Should the law permit terminally ill patients to end their lives?![]() “Provided that a person has capacity then the principle of sanctity of life must yield to autonomous self-determination in respect of refusal of life-saving medical treatment. A competent person's refusal must be obeyed even if patently contrary to her own best interests (as objectively assessed) and even if it is plain that an adverse outcome may result...”[1] This essay seeks to examine the law on assisted suicide in England and Wales, as well as a clear analysis of the advantages and disadvantages of introducing legislation where terminally ill individuals are permitted to end their lives; it will ultimately conclude whether or not England and Wales should introduce legislation permitting assisted suicide for terminally ill individuals. Physician Assisted suicide and Euthanasia are two methods in which terminally ill patients can end their lives. Euthanasia is the painless killing of a patient suffering from an incurable and painful disease or an irreversible coma.[2] Euthanasia is regarded as manslaughter or murder and is punishable by law with a maximum penalty of up to life imprisonment.[3] Euthanasia can be seen as ‘mercy killing’. Physician assisted suicide is where a doctor provides lethal drugs to a terminally ill, mentally competent adult, making the choice of their own free will and after meeting with strict legal safeguard, can commit suicide.[4] Assisted suicide is illegal under the terms of the Suicide Act [1961] and is punishable by law with up to 14 years imprisonment.[5] Assisted suicide is seen as encouraging someone to kill themselves. The law in England and Wales is quite inconsistent in terms of Assisted Suicide. In 1961, the Suicide Act (SA [1961]) was passed, S. (1) SA [1961] states that suicide is not a crime,[6] however, a person can be criminally liable for complicity in another person’s suicide if they commit an act capable of encouraging or assisting the suicide or attempted suicide of another person, and their act was intended to encourage or assist suicide, or an attempt at suicide.[7] Inconsistency occurs because S. 2(1)-(1C) of the SA [1961] was substituted for S. (2A) (1.2.2010) by S. 59(2A) Coroners and Justice Act (CJA) 2009 (c. 25) where the law goes into detail that if the defendant arranges for a person to do an act that is capable of encouraging or assisting the suicide or attempted suicide of another person and the person does that act, the defendant is also to be treated as having done it. Where the facts are such that an act is not capable of encouraging or assisting suicide or attempted suicide, for the purposes of CJA [2009] it is to be treated as so capable if the act would have been so capable had the facts been as defendant believed them to be at the time of the act or had subsequent events happened in the manner the defendant believed they would happen (or both). A reference in this Act to a person doing an act that is capable of encouraging the suicide or attempted suicide of another person includes a reference to the person doing so by threatening another person or otherwise putting pressure on another person to commit or attempt suicide.[8] S. 10(1) (2) The CJA [2009] also states that “old offence” means an offence under S. 2(1) of the Suicide Act 1961 as that section had effect before the section 59 commencement date, or an attempt to commit such an offence; and “new offence” means an offence under S. 2(1) SA [1961] as that Act is amended by S. 59 CJA [2009]. Sub-paragraph (3) applies where— a person (“the defendant”) is charged in respect of the same conduct with both an old offence and a new offence, the only thing preventing the defendant from being found guilty of the new offence is the fact that it has not been proved beyond reasonable doubt that the offence was committed wholly after the section 59 commencement date, and the only thing preventing the defendant from being found guilty of the old offence is the fact that it has not been proved beyond reasonable doubt that the offence was committed wholly or partly before the section 59 commencement date.[9] In 2015, Lord Falconers Assisted Dying Bill [2014][10] came to naught due to a lack of time with the impending General Elections in May, 2015 and no progress was made on the Bill. It proposed to permit terminally ill, mentally competent adults to have an assisted death after being approved by two doctors; under the proposal, people with fewer than six months to live could have been prescribed a lethal dose of drugs, which they had to be able to take themselves. The bill was based on the Oregon Death with Dignity Act, which has permitted assisted dying in Oregon since 1997. [11] MP Rob Marris decided to introduce an Assisted Dying Bill [2015][12] based on the law that had been agreed by the House of Lords earlier that year. Unlike in the House of Lords, where regular debates had been held on assisted dying for many years, this was the first ever debate on an assisted dying law and the first vote on the principle since 1997. The Bill was defeated at its Second Reading in 2015 after four hours of debate because despite 118 MPs being in favour, 330 were against.[13] Opening the debate, Mr. Marris said the current law did not meet the needs of the terminally ill, families or the medical profession. He said there were too many "amateur suicides, and people going to Dignitas- to live with dignity, to die with dignity" and it was time for Parliament to debate the issue because "social attitudes have changed". He added that the bill would offer more protection for the living and more choice for the dying and that he was unsure what choice he would make if he was terminally ill, further stating that it would be comforting to know that the choice was available. The ethical argument states that individuals should have a freedom of choice as to how and when they die, and that they should do so with dignity. Life should only be prolonged for as long as the individual believes it is worth living; someone shouldn’t have to endure intolerable pain and if the quality of their life is severely diminished. Diane Pretty, a British woman suffering from motor neurone disease wished to end her life because of the pains and problems she had endured. She stated that she wanted to have a quick death without suffering, at home surrounded by my family. She attempted to change British law by going before the court and using the Human Rights Act 1998 to argue that the Director of Public Prosecutions should legalize assisted suicide. The House of Lords, turned down her case and so did the European Court of Human Rights when she appealed. She stated that she felt as though she had no rights after her appeal failed. She eventually died in May 2002 as her health deteriorated.[14] Another case that portrayed this same view was R (Nicklinson) V Ministry of Justice; R (On The Application of AM) V The Director of Public Prosecutions [2014].[15] The pragmatic argument states that since euthanasia and physician assisted suicide is allegedly currently occurring, society might as well legalize it and ensure that it is adequately regulated. A retired French teacher, Chantal Sebire had been diagnosed with esthesioneuroblastoma, a rare form of cancer in 2000. In February 2008 she made a public appeal to the French President, Nicolas Sarkozy, to permit her to die through euthanasia stating that, “One would not allow an animal to go through what I have endured.” However, on March 17th, 2008 she lost her case. March 19, 2008, she was found dead in her home. An autopsy conducted on March 21, 2008 concluded that she did not die of natural causes. Subsequent blood tests revealed a toxic concentration of the drug pentobarbital, a barbiturate that is not available in French pharmacies but is used elsewhere in the world for the purpose of physician assisted suicide.[16] Fiona Bruce, the MP for Congleton- opposing, said the bill was so completely lacking safeguards for the vulnerable that "if this weren't so serious it would be laughable". She concluded that we are here to protect the most vulnerable in our society, not to legislate to kill them. This bill is not merely flawed, it is legally and ethically totally unacceptable. [17] The Universal Declaration of Human Rights [1948][18] guarantees that all individuals have a right to life, liberty, and security of person. The United Nations’ Convention on the Rights of Persons with Disabilities promotes respect for the inherent dignity of persons with disabilities. The right to life is enshrined in Article 6 of the International Covenant on Civil and Political Rights [1976].[19] It can be said that once government and health care services begin killing their own citizens, a dangerous precedent has been set. The outcome can be identified as a ‘slippery slope’. Legalizing euthanasia and assisted suicide has a range of unforeseen consequences. Legalizing assisted suicide may discourage research into palliative treatments, consequently preventing cures for those with terminally illnesses. Exceedingly ill people, especially the elderly who are in a constant need of care may feel pressured to commit suicide since they may fall as though they are a burden to their family.[20] According to the International Code of Medical Ethics, “A physician shall always bear in mind the obligation to respect human life.” Legalizing assisted suicide therefore violates one of the most important medical ethics. A doctor’s duty is to preserve human life, thus, asking a doctor to do otherwise can in turn damage the ‘doctor-patient’ relationship. Patients may think that their doctor would rather ‘kill them off’ than take responsibility for a complex and challenging case. The repercussions of hastening death on a regular basis can lead to a lack of compassion towards elderly, incapacitated, or terminally ill individuals, also those with complex and challenging health needs can become sceptical towards their doctor’s efforts and intentions.[21] The mere argument of a right to die, simply implies, a duty to kill. The case of Tony Bland is where judges permitted euthanasia. He was caught in the Hillsborough disaster [1989] which caused him to enter a persistent vegetative state. After three years of life support, the hospital with consent of his parents applied for a declaration to discontinue all life sustaining treatment. The declaration was granted under the terms that withdrawal of treatment is seen as an omission, however since there was no duty to act, given that treatment was not in the best interest of the patient and there were no prospects of his health improving.[22] When confronted with the question of whether or not legislation should be granted for assisted suicide we acknowledge Dr Peter Saunders, campaign director of Care Not Killing, he welcomed the rejection of the legislation, saying the current law existed to protect those who were sick, elderly, depressed or disabled. He said that it protects those who have no voice against exploitation and coercion, it acts as a powerful deterrent to would-be abusers and does not need changing. Consequently, as a society, we must commit ourselves to caring better for patients at life's end. Authorizing doctors to assist suicide is a simple, but far more dangerous than a solution. Legalized assisted suicide has an inconsistent impact on incapacitated people, while everyone else receives suicide prevention, those with incapacities, certain ailments, and old individuals, will obtain a ‘fast pass’ because their lives are regarded as less valuable. Assisted suicide speaks of a fundamental reverence for life and the risk of hurling down a slippery slope toward a diminished respect for life. With legislation in the offing, life and dignity is far more important than death.
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9/12/2022 08:19:15 am
The declaration was granted under the terms that withdrawal of treatment is seen as an omission, however since there was no duty to act, given that treatment was not in the best interest of the patient . Thank you for taking the time to write a great post!
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9/12/2022 08:47:23 am
Unlike in the House of Lords, where regular debates had been held on assisted dying for many years, this was the first ever debate on an assisted dying law. I truly appreciate your great post!
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