Critical evaluation of Legislation of physician-assisted

suicide in the UK

SHUYUAN YANG (1878685)

Word count 2587

Introduction

Whether physician-assisted suicide (PAS) should be legalized is a disputed but

essential topic in the UK, since it is a classic issue relating to Human Rights and the

UK legal system. While a large proportion of the public prefer it to be decriminalized,

the UK government still opposes its legislation. PAS is defined by various schools of

thought in diverse ways. For Robinson (2012), PAS means “the prescription of lethal

medication given by a doctor under the administration of a patient”. However, to put

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more emphasis on the voluntary nature of a patient’s decision, another definition will

be adopted. This definition is used by the European Association for Palliative Care as

‘a doctor intentionally helping a person to commit suicide by providing drugs for self-

administration, at that person’s voluntary and competent request’.

Most articles in the field of PAS focus on a particular view, but articles which present

arguments from both perspectives are very limited. The aim of this essay is to shed

more light on this controversial topic by putting forward statements from both sides.

This essay would argue that the UK government’s and doctors’ concerns may lack

strong evidence to support, therefore, PAS should be legalized to give back the rights

which originally belong to patients. In the first part, representative opinions and

concerns against the legislation of PAS from the UK doctors as well as governments

will be presented. The second part will present the public attitude to draw a

comparison. In part three, the conflict between UK legislation and the European

Convention of Human Rights will be argued to present the legal ground for legislation

of PAS.

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Part 1 The UK doctor’s and government’s attitude towards PAS

1.1 Attitudes of the UK doctors towards PAS

1. Attitudes from the UK doctors

A research using online databases, key journals, bibliography and other available

sources to analyse attitudes of UK doctors towards PAS was conducted by

McCormack et al. (2011). In this research, combinations of ‘assisted suicide’ or

‘assisted death’ or ‘assisted dying’ were used as keywords to find the relevant

resources. After filtering irrelevant articles, fifteen studies were chosen as the main

data resources. These fifteen studies, using questionnaires as a method to collect data,

included an average number of 735 doctors in each study, with the average response

rate of 54%(29.6-76.8%). The results of all these fifteen studies indicates that a large

proportion of doctors holds an opposite attitude towards legalization of PAS.

However, there are several drawbacks in this research. Firstly, the scale of the

research is limited with an average response rate of 54%. The small size of the dataset

means that it is not possible to draw a conclusion about the full picture of the UK

doctors’ attitude. Another major source of uncertainty is in the uniform definition of

PAS. Just as McCormack et al. (2011), the questionnaires which were used in these

fifteen studies have failed to reach a uniform definition of PAS. As a result, the

respondents might understand PAS in various ways, which probably caused inaccurate

answers and results. Moreover, the questionnaires did not target the respondents

precisely. For example, seven of these studies use GPs’ attitudes as their main data

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resource, which means that not all of the respondents, namely GPs, have experience in

treating patients who are suffering from terminal diseases. The questionnaire would

have been more useful if it had given emphasis to the participants who possess the

experience and knowledge, namely doctors working in intensive care units.

2. Potential influence on UK doctors’ opinion

To figure out what potentially influenced the doctors’ opposing stance towards PAS,

further analysis was carried out by McCormack et al. (2011) in the same research.

Four out of fifteen studies claim that religion may have been an important factor

influencing the doctors’ stance. Three of four show a negative correlation between

degree of religiousness and opposing stance towards PAS. Despite that whether

religious affiliation has an effect on doctors’ attitudes still needs further study.

However, another angle on this debate suggests that the main duty of medical staff is

to cure disease or relieve their suffering. Their first priority is the best interest of the

patients rather than safeguarding their religions, when patients, who have decision-

making capacity, make reasonable requirements that conflict with their personal

interests, like religion. Regarding the legislation of PAS, the influence that religion

exerts on a doctor might hinder the doctors acceptance and application of PAS.

3. UK doctors’ main concerns

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Additionally, three main concerns towards PAS from the opposing doctors were

extracted from the 15 selected studies by McCormack et al. (2011). First is that the

palliative care may be negatively influenced by PAS, which makes it gradually lose its

function. Second is that adequate safeguard procedures relating to PAS need further

enhancement, which means that if PAS is introduced under the previous circumstance,

it might have the possibility to cause adverse consequences, namely ， vulnerable

groups’ involuntary PAS. The third is that ‘acting with the primary intention to hasten

a patient’s death would be difficult to reconcile with the medical ethical principles of

beneficence and non-malificence’ （General Medial Council ）. Nevertheless, many

writers have challenged the third concern, they claim that the medical ethical

principles are not only about securing a patients’ life, but also relieving their pain and

suffering. (Pauline Griffiths, 1999).

Section B The UK government’s attitude towards PAS

1.2.1 previous situation about PAS in the UK law

PAS has been legalized by several countries, namely Switzerland, the Netherlands,

etc. On the contrary, the UK government still seems to take a conservative attitude,

which may judge its stance by the action of rejecting bills to reform the law to allow

PAS. On the top of that, Suicide Act 1961 has encoded the behaviour of “encouraging

or assisting suicide” as a criminal offence. This Act defines assisted suicide as

“aiding, abetting, counselling, or procuring a suicide”. Afterwards, in the Coroner and

Justice Act 2009 the definition of assisted suicide was modified as ‘encoring or

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assisting’. According to the Act, anyone who committed this offence is liable to be

prosecuted (maxim imprisonment is 14 years). When it comes to PAS, the regulation

seems to be more rigid. In 2010, the Director of Public Prosecution (DDP) (England

and Wales) has published new regulations relating to PAS, which is anyone ‘acting in

his or her capacity as a medical doctor, nurse and other healthcare professional

assisting a patient under his or her cares suicide’, will be prosecuted even if these

professionals only provide contact details relating to the organizations which are

capable of supporting PAS (DDP 2010).

1.2.2 The UK government’s first concern (put the vulnerable group at risk)

The current records of parliamentary debate relating to PAS are collected and

analysed by Robinson V (2012). These records identify an interesting viewpoint from

Parliament on PAS.

Robinson (2012) states that the first reason why the parliament is unwilling to legalize

PAS is that it may pose a risk to vulnerable groups. In law, the term ‘vulnerable

groups’ refers to a group of people who are suffering from developmental disable

problems. However, this term is interpreted more widely under the PAS circumstance,

and includes those who are physically disadvantaged or mentally impaired, for

example, people who are old, patients who are suffering from terminal diseases or

people who fail to articulate themselves clearly (Battin et al, 2007). He states that if

PAS is legalized, hastened death may be considered by doctors as the backup plan

instead of treating and saving patients, which will impair the relationship between

doctors and patients. More importantly, those who fail to articulate themselves clearly,

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like the elderly, will have an increased possibility to be involuntarily applied PAS.

Surprisingly, according to another research carried out by Battin et al (2007), this does

not appear to be the case. The research collected the data from relative reports and

studies published by country which have already legalized PAS and compared the

natural death rate of two age groups, which are the people older than 85 (defined by

researchers as vulnerable groups) and the people aged between 18-64. The result

shows that the former age group has a higher natural death rate than the latter age

group.

1.2.3 The UK government’s second concern (hard to detect and evaluate depression)

Robinson (2012) states that the second concern for government lies in the difficulties

to judge whether the patient has a sound mind. Depression may impair a patients’

decision-making ability and it is hard to detect. Its symptoms, like losing sleep, can be

also be caused by different diseases. Therefore, it is a problematic issue to detect

depression among those patients who suffer from terminal diseases. Furthermore, if

depression is detected, it is also very complex to evaluate to what extent depression

can affect a patient’s decision-making ability. For example, according to a study

(Ganzini et al, 2000a), doctors who oppose PAS may have a higher requirement of

mental capacity compared to those who support it. Complex as it seems, other

countries have already found a solution to this problem. Taking Switzerland as an

example, the decision-making ability is not defined specifically by Swiss law, which

means patients who have the ability to make general decisions, like purchasing, are

able to access to PAS.

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Part 2

The UK public’s attitude towards PAS

The UK’s public opinion towards PAS has revealed a stark contrast when compared to

the opinion of the UK doctors and government. To understand the trend of public

support for PAS in the past decades, a research, using data (1983-2012) from the

British Social Attitudes survey, has been carried out by J.E. Cairnes School of

Business and Economics in Ireland. This research included six years’ data, 1983,

1984, 1989, 1994, 2005, and 2012, and covered a total number of 8099 participants.

They were asked, “Suppose a person has a painful incurable disease. Do you think

that doctors should be allowed by law to end the patient's life, if patients request it?”

The answers to the question were “yes”, “no” or “don’t know”. The data showed that

support for PAS is steadily increased from 75.8% to 83.8%. Additionally, to find out

whether there is a correlation between religion and the rising trend, five groups were

divided, which were no religious affiliation, Roman Catholics, Church of England,

other Christians, and non-Christians. A negative correlation was found between

religiousness and support for PAS. Moreover, the data also revealed that the support

of PAS shares the same trend with the increasing proportion of non-religious

affiliation group. The finding of this research suggests that if the increasing

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secularization persists, the rising trend will change the previous UK law and legalize

PAS in the future. If this trend maintains its momentum it is possible to that it might

lead the decriminalisation of PAS by the Parliament or higher courts, because the law

is fruit of the sublimation of public will. However, this conclusion must be read with

caution since it is hard to speculate about the future.

Part 3 dilemma in the UK law system relating to PAS

3.1 The illegalisation of PAS is an infringement of the right to life

It is widely accepted that the right to live is an inherent right that every UK citizen

enjoys whereas under the current UK legal system, this right has, to some extent, been

compromised. To be more specific, there is no obligation to restrain from killing

oneself since committing suicide is no longer a criminal offence after 1961. (SAMIA

A. HURST 2017). Samia states that this modification has a profound implication on

the distinction to which category the right to life belongs. According to “the four

hohfeldian rights”, which means “A has a right to f implies A has no duty not to f”.

For example, patients have the freedom to live, that is, they have no duty to live,

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which means, they are entitled to the right to die. On the other hand, he claims that

this kind of right can not impose any obligations on others, like doctors. Physicians,

using their own professional skills to evaluate and judge the patients’ decision-making

capacity without interference, have the choice to honour or decline the patient request

for PAS.

Samia (2017) also holds the view that Section 2 of the Suicide Act 1961 makes the

right to die, a “naked right” without further secondary regulation to implement this

right. Moreover, there is a conflict in law between the right to die and prohibition of

PAS. Hence suicide is not illegal, which means the patient can decide when and how

to end their life at their own will. But patients who need assistance from doctors to

implement that right will put the doctors without possessing any ‘men area’ relating to

murder or manslaughter under criminal liability. Additionally, according to the UK

Criminal Act, murder or manslaughter means intentionally shorten one’s life

expectancy. However, for the doctors who assist their patients suicide, they do not

shorten their patents’ life expectancy. On the contrary ， they try their best to extent

their patients’ life expectancy although the patients’ body can not sustain their own

life. The only option left to the doctor is to relief the patients’ pain. Similar to the

morphine given by doctors in patients’ final stage. Morphine can also shorten a

patients’ life expectancy, but the doctors won’t be liable for a murder offence because

they give their patients morphine to relief their pain (Pauline Griffiths, 1999).

3.2 Conflict with article 6 of European Convention on Human Rights

In a typical case ， the claimant, called Noel Douglas Conway, requiring increasing

level of assistant because he is suffering from a serious disease which can induce his

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muscles, including his lung’s muscles, to gradually lose his function. Under this

circumstance, he wanted PAS to be carried out and claimed that the Suicide Act 1961

was in contradiction with article 6 of European Convention on Human Rights. He

claimed that under the government power’s interference, patients with the similar

situation may failed to make a decision for their own life. In another case, an almost

totally paralysed woman wants to end her life by refusing food and water. However,

the UK hospital overrode her will and detained her for treatment.

From these two cases above, it is thought that the government may interfere too much

on individuals’ private life, especially on the decisions of the patients who are

suffering from terminal diseases or those who can not end their life by themselves.

Their decisions of ending their own life neither pose a threat to the national security

nor the whole society, which is to say the government should give their more freedom

on their personal matters, even to terminate their life.

Conclusion

This essay has shown that the two representative groups, namely the UK doctors and

the UK government, who oppose to legalize PAS share the same concern about the

safety of a vulnerable group of people affected by this legislation. However, this

concern needs further evidence to support. What’s more, supporting with strong

evidence, this essay has presented that the public support rate for PAS is steadily

rising. Moreover, patients’ right of respect their private life and the right to die have

been restricted by the UK law.

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It is unfortunate the samples which have been collected to corroborate the rising

public support towards PAS are narrow. Additionally, more binding case law is needed

to further demonstrate the dilemma about PAS in the UK legal system.

Notwithstanding these limitations, the study suggests that there is a broad basis and

legal ground to legalize PAS in order to safeguard the patients’ human right. Further

studies should be focus on how to protect PAS from abuse in case it is legalized in the

future.

References

Robinson, V. and Scott, H., 2012. Why assisted suicide must remain illegal in the UK. Nursing
Standard, 26(18).

McCormack, R., Clifford, M. and Conroy, M., 2012. Attitudes of UK doctors towards
euthanasia and physician-assisted suicide: a systematic literature review. Palliative
Medicine, 26(1), pp.23-33.

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Griffiths, P., 1999. Physician-Assisted Suicide and Voluntary Euthanasia: is it time the UK law
caught up?. Nursing ethics, 6(2), pp.107-117.

Suicide Act 1961

Coroner and Justice Act 2009

Hurst, S.A. and Mauron, A., 2017. Assisted suicide in Switzerland: clarifying liberties and
claims. Bioethics, 31(3), pp.199-208.

Battin, M.P., Van der Heide, A., Ganzini, L., Van der Wal, G. and Onwuteaka-Philipsen, B.D.,
2007. Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning
the impact on patients in “vulnerable” groups. Journal of medical ethics, 33(10), pp.591-597.

Ganzini, L., Leong, G.B., Fenn, D.S., Silva, J.A. and Weinstock, R., 2000. Evaluation of
competence to consent to assisted suicide: views of forensic psychiatrists. American Journal
of Psychiatry, 157(4), pp.595-600.

Danyliv, A. and O'Neill, C., 2015. Attitudes towards legalising physician provided euthanasia in
Britain: The role of religion over time. Social Science & Medicine, 128, pp.52-56.

Griffiths, P., 1999. Physician-Assisted Suicide and Voluntary Euthanasia: is it time the UK law
caught up?. Nursing ethics, 6(2), pp.107-117.

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