What is assisted dying?
Assisted dying is one of the terms — along with assisted suicide, physician assisted dying, and voluntary euthanasia — used to describe a decision that may be taken by a person who is mentally competent and wishes to end their life in the face of terminal illness, incapacity or suffering.
Assisted dying and assisted suicide are essentially the same — death follows an action by someone to end their own life with the support and comfort of another.
Physician assisted suicide requires the death to be medically supervised. Euthanasia is defined by the OED as a ‘gentle and easy death; bringing about of this… in cases of incurable and painful disease’. Death is the result of another’s action (active) or inaction (passive), and differs in that regard from suicide. However voluntary euthanasia — like assisted dying — is a compassionate response to a rational and conscious wish to die.
What is the law on assisted dying in the UK?
The law on assisted dying is both confused and confusing, which is one of the reasons there have been numerous attempts to introduce new legislation in both the Scottish and UK Parliaments. The 2012 Commission on Assisted Dying described UK law as "inadequate and incoherent" while the position in Scotland has been described as "hopelessly unclear" at best and also "shocking and alarming".
In England and Wales, the Suicide Act of 1961 decriminalised suicide but makes it an offence to "encourage or assist" the suicide or attempted suicide of another.
In Scotland, the Lord Advocate has said on many occasions that assisted suicide is regarded as deliberate killing and thus falls under the common law of homicide, which includes murder and culpable homicide. Without legislation on suicide or assisted suicide in Scotland, the Lord Advocate’s position can be no more than opinion. Ironically, it is not known whether, in law suicide itself is, in fact, legal but there is a general assumption that it must be given the lack of criminal proceedings brought against those who attempt it.
Decision on prosecution rests with the Director for Public Prosecutions (DPP) in England and the Procurator Fiscal Service in Scotland, taking account of all the circumstances, including the public interest. The lack of relevant case law, particularly in Scotland, makes it difficult to establish how likely prosecution is to happen in any particular case.
Is assisted dying legal elsewhere?
Yes, The Netherlands legalised assisted suicide in the early 1970s. Today Belgium, Luxembourg, Switzerland and, the states of Oregon, Washington, Montana, Vermont, New Mexico and California in the US have enacted legal provision to permit assistance at the end of life. Some 50 million US citizens now have access to assisted suicide compared with zero in the UK. Canada became the latest country to legislate in 2015.
Is it illegal to accompany someone who travels to Switzerland for the purpose of committing suicide?
Perhaps yes in England and Wales, although prosecution authorities will only decide whether to bring a case to court after the event. It was this lack of clarity that was challenged by the Supreme Court and led to new guidelines in England and Wales in 2010.
Perhaps no in Scotland. No such guidelines have been published in Scotland and there is inadequate case law to determine the question, possibly because prosecutors here have taken a compassionate view.
One in five deaths at Swiss suicide clinic Dignitas is from a UK national. So far more than 290 British citizens have died there at a cost of around £15,000 each. No one has been prosecuted upon their return for assisting or encouraging suicide.
Can doctors assist their patients to die?
The law allows doctors to withhold or withdraw treatment from patients where such treatment — including feeding and hydration — is deemed ‘futile’. In addition doctors may provide high doses of pain relieving drugs, knowing that doing so may shorten the patient’s life, if their motivation is to control pain. This is the so called Doctrine of Double Effect. Doctors are required in all circumstances to act in the patient’s best interest. A doctor may decide that the patient’s best interest is "terminal sedation", rendering the patient unconscious up to the point of death.
Is there a 'right to die'?
No. Diane Pretty who suffered from MND and was unable to take her own life sought an undertaking that her husband would not be prosecuted if he assisted her. Her application was rejected. In upholding that decision the House of Lords ruled that the right to life set out in Article 2 of the European Convention on Human Rights (ECHR) was based on the sanctity of life. The European Court of Human Rights ruled that "Article 2 cannot, without a distortion of language, be interpreted as conferring the diametrically opposite right, namely a right to die; nor can it create a right to self-determination in the sense of conferring on an individual the entitlement to choose death rather than life."
However, in the case of Debbie Purdy who wanted to know if her husband would be prosecuted if he accompanied her to Switzerland so that she might die, the Supreme Court decided that such end-of-life decisions should be subject to the right to respect for family life under Article 8 of the ECHR so that "any interference with a person’s liberty and self-determination must be in accordance with the law, pursue a legitimate aim and be proportionate." This ruling obliged the DPP to publish new guidelines on assisted dying. No clarification has been provided in Scotland by the Lord Advocate, despite increasing pressures to do so and claims that he is breaching Article 8 of the ECHR.
What is an Advance Directive or Advanced Decision?
An Advance Directive (in Scotland) or Advanced Decision (in England) — or living wills as they used to be called — allows us to specify what future treatment we would expect or refuse in the event of our no longer being able to decide or to express our wishes. It ensures that we are involved in critical end-of-life decisions even if we are no longer able to express our views. While an Advance Directive/Decision (AD) is legally binding in England and Wales and "potentially binding" in Scotland they will only bind medical practitioners to the specific terms of the directive. They would not necessarily rule out treatments that were unavailable when the AD was written, for example.
Read more about Advance Directives/Decisions and how to write one.
What do opinion polls say about assisted dying?
Over the last 30 years, the British public — as evidenced through polls, media campaigns and lobby groups — has consistently supported a change in legislation which would allow a terminally ill, mentally competent adult to request assistance to die. The 2010 British Social Attitudes (BSA) survey found that 82 per cent of the general public agreed that a doctor should probably or definitely be allowed to end the life of a patient with a painful incurable disease at the patient’s request. The 2007 BSA survey found that 80 per cent agreed that a person with a terminal and painful illness from which they will die should be allowed an assisted death.
74 per cent of submissions to the Scottish Parliaments Health and Sport Committee asked for the Assisted Suicide (Scotland) Bill to be passed, and almost 4,000 people signed a petition to MSPs in favour of the Bill. A poll for My Life, My Death, My Choice (MLMDMC) conducted in February 2015, found that 78 per cent of the Scottish electorate believe it was of medium or high importance that the Assisted Suicide (Scotland) legislation became law.
What is palliative care?
Palliative care seeks to manage as comfortably as possible conditions that are incurable and terminal, alleviating pain and mitigating other distressing symptoms. It also seeks to provide psychological, social and spiritual support to the patient and family or caring network.
Doesn’t better palliative care remove the need for assisted dying?
Despite progress in the management of pain and the support that is provided through an holistic approach, palliative care is not uniformly available at a uniformly high standard. Evidence suggests that around 50 people with terminal conditions take their own lives each year in Scotland — almost one a week — and often violently. Palliative care is not always appropriate or effective: where paraplegia removes all sense of autonomy but is not life threatening for example, or where pain relief becomes unconsciousness or in degenerative illnesses like motor neurone disease (MND). Importantly, these conditions also prevent people acting on their own behalf. Studies have found that those countries that allow assisted suicide also offer high standards of palliative care.
A study for the MND Association found that sufferers wanted more to be done to promote "informed choice and self-determination at the end of life, and some interviewees felt this should include information and discussion on assisted dying as well as advance directives and palliative care."
What is FATE’s position on assisted dying?
FATE believes that everyone should have the best possible opportunity to live well right up to the end of their lives and to make end-of-life choices appropriate for their circumstances. The right to autonomy in respect to one’s own body is well established. Everyone, whether physically capable or otherwise, should be able to make end-of-life decisions that they feel are consistent with their sense of themselves, their values and beliefs.
As it stands, the law permits suicide and allows competent adults to refuse life-sustaining treatment. It also permits doctors to withhold and withdraw life-prolonging treatment that is considered ‘futile’ from patients who cannot express an opinion (for example patients in a permanent vegetative state).
However, patients who are not physically able to commit suicide and are not in a position to end their lives by refusing treatment are not entitled to ask for help to die. FATE believes this situation is discriminatory, illogical and inconsistently regulated. That is why FATE is campaigning to change the law.