On 16 January this year the House of Lords revisited the Assisted Dying Private Member's Bill proposed by Lord Falconer. The bill reached the committee stage with 150 proposed amendments and with a new government, its future is unclear. Lord Falconer has however already expressed a desire to re-introduce the Bill to the present session of Parliament.
The Suicide Act 1961 makes it a criminal offence punishable with up to 14 years in prison for anyone to encourage or assist a suicide or suicide attempt. Belgium, Luxembourg and the Netherlands have already implemented assisted dying legislation but it remains unlikely that England and Wales will follow suit in the foreseeable future and so those wanting to die will have to continue to travel abroad to foreign clinics to do so.
The preamble to the Bill states it is to "enable competent adults who are terminally ill to be provided at their request with specified assistance to end their own life". Every part of that laudable aim raises questions of ethics, morality, religion and medicine and this is why the future of the Bill is unclear.
The Bill sets out a number of criteria to try to guard against the exploitation of those dying and misuse by those providing assistance:
- there must be a clear and settled intention to end the person's life
- that intention must be "declared"
- it must be the reasonable opinion of a registered medical practitioner that the patient has less than 6 months live
It is proposed that a written declaration is made and signed by the patient to the effect that they wish to end their life and this must be witnessed by a non relative or someone not involved in their care. The declaration must be countersigned by the doctor who is going to assist the end of life and another registered doctor who is not the witness, in the same practice as the other counter signatory or a relative. The counter signature is to confirm the terminally ill person has made the decision of their own free will and has been fully informed of the palliative care and hospice options available.
The most recent debate illustrates the high emotions the subject elicits. The subject was whether the words "assisted dying" should be changed to "suicide". Some peers, such as Lord Winston considered the change necessary to make it clear to those making the decision what it is to which they are agreeing to avoid them being taken advantage of; others took the view that the stigma of suicide needs to be removed from the Bill. It seems that on this occasion to wish to avoid stigma won over perceived clarity and this amendment failed.
One objection raised by those against the Bill is that it allows the vulnerable to be taken advantage of by avaricious relatives. It is also argued that it will tempt doctors into assisting death by offer of payment. It is unclear from the Bill whether the drugs and care required to assist suicide would be available on the NHS but this is perhaps unlikely. The spectre of Harold Shipman haunts the argument against the Bill and some present a picture of poor defenceless elderly victims at the mercy of greedy murdering doctors. This is emotive but is it likely to be a real problem? In addition it is argued that relatives will press their dying relatives into making the decision to die earlier than they would otherwise want, but again does this seem likely to be a big problem? Many patients now are sent home for care by relatives with access to large bottles of morphine but this does not seem to have resulted in a spate of killings of unwanted relatives.
Ethically it is of course argued that doctors should not be assisting death. That however is something which has been happening by omission for many years. It is well known that hospitals sometimes make a decision not to resuscitate a patient and turn off life support and many argue that therefore assisted dying is already going on. In law there is a good deal of argument as to whether an omission in law is any different from a positive act but that does not address the reason why this subject is so problematic. In permitting assisted dying for those with only a very few months to live the Bill is asking us to set aside hundreds of years of religious, moral and medical teaching. It is for that reason that it seems unlikely we are going to see any legalised assisted deaths in this country for some years yet.
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