Contents
Chapter 1: Debates & ethics
Euthanasia and assisted suicide
1
What is current BMA policy on assisted dying?
4
Assisted dying: the opposing views
5
Physician-assisted suicide: the ethics of euthanasia
6
Arranging an assisted suicide is the ultimate in control freakery
8
Dignitas dad Jeffrey Spector, who took his own life after emotional ‘last supper’,
said he did it for his family
9
Should people with acute mental suffering be allowed to die?
11
Belgian rapist will be euthanised this week
12
Going Dutch?
13
‘I should be allowed to end my life’
14
Personal stories – against Euthanasia
15
End-of-life care requires ‘widescale improvements’, report says
16
Move to overturn UK assisted suicide law fails
18
Chapter 2: The law
Assisted suicide – FAQs
19
The law in other countries
22
Never say die
23
Assisted dying: setting the record straight
25
Assisted Dying Bill threatens doctor-patient relationship
27
Three in four support changing assisted-dying law
28
‘Assisted dying’ and public opinion
29
Majority of disabled people fear change to assisted suicide law
30
79% of disabled people support a change in the law on assisted dying
32
Summary of differences between proposed Scottish and English legislation
33
Breakthrough UK briefing on assisted suicide (AS)
34
The battle over assisted dying in the UK is far from over
35
Sir Patrick Stewart backs Assisted Dying Bill to prevent terminally ill going through ‘torture’
37
We all deserve the right to die without pain or fear, but assisted suicide won’t fix that
38
Euthanasia in The Netherlands
39
Key facts
40
Glossary
41
Assignments
42
Index
43
Acknowledgements
44
Chapter
1
Debates & ethics
Euthanasia and assisted suicide
E
uthanasia is the act of
deliberately ending a person's
life to relieve suffering.
For example, a doctor who gives
a patient with terminal cancer an
overdose of muscle relaxants to end
their life would be considered to have
carried out euthanasia.
Assisted suicide is the act of
deliberately assisting or encouraging
another person to kill themselves.
If a relative of a person with a terminal
illness were to obtain powerful
sedatives, knowing that the person
intended to take an overdose of
sedatives to kill themselves, they may
be considered to be assisting suicide.
Legal position
Both active euthanasia and assisted
suicide are illegal under English law.
Depending on the circumstances,
euthanasia is regarded as either
manslaughter or murder and is
punishable by law, with a maximum
penalty of up to life imprisonment.
Assisted suicide is illegal under the
terms of the Suicide Act (1961) and
is punishable by up to 14 years’
imprisonment. Attempting to kill
yourself is not a criminal act in itself.
Types of euthanasia
Euthanasia can be classified in
different ways, including:
Ö active euthanasia – where a
person deliberately intervenes to
end someone’s life – for example,
by injecting them with a large
dose of sedatives
Ö passive euthanasia – where
a person causes death by
withholding
or
withdrawing
treatment that is necessary to
maintain life, such as withholding
antibiotics from someone with
pneumonia.
ISSUES: Assisted Suicide
Euthanasia can also be classified as:
Ö voluntary euthanasia – where
a person makes a conscious
decision to die and asks for help
to do this
Ö non-voluntary euthanasia – where
a person is unable to give their
consent (for example, because
they are in a coma or are severely
brain damaged) and another
person takes the decision on
their behalf, often because the ill
person previously expressed a
wish for their life to be ended in
such circumstances
Ö involuntary euthanasia – where
a person is killed against their
expressed wishes.
Depending on the circumstances,
voluntary
and
non-voluntary
euthanasia could be regarded as
either voluntary manslaughter (where
someone kills another person, but
circumstances can partly justify their
actions) or murder.
Involuntary euthanasia is
always regarded as murder.
almost
There are arguments used by
both supporters and opponents of
euthanasia and assisted suicide.
End-of-life care
If you are approaching the end-of-life,
you have a right to good palliative care
– to control pain and other symptoms
– as well as psychological, social and
spiritual support.
You’re also entitled to have a say in the
treatments you receive at this stage.
For example, under English law, all
adults have the right to refuse medical
treatment, as long as they have
sufficient capacity (the ability to use
and understand information to make
a decision).
1
If you know that your capacity to
consent may be affected in the future,
you can arrange a legally binding
advance decision (previously known
as an advance directive).
An advance decision sets out the
procedures and treatments that you
consent to and those that you do
not consent to. This means that the
healthcare professionals treating you
cannot perform certain procedures or
treatments against your wishes.
Other countries
Active euthanasia is currently
only legal in Belgium, Holland
and Luxembourg. Under the laws
in these countries, a person’s
life can be deliberately ended by
their doctor or other healthcare
professional.
The person is usually given an
overdose of muscle relaxants or
sedatives. This causes a coma and
then death.
However, euthanasia is only legal if
the following three criteria are met:
Ö The person has made an active
and voluntary request to end
their life.
Ö It is thought that they have
sufficient mental capacity to
make an informed decision
regarding their care.
Ö It is agreed that the person
is suffering unbearably and
there is no prospect for an
improvement in their condition.
Capacity is the ability to use and
understand information to make a
decision.
In some countries the law is less
clear, with some forms of assisted
suicide and passive euthanasia
legal, but active euthanasia illegal.
Chapter 1: Debates & ethics
used carry a risk of speeding up
death. Therefore, it could be argued
that palliative sedation is a type of
active euthanasia.
The pragmatic argument is that if
euthanasia in these forms is being
carried out anyway, society might as
well legalise it and ensure that it is
properly regulated.
It should be stressed, however, that
the above interpretations of DNACPR
and palliative sedation are very
controversial and are not accepted
by most doctors, nurses and palliative
care specialists.
Arguments against
euthanasia and assisted
suicide
There are four main types of
argument used by people who are
against euthanasia and assisted
suicide. They are known as the:
Ö religious argument – that
these practices can never be
justified for religious reasons; for
example, many people believe
that only God has the right to end
a human life
creation of God, so human life is, by
extension, sacred. This is known as
the ‘sanctity of life’.
Only God should choose when a
human life ends, so committing an
act of euthanasia or assisting in
suicide is acting against the will of
God and is sinful.
This belief – or variations of it – is shared
by many members of the Christian,
Jewish and Islamic faiths, although
some individuals may personally feel
that there are occasions when quality
of life becomes more important than
sanctity of life.
The issue is more complex in
Hinduism and Buddhism. Scholars
from both faiths have argued that
euthanasia and assisted suicide are
ethically acceptable acts in some
circumstances, but these views do
not have universal support among
Hindus and Buddhists.
Some non-religious people may also
have similar beliefs based on the
view that permitting euthanasia and
assisted suicide ‘devalues’ life.
‘Slippery slope’ argument
Ö ‘slippery slope’ argument – this
is based on the concern that
legalising
euthanasia
could
lead to significant unintended
changes in our healthcare
system and society at large that
we would later come to regret
The slippery slope argument is
based on the idea that once a
healthcare service, and by extension
the Government, starts killing its own
citizens, a line is crossed that should
never have been crossed, and a
dangerous precedent has been set.
Ö medical ethics argument – that
asking doctors, nurses or any
other healthcare professional to
carry out euthanasia or assist in
a suicide would be a violation of
fundamental medical ethics
The concern is that a society that
allows voluntary euthanasia will
gradually change its attitudes to
include non-voluntary and then
involuntary euthanasia.
Ö alternative argument – that
there is no reason for a person
to suffer either mentally or
physically because effective
end-of-life
treatments
are
available; therefore, euthanasia
is not a valid treatment option,
but represents a failure on the
part of the doctor involved in a
person’s care.
Legalised voluntary euthanasia could
eventually lead to a wide range of
unforeseen consequences, such as
the following:
Ö Very ill people who need
constant care, or people
with severe disabilities, may
feel pressured to request
euthanasia so that they are not
a burden to their family.
The most common religious argument
is that human beings are the sacred
Ö Legalising euthanasia may
discourage
research
into
palliative
treatments,
and
possibly prevent cures for
people with terminal illnesses
being found.
ISSUES: Assisted Suicide
3
These arguments are described in
more detail below.
Religious argument
Ö Occasionally, doctors may
be mistaken about a person’s
diagnosis and outlook, and the
person may choose euthanasia
after being wrongly told that
they have a terminal condition.
Medical ethics argument
The medical ethics argument, which
is similar to the ‘slippery slope’
argument, states that legalising
euthanasia would violate one
of the most important medical
ethics, which, in the words of the
International Code of Medical Ethics,
is: ‘A physician shall always bear in
mind the obligation to respect human
life.’
Asking doctors to abandon their
obligation to preserve human life
could damage the doctor-patient
relationship. Hastening death on a
regular basis could become a routine
administrative task for doctors,
leading to a lack of compassion
when dealing with elderly, disabled
or terminally ill people.
In turn, people with complex health
needs or severe disabilities could
become distrustful of their doctor’s
efforts and intentions. They may
think that their doctor would rather
‘kill them off’ than take responsibility
for a complex and demanding case.
Alternative argument
The alternative argument is that
advances in palliative care and
mental health treatment mean there
is no reason why any person should
ever feel that they are suffering
intolerably, whether it is physical or
mental suffering, or both.
According to this argument, if a
person is given the right care, in the
right environment, there should be no
reason why they are unable to have a
dignified and painless natural death.
11 August 2014
Ö The above information is reprinted
with kind permission from NHS
Choices. Please visit www.nhs.
uk for further information.
© NHS Choices 2015
Chapter 1: Debates & ethics
What is current BMA policy on assisted
dying?
ISSUES: Assisted Suicide
88
85
71
68
39
33
24
27
65
60
58
60
44
42
38
85
65
46
37
71
65
60
59
49
38
27
21
16
Year
4
13
20
12
11
20
10
20
09
20
20
08
0
20
The majority of BMA policy, including
the policy on assisted dying, is made
through debate at the Association's
annual representative meetings
(ARMs),
where
representatives
97
95
90
30
116
114
6
How is BMA policy made?
122
120
20
07
Ö insists that if euthanasia were
legalised there should be a clear
demarcation between those
doctors who would be involved
in it and those who would not.
150
20
0
Ö insists
that
non-voluntary
euthanasia should not be made
legal in the UK
Deaths
Prescription Recipients
20
05
Ö insists that voluntary euthanasia
should not be made legal in the
UK
© BMA 2015
People using Oregon’s Death With Dignity Act
03
Ö insists that physician-assisted
suicide should not be made
legal in the UK
Ö The above information is
reprinted with kind permission
from
the
British
Medical
Association.
Please
visit
www.bma.org.uk for further
information.
Ö Such a change would be contrary
to the ethics of clinical practice,
as the principal purpose of
medicine is to improve patients’
20
04
Ö believes that the ongoing
improvement in palliative care
allows patients to die with dignity
20
The BMA:
Ö Only a minority of people want to
end their lives. The rules for the
majority should not be changed
to accommodate a small group.
Ö Permitting assisted dying for
some could put vulnerable
people at risk of harm.
20
02
The Association has clear policy on
the issue, agreed in 2006.
Ö For most patients, effective and
high-quality palliative care can
effectively alleviate distressing
symptoms associated with the
dying process and allay patients’
fears.
Current BMA policy firmly opposes
assisted dying for the following key
reasons.
20
01
While the BMA fully acknowledges
this broad spectrum of opinion
within
its
membership,
the
consensus since 2006 has remained
that the law should not be changed
to permit assisted dying or doctors’
involvement in assisted dying.
The
BMA
has
considerable
sympathy with individuals facing
the effects of terminal illnesses and
other incurable conditions but is
concerned that giving them a legal
right to end their lives with physician
assistance,
even
where
that
assistance is limited to assessment,
verification or prescribing, could
alter the ethos within which medical
care is provided.
20
00
The BMA represents doctors
throughout the UK who hold a
wide range of views on the issue of
assisted dying.
Ö Legalising assisted dying could
weaken society’s prohibition
on killing and undermine
the safeguards against nonvoluntary euthanasia. Society
could embark on a ‘slippery
slope’
with
undesirable
consequences.
What are the key arguments
for the BMA’s opposition to
assisted dying?
8
Ö supports the establishment of
a comprehensive, high quality
palliative care service available
to all, to enable patients to die
with dignity.
19
99
Ö supports the current legal
framework,
which
allows
compassionate and ethical care
for the dying, and
19
9
Ö opposes all forms of assisted
dying
quality of life, not to foreshorten
it.
discuss motions put forward by
local divisions and vote on them
after hearing the arguments on
both sides. The BMA’s democratic
process is intended to capture a
representative snapshot of BMA
members’ views.
Number of people using Oregon’s Death With Dignity Act
Current BMA policy
Source: Oregon Health Authority
Chapter 1: Debates & ethics
a big “but” big enough to keep me
alive, I made an important discovery.
I wanted to live no matter what. I
wanted to be here with my son, with
my husband, who by now had the
look of a rabbit in the headlights...
he kept that for all of the nearly three
years until I could feed myself and we
found hope and a future.
‘Slide back to before this day and I if
I’m honest before then I would have
said, I wouldn’t want to live if I couldn’t
walk or talk for nearly six months or,
especially this, hold my little boy in
my arms. Of course if I had signed
an Advanced Directive, then “they”
would have had the right to end my
life. They could have assessed (they
like assessments) my life and rather
like Mr Spector said, that my “quality
of life”, for that’s what it’s all about,
wouldn’t be good enough.
‘I’m really sad that Mr Spector
couldn’t see a way through, I know,
I really know, what he was afraid of;
it isn’t easy. The barriers to my life
usually aren’t mine; they are created
by other people, not us, the disabled.
The barriers are literally there and the
barriers to understanding our lives
goes on, usually because we are
seldom represented.
‘I believe that people want to support
decisions like Mr. Spector’s simply
because they are afraid of pain,
loneliness and being cared for, which
to them and for him, meant losing
your dignity and independence. The
truth is as a young friend of mine once
said, “There’s a lot worse things can
happen to you than having someone
wipe your a***.” This is true, so true,
so to the healthy and aspiring wealthy
out there I say, don’t go with those
who would have us euthanised, stay
with me. Life is good.’
Physician-assisted
suicide: the ethics of
euthanasia
By Philip Tennyson
S
uicide was abolished as a
crime over 50 years ago by
the Suicide Act 1961. The
same act ruled against encouraging,
assisting or completing euthanasia
on another. This latter ruling has
been challenged by many UK cases
since its creation, all of which
have been unsuccessful as the
Government (and judiciary) remain
reluctant to address the issue. But
who can blame them when there is
so much to consider?
Public opinion certainly seems to
support change. Gallup[I] found that
70 per cent of Americans support
voluntary euthanasia if the patient
and their family condone it, 27 per
cent oppose it and three per cent
have no opinion. The poll shows
a clear desire for change, but the
desire comes from an ill-advised
audience who have little knowledge
of this area.
So, let’s make sure we’re on the
same page. Euthanasia will never
be legalised in the UK. However
physician-assisted suicide (PAS)
may find its way into legislation one
way or another. Only a qualified
medical practitioner will be granted
the power to end a life and only with
certain safeguards.
‘Death with dignity’ is the pro-PAS
argument which carries the most
weight, presupposing that we all
have a right to live with dignity
and therefore should have a right
to die with dignity. Ultimately
preservation (or an extension) of the
right to freedom is desired to help
those suffering unremitting pain or
constant low quality of life to help
them end their life in a peaceful
manner.
Controversy, however, arises from
distinguishing at what stage in an
illness or disease a patient should
be eligible for PAS. It is estimated
that 25,000 Americans[II] would
be relieved of unremitting pain
should euthanasia be legalised. Is
it fair that this many people live in
suffering just because there is such
a huge pressure on preserving
human life? If an animal was
suffering this badly with no sign of
recovery, the vet wouldn’t hesitate
26 May 2015
Ö The above information is
reprinted with kind permission
from The Independent. Please
visit
www.independent.co.uk
for further information.
© independent.co.uk 2015
ISSUES: Assisted Suicide
6
Chapter 1: Debates & ethics