Euthanasia: the institutional response.
For health institutions, euthanasia represents an increasingly complex but increasingly inescapable debate, in which the expectations of health professionals have moved away from the declaratory answer in search of greater sophistication and clarity. The House of Lords' Committee on Medical Ethics drew attention to the unavoidable complexity of future medical decisions at the end of life, the inexorably changing doctor-patient relationship and the demographic shift resulting in greater numbers surviving longer to face chronic, degenerative conditions. The committee proved a watershed in many respects, not least in the moral debate it triggered in the public and among health professionals. Arguably it aired questions which still have not been conclusively answered. Its questioning mirrored the trend observable among the institutions' membership for rigour and detail to justify the positions adopted. It represents one facet of the pressure on health institutions, whose previous mode of dealing with the euthanasia debate was by declaration and some would say by pontification. Their reticence to probe deeper was undoubtedly based partly on the conviction that detailed debate about euthanasia was an anathema within professional groups committed to the traditional life-preserving goal of medicine. Also influential has been the assumption that it would be otiose for professional bodies to issue guidance on matters unambiguously covered by law. Arguably, both of these views should have been challenged if not dispelled by the effort involved in contributing evidence to the House of Lords' Committee. That exercise exposed the need for guidance and the ambiguities at law but it remains to be seen how the debate will be taken forward, or not, by health institutions.