Assisted Dying (AD) is when a person is given help to die. This is most usually by giving them a lethal substance that they can take at a time of their choosing. It is used by terminally ill adults who are suffering unbearably with no prospect of relief of their suffering other than through the ending of life. AD is legal in Belgium, the Netherlands, Luxembourg, and the US state of Oregon; AD is decriminalised in Switzerland. In all these jurisdictions there are strict guidelines and safeguards to ensure that the use of AD is not misused. There is evidence to show that AD legislation works well in these places, complementing palliative care rather than replacing it.
The Secular Medical Forum (SMF) supports patient autonomy and works to protect patients from the imposition of other people’s personal religious views. Several polls have shown that at least 80% of the British population supports the concept of assisted dying for the terminally ill who are suffering unbearably. Strong opposition to AD comes from religious leaders who regard life as sacred and AD as intrinsically harmful. On the other side of the spectrum many people regard refusal to afford people a final relief from their unbearable suffering as a harmful act. The SMF supports the democratic right of all people to contribute to this debate. However, the over-representation of religious groups and the special status granted to religious groups currently imposes a disproportionate level of influence. The feelings of the general public, professionals and relevant organisations should be fairly reflected at policy level.
Without a legal structure for AD, relatives and friends of terminally ill adults sometimes feel they have nowhere to turn and may resort to ‘assisting’ their loved-one to take their own life. This leads to botched suicides, and to increased distress for relatives and friends who have felt that they had no option but to take matters into their own hands. It also creates added worry for the patient who may be concerned that his/her relatives might be prosecuted after their death. The SMF supports the direction of guidance recently issued by the Director of Public Prosecutions (see below), but has concerns that, without a formal legal structure for AD, vulnerable patients may be more at risk since there is no recognised pathway under current legislation to gauge and record the patient’s views before death; the assessment by prosecutors is invariably made after the person has died when their views cannot be known with certainty.
Also, the SMF objects to the fact that, perversely, doctors are more likely to be prosecuted under current guidance than others involved in AD. This is despite the fact that doctors are best able to ensure that there are no further effective treatments for the patient, to ensure that the patient has capacity and has considered all available options- maintaining a sustained wish to die in the face of those options, and who are best able to ensure a painless and straightforward death for those who want it.
Within the SMF, individual members hold a range of views about AD. All are agreed that religious privilege should have no place in the decision-making process. The majority SMF view is that AD, with adequate safeguards for terminally ill, competent adults, should be introduced in the UK as soon as possible. The SMF supports good quality palliative care alongside the option of AD for competent adults. The SMF supports other concerned organisations such as Dignity in Dying, Friends at the End and Healthcare professionals for Assisted Dying (HPAD) in their campaign to legalise AD.
Background and Legal Developments
General medical opinion has been divided on the need for legislation for assisted dying. A BMA News Review survey of 750 physicians, back in 1996, revealed a 50/50 split. At the BMA annual representatives meeting (ARM) in 2005, a neutral position was officially adopted, only to be reversed to the previous negative stance in 2006 after a vigorous campaign led by the Christian Medical Fellowship. The SMF considers that any change in the law, to permit AD, should be a decision for society as a whole – not just for physicians or religious leaders.
Jeremy Purvis, a Member of the Scottish Parliament, and Lord Joffe, in the House of Lords at Westminster, have introduced bills in these legislatures, in recent years (2005 and 2006 respectively), which are either identical (in the Scottish Parliament) or very similar (in the House of Lords) to the Oregon Death with Dignity Act, which has been closely monitored since it was approved in 1997. Today, Oregon can demonstrate much more clearly than elsewhere a structure for legalised assisted dying which works well and which has demonstrably good safeguards.
The House of Lords debated Lord Joffe’s Assisted Dying for the Terminally-ill Bill on 12 May 2006. Fourteen members of the Anglican Bench of Bishops (who sit ex-officio in this legislature) voted to block further discussion. The other twelve bishops in the Lords did not register an opinion. In addition, the Chief Rabbi and the Roman Catholic Church also opposed Lord Joffe’s efforts.
In February 2010, in response to the High Court challenge from Debbie Purdy, the Director of Public Prosecutions, Keir Starmer, clarified the guidance to prosecutors about Assisted Dying. Prosecutors are less likely to prosecute relatives and friends who have acted out of love and compassion in helping someone to end their life. However, despite this clarification, there remains uncertainty around AD, the role of medical practitioners, and the rights of people to have help in ending their lives.
In September 2010 the Commission on Assisted Dying, chaired by Lord Falconer, was established to consider whether the current legal and policy approach to AD in England and Wales was fit for purpose. The commission received evidence, written and oral, from people and organisations representing all sides of the debate. The Commission published its conclusions on 5th January 2012. The Commission on Assisted Dying concluded that the current legal status of Assisted Dying is inadequate and incoherent. Further, the Commission found that there was a strong case for providing the choice of Assisted Dying for terminally ill people and made further recommendations towards a safe statutory framework for Assisted Dying.