The topic of euthanasia is a classical topic that comes up in medical school interviews. Examiners will test your knowledge of the subject and expect you to weigh up the ethical arguments and come to a conclusion. They may ask you questions generically or give you a scenario where you have to use your knowledge of the subject and apply it to the case they give you. The latter is becoming more common in interviews as is the general trend to moving towards scenario based MMI stations

Tip: It is helpful to know some cases that you can use to refer to in your answers. We feel this is essential if you are in an Oxford or Cambridge interview.

The medical school could theoretically give you a role play scenario where a patient wishes to end his life but we feel this is a bit beyond medical school interview level.

Let's start off with the basics including definitions.

Euthanasia refers to the act of ending a person’s life deliberately, in order to relieve their suffering. The decision to carry it out is usually made based on the sick person’s request, however it can also be decided for by relatives, medics or even the courts in circumstances where the patient is too ill.

The process of euthanasia is complex, it requires the consideration of many factors including the legalities in that country, the person’s health both physically and mentally and any personal beliefs or wishes they may have.

Next you need to be aware that there are several forms of euthanasia

Active euthanasia

This is when something is actively done to bring about death, for example injecting a person with a lethal dose of a sedative with the purpose of ending their life.

Passive euthanasia

This is withdrawing any form of treatment which is life-sustaining for the person in question, which consequently causes the person to pass away more quickly.

Voluntary euthanasia

Euthanasia is considered voluntary if a person consciously makes the decision to seek help to end their life. They must give fully informed consent i.e. understanding fully what will happen.

Non-voluntary euthanasia

This form of euthanasia involves the decision for a person’s life to be ended being made by somebody else, who is usually a family member. This form happens when the person is permanently incapacitated or fully unconscious.

Assisted suicide

This is also known as physician assisted suicide. This involves a doctor helping to end someone’s life knowingly. They may decide which method is most effective and painless for the person and provide the means, e.g. a lethal dose of opioids. However, in the end it is up to the person whether or not they actually end their life.

Trying to kill yourself is not currently an criminal act in the UK. Questions around whether someone should have the right to kill themselves we feel are beyond medical school interview level.

While euthanasia is legal in certain circumstances in numerous countries, it still remains illegal in many including the UK. Sometimes in some nations physician assisted suicide is legal whilst euthanasia remains illegal, for example in Switzerland, where a person may be provided the drugs to end their life but they must carry out the act themselves. It is illegal for the physician to carry it out.

Euthanasia including physician assisted suicide is legal in several countries including the Netherlands, Belgium, Luxembourg, Colombia and Canada.

Ethical framework to use to answer euthanasia questions

Ethical arguments for euthanasia

• Autonomy – Allowing someone to die with dignity is really important, and the state should not interfere with such a personal matter. It is that person’s own life, and it should be their choice what to do with it.

• Beneficence/Non-maleficence - By not allowing the person to die it is prolonging their suffering and therefore goes against the principle of beneficence.

• Justice - Keeping someone alive can be very expensive, as well as taking up a hospital bed. Even if cared for at home, the nursing and social care costs may be substantial . Allowing euthanasia would certainly free up some funding which could be used for other patients who have more positive outcomes.

Ethical arguments against euthanasia

• Autonomy – Concern that allowing euthanasia could be a step onto a ‘slippery slope’ leading to involuntary euthanasia. It may also be hard for some people to consent to euthanasia if in a compromised situation, for example, terminally ill patients may feel the pressure to choose euthanasia so as not to be a burden if it is legalised.

• Non-maleficence - Ending a person's life can be seen as the ultimate harm. There are alternatives to help with the pain and distress of terminal illness.

• Justice - People are worried it will weaken society’s respect for the value of life and could result in a lower standard of care for people with a terminal illness, and discourage people from finding cures for illnesses such as cancer.

You will need to adapt your answers to the questions. Come on our medical school interview course - learn about euthanasia from a medical school tutor in a classroom and take the hot seat.

CLICK TO LEARN MORE ABOUT OUR MEDICAL SCHOOL INTERVIEW COURSE

Position on euthanasia the United Kingdom

In the UK, euthanasia and physician assisted suicide is illegal and can lead to imprisonment. Active euthanasia can lead to imprisonment of up to a maximum of life, and physician assisted suicide 14 years. Circumstances described as euthanasia are treated as murder or manslaughter in the UK; euthanasia does not hold any special legal position in the UK.

There is an important distinction in UK Law between active and passive euthanasia; removing life-saving care or treatment is not illegal.

For this reason, many terminally ill people in the UK who wish to end their life go abroad to do so. Switzerland, where physician assisted suicide is legal, allows non-Swiss citizens to use a clinic, however it is costly to use assisted suicide services.

There is however the option in the UK to make an Advance Decision to Refuse Treatment (ADRT), which is a decision you make when you have capacity about the medical treatment you wish to receive when you may lose capacity, and also about the life-sustaining treatment you can refuse which would cause a person to pass more quickly.

Some cases on euthanasia in the United Kingdom

It is useful to be able to reference some cases in your answers, especially is the scenario they give you has similarities.

Tony Nicklinson is a man who campaigned tirelessly for the right to die, following his paralysis neck down due to a stroke. After being refused by the High Court in 2012 to end his life (by refusing to allow immunity to the doctor that helps him with this), he refused food. He died of pneumonia surrounded by his family and friend

In 2015 parliament rejects the ‘Assisted Dying Bill’. The bill would have stopped criminal prosecution of doctors that help patients end their life.

Reference case of Simon Binner in 2015 who posted details online of his medical condition (motor neurone disease), death and funeral before travelling to Switzerland.

How to structure your answers if you get asked about euthanasia in your interview

If you asked about your personal opinion your safest bet is to err on the side which fits in the law in your country

• Make sure you present both sides of the argument before reaching a conclusion

• Do not present a polarised one sided argument

• Use the ethical frameworks we teach you to structure your argument so your answer flows in a natural way

We teach ethical topics on our medical school interview courses. Come and learn in small classrooms and take the hot seat.

CLICK TO LEARN MORE ABOUT OUR MEDICAL SCHOOL INTERVIEW COURSE