“Yet we have gone on living, living and partly living.”*

In this article...

• Legislation
• The debate
• Guidance and case law
• Conclusion

Assisted suicide is one of the most complex and controversial ethical issues of our time. The recent case brought by MS sufferer Debbie Purdy who wants to ensure that her husband is not prosecuted for helping her travel abroad to end her life, the televised assisted suicide of Craig Ewert, and the death of the young rugby player Daniel James and subsequent decision by the Director of Public Prosecutions (DPP), Keir Starmer, not to prosecute Daniel James’ parents has inflamed the passionate and intense debate further.

Gordon Brown has stated that he opposes legislation for assisted deaths. However a recent poll by YouGov found that:

• more than two thirds of people supported a change in the law on assisted suicide,
• 61% would consider ending their life if they were suffering from a terminal disease, 
• 69% supported offering immunity from prosecution to people who help friends and relatives who travel to foreign clinics to commit suicide. 

Legislation

Some jurisdictions, namely Oregon, Washington State, Belgium, Luxembourg, Switzerland and the Netherlands, have enacted legislation which under certain conditions allows terminally ill people to end their lives through the voluntary self-administration of lethal medicine expressly prescribed by a doctor for that purpose.

In the UK it is an offence to assist someone to commit suicide. The Suicide Act 1961 s.2(1) sets out the current UK legal position:

”A person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years.”  No proceedings will be instituted except by or with the consent of the DPP.

In 2006 Lord Joffe tabled an End of Life Choices (Scotland) Bill with the aim of allowing terminally ill people to be helped to die, but this was blocked by the House of Lords.

The independent MSP Margo Macdonald launched a consultation in December 2008 to legalise assisted suicide and she hopes to have a debate about bringing legislation before the Scottish Parliament this year.

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The debate

Proponents of a change in the law argue that human beings should be able to decide when and how they die. They believe that the current position provides individuals with no autonomy or control over the manner of their death. They are concerned that some individuals may end up having violent, botched suicides in a desperate attempt to end their lives, and state that rigorous safeguards can be put in place to ensure that any change in legislation is used appropriately.

Opponents of change, which include some disability groups, cite a variety of reasons for their opposition, namely:

• legalising assisted suicide will set a dangerous precedent and place vulnerable individuals under unreasonable pressure, particularly where care for the sick, elderly and disabled is expensive.
• such legislation would reinforce the view that the lives of those who are disabled or terminally ill are worth less than others
• a change in the legislation will alter the relationship between the doctor and patient and that in the light of Shipman may also be open to abuse by healthcare professionals
• end of life care is already underfunded and that such legislation will reduce the pressure to improve palliative care
• good support and aggressive palliative care can have a transformative effect and that individuals such as Daniel James can not know how access to future technology and advances in medicine may affect their condition. 

The current position of the British Medical Association is:

• ongoing palliative care allows patients to die with dignity
• physician assisted suicide should not be made legal in the UK
• non-voluntary euthanasia should not be made legal in the UK; and ,
• if euthanasia were legalised, there should be a clear demarcation between those
• who would be involved in it and those who would not. 

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Guidance and case law

In 2002 the European Court of Human Rights ruled that the refusal of the British Courts to allow Diane Pretty’s husband to help her to die did not contravene her human rights. The Voluntary Euthanasia Society (now called Dignity in Dying) and civil rights organisation Liberty lobbied for the DPP to draw up a policy document providing guidance as to when individuals could help others to die without fear of prosecution.

In March 2007 Daniel James, a 23 year old rugby player, was paralysed from the chest down whilst playing rugby. Finding what he called his “second-class existence” intolerable, in October 2008 he travelled with his parents to Dignitas in Switzerland and died. His death has caused huge controversy as he was not suffering from a terminal illness and is one of the youngest Britons to die at Dignitas. In December 2008 in his first decision as DPP, Keir Starmer stated that while there was sufficient evidence for a realistic prospect of conviction of the parents of Daniel James for assisting his death, such a prosecution was not in the public interest.

In October 2008 Debbie Purdy launched a High Court challenge to require the DPP to set out guidelines on when assisted suicide cases would be prosecuted. She argued that the lack of clarity on the law was a breach of her human rights. The court decided that only Parliament could define or limit the law in that way and her challenge was unsuccessful. Debbie Purdy appealed this decision at the Court of Appeal on 2 February 2009 and argued that the DPP should be required to issue specific policy guidelines. The Court of Appeal has not yet published a decision.

In the last six years, approximately 100 Britons have travelled overseas to get help in taking their own lives. Some of the relatives who have assisted these individuals have been questioned by police but not one has been prosecuted.

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Conclusion

Although the law itself would appear to be clear, the cases of Craig Ewert, Debbie Purdy and Daniel James have resulted in more confusion and uncertainty as to how the law is to be applied and the factors that may influence a decision to prosecute. The published decision of Keir Starmer not to prosecute the parents of Daniel James is of huge significance. The DPP spokesman said that the decision does not set a precedent which will protect other relatives who assist in a suicide, that the decision was taken on the “very specific and unique facts” of the case and that “each case is considered on its merits”. Nevertheless it is difficult to see, what was unique about the James case and how the parents' situation might be different from that of other relatives in a similar position in the future. Surely, the implied message from this decision, and other cases where there has been a failure to prosecute, is that those who assist others to die will not be prosecuted.

No-one would disagree that it is a great tragedy that Daniel James felt that his accident meant that he had a “second class existence.” Whether or not the legislation changes to legalise assisted suicide, society surely needs to resist the deeply negative view of disability and serious illness that made Daniel James feel as he did.

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