthanasia

Things would have been different if Diane Pretty had been living in the Netherlands. Last April, the Netherlands became the only country to formally legalise euthanasia or mercy killing.

Since January this year Dutch doctors may assist in suicide only if a patient faces unbearable, interminable and incurable suffering and has made a voluntary, well-considered request to die.

The doctor has to first get a second expert opinion on the case from a colleague and register with a commission comprising a medical doctor, a lawyer and an ethics expert.

The process is closely regulated, but outside the Netherlands, euthanasia is against the law and classified as a criminal act.

Euthanasia stirs terrible Nazi atrocities

Things are no different in Germany. Here that the word "euthanasia" evokes strong associations of terrible abuses committed by the Nazis, who exterminated thousands of handicapped children and mentally ill adults.

In October 1939, Hitler ordered widespread "mercy killing" of the sick and the disabled. Code-named "Aktion T4" the Nazi euthanasia programme to eliminate "life unworthy of living" at first focussed on new-borns and very young children.

It was later expanded to include older disabled children and adults. Gas chambers, drugs and starvation were the methods used to simply wipe out large numbers of people and doctors were encouraged to decide in favour of death whenever euthanasia was being considered.

Legislation bans active assistance in suicide

Today actively assisting in a suicide is forbidden in Germany. For instance, a lethal injection administered by the doctor is seen as murder and can even lead to stringent punishment.

Paragraph 216 in the German constitution lays down that assisting in a suicide such as allowing a patient access to lethal medicines amounts to "killing on demand" and entails a prison sentence from six months up to 5 years.

The law only looks the other way when it comes to certain cases of so-called indirect suicide assistance. Here, a doctor could be spared penal action when he switches off life-prolonging oxygen machines in the case of a patient who is "close to death" or in a vegetable state.

A legislation passed by the German Federal Chamber of Doctors allows doctors in the case of terminally-ill patients to stop life-prolonging measures and instead turn to pain-alleviating treatment if the patient wishes. That’s also possible if the patient is not terminally ill.

Hospices - dying with dignity

Though a law permitting legal euthanasia such as the one in the Netherlands is unthinkable in Germany -- at least in the foreseeable future on account of the historical baggage that the country carries -- German physicians are casting around for other ways of helping the terminally ill.

One of these is a hospice that tries to ensure that patients can die with dignity even without committing suicide. The hospices mainly endeavour to provide loving care and palliative treatment for the terminally ill, but not life prolonging measures.

The top priority of the hospice movement is to make it possible for the dying "to pass away at home". If palliative treatment cannot be administered in the patient's home, a semi-residential or institutionalised care can be provided.

As of May 2001, 85 small in-patient hospices with 8 - 12 beds per unit have been opened in Germany, as a complement to traditional home care services.

Here patients, usually in the last stage of their lives, but also in cases of temporarily critical situations, are admitted when there is no other possibility for them to find support elsewhere.

For terminally ill patients with a restricted life expectancy and a serious need for nursing care, the German Statutory Health Insurance and the Disability Nursing Funds cover a great part of the costs.

There are also some 1,000 local hospice associations in Germany. They are often created by private initiatives and are not part of the social care system.