1. End of Life and the ethics
problems
Reporter: Jianfeng.Zhang

2. The legal definition of death
• Doctors traditionally diagnosed people as dead on the basis of
pulseless(无脉动), apnoeic（呼吸停止）, with fixed pupils
（瞳孔无变化） and no heart sounds（没有心跳）
• Criteria for establishing brain death
– Deep coma with no spontaneous respiration(呼吸作用)
– An absence of various possible reversible causes for such coma
– All brainstem reflexs are absent

3. Part 1: The law for ending life
(But not the law of China)
• Case: active euthanasia(安乐死)（mercy
killing）is illegal(murder):the case of Cox
– By a belief that the patient was totally beyond
recall and by an intense compassion for the
patient’s fearful suffering.
– Injected her with potassium chloride(氯化钾) ,for
the primary purpose of killing her, or hastening
her death.
– Be charged of attempted murder

4. Interpretation of this case
• Intending death and foreseeing death are
different. The former is potentially
murder, the second may be good practice.
• Intend to reduce pain, even may become an
obvious risk of hastening death, is legal.

5. Withholding and withdrawing
treatment are not necessary illegal
• Case of Bland:
– Got a seriously hurt and result him being
permanently vegetative state(PVS).
– After had been in this state for about 3 years, they
discontinue his life support, lead his death.

6. Intending relief of distress,but
foreseeing death, is normally legal
• Injection of morphine, with the intention of
relieving the patient’s distress, but with the
foreseen result that it is likely to shorten life, is
normally legal.

7. Assisting suicide is a criminal offence
• The suicide act is illegal, but attempting or
committing suicide is not.
• Assisting suicide is illegal.
– If a doctor lives an overdose of tablets and that is
of the intention of assisting patient to suicide, it is
illegal.

8. refuse life-saving treatment isn’t
committing suicide
• For compentent patient, they can refuse
any, even life-saving treatment.
• The doctor is not guilty.

9. Summary of the ending life law
• Active euthanasia is illegal but passive may
not
• Withholding or withdrawing treatment is legal
• Doctor’s duty is to act for patient’s best
interest, with this purpose, passive act will
almost legal.

10. Part 2: the doctrine of double effect
• The moral between foresight and intention is
different
• Two moral claims:
– Perform a bad act in order to bring about good
consequences is always wrong
– Perform a good act, which may foresees lead to
bad consequences, may sometimes be right.

11. Case of a mother
• A pregnant woman suffers from sarcinoma of
the uterus.
• The only way to save the mother is to remove
the uterus
• That will lead the fetus’s death
• It is legal because they do it in order to save
the mother, not kill the fetus.
• Killing the fetus is the side effect.

12. Cognition in the Vegetative State
• Vegetative State(vs):
– almostly have no consciousness
• Minimally Conscious State(MCS):
– inconsistent but reproducible signs of awareness
• locked-in syndrome(LIS)
– patients are both awake and aware but are either
unable to produce any motor response
• The differences are measured by neurosicence
technology, and will eventually impact the ethics
laws.