`The distinction between deliberate killing and the administration of painkilling
drugs or the withdrawal of treatment such as to have the effect of shortening life,
though sometimes a very fine one in practice, must remain a guiding
principle.'[17]It is widely believed that this position involves drawing a moral distinction
between active and passive euthanasia. Many people seem to think, if they think
that euthanasia can be justified at all, that it can be more readily justified if it is
passive rather than active. Many people also seem to think that, whereas English
law strictly forbids active euthanasia, it does, sometimes, allow that passive
euthanasia may be permissible. Both doctors and lawyers talk as if they believe that
this is so. For example:
`A Down's syndrome child is born with an intestinal obstruction. If the
obstruction is not removed, the child will die. Here ... the surgeon might say `As
this child is a mongol ... I do not propose to operate; I shall allow nature to take
its course'. No one could say that the surgeon was committing an act of murder
by declining to take a course which would save the child.
Aseverely handicapped child, who is not otherwise going to die, is given a
drug in such amounts that the drug itself will cause death. If the doctor acts
intentionally then it would be open to the jury to say: yes, he was killing, he was
murdering that child.
There is an important difference between allowing a child to die and taking
action to kill it.' [18]
`No paediatrician takes life; but we accept that allowing babies to die ± and I
know the distinction is narrow, but we all feel it tremendously profoundly ± it is
in the baby's interests at times. [19]This is potentially most misleading, and should not be taken at face value. I am not
alegal specialist, and the law in this area is complicated, but it is perfectly clear that
being passively responsible for someone's death is,in itself,nodefence in law to a
charge of either murder or manslaughter. InRv.Bonnyman1942) Bonnyman was
adoctor who realised that his wife was exhibiting all the symptoms of diabetes,
and he refrained from telling her. Thinking that she merely had a particularly bad
bout of influenza, she did not seek treatment and died. Dr Bonnyman was found
guilty of manslaughter by criminal negligence. There are many other such cases. In
Rv.Pitwood1902) Pitwood was a level crossing keeper who failed to close the gate
when a train was approaching and was held to be responsible for the deaths that
ensued; inRv.Gibbins and Proctor1918) Gibbins and Proctor were found
criminally responsible for the death of their child whom they had failed to feed; in
Rv.Stone and Dobinson1977) Stone and Dobinson were convicted of man-
slaughter for the neglect of a dependent relative who died in their care.
English law holds that murder and manslaughter, specifically, are crimes which
can be committed either by act or omission. Of course, where a death is caused by
someone's action, it is usually relatively easy to identify the responsible agent. He
or she is the one who performed the action in question. But who is responsible
when someone dies as a result of a failure to act? The responsible agent here is
anyone who failed to actwhen they had a legal duty to act. According to one
The Critically Ill Patient 219