14 • Ethics


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Assisted Suicide and the Law


• The 1961 Suicide Act makes it an off ence to encourage or assist a suicide in England and Wales. However, in the last few years many UK citizens have travelled to Dignitas in Switzerland to end their lives - no relative or friend who has accompanied them has been prosecuted. In Scotland the situation is more uncertain as there is no specifi c legislation concerning assisted suicide. In other countries, such as Belgium, Luxembourg and the Netherlands, legislation has been introduced to allow assisted dying. • In 2010 the Director of Public Prosecutions issued guidance regarding the factors which would be considered when deciding if someone would face prosecution for assisting in a suicide. Although indicating that the individual circumstances of each case would still need to be investigated, these included whether it was a “voluntary, clear, settled and informed” decision and those assisting would have to demonstrate that they had acted out of compassion and with no fi nancial motivation. • In 2012, MSP Margo MacDonald launched a second bid to change the law on assisted suicide in Scotland. The aim is to make it legal to assist competent adults with a terminal illness to end their lives. Following consultation, the draft proposal received enough support from MSPs to go forward. No timetable for debating the draft legislation has been agreed. Similar bills have been proposed in the UK parliament.


appears to be greater than the harm of death itself? If the means to end suff ering is available should we not at the very least permit those who choose to do so, to take this course of action? Although many may fi nd these arguments


persuasive there are several equally eloquent and well-reasoned ethical objections to following the example of Holland and Switzerland. Not least among these is the belief that many members of the public and health professionals hold regarding the sanctity of life. This belief may be a tenet of religious principles or may equally arise from a moral standpoint that, whatever the circumstances, it is always wrong to deliberately kill someone and it is equally wrong to help someone kill themselves no matter how voluntary this decision is. It could be argued that when treatment is withdrawn or withheld, the intention is to let the patient die and it will have the same consequence as actively intervening to end their life – but many would reject the proposal that these actions have the same moral equivalence.


suggests that if patient A has a certain condition and as a result decides to and is permitted to end his life this inevitably devalues and makes less meaningful the existence of patient B who has the same condition but has no desire to end his life. How can Patient B and all others in that situation possibly wish to carry on living in circumstances which Patient A found so intolerable and distressing? This argument is also refl ected in the concern


that although some patients may already choose to end their lives because they do not wish to be an emotional or fi nancial burden on their family or the NHS, more will feel increasingly compelled to follow this course of action if assisted suicide is legalised. This could in turn lead to unscrupulous relatives or care providers pressurising or coercing patients into acquiescing to this course of action.


Erosion of trust? Justifi able concern has also been expressed about the eff ect the acceptance of physician-


“ What if there are competing harms? How should we behave when the harm of being kept alive and prolonging dying appears to be greater than the harm of death itself?”


A slippery slope Slippery slope arguments are often used in ethical debates. Put simply they suggest that although you may embark on a course of action with clearly expressed limitations to the scope of this intervention, almost inevitably these boundaries will be loosened and the scope of the action will be extended beyond what was originally envisaged. So, if the introduction of assisted suicide is permitted, even if tightly regulated and restricted to a few specifi c clinical circumstances, before we know it the remit of this intervention will have been extended and ultimately could lead to patients who are helpless, vulnerable and whose care is costly being pressurised or coerced into state- sponsored euthanasia. There are echoes of this argument in the furore over the Liverpool Care Pathway where some commentators portrayed the decision to withdraw active treatment which was considered futile and inappropriate more as a decision based on a desire by the NHS to save resources. A variant of the slippery slope argument


assisted suicide would have on how doctors view themselves and are viewed by patients and society. It has been argued that pursuing this particular course of action appears to be counter to both our intuitive and professional standards and would diminish our own perception of our professional value and our ability to intervene and infl uence other areas. It could also decrease the trust between patients and doctors and destabilise the covenant that allows us to act as advocates for many of the most vulnerable members of society. This remains a complex and extremely


contentious issue where the concept of unintended harm can seem an appropriate argument for both sides of the debate to employ. However, as we have seen with the coverage of the Liverpool Care Pathway, there is a need for a more informed, reasoned and thoughtful discussion that considers all the competing arguments.


Dr Niall Cameron is a GP and associate adviser at NES


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