In England and Wales assisting someone to die is illegal. Euthanasia, (killing someone, at their request, for example by lethal injection), is considered to be murder. Suicide, (ending your own life without involving anyone else), has been legal since 1961, however assisting someone to end their own life, such as providing them lethal medication for them to take, is a criminal offence under the Suicide Act 1961. The law in Scotland is rather different. The campaign group most involved with changing the law in Scotland is Friends At The End (FATE) which is closely affiliated with MDMD.
In 2010, following the case of Debbie Purdy, the Director of Public Prosecutions, (DPP), published guidelines which suggests that it is not in the public interest to prosecute in the case of someone who assisted suicide if they acted out of compassion. (Debbie suffered from MS and wanted an assurance that if her husband helped her to go to Switzerland for an assisted suicide he would not face prosecution.)
The 2010 DPP guidelines indicate that prosecution is more likely in the case of a medical professional who assists the suicide, though an amendment in 2014 clarifies that this is only the case for medical professionals who were responsible for the care of the person who ended their life.
Because of this law, combined with the DPP guidelines and the ethical positions of their professional organisations, UK medical professionals are not free to discuss or assist any form of assisted dying with their patients – leaving many people to suffer far more and for far longer than they wish. Doctors may even attempt to stop people traveling to countries like Switzerland to have professional life ending treatment there.
It is clear that nurses are frequently approached by patients with requests for assistance. In 2011 the Royal College of Nursing (RCN) published a 24 page booklet giving advice on how to respond
“When someone asks for your assistance to die
”. The RCN, quite understandably, advises nurses that they can not help shorten anyone’s life, on their request. One of the frequently asked questions in the RCN’s booklet is revealing:
If a patient or their family asks, am I able to directly provide contact details or website addresses for organisations that promote or provide support for people wishing to commit suicide?
No. It is the RCN’s view that it is inappropriate and potentially illegal to provide contact details or website addresses for organisations that promote or provide support for people wishing to commit suicide.
While we understand the reasons for the RCN’s advice, given the current legal position, the fact that our medical professionals are unable to advise people of where they might get information about some end of life options which may be appropriate, demonstrates a serious breakdown in supporting people to have the good death they wish for, when that is a quick, medically assisted end to suffering. (MDMD provide some information here)
As a consequence of the restrictive UK legislation, some people choose to travel abroad for professional assistance to die. They often have to go before they would wish, while they still can. Other people beg close friends or relatives to help them end their lives, or attempt to end their own lives while they still can. These are traumatic tragedies that can only be avoided by giving people the certainty that safe medical assistance to die will be available if they reach the point of needing it.
Although the DPP guidelines are a temporary help until the law is eventually changed, they are far from satisfactory. Vulnerable people are in danger from unscrupulous people who may persuade someone to end their life, possibly doing more than assisting a suicide. Among the shortcomings of the current legal situation are:
- There is no professional counselling or evaluation available in the UK to ensure that assisted dying is the most appropriate option. People are unable to have a full and free conversation about their end of life options with medical professionals in this country, if they are interested in the possibility of an assisted death.
- In the case of anyone else being present at an assisted death, the primary witness has no voice in the evidence gathering stage to determine whether the death was freely decided and requested by the deceased, as they are dead by the time an investigation takes place.
- The suicide is likely to be done in an amateur and traumatic manner, as the people involved are not professionals and do not have legal access to appropriate drugs.
- The attempted suicide may not succeed, leaving the person in a worse state than before, and the assistant facing criminal charges.
- Anybody who does successfully assist suicide out of compassion has to contend with a criminal investigation and possible prosecution, in addition to their loss of the person who has died.
In September 2015 the House of Commons, with the support of a collection of “faith leaders” led by the Archbishop of Canterbury, voted to reject a private members Bill proposed by Rob Marris which would have improved the current situation, though the proposed Bill fell far short of what is needed to help many people due to it being restricted to mentally competent people diagnosed as having 6 months or less to live. Many high profile right-to-die cases would not have been helped by this Bill, nor would anyone with the early stages of dementia who did not want to suffer the degradation this illness can bring. The transcript of the parliamentary debate can be read here and the video watched here.
MDMD believes that MPs and “faith leaders” have failed badly to show compassion for suffering people, and have ignored the weight of public opinion that supports a change in the law. To move forward we need to consider carefully the arguments used against the Marris Bill, and create a new proposal which addresses the valid concerns of those opposed to it, in particular, ways to safeguard “vulnerable people” and the difficulties of a prognosis of 6 month terminal illness (or any fixed time limit). We put forward some suggestions here: What We Advocate.
In particular, we propose a new way to protect vulnerable people called an Extended Advance Decision. Under this suggestion anyone considered to still have mental capacity, but nevertheless to be significantly vulnerable, would have their request for an assisted death refused unless they had made a witnessed statement, prior to them becoming significantly vulnerable, of their wish for the option of an assisted death at some point in the future, should they deem it necessary at that future time.