The law in the UK places an absolute ban on assisting another person to die. Assisting a suicide is an offence under the Suicide Act 1961, punishable with up to 14 years of imprisonment.

The Suicide Act is nearly 50 years old and is out of step with public opinion and current morals and values. In a recent ruling in the case of Ms Debbie Purdy, the judges acknowledged that the offence of assisting a suicide is very widely drawn but they were not prepared to support Ms Purdy's request for greater clarity in the interpretation of the Act. They ruled that only Parliament can change legislation.

The law is "broke" and we must fix it

Some opponents of a change in the law on assisted dying argue that that the law "ain't broke so don't fix it". But the evidence shows that despite these confident claims the status quo has many negative consequences and forces terminally ill people to look for alternatives in order to exercise control of the manner and timing of their deaths when they feel their suffering has become unbearable.

The terrible cost of the status quo in British people's lives:

• On average, 16 British citizens travel to Dignitas each year.
• The UK Home Office identifies an average of 4 cases of "mercy killings" each year. This only represents a small fraction of the real number of cases of "mercy killing", which often never reach the courts.
• Each year, a number of terminally ill people resort to violent and often botched suicides.
• A number of people refuse food and water to exercise control about their time and manner of death.
• Each year, over 900 people receive assistance in dying from their doctor, upon their explicit request.
• Over 900 people in the United Kingdom are forced to get illegal assistance to die each year. The consequences for those that help them can be dreadful.
• Many more terminally ill people are driven to desperate measures such as violent suicide or starvation, because they are unable or unwilling to find someone to break the law to help them end their suffering.
• These figures demonstrate that the current status quo has a negative impact on a sizeable proportion of terminally ill people.

Palliative care

Dignity in Dying campaigns for all terminally ill people to have access to excellent palliative care services, regardless of their age, disease, geographical location or any other factor.

However, we know that for some people, good quality palliative care cannot address their concerns about losing autonomy, control and dignity at the end of their lives. This is not a failure of palliative care; these are person-centred issues, and they are most frequently at the heart of a request to die.  It is wrong to see this is an issue of assisted dying OR palliative care. They are not in conflict.

The House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill recognised that there is a group of patients whose demand for medically assisted dying will not be deflected by more or better palliative care[1].  The National Council for Palliative care, the British Medical Association and Macmillan have all acknowledged this fact[2].

Dignity in Dying believes that mentally competent, terminally ill adults should be allowed the option of an assisted death, within strict legal safeguards. This would bring an end to the many negative consequences of the status quo on terminally ill people and their loved ones:

Individuals taking matters in their own hands:

1) Dignitas deaths

The Swiss organisation Dignitas, which helps people with incurable illnesses to die, regularly features in the British media.
Over 650 British citizens are members of Dignitas.
Over 100 British citizens have travelled to Switzerland to have an assisted death since October 2002. 
This corresponds to an average of 16 British citizens being assisted to die at Dignitas each year.

Personal story:

Reg Crew had MND. His wife, Win Crew, and daughter Jan Healey, accompanied him to Dignitas where he died in January 2003. Win has written:

"Although I am a Roman Catholic, like many others in my position, when Reg said he wanted medical assistance to die, to avoid a long and painful death, I felt this was the right thing to do. I agreed with him that the disease should not rob him of the ability to choose the manner of his inevitable death.  For several months after my return, I had the threat of legal action hanging over me but what alternative was there"

Negative consequences of the current state of the law:

People who travel to Dignitas with the help of their loved ones fear legal consequences for their loved ones upon their return to the UK.
The lack of legal certainty around prosecution of those who accompany loved ones to Dignitas leads some terminally ill people to travel to Switzerland all by themselves; and as a consequence often earlier than they would have liked to.

People are forced to die in a foreign country, away from their familiar surroundings and, in some cases, without their loved ones.

2) "Mercy killings"

Under the current law, anybody who ends the life of another can be convicted of murder and receive a life sentence - even if the act is a compassionate response to a dying persons' request for help to die (a 'mercy killing'). 

Despite the risk of being convicted of murder, a number of people resort to "mercy killing" and often regard this as a final act of love towards a loved one who is suffering and requests help to die.

From 1990/1991 to 2004/2005, Home Office records show a total of 57 suspects of homicide cases that can be described as "mercy killings"[3].

This only represents a small fraction of the real number of cases of "mercy killing", which often are never discovered.

Personal story:

Heather Pratten on how she helped her son to die:

"My son Nigel had the hereditary degenerative neurological disorder, Huntington's Disease.

"We'd both watched my husband die from the illness and knew the distress and agony it could cause.  Nigel knew what was going on and that he did not want to be around to suffer anymore. On his 42nd birthday he told me the best present I could give him would be to end his life. He didn't want to die alone. I tried to persuade him against it but I would not let him die alone and promised him I would not let him fail. Looking back I still believe that it was his right to choose.

"Other people have tried to end their lives and failed and then been left in an even worse situation than they were previously in.  I was put on bail for murder for being with Nigel and putting a pillow over his face when he lost consciousness from the overdose.  In the end I was charged with aiding and abetting a suicide and received a conditional discharge for one year.

"I wish that Nigel could have asked a doctor to help him to die legally and peacefully."

Negative consequences of the current state of the law:

The current situation has very negative effects on the lives of "mercy killers". These range from imprisonment to long drawn-out trials and public labeling. People who have committed an act of "mercy killing" also often suffer from long-term effects on their mental health, which can lead to self-harm and even to suicide. The Home Office has reported that, of 57 suspects of acts of 'mercy killing', 21 have committed suicide[4].

With no clear policy in place, people may claim to have committed a "mercy killing" or assisted a suicide for compassionate reasons, when in fact their motives are more sinister or selfish.

3) Violent and botched suicides

Some people take matters in their own hands and attempt to commit suicide. This can lead to long drawn-out and painful deaths. Some people will end up in a worse situation than they were previously in if their attempt to commit suicide fails.

It is impossible to estimate the number of terminally ill people who commit or attempt suicide, but anecdotal evidence tells us that some do resort to suicide in order to exercise choice and control over the time of their death.

Personal story:

Sue on how her terminally ill father attempted to commit suicide:

"My father had prostate cancer. At some point there was nothing more the doctors could do. My Dad sadly experienced how the laws in this country operate. He threw himself down the stairs in an attempt to kill himself. It didn't work, but the doctor left him there as long as he could, waiting to see if he might die. This is how the law forces doctors to abandon their patients. My father was left at the bottom of the stairs for two hours with a cut on his head. Eventually he died a week later at home."

Negative consequences of the current state of the law:

People are forced to die a lonely death in the absence of their loved ones, out of fear of legal consequences for anyone they asked to be present at the time of death.

Some people will die a long drawn-out and painful death. Others will fail to commit suicide and possibly end up in a worse situation than before.

Because it is illegal for anyone to help another person to die, some people choose to commit suicide while they are still able to do so. This means that these people die earlier than they would like to.

Authorities in Oregon are aware of 94 terminally ill people who were prevented from committing violent suicide because the option of assisted dying was available to them. 50 of these people went on to die a natural death[5].

4) People refusing food and water

Some people decide to exercise control about their time and manner of death by refusing food and water.

The refusal of food and water is different from the refusal of artificial nutrition and hydration, which constitutes a form of medical treatment.

Personal story:

Oliver Coles on the death of his wife Waltraud Coles by starvation:

"Waltraud died in February 2005 aged 54. The cause of her death was an infection which her body, weakened by the combination of 19 days starvation and very advanced secondary progressive multiple sclerosis, could not resist. Her actual death, in her sleep and at home, represented the kind of end she had wanted.

"Waltraud had thought of every legitimate way of dying. She was not suicidal, but saw a fatal overdose as an option to be seized whilst she could do this unassisted. She planned it but then lost the use of her hands by the time she was ready. She also ensured her Advance Decision was effective in practice.

"Waltraud's decision to starve was well-considered. She was a very courageous, well-informed, completely law-abiding person. She knew that her illness would, step by step, destroy but not end the quality of her relatively young life and she knew starvation was the only lawful option for her to end what she herself described as "the unbearable daily ordeal" which was all that was left of her life."

Negative consequences of the current state of the law:

People who choose to refuse food and water will often die a long and protracted death, while they would rather have an immediate death.

Doctors helping their patients to die:

5) Assisted dying practices

Research has shown that, of all deaths in the UK in 2004, 0.16% were cases of doctors ending life following an explicit request from the patient[6] (voluntary euthanasia).

In absolute figures, this means that in 2004, 936 deaths were the consequence of patients receiving assistance in dying from their doctor upon their request. This assistance was given outside any applicable legal framework and without any safeguards.

Negative consequences of the current state of the law:

Assisted dying already takes place underground, without any safeguards. This particularly puts vulnerable people at risk.

Research suggest that legalisation would reduce the rate of assisted deaths in the UK: research conducted in the United States found that the assisted dying rate in Oregon, where assisted dying is legal since 1997, is lower than in any other state: 1 in 250 versus 1 in 10007.

Footnotes

1 Select Committee: Assisted Dying for the Terminally Ill Bill. HL Paper-86. Volume 1 Report.

2 National Council for Hospice and Specialist Palliative Care (now known as the NCPC), http://www.hospice-spc-council.org.uk/publicat.ons/text/euthanas.htm, in 1997: ""universal availability of excellent palliative care services will not and can never eliminate all such rational and persistent requests for euthanasia".We acknowledge that maintaining a legal prohibition on the practice of euthanasia exacts a high price on some individuals who may feel that their autonomy has been unacceptably compromised."; British Medical Association, Medical Ethics Today: The BMA's handbook of ethics and law, 2nd Ed., BMA Publishing GroupMacmillan, 2004; Macmillan Cancer Relief, End of life issues position statement, approved 23 July 2003.

3 Home Office, Homicide victims where the circumstances were described as a mercy killing defined as mercy killing, 2005. 

4 Home Office, Homicide victims where the circumstances were described as a mercy killing defined as mercy killing, 2005. 

5 http://www.dignityindying.org.uk/news/news.asp?id=196 (1998-2005)

6 C. Seale, "National survey of end-of-life decisions made by UK medical practitioners", Palliative Medicine 2006; 20: 3 Â? 10.

7 Tolle SW, Tilden VP, Drach LL, Fromme EK, Perrin NA, Hedberg K, "Characteristics and Proportion of Dying Oregonians Who Personally Consider Physician-Assisted Suicide", JME 2004, 15(2), 111-118.