Respecting choice at the end of life

Today the Suicide Act 1961 is fifty years old. It ended the criminalisation of those who attempted suicide, whilst introducing an offence of assisted suicide, punishable by up to 14 years in prison. A crime that casts a very wide net, and prohibits doctor assisted-dying for terminally ill adults.

We are living, and many people are dying, in the midst of a standoff in end-of-life decision-making. A clear majority of the public supports change to allow terminally ill, mentally competent adults the choice of a doctor assisted death in the last days and weeks of life, as evidenced by a new opinion poll out today (available at www.DignityinDying.org.uk) and countless polls preceding it. Furthermore, the Crown Prosecution Service is understandably reluctant to prosecute those who compassionately assist a loved one to die, supported by prosecuting guidelines published by the Director of Public Prosecutions in 2010. Yet Parliament fails to act, and in doing so turns a blind eye to practice which is at odds with statute.

It is questionable how compassionate this classic British fudge of non-prosecution is. By failing to provide a safeguarded means of assisted dying we tacitly endorse people travelling abroad to die, amateur attempts to end life at home, and the need for many people to turn to friends and family for help to die illegally. Those opposed to a change in the law often argue that legalising assisted dying in limited circumstances would lead to a ‘slippery slope’, but if there is a ‘slippery slope’ we are already descending down it. Laws which are not respected are not enforced. Parliament needs to set out who can be helped to die and in what circumstances.

One answer is to improve access to good quality end-of-life care. However, palliative care can relieve much, but not all, of the suffering that the dying process can cause. As a result, not even the best quality palliative care can negate the need for the safeguarded choice of assisted dying for those who are suffering at the end of their lives and want control over their own death. Existing medical practice and the law allow death to be hastened in the last days and weeks but only via the withdrawal of medical treatment, including artificial foods and fluids. So why do we not also allow dying adults to request help to die from a doctor via a prescription for life-ending medication, subject to up-front safeguards?

Putting to one side the arguments of a vocal minority who fundamentally oppose change in principle (and will pay little heed to what I have to say), there are genuine concerns about public safety. Citing the example of the Netherlands which allows voluntary euthanasia and assisted suicide, it is understandable that some people would be concerned about change. The Dutch law all embracing, allowing doctors to directly end the lives of not only dying adults, but also disabled people who request it. But the Dutch did not slide into such broad legislation – they specifically created a law which would grant the non-terminally ill assistance to die. A better example in terms of the campaign for change in Britain is the American state of Oregon, which has had an assisted dying law for over 13 years – a law which only applies to terminally ill people. Oregon has not widened its law or seen a dramatic increase in the numbers choosing an assisted death. Furthermore there has been no evidence of abuse. After close examination of their neighbouring state’s law, the citizens of Washington state enacted their own assisted dying legislation in 2008. So both Oregon and Washington allow mentally competent adult residents who are terminally ill and expected to die within six months, to self-administer life-ending medication prescribed by a doctor, subject to a range of up-front safeguards.

This is in stark contrast to UK laws which at present attempts to protect people from undue influence by looking for evidence of coercion after someone has died. Family members returning from Switzerland, grieving for the loss of a loved one, often endure months of investigation, with the end result always being the same: a decision not to prosecute. Why put families through this when it would surely make more sense to give full consideration to someone’s request to die while they are still alive, at a point when two doctors (and a psychiatrist if needed) can confirm diagnosis, mental competence and whether or not the dying patient is being coerced.

Regardless of whether one respects other people’s choices at the end of life or not, Parliament will never stop dying people and their loved ones taking matters into their own hands. But what Parliament can do is ensure that dying adults are taking informed decisions of their own free will. And, ultimately, Parliament can change the law to offer dying adults who are suffering unbearably, the choice of an assisted death, at home, surrounded by their loved ones. Changing the law would enable choice at the end of life and offer better protection, fifty years on its time to revisit the Suicide Act.