‘I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.’
Everyone dies. Approximately 500,000 people die per year in England and Wales. In relation to surgery, perioperative mortality is less than 2% for patients classified as American Society of Anesthesiologists (ASA) grades I, II and III (i.e. no comorbidity to severe but not incapacitating systemic disease), a figure which is increased to 8–10% in ASA IV and V patients, and particularly when emergency surgery is performed. Preceding a significant proportion of death is a period of high-dependency or intensive care treatment, during which the patient – who was previously competent – is rendered legally incompetent, by reason of sedation, illness or unconsciousness. In addition, there are a number of ill but competent patients, undergoing higher risk surgery, who have a significant chance of dying perioperatively.
This section is concerned with the degree to which sick or incompetent patients can influence their own treatment and discusses aspects of UK law once death has occurred.
The ethics of death encompass a wide range of topics, including suicide, euthanasia and organ retrieval. However, a number of issues relating to death and dying reappear in discussions about these various topics:
sanctity of life arguments;
autonomy, dignity and surviving interests;
justice and justification for killing;
the doctrine of double effect;
physician involvement in or detachment from dying.