2024
INTRODUCTION
Physician assisted dying is a term encompassing both assisted suicide and euthanasia. Assisted suicide is the practice of allowing doctors to prescribe life-ending drugs to be administered by individuals who want to die to avoid further suffering. Euthanasia is where someone else – usually a doctor – administers the lethal drug.
The past few decades have seen an international trend of legalising this practice, sometimes for just the terminally ill, sometimes the chronically ill, and sometimes even people whose body is healthy but whose mental illness is so extreme that their suffering is thought to justify the procedure. As this has happened in several liberal societies, many questions have been raised. Can someone ever rationally justify taking their own life, or is it a simple, reasonable choice to make for those who are suffering? What are the wider implications to a society that accepts that sometimes life isn’t worth living? Does the medical profession suffer when the role of the doctor is extended from life-preserver to include life-taker, or is it better that the option to die is put into the hands of professionals?
DEBATE IN CONTEXT
This section provides a summary of the key issues in the debate, set in the context of recent discussions and the competing positions that have been adopted.
Since it was first legalised in Oregon in 1997 [Ref: Guardian], there has been a trend towards legalisation across the liberal world. Since then, countries including Canada, Belgium, Australia, Switzerland and the Netherlands [Ref: The Week] have legalised the practice to varying degrees, and plans are now being pushed forward in Scotland, the Isle of Man and Jersey [Ref:Guardian]. A new Westminster-based inquiry was being carried out in 2023 [Ref: UK Parliament] with the findings yet to be published.
This is not the first attempt for a nationwide legalisation of the practice in the UK. In 2014, Lord Faulkner put forward the Assisted Dying Bill, which passed its first reading in the House of Lords [Ref: BBC] but failed to make it into law. In 2015, a similar bill introduced by MP Rob Maris was defeated in the House of Commons after four hours of debate [Ref: BMJ].
There is evidence to show that the UK public now support assisted dying to a greater extent than they did then, with 84 per cent thinking terminally ill adults believing should be allowed to make that choice, and over half of doctors being unopposed to a law change on assisted dying [Ref: Dignity in Dying]. Amongst UK lawmakers, only 35 per cent of MPs polled by YouGov were in favour of doctor-assisted suicide [Ref: YouGov]. So, does this disconnect between the opinions of public and politicians mean something in the debate is being missed? And, is public support enough to say assisted suicide should be made legal?
Is a life ever worth living?
The central argument of those in favour of legal assisted dying is that people who are suffering unbearably deserve the choice to shorten their suffering. In many people’s eyes, a life with the guarantee that already-unbearable suffering will get worse is not worth living. For many people, it is humane, therefore, to allow people to choose a time to leave the world, and even that it is degrading to disallow it. Most of these people are going to die soon and to force them to live a little longer is to simply subject them to further torture.
Assisted-dying campaigner and television presenter Esther Rantzen told the BBC: ‘The thing that motivates me greatly is having watched the deaths of loved ones around me and seen how memories of a bad death obliterate happy memories and become very painful for those involved.’ [Ref: BBC News]
Defenders of assisted dying argue this is an extension of the liberal ideal of bodily autonomy. In our society, we value the freedom to choose what we do with our bodies during life, so why should we suddenly lose this freedom when it comes to choosing a better death? Even some religious figures back assisted suicide. The late Archbishop Desmond Tutu argued a change in the law would recognise the right of individuals to have ‘autonomy and dignity’ in death [Ref: Guardian].
However, critics maintain that the growing legalisation of assisted dying is part of a more general trend towards the devaluing of human life. Professor Kevin Yuill argues the case for assisted dying is based on unfounded fears about dying, that it will undermine society’s efforts against suicide, and that it is morally wrong. ‘If we are to place value on even the most wretched of human lives – an important marker of civilisation – neither the death penalty or assisted suicide can be justified’ [Ref: The Independent].
In criticising the idea of assisted suicide, Katie Breckenridge also argues ‘in a just society, every human being is expected to believe (and it is just a belief) that all others have basic, inherent, and absolutely equal value and worth’ [Ref: The Scotsman]. Breckenridge argues that assisted suicide is an attack on this idea and pushes the belief that people who need help to ease their suffering are of less moral worth in our society and should therefore be allowed to die. She argues that justice and equality cannot exist when we hold the view that certain individuals have lives that should be ended.
Impaired Judgement and the Pressure Not to be a Burden
Breckenridge’s point leads us onto one of the biggest fears of those against assisted dying: the fear that severely ill individuals will either lack the mental capacity to make a reasoned choice or be pressurised into killing themselves, so as not to inconvenience those immediately around them and wider society in general.
A complicating factor of this is that, while obviously cruel and forthright pressure from relatives can be spotted, the terminally ill with the legal option to die might impose this pressure on themselves. As journalist Giles Fraser argues, ‘my loved ones are never going to accept the relief of their distress as a good enough reason for me to choose assisted suicide’ [Ref: Guardian], but this does not stop people from privately believing it would be better for their loved ones if they chose assisted dying. It is the legislative endorsement of such a method itself that puts this pressure on people to choose assisted dying and who would otherwise live out and make the most of the rest of their lives.
But those defending assisted suicide argue that not wanting to put one’s own family and friends through the trauma of witnessing a prolonged, painful and possibly graphic death can be a valid contributing reason in a dying person’s decision to seek assisted suicide. They point out that, in countries where it is legal, there are already many safeguards in place to stop exploitation. Moreover, how do we decide the validity of someone’s private, reasoned decisions? People make sacrifices for their family and friends all the time so it could be argued that it is condescending to object to this particular sacrifice.
Columnist Matthew Parris is explicit in seeing this as a good thing for society: ‘how are our economies going to pay for the ruinously expensive overhang that dare not speak its name: old age and infirmity? It may sound brutal, but I don’t apologise for the reductivist tone in which this column treats human beings as units — in deficit or surplus to the collective.’ [Ref: The Times]
In fact, they argue, the pain of putting loved ones through this distress can be seen as an addition to the individual’s existing pain. By choosing assisted suicide, someone is not only escaping the pain of their body, but also their mind. As long as safeguards are in place to stop clear external pressure and guilt tripping, many argue there is no reason to ban the practice on the grounds that people will choose it for their own reasons.
The extent to which safeguards are effective is disputed, however. For example, in the Netherlands, one in five of those euthanised (note this is not assisted suicide) have not given explicit consent. In Belgium, involuntary euthanasia is at a three times higher rate than in the Netherlands [Ref: USA National Library of Medicine]. However, defenders of assisted suicide can argue that examples of poor implementation are not an argument against a principle and, even so, these rates are due to the deaths of people in comas and inescapable, near-vegetative states.
Another consideration, argued by both sides of this debate, is how the legalisation of assisted dying might affect palliative care. Those in favour point to evidence that it would enhance palliative care [Ref: Humanists UK], whilst those against argue, if the option to terminate a life is introduced, this will inevitably lead to a decrease in the quality and availability of palliative care options and could lead to a breakdown in the trust between doctors and the public [Ref: BMA].
A Slippery Slope?
Although 84 per cent of the public think the law should be changed to allow assisted suicide for the terminally ill [Ref: Dignity in Dying], detractors of the idea fear it will lead to further relaxation of the law. These people point to the expansion of the practice of assisted dying to the chronically ill and even the depressed, once it has been made legal for the terminally ill [Ref: Al Jazeera].
Adding to this, some worry about the expansion of assisted suicide to children, a group not given the right to make such big personal decisions in other areas of the law. Belgium and the Netherlands are often cited as evidence of this, with the Netherlands planning to legalise euthanasia for children under 12 [Ref: BBC] and Belgium having controversially allowed depressed healthy people to access assisted suicide [Ref: Daily Mail]. Canada has announced plans to allow assisted dying for people suffering only from mental illness from March 2024 [Ref: BBC], although the introduction has been put back to 2027 [Ref: BBC News].
Rather than calling it a slippery slope, Professor Yuill thinks of assisted suicide as a ‘moral Rubicon’ [Ref: The Independent]. From his perspective, the moral line has already been crossed when we allow assisted suicide at all. He argues that once any form of assisted dying is considered as medical treatment for unbearable suffering, it is difficult to deny it to others who suffer unbearably from other causes.
But defenders of physician-assisted suicide push back against this. Columnist Polly Toynbee states that arguments about the uncertainty of where the changes could lead are used inappropriately in this case, because: ‘Everything is a potential slippery slope to somewhere: the law is there to define precisely how far, and no further.’ [Ref: Guardian]
So, would legalising assisted dying fundamentally change the way in which society views death and dying, and does this have negative repercussions for vulnerable groups such as the elderly and disabled? Or is it an important step in recognising the autonomy of the individual, because: ‘any meaningful right to life entails the right to choose how we die’ [Ref: Huffington Post]?
READINGS
FOR
Assisted dying: ‘I don’t have quality of life anymore’ Man with terminal cancer calls for law change
ITV 6 March 2023
Today, 17 people will likely die in unimaginable pain. Here’s how you can help stop that
Polly Toynbee Guardian 19 January 2023
Desmond Tutu: a dignified death is our right – I am in favour of assisted dying
Desmond Tutu Guardian 12 July 2014
The world should follow Belgium’s lead in granting prisoners the right to die
Natasha Lennard Vice 14 September 2014
AGAINST
If every human life is of equal value, why promote assisted suicide?
Katie Breckenridge The Scotsman 9 March 2023
How euthanasia has revived the death penalty
Kevin Yuill spiked 8 March 2023
Doctor-assisted suicide is unethical and dangerous
Ira Byock New York Times 4 September 2015
The slippery slope of assisted dying is real
James Mildred Economist 29August 2018
IN DEPTH
Assisted dying/assisted suicide Inquiry
UK Parliament
MPs to revisit assisted dying with an inquiry next year
Harriet Sherwood Guardian 5 December 2022
Assisted dying inquiry must lead to Government action says poll
Dignity in Dying 19 January 2023
The liberal, humanist case against assisted dying
Kevin Yuill spiked 25 March 2022
Humanists UK calls for a compassionate assisted dying law across the UK and Crown Dependencies
Humanists UK 6 February 2023
Slippery Slope or Wise Demise? The pros and cons Of Medically Assisted Dying
Avivah Wittenberg-Cox Forbes 1 November 2022
Three quarters of Britons support doctor-assisted suicide. Just one in three MPs say the same
Matthew Smith YouGov 4 August 2021
The countries where euthanasia is legal
The Week 22 September 2021
An evidence-based approach to Assisted Dying
Stephen Matthews King’s College London 11 May 2022
20 years of euthanasia in Belgium
ADF International 25 May 2022
Genevieve Lhermitte: Belgian mother who killed her five children euthanised
Jeremy Gahagan BBC News 3 March 2023
How the assisted suicide of a 23-year-old woman created a national scandal in
Sue Reid Daily Mail 17 October 2022
Netherlands backs euthanasia for terminally ill children under-12
BBC News 14 October 2020
One in four Canadians supports euthanasia on grounds of poverty
James Billot UnHerd 9 May 2023
IN THE NEWS
I’m glad the debate on assisted dying is forging ahead. But few understand why it frightens so many
Frances Ryan The Guardian 29 February 2024
Canada seeks to delay assisted dying for people with mental illness
Jessica Murphy BBC News 2 February 2023
Portugal euthanasia: Parliament backs assisted suicide bill
Alison Roberts BBC News 9 December 2022
Assisted dying inquiry likely in early 2023
Humanists UK 28 November 2022
WATCH/LISTEN
How should we talk about suicide?
BBC Moral Maze 24 May 2023
Prue and Danny’s Death Road Trip
Channel 4 16 February 2023
The expansion of assisted suicide in Canada
Al Jazeera 30 November 2022
Exploring the moral quandaries of Canada’s assisted dying law
CNN 27 February 2023