The debate about legalising assisted suicide is an increasingly relevant and controversial topic among both medics and the public. It is also one I have accounted multiple times during work experience and volunteering in palliative care. It further must be discussed to protect both doctors from being sued and vulnerable patients.
To start I would like to make clear some basic definitions. Assisted suicide or assisted dying is the deliberate act or encouraging in assisting someone to commit suicide. Euthanasia differs in that it is the deliberate act of ending someone’s life to stop suffering. Currently the UK law states that all acts or euthanasia and assisted suicide are illegal, with euthanasia being treated as murder or manslaughter, and a maximum of 14 years for assisted suicide.
However, there is a call to the change the UK laws. In multiple countries, for example Belgium, Luxembourg, The Netherlands, Switzerland and some states of America, there are acts that legalise the assisted dying of terminally ill patients. One of the most successful schemes is Oregon’s dying with dignity act. It allows physicians to prescribe lethal doses of a drug (usually a barbiturate) to citizens of Oregon who are over 18, terminally ill with a prognosis of less than 6 months to live, and are proven to be mentally competent. In Oregon’s annual report it states that the top three reasons patients request assisted suicide are due to loss of autonomy (89.5%), loss of dignity (65.4%) and the loss of ability in engaging in activities that make life enjoyable (89.5%). It seems compassionate to allow terminally ill adult patients to have control and dignity over their death, which is guaranteed to be safe and peaceful by assisted dying. Many of these people would instead commit suicide in their homes, risking a painful and gruesome death, or instead have to travel to Switzerland to do this, spending around £10,000. Making assisted dying illegal therefore seems disrespectful and unreasonable when (according to the dignity in dying British campaign group) 82% of the public would support to legalise assisted dying for the terminally ill, and schemes around the world show that it can realistically work without being violated. So, why is it still illegal?
Firstly, and perhaps most importantly, patients may agree against their will to assisted dying due to pressures from family, caregivers and doctors. This is backed by Oregon’s research which stated that in 2017 65% of those that requested assisted dying did so because they felt they were a burden on their family. In this perspective encouraging people to commit suicide therefore seems unethical. This is largely backed by The British Medical Association and the Royal College of General Practitioners, who share the view that assisted dying would be contrary to the ethics of clinical practice, as the principal purpose of medicine is to improve a patient’s quality of life, not to intentionally foreshorten it. Religious people also generally see suicide as a sinful act as all life is sacred so must not be deliberately ended.
Further, assisted suicide requires self-administration of a drug often taken orally. This prevents those who are incapacitated from being granted help to die. Surely everyone will a terminally illness should have the same rights? This raises the question if assisted suicide is legalised, should voluntary euthanasia be legalised? From these questions, many people worry that legalising assisted suicide will lead to a ‘slippery slope’ towards widespread euthanasia, where euthanasia becomes a cheap alternative to palliative care and the vulnerable are exploited. There is also worry that introducing assisted suicide into the UK will downgrade palliative care.
In summary, it is obvious that there is no clear answer to: is assisted suicide right or wrong, and can it be safely introduced into the NHS? It is not a question that should be taken lightly, however I think there is great importance in raising awareness about the debate, and seriously considering a change in the law.