9. The end of life

This chapter deals with key legal and ethical issues surrounding end-of-life decisions, with particular reference to physician-assisted death, such as euthanasia. Suicide and assisted suicide, administration of pain relief, and futility are considered. Relevant legislation such as the Suicide Act 1961 (as amended by the Coroners and Justice Act 2009), the Human Rights Act 1998, and the Mental Capacity Act 2005 are discussed. The chapter examines several bioethical principles, including sanctity-of-life and quality-of-life debates; autonomy, beneficence, and medical paternalism; personhood, palliative care, and the double effect doctrine. Finally, it considers human rights issues, treatment requests, incompetent patients, prolonged disorders of consciousness, and locked-in syndrome. Recent cases are considered.