Situating Medical Power within the Modern (Legal) History of Assisted Death: 1936 – Present

Abstract

The issue of assisted death is traditionally problematised through the frameworks of law and ethics. For some, it is a problem that can be solved through some legal principle or doctrine, such as the doctrine of necessity. For others, it can be resolved through some ethical principle or doctrine, such as the principle of respect for autonomy. Both sides of the debate try to win the normative game by drawing upon equally available ethical and legal rhetorical devices. For example, suppose one person raises the argument of patient autonomy as a basis for changing the law. In which case, another may raise the interest of the doctor's autonomy to cancel out the argument. Similarly, if one person submits the argument of human rights to legitimise a change in the law, another may raise the argument that there exists no right to die to cancel out the argument. The exchange gives the problem of assisted death an irredeemable and indeterminate quality that Pierre Schlag refers to as a 'rhetorical circularity'. A rhetorical circularity denotes the process of deploying one rhetorical device or discourse to persuade that the law should change. However, this is counteracted with an inversion of the same rhetorical device or discourse to convince that the law should not change. This creates a cyclical problem within the debate. An underlying problem of the cyclical nature of the debate means essential historical, cultural, and political contexts are often lost in the mainstream debate. It also means that the coercive and ideological power moves of those involved in the rhetorical circularity are overlooked. This thesis aims to challenge this rhetorical circularity by constructing a power perspective to examine the underlying contexts of the debate. By adopting a critical historiographical method inspired by the work of Michel Foucault, this thesis sheds light on how assisted death is an ideological problem historically contingent and situationally negotiated through an evolving constellation of power relations. It will be argued that this constellation of power relations gives rise to an underlying tension whereby groups of institutional actors compete over the terminal body . The terminal body, as in the actual physical structure (comprised of flesh and bones) in a terminal phase, is transformed into a new target of power relations where new forms of knowledge, discourse and power are produced. It will be argued that from the first introduction of the Voluntary Euthanasia Bill in 1936, an underlying tension between various institutional actors emerged. This tension comprises one side competing to maintain and preserve the status quo of medical power and authority in end-of-life matters; whilst the other side seeks to undermine the status quo. This thesis argues that this underlying tension has ultimately shaped legal developments in assisted death. It invites the conclusion, however, that notwithstanding the impairments of legal developments in this area, the case of Debbie Purdy provides some foundation to resist the law and, by extension, the status quo of medical power and authority.

Date of Award	31 Dec 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	John Haskell (Supervisor) & Kirsty Keywood (Supervisor)