Should physician assisted suicide / dying be legalised?

September 2009

Head to head debate with Kevin Yuill and Ray Tallis

The question of assisted dying is rarely out of the media spotlight, and whilst the Assisted Dying for the Terminally Ill Bill was blocked by the House of Lords in 2006, a spate of TV dramas and documentary films keep alive the debate about introducing a change to the law to assist terminally ill patients who request the ‘right to die’. The issue has been kept alive with high profile interventions including former Health Secretary Patricia Hewitt’s recent campaign to amend the Coroners and Justice Bill, campaigner Debbie Purdy’s recent legal victory, and Gordon Brown’s announcement that he is firmly opposed to changes proposed.

Proponents of assisted suicide/dying aim to give people the ability to control their destiny. Opponents are concerned that loosening the law would be a slippery slope leading to an increasing prevalence of assisted suicide, opening the door to euthanasia and worry that a change to the law would signal a cultural acceptance of suicide more generally. They emphasise the value of life and argue for a focus on prolonging life or on palliative care, suggesting that legalising assisted suicide would irretrievably transform the relationship between doctors and patients. Advocates of assisted dying retort that legalisation would allow the practice to be publicly regulated and scrutinised. Does the right to die at the time and in the manner that one wishes follow directly from the right to choose how one lives, or should suicide always be discouraged? How does the concept of ‘dignity’ fit in to this discussion? And why has the assisted dying debate come to assume such cultural and political importance in recent years?

The format of discussion will be for each speaker to motivate their preferred arguments for or against changing the law to allow Physician Assisted Suicide, a couple of introductory questions by the chair, Helen Birtwistle, followed by questions and comments by everyone else.

Kevin Yuill's assessment

The case for legalization bears much more scrutiny than most people give it. First, it is unnecessary. Very few, evidence from Oregon shows, will ever want to take up this option. Nor will it give anyone a right that they do not already have; every single one of Dr. Kevorkian’s “patients” had the motor ability to commit suicide unaided. No jury has convicted in a case that clearly involves mercy killing. Physical pain can be generally controlled and every study to date has demonstrated that pain is not the major reason for wanting an assisted suicide.

Second, it is an unwelcome regulatory intervention of the deathbed scene. Ironically, the basic act of mercy that doctors take in an estimated 3000 cases per year – to despatch patients in their last hours or days of suffering – will be threatened by the onerous regulatory apparatus designed to protect the “vulnerable.” There is no need to police the dying process. No doctors today languish in jail for true acts of mercy and focusing the harsh legal spotlight on the final scene will benefit no one.

Third, the case in favour is seriously flawed. It either legitimates all adult suicide (after all, who but the individual should judge what “unbearable suffering” is?) or patronisingly judges whose depression is real and whose should not be recognised.

Finally, it is an important step towards changing our attitude towards suicide. Whereas it is right to tolerate suicide for the good of the botched suicide and those left behind, we are being asked here to approve of the act of self destruction, to validate hopelessness and depression, to give the proverbial man teetering on the bridge a push. Let us treat individual cases with the sympathy they deserve but leave the general disapproval of suicide intact.

Ray Tallis's assessment

The case for legalisation of assisted dying (in which the last act is carried out by the patient) is overwhelming and has been supported over many years by a steady 80% of the population. There could be no clearer example of the right to self-determination than the right to choose assistance in dying when one has a terminal illness, with  a very short life expectancy, and is in a state of unbearable suffering which even the best medical care cannot alleviate. The cruelty of the present law which threatens anyone who assists another to die with a 14 year jail sentence for manslaughter, and results in botched suicides and grim pilgrimages to Dignitas in Switzerland, is acknowledged by juries: there has been not one prosecution of people who have assisted at a 'mercy' killing.

So why is the law opposed, given that proposed legislation has included a multitude of safeguards to protect people against exploitation and pressure and to ensure that the request for assistance in dying is not the result of undiagnosed or untreated psychiatric illness? The case against assisted dying has been based on many claims that, as experience from countries with more liberal legislation has demonstrated, are entirely without foundation. There is no evidence that: universal availability of good palliative care would obviate the need for assisted dying; that legalising assisted dying would stunt the development of palliative care;  that there is 'a slippery slope' leading to involuntary euthanasia of vulnerable people; or that assisted dying would undermine trust between doctor and patient. Surveys from the UK show that the present situation - a clinical, ethical and legal fudge - places patients and doctors at considerable risk. International experience shows that legislation brings benefits to dying patients far beyond the small numbers of people who may avail themselves of assistance in dying.

Suggested background reading:

On the slippery slope argument: Kevin Yuill, "Assisted suicide: the real slippery slope" spiked, 8 September 2009

On the increased regulation issue: Kevin Yuill, "Turning death into a consumer product" spiked, 25 August 2009

On the Euthanasia argument: Kevin Yuill, "Giving the green light to suicide" spiked, 23 June 2009

On the misanthropy of the 'right to die' lobby: Kevin Yuill, "Suicide is a marvellous possibility for humans" spiked, 8 April 2009

On the Debbie Purdy Case: Brendan O'Neill and Debbie Purdy, "Should we all have the right to die?", Big Issue debate, 13-19 August 2009

On Royal College of Nursing's approach: RCN, "Assisted Suicide - An Overview of the Debate", RCN Policy Unit, April 2009

On a Maranatha secular approach: Maranatha Community Group Manchester "Euthanasia and Physician-Assisted Suicide" Maranatha Briefing, September 2003

On the “slippery slope” argument: Battin MP, van der Heide A, Ganzini L, van der Wal G, Onwuteaka-Philipsen BD, “Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in vulnerable groups”, J Med Ethics 2007, 33: 591-597

On palliative care and assisted dying: Bernheim JL, Deschepper R, Distelmans W, Mullie A, Bilsen J, Deliens L, “Development of palliative care and legalisation of euthanasia: antagonism or synergy?” BMJ 2008, 336: 864-867 Ganzini et al, “Oregon Physician’s attitudes about and experiences with end-of-life care since the passage of the Oregon Death with Dignity Act”, JAMA 2001, 285;18, 2363-2369

On the motivations for assistance in dying: Ganzini L, Back A, “From the USA: Understanding requests for physician-assisted death”, Palliat Med 2003, 17(2): 113-114 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

On the problems with the law at present: Dignity in Dying Report, A law out of step, June 2009

Note: This issue is being revisited in a Salon discussion on Monday 20 May - see Assisted Dying