voluntary euthanasia: who can choose when to die?
by Jenny Bryan
Following the assisted suicide of 74-year-old Reginald Crew in Switzerland, the Voluntary Euthanasia Society (VES) is pressing for an urgent review of the law in the UK and wants the Director of Public Prosecutions to make clear the circumstances under which people can be prosecuted for helping friends or relatives to die.
© C4
'It is of immense public concern that people with terminal illnesses are forced to travel to a foreign country to end their days, in unfamiliar surroundings and without proper safeguards in place,' said VES chief executive, Deborah Annetts. 'If friends and families accompany them, they are confronted with the added burden of not knowing if they will face prosecution on their return to the UK.'
Terminally ill with motor neurone disease and unable to end his life without help, Mr Crew travelled to Switzerland where volunteers from the charity, Dignitas, gave him a barbiturate drink to assist his death. Anyone assisting a suicide in the UK can be prosecuted under the Suicide Act 1961, as confirmed last year in the case of Diane Pretty, who campaigned unsuccessfully through the courts for her husband to be allowed to help end her life without being prosecuted.
The All-Party Parliamentary Group for Compassion in Dying was subsequently set up to press for wider debate about assisted suicide for people who are terminally ill but mentally capable of deciding what should happen to them.
'Diane Pretty's efforts have not gone to waste,' said the Group's Chairman, James Plaskitt MP at its launch. 'Ninety per cent of the general public want to see a change in the law to allow someone like Diane Pretty to have medical assistance to die at a time of her choosing.'
The Group wants parliament to debate the issues arising from the deaths of people like Diane Pretty and Reginald Crew and to consider legislation to take account of the needs of those with terminal illnesses who wish to end their lives but need assistance to do so.
Recent changes in the law in Belgium and The Netherlands have demonstrated that it should be possible to help people with incurable diseases to end their lives if they wish, without opening the door to forced euthanasia. Indeed, the law was changed in Belgium because of evidence of unregulated non-voluntary euthanasia.
Research showed that drugs were used to end life without a person's explicit request in 3.2% of deaths in Flanders, Belgium. The figure was similar to the 3.5% obtained from a comparable study in Australia but well above the 0.8% in The Netherlands where physicians are not prosecuted if they assist a suicide provided they stick to strict guidelines about the treatment of the terminally ill.
the need for research
The VES wants similar research to be carried out in the UK. It is concerned that, as assisted suicide goes on in secret in the UK, in some cases people are given lethal doses of morphine or other drugs without their consent because relatives think they are doing the right thing. It wants a confidential survey to find out what is happening in hospitals, hospices and elsewhere. At present, a doctor may increase a patient's dose of morphine in the last days of his life and it is very difficult to find out whether this was to assist their death or to treat their symptoms.
If assisted suicide came out into the open in the UK, people would not only be protected against non-voluntary euthanasia, argues the VES, more care would have to be taken to ensure that every avenue of palliative (relieving without curing) care had been explored. If doctors were allowed to help patients to die, it would also remove the burden on families and friends. Those who may become involved in helping loved ones to die are likely subsequently to suffer immense emotional distress and remorse – even becoming suicidal themselves. If a family member or friend actively assists in the process of helping a terminally ill loved one to die, legally she or he could be opening up the risk of a criminal prosecution for manslaughter or even murder.
'As a long-term solution the Government must act to empower and protect competent terminally-ill adults by giving them the choice of a well-regulated, medically-assisted death here in the UK,' says Ms Annetts.
the US experience
In Oregon – the only US state that allows physician-assisted suicide – palliative care costs have gone up, not down, says the VES. The Society argues that, under a properly regulated system, if patients make repeated requests for help in ending their life, their doctors have to ensure that they have access to all possible types of palliative care.
In Oregon, the Death and Dignity Act has allowed physician-assisted suicide since 1997. It requires two doctors to agree that a patient is mentally competent and has less than six months to live before they can help them end their life. The US government has recently sought to overturn the legislation, but the federal court has so far prevented any change.
Dutch controls
The Netherlands is probably the country best known for its lenient attitude to physician-assisted suicide, though this was only confirmed by legislation in 2001. Now, doctors will not be prosecuted if they help a patient to die who has made a voluntary request, provided they are sure that the patient is suffering unbearably and has no chance of improving.
Belgian law
Belgian doctors must fulfill comparable criteria under a law passed in May 2002. The patient's request to die must be voluntary and well-considered, his or her condition hopeless and their pain unbearable. A second doctor must agree this is the case and, after the assisted suicide has taken place, it must be reported to a regional committee to determine whether it was performed with due care. Details of the case are then sent to the Public Prosecution Service but, provided that the committee has backed the doctor's decision and care, no proceedings are taken.
voluntary euthanasia in the UK?
The VES supports similar requirements to those of The Netherlands and Belgium, but it wants to see each case referred for legal opinion before rather than after the assisted suicide has taken place. It recommends that a doctor must:
- be satisfied that the patient is competent and that he has made a voluntary and carefully considered request
- have consulted a legal practitioner who has confirmed that the patient is competent and is making a voluntary request
- be satisfied that the patient is suffering unbearably from an incurable illness and that there is no prospect of improvement
- have informed the patient of his situation and prospects and all the care options available including palliative care
- have consulted at least one other independent doctor who must have seen the patient and given a written opinion that all the above due care criteria have been met.
The VES also advocates a waiting period between the date when all the criteria are met and the time that the doctor helps the patient to die.
As a group, British doctors do not support any form of physician-assisted suicide. In spring 2000, the British Medical Association held a consensus conference to debate the issues surrounding physician-assisted suicide, and concluded that no change should be made in current laws forbidding such acts. Following the European Court of Human Rights' decision against Diane Pretty, Dr Michael Wilks, chairman of the BMA's Ethics Committee, confirmed its earlier conclusions:
'The BMA's opposition to euthanasia and physician-assisted suicide has been repeatedly confirmed by annual representative meetings. Overwhelmingly, BMA members from a wide range of moral viewpoints, agreed that they could not recommend a change in the law to allow euthanasia and physician-assisted suicide,' he said.
refusing treatment
The debate over voluntary euthanasia and physician-assisted suicide is quite separate from the issues relating to withholding or withdrawing of medical treatment, highlighted in 2002 by the Ms B case. All adults who are judged mentally competent have the right to refuse medical treatment, even if their decision will result in their death.
Ms B wanted her ventilator to be switched off because of her incurable paralysis and poor quality of life. And, in her judgment on the case, Dame Elizabeth Butler-Sloss, president of the High Court's Family Divison, reminded the medical profession that people with serious physical disabilities have the same right to refuse lifesaving treatment as any one else who is judged mentally capable.
Last summer, Britain's doctors received updated guidance from the General Medical Council (GMC) aimed at clarifying issues arising from advances in life support and other techniques capable of prolonging life. The guidance stressed that doctors must respect the refusal of a mentally competent adult to accept treatment even where complying with the decision will lead to the patient's death.
Doctors who fail to follow any part of the guidance are warned that they should be prepared to explain and justify their actions and decisions, to patients and their families, their colleagues and, where necessary, the courts and the GMC.
living wills
A living will (also called an advanced directive) enables people to make clear under what circumstances they do not want life-prolonging treatment, such as tube feeding, antibiotics, or ventilator support. In this way, anyone over 18 and mentally competent at the time that they make the will can determine what can happen to them at a later date if they are so ill that they are unlikely to recover but are unconscious or otherwise unable to refuse treatment.
Although there is no law about living wills, doctors must abide by them in the same way as they must follow the wishes of any patient who is shown to be medically competent to decide whether to accept treatment. However the effectiveness of living wills can only extend to stating what medical treatment a patient wishes not to have – a patient cannot require a particular form of treatment
Young people under 18 do not have the same rights as adults, but the Children Act 1989 broadly emphasises the importance of including them in decisions about their own health, along with their parents or legal guardians.
limited choices
Thanks to the publicity surrounding the Ms B case, few doctors can now be unaware of their patients' rights to refuse treatment. But, when it comes to enlisting their support actively to end life, the situation in the UK remains unchanged. No one doubts that some doctors can and do help people with terminal illness and deep mental or physical anguish to end their life. But Britain appears to be in no hurry to follow the Dutch and Belgian lead and provide a legal framework within which such doctors may give their patients the right to die at a time of their own choosing.
help and info
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organisations
VES (The Voluntary Euthanasia Society)
13 Prince of Wales Terrace
London W8 5PG
Tel: 020 7937 7770
E-mail: info@ves.org.uk
Website: www.ves.org.uk
Campaigns to make it legal for a competent adult, who is suffering unbearably from a terminal illness, to be allowed to request medical help to die at their own informed and persistent request – if that's what they want.
ALERT (Against Legalised Euthanasia – Research and Teaching)
27 Walpole Street
London SW3 4QS
Tel: 020 7730 2800
E-mail: alert@donoharm.org.uk
Website: www.donoharm.org.uk/alert/index.shtml
Aims to warn people of the dangers of any type of euthanasia legislation and pro-death initiatives.
websites
British Medical Association
www.bma.org.uk
A professional association of doctors, representing their interests and providing services for its members.
Dignitas: Swiss suicide helpers
http://news.bbc.co.uk/1/hi/world/europe/2676837.stm
BBC News article discussing the Swiss charity, Dignitas, with a link to their website.
Euthanasia.com
www.euthanasia.com
Committed to the belief that the direct killing of another person is wrong. Features information on euthanasia, physician-assisted suicide, living wills, and mercy killing. Has a range of articles, FAQs, personal stories and facts.
General Medical Council
www.gmc-uk.org
Regulatory body with legal powers to maintain standards within the medical profession. Its purpose is the protection, promotion and maintenance of the health and safety of the community. It holds a register of all doctors qualified to practise in the UK. 'Withholding and Withdrawing Life-Prolonging Treatments: Good practice in decision-making' can be found by clicking 'Ethical Guidance' on the website.
Justice 4 Diane
www.justice4diane.org.uk
Website on Diane Pretty's campaign for the right to die with dignity at a time of her choosing.
Pro Life Alliance
www.prolife.org.uk
Europe's first Pro-Life Political Party. Website has FAQs, articles and features on issues such as human embryo abuse, human cloning, abortion and euthanasia. Contains images that some people may find upsetting.
UkActNow.org
www.ukactnow.org
The ukActNow team came together after Diane Pretty lost her legal battle for the right to choose medical assistance to die with dignity and avoid what she considered to be a distressing death and unnecessary suffering.
United Kingdom Parliament Assisted Dying Bill
www.publications.parliament.uk/pa/ld200203/ldselect/ldliaisn/183/18302.htm
If it becomes law, the Bill will allow a competent terminally ill patient who is suffering unbearably the right to request pain relief and ask for assistance to die, within strict safeguards.
Very Much Alive
www.donoharm.org.uk/verymuchalive
A small group of individuals with disability who have got together to challenge what they see as the increasingly common view that sick and disabled people may be 'better off dead'.
The World Federation of Right to Die Societies
www.worldrtd.net
Consists of 38 right-to-die organisations from 22 countries, and provides an international link for organisations working to secure or protect the rights of individuals to self-determination at the end of their lives. Extensive resources include news from around the world, FAQs and a range of links.
reading
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A Chosen Death: The dying confront assisted suicide by Lonny Shavelson (University of California Press, 1998) |
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Dying Right: The Death With Dignity movement by Daniel Hillyard and John Dombrink (Routledge, 2001) |
Euthanasia and the Right to Die by Jennifer Scherer and Rita Simon (Rowman & Littlefield Publishers, 1999) |
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Euthanasia, Ethics and Public Policy by John Keown (Cambridge University Press, 2002) |
The Euthanasia Issue edited by Craig Donnellan (Independence Educational Publishers, 2001) |
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(updated January 2003, resources updated January 2005)
