‘Mrs A’: a controversial or extreme case?

Correspondence to Dr Jesse Wall; [email protected]

It is sometimes said by legal scholars that ‘hard cases make bad law’, by which they mean an extreme case provides a poor lens through which to view general laws. It can be said in retort that ‘bad laws make hard cases’; implying that the case may be a controversial one only because the general laws that govern it are poorly formulated. The same tension may be found in medical ethics. Perhaps extreme cases provide a poor lens through which to view general ethical standards, or perhaps the case is controversial by virtue of the prevailing ethical standards being poorly formulated. It becomes important to consider whether a case is controversial or extreme.

At first blush, the case of ‘Mrs A’—outlined in this edition by Miller et al ¹—is both. The article by Miller et al raises a series of ethical questions concerning Advanced Euthanasia Directives (AEDs) and highlights weaknesses in the Dutch regulatory procedures. Also included in this edition are responses to the Miller et al article, by Menzel² and Jongsma et al.³ These responses challenge some of implications that Miller et al seek to draw from the case. Miller et al have also replied to Jongsma et al in this edition.⁴

While the Miller et al article provides a detailed account of the formulation and application of Mrs A’s AED,¹ I wish to draw your attention to the text of the directive. As Miller et al explain, soon after being diagnosed with Alzheimer’s, Mrs A formulated a directive, which stated:

I want to make use of the legal right to undergo voluntary euthanasia when I am still at all mentally competent and am no longer...