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Research by Dignity in Dying found that there is an average of 14,800 internet searches of “Dignitas” every month from the UK. In 2018, 43 people from the UK died at Dignitas and Life Circle, two facilities for assisted suicide in Switzerland. Campaigners in the UK are calling for a change in the law to mirror those in other countries such as Switzerland. Since the start of the 21st century, there have been moves to legalise assisted dying for terminally ill people in a number of countries around the world including in the UK, and opinion polls show strong public support for proposals to reform the law.
In February 2020, the British Medical Association (BMA) carried out a survey of its members on physician-assisted dying for the first time. This was conducted by Kantar, an independent research organisation, on BMA’s behalf. Nearly 29,000 members of the BMA responded, making it the largest ever survey of medical opinion on physician-assisted dying in the UK. When asked for their personal views on law change, 50% of doctors were in favour of law change on assisted dying with 39% opposed and 11% undecided. When asked whether they would be willing to participate, in any way, in the process if the law changed on prescribing drugs for eligible patients to self-administer to end their own life, 45% said no, 36% said yes, and 19% were undecided.
Then in September 2021, the UK’s largest doctors’ union, the BMA, dropped its long-standing opposition to assisted dying following a landmark vote at its annual meeting. Members voted to adopt a neutral stance on assisted dying, with 49% in favour, 48% opposed and 3% abstaining. The BMA said that the decision means it will neither support nor oppose attempts to change the law.
A YouGov survey on doctor-assisted suicide in the UK in August 2021 reported that three quarters of Britons support doctor-assisted suicide; however, just one in three MPs say the same. The public and MPs are also out of step when it comes to allowing assisted suicide for non-terminally ill patients suffering from painful incurable diseases.
What is suicide?
Suicide is death caused by injuring oneself with the intent to die. A suicide attempt is when someone harms themselves with any intent to end their life, but they do not die as a result of their actions.
MIND defines suicidal feelings as: “Suicidal feelings can mean having abstract thoughts about ending your life or feeling that people would be better off without you. Or it can mean thinking about methods of suicide or making clear plans to take your own life. Different people have different experiences of suicidal feelings”.
When a person indicates that they want to commit suicide but is unable to carry it out without some form of assistance from another person, it is known as assisted suicide.
What is assisted suicide?
Intentionally helping another person to kill themselves is known as assisted suicide. This includes providing the means for another person to commit suicide even if that person is not present when the act itself occurs, such as providing someone with strong sedatives to end their life or buying them a ticket to a country where assisted suicide is legal, to end their life.
Another term that is often talked about when the topic of assisted suicide is mentioned is euthanasia. There are different types of euthanasia, for example, active euthanasia, this is when a person directly and deliberately causes the patient’s death. It has been said that this was the case in the death of Queen Elizabeth II’s Grandfather George the Fifth, although it was never proved. Then there is indirect euthanasia, where providing treatment, usually to reduce pain has the foreseeable side effect of causing the patient to die sooner.
There is also non-voluntary euthanasia where the person is unable to ask for euthanasia, perhaps because they are unconscious or otherwise unable to communicate or to make a meaningful choice between living and dying, and an appropriate person takes the decision on their behalf, perhaps in accordance with their living will, or previously expressed wishes. Finally, Voluntary euthanasia where euthanasia is carried out at the request of the person who dies. All forms of euthanasia are illegal in the UK, and also illegal in many other countries.
There are only a limited number of countries where assisted suicide is legal; these include:
- Switzerland – Switzerland allows physician-assisted suicide without a minimum age requirement, diagnosis or symptom state. However, assisted suicide is deemed illegal if the motivations are “selfish”, for example, if someone assisting the death stands to inherit earlier, or if they don’t want the burden of caring for a sick person. Euthanasia is not legal in this country.
- Netherlands – Euthanasia and assisted suicide are legal in the Netherlands in cases where someone is experiencing unbearable suffering and there is no chance of it improving. There is no requirement to be terminally ill, and no mandatory waiting period.
- Spain – In March 2021, Spain made it legal for people to end their own life in some circumstances. The law allows adults with “serious and incurable” diseases that cause “unbearable suffering” to choose to end their lives. The adult must be a Spanish national or legal resident and be “fully aware and conscious” when they make the request, which has to be submitted twice in writing.
- Belgium – Belgium allows euthanasia and assisted suicide for those with unbearable suffering and no prospect of improvement. If a patient is not terminally ill, there is a one-month waiting period before euthanasia can be performed. Belgium has no age restriction for children, but they must have a terminal illness to meet the criteria for approval.
- Luxembourg – Assisted suicide and euthanasia are both legal in Luxembourg for adults. Patients must have an incurable condition with constant, intolerable mental or physical suffering and no prospect of improvement.
- France – Palliative sedation, in which someone can ask to be deeply sedated until they die, is permitted in France, but assisted dying is not.
- USA – Several states now offer legal assisted dying. Oregon, Washington, Vermont, California, Colorado, Washington DC, Hawaii, New Jersey, Maine, Montana and New Mexico all have laws or court rulings allowing doctor-assisted suicide for terminally ill patients. Doctors can write patients a prescription for the fatal drugs, but a healthcare professional must be present when they are administered. All of the states require a 15-day waiting period between two oral requests and a two-day waiting period between a final written request and the fulfilment of the prescription.
- Australia – The Australian state of Victoria was the country’s first to pass voluntary euthanasia laws, which happened in November 2017 after 20 years and 50 failed attempts. To qualify for legal approval, you have to be an adult with decision-making capacity, you must be a resident of Victoria, and have intolerable suffering due to an illness that gives you a life expectancy of less than six months, or 12 months if suffering from a neurodegenerative illness. A doctor cannot bring up the idea of assisted dying; the patient must raise it first.
- Canada – In March 2021, Canada expanded its law on assisted dying. Now adults with a serious and incurable “disease, illness or disability” who are in an advanced state of decline and are suffering, are able to seek a medically assisted death, even if they are not dying. In Quebec, only euthanasia is allowed.
- New Zealand – In October 2020, New Zealand voted to legalise euthanasia in what campaigners have called a victory for compassion and kindness. The law allows terminally ill people with less than six months to live the opportunity to choose assisted dying if approved by two doctors.
Who would be involved in assisted suicide?
In the UK there have been ongoing debates on the topic of assisted suicide for many years; however, as yet no legal decision has been made. The medical profession has set out proposed criteria for doctor-assisted dying should there be a change in the law.
Doctor-assisted dying refers to doctors’ involvement in measures intentionally designed to end a patient’s life, covering the below situations:
- Where doctors would prescribe lethal drugs at the voluntary request of an adult patient with capacity who meets defined eligibility criteria, to enable that patient to self-administer the drugs to end their own life. This is sometimes referred to as physician-assisted dying or physician-assisted suicide.
- Where doctors would administer lethal drugs at the voluntary request of an adult patient with capacity who meets defined eligibility criteria, with the intention of ending that patient’s life. This is often referred to as voluntary euthanasia.
It is not proposed in any of the anticipated UK legislation for anyone other than a medical professional to be legally allowed to assist a suicide. Under current UK law, anyone, including friends, family or the medical profession, who assists another person to commit suicide, risks prosecution.
In February 2010, the Director of Public Prosecutions (DPP) issued the prosecuting policy on cases of ‘Encouraging or Assisting Suicide’. It covers actions that happen in England and Wales, even if the suicide happens abroad. Although suicide itself is no longer a criminal act, under section 2 of the Suicide Act 1961, it remains a criminal offence for a third party to assist or encourage another to commit suicide. The policy gives people a much clearer understanding of how they will be treated under the law if they encourage or assist suicide.
What is the difference between assisted suicide and euthanasia?
Euthanasia refers to an instance where active steps are taken to end someone’s life but the fatal act is carried out by someone else, such as a doctor. Assisted suicide is when someone takes their own life but is assisted by somebody else. Rather than a doctor carrying out the fatal act, they themselves do so. Assisted dying can refer to either euthanasia or assisted suicide. However, withdrawing life-sustaining treatment can be part of good palliative and end-of-life care and should not be confused with euthanasia.
Is assisted suicide illegal in the UK?
All forms of assisted suicide are currently illegal in the United Kingdom, and doctors found to be assisting a suicide can be jailed for up to 14 years under the Suicide Act 1961.
The law around assisted suicide
Currently, in all four UK nations euthanasia is illegal and could be prosecuted as murder or manslaughter. However, in 2018, the UK Supreme Court ruled that legal permission would no longer be needed to withdraw treatment from patients in a permanent vegetative state.
In England and Wales “assisting or encouraging” another person’s suicide is prohibited by s.2 of the Suicide Act 1961, as amended by the Coroners and Justice Act 2009. The Director of Public Prosecutions (DPP) examines individual cases to decide whether to prosecute. That decision is guided by offence-specific guidelines published in 2010. Since April 2009, there have been 167 cases referred to the Crown Prosecution Service (CPS), three of which have been successfully prosecuted.
In Northern Ireland, “assisting or encouraging” another person’s suicide is illegal under s.13 of the Criminal Justice (Northern Ireland) Act 1966, which extends the Suicide Act 1961 to Northern Ireland. The Public Prosecution Service (PPS) examines individual cases to decide whether to prosecute. That decision is guided by offence-specific guidelines published in 2010.
In Scotland, however, there is no specific offence of assisting or encouraging suicide in Scotland. Any suspected offence would be dealt with under homicide law. The Crown Office and Procurator Fiscal Service (COPFS) makes the decision on whether to prosecute. There are no offence-specific guidelines in Scotland and the decision will be taken on the basis of the general prosecution code. A legal challenge to compel the COPFS to produce offence-specific guidelines failed in 2015. The last known prosecution was taken in 2006, in an unreported case.
There have been attempts to introduce a law to legalise assisted suicide in England and Wales. Introduced by the former Lord Chancellor and Labour Peer Lord Falconer, the Assisted Dying Bill was first brought to the House of Lords in June 2013. It proposed to allow terminally ill, mentally competent adults to have an assisted death after being approved by two doctors. The Bill made no progress through Parliament; however, a Private Members’ Bill on Assisted Dying was introduced in the House of Lords during the 2021-22 session by Baroness Meacher, a former social worker, crossbench peer and the Chair of Dignity in Dying. The Bill seeks to “enable adults who are terminally ill to be provided at their request with specified assistance to end their own life”, and is currently at the second reading stage in the House of Lords.
The controversy around assisted suicide
There have been several high-profile legal battles fought by right-to-die campaigners; however, several groups believe the laws around all forms of assisted death should remain the same. Although in recent years there has been something of a shift in public and medical opinion as to whether assisted suicide should remain completely criminal, nevertheless the debate remains highly polarised.
The key argument made by those who support the liberalisation of the law is based on personal autonomy. Humanists UK has stated: “Humanists defend the right of each individual to live by their own personal values, and the freedom to make decisions about their own life so long as this does not result in harm to others. Humanists do not share the attitudes to death and dying held by some religious believers, in particular that the manner and time of death are for a deity to decide, and that interference in the course of nature is unacceptable. We firmly uphold the right to life but we recognise that this right carries with it the right of each individual to make his or her own judgement about whether his or her life should be prolonged in the face of pointless suffering”.
Conversely, the Care Not Killing alliance argues that any change to the law would result in elderly or vulnerable people being worried about being a financial burden and feeling under greater pressure to end their lives. Many opponents argue that opening the doors to voluntary euthanasia and assisted suicide could lead to non-voluntary and involuntary euthanasia, by giving doctors the power to decide when a patient’s life is not worth living. Another argument put forward to counteract the right-to-die contention is the assumption that should patients have a right to die then this would impose on doctors, a duty to kill.
Historically, most religious groups have been opposed to doctors or others helping patients to kill themselves, even those who are terminally ill or experiencing significant suffering. However, in recent years there has been a growing movement of religious people arguing in favour of legalisation. The campaign group Dignity in Dying, the main pressure group which lobbies for changing the law, has gathered a coalition of faith leaders who argue their religious principles actively endorse assisted suicide rather than oppose it. This alliance is primarily spearheaded by the Reform Rabbi Jonathan Romain, the former Archbishop of Canterbury Lord Carey, and, until his death, the iconic South African former Archbishop Desmond Tutu. Dignity in Dying wants a law allowing assisted dying. In contrast to euthanasia and assisted suicide, assisted dying would apply to terminally ill people only.
However, most religious denominations continue to oppose legalising assisted suicide in Britain. The Church of England’s position is that the current laws and DPP guidelines strike a “fair, balanced and compassionate approach to a difficult issue which has defied consensus”.
Sir Keir Starmer, Labour Party Leader and former Director of Public Prosecutions (DPP), stated: “We have arrived at a position where compassionate, amateur assistance from nearest and dearest is accepted but professional medical assistance is not, unless someone has the means and physical assistance to get to Dignitas. That to my mind is an injustice that we have trapped within our current arrangement”.
It appears that this topic will remain controversial with very solid arguments on both sides. As the Assisted Dying Bill moves through the UK Parliament, the wide-ranging debate will continue.