Nursing Law and Ethics

this would probably lead to his death. This distinction may have no practical
consequences in those two actual cases, given that both led to the death of the
patients concerned. It matters, nonetheless, insofar as they are treated as pre-
cedents for action in future cases which may look superficially similar.
It is not because it is merely a matter of allowing a patient to die rather than
acting in order to bring about their death, that passive euthanasia is permissible. In
cases where the patient's death is imminent or where treatment is painful and
offers only a very remote chance of success, then it is justifiable, if the patient and/
or his or her relatives consent, to cease to continue treatment.
Moral responsibility for an event is not determined by whether it came about
because one acted or failed to act; it is determined by one's intentions and duties. If
there is no duty to treat, and also persuasive reasons for not doing so, it must
normally be entirely permissible to withdraw treatment, even if to do so results in
the death of the patient.
So what about Dr Cox? Clearly he cannot be excused on these grounds, for they
do not apply to his case. What can be said is that it is possible to imagine
circumstances where the suffering of the patient is so great and the possibility of
immediate remedy so small that killing the patient is the only available means of
preventing the pain. In national disasters or wars such circumstances may arise, or
in parts of the world where medical resources are extremely limited. In those
circumstances it is possible that acting so as to bring about the death of the patient
as easily and quickly as might be would not be wrong [22]. It may be that those
were the circumstances in which Nigel Cox found himself. Without being a part of
the situation it is impossible to say. It must be a matter of judgement and one
which I hope I never have to exercise. For that reason it cannot be said conclusively
that what Cox did was wrong, but, also for that reason, it is also a matter which the
law, on policy grounds, can never permit.

10.11 Notes and references

1. For example, it has been doubted whether babies, fetuses, or those who, whilst still
   biologically alive, lack any response to the world around them are persons in the strict
   sense of the term. See Robert F. Weir 1989)Abating Treatment with Critically Ill
   Patients,Oxford University Press, New York, pp. 70±71 and 405±12.) It can also be
   argued that higher apes and cetaceans dolphins, porpoises and whales) might con-
   ceivably be persons in the required sense. See Peter Singer 1979)Practical Ethics,
   Cambridge University Press,passim.) A useful source on the whole debate is H. Kuhse
   &P.Singer eds) 1999),Bioethics,Part IV. Blackwell, Oxford.


2. But see E. Matthews 2000) Autonomy and the Psychiatric Patient, inJournal of Applied
   Philosophy, 17 1). He sees this as a misinterpretation of Kant and would prefer to
   ground the point on Mill's argument. See note 3.)


3. For a more complete, and classic, exposition of this view, see John Stuart Mill,On
   Liberty.There are many editions of this, but a good one which includes critical essays is
   edited by John Gray and G.W. Smith 1991)J.S. Mill On Liberty In Focus,Routledge,
   London.)


4. See Margaret Brazier 1992)Medicine, Patients and the Law,3rd edn, pp. 449±50.
   Penguin, Harmondsworth.

222 Nursing Law and Ethics