doctor – Not Dead Yet UK

This is a summary of a report on Assisted Dying compiled for the UK Parliament. Zeynab Al-Khero a researcher for Not Dead Yet UK, contributed to the report.

If you want to read the complete report, click this link Assisted Dying Report

Summary

There is no consensus on which terminology to use when debating the issue of whether people should be legally permitted to seek assistance with ending their lives. A range of terms are used internationally, and the choice of term often reflects underlying views on the debate. The terms used in this briefing are not intended to endorse or reflect any particular stance on the debate about changing the law.

‘Assisted dying’ refers here to the involvement of healthcare professionals in the provision of lethal drugs intended to end a patient’s life at their voluntary request, subject to eligibility criteria and safeguards. It includes healthcare professionals prescribing lethal drugs for the patient to self-administer (‘physician-assisted suicide’) and healthcare professionals administering lethal drugs (‘euthanasia’).

It is an offence (in England and Wales) to assist or encourage another person’s suicide under section 2(1) of the Suicide Act 1961. Euthanasia is illegal across the UK under the Homicide Act 1957 and could be prosecuted as murder or manslaughter.

This POST brief provides a brief overview of assisted dying, including ethical debate and stakeholder opinion. It examines how assisted dying functions within health services in countries where it is a legal option, focusing on jurisdictions where most data are available on outcomes: Belgium, Canada, the Netherlands, Oregon (United States), Switzerland and Victoria (Australia). It also covers evidence and expert opinion on key practical considerations that are raised in the context of assisted dying.

Further information on the criminal law on assisted suicide (a subset of assisted dying), human rights challenges and previous parliamentary activity is provided in the Commons Library briefing on The law on assisted suicide.

Key points

Key ethical debate centres on autonomy and the protection of vulnerable groups. Robust data on UK public perspectives on assisted dying and variations between different groups are limited. Public understanding of the term ‘assisted dying’ is low in the UK, but some recent UK polls and surveys suggest that a majority of the UK public support some form of assisted dying.

Several medical bodies are opposed, while others have moved from opposing assisted dying to a position of neutrality, meaning that they neither support nor oppose a change in UK law.

No medical Royal College has expressed support for changing the law on assisted dying in the UK.

At the time of writing, some form of assisted dying is legal in at least 27 jurisdictions worldwide. Legislation on eligibility and governance of assisted dying varies:

In almost all jurisdictions, it is restricted to adults (including Canada, Oregon, Switzerland and Victoria), while in a few it can also include children with parental consent (including Belgium and the Netherlands).
In some jurisdictions, assisted dying is restricted to people with a terminal illnesses (including Oregon and Victoria). In others, it can also be accessed by those experiencing “constant and unbearable” suffering that cannot be relieved but who are not terminally ill. This can be restricted to suffering arising from serious physical illness only (including Canada until 2023), or also include those whose suffering arises from psychiatric illness (including Belgium, Canada from 2023 and the Netherlands).
In many jurisdictions where it is a legal option, assisted dying is provided as part of the healthcare system; in Switzerland, it is not part of the healthcare system.
Recent official data show that use in different jurisdictions varies. For example, recorded deaths from assisted dying were 0.59% of the total deaths in Oregon in 2021 and 4.2% of the total deaths in the Netherlands in 2019. Research suggests that there is underreporting of assisted dying in some jurisdictions where it is a legal option. Official figures show increasing use over time.Research and stakeholders highlight a range of key practical considerations in the context of assisted dying. Many of these issues are interrelated and are raised in ethical debates:

There are different perspectives on whether it is difficult to prevent incremental extension of legislation and eligibility criteria once assisted dying is legalised and whether this is perceived as a concern or as removing barriers to access.
Determining prognosis of terminal illness can be difficult and there is debate on how to evaluate whether suffering is “constant and unbearable”. For patients with mental disorders, debate also focuses on how to assess whether suffering is irremediable or whether it could be relieved over time.
Assessing patients’ mental capacity for assisted dying requests is complex and can be particularly challenging where the person has psychiatric disorders, such as severe depression, which can impair decision-making capacity. There is also debate on who is best placed to assess capacity and identify potential coercion. The practice of relying on advance directives to authorise euthanasia and the use of assisted dying in those aged under 18 years is controversial.
There are limited empirical data on the impact of assisted dying on vulnerable groups, including older people and people with disabilities, in jurisdictions where it is legal. Available studies do not report evidence that assisted dying has a disproportionate impact on vulnerable groups. However, concerns about potential abuses in some jurisdictions have been reported in academic literature and several studies have called for detailed monitoring of assisted dying practice and further research.

There is debate on whether assisting dying is compatible with the role of healthcare professionals. Research on the effects of their involvement in assisted dying on healthcare professionals in jurisdictions where it is a legal part of healthcare suggests that healthcare professionals have a range of experiences, both positive and negative.
None of the drugs used for assisted dying are approved by a regulatory authority for medicines for a lethal purpose. There is not consensus on the most effective drug or drug combination for ending a human life and specific drugs, doses and monitoring vary.
There is very limited research on the social and cultural impact of legalising assisted dying.
There is debate on whether legalising assisted dying has an adverse or beneficial impact on palliative and end of life care (P&EOLC) resources and services. Evidence is mixed and suggests that the relationship between P&EOLC and assisted dying is varied and that impacts in any jurisdiction may not be the same as in other jurisdictions, even within the same country.

Not Dead Yet UK is determined to resist a change in the law on assisted suicide. We believe that it is not possible to provide adequate safeguards to protect the lives of disabled people. We are also deeply concerned that an alteration in the law would inevitably lead to further changes that would put even more disabled people at risk, the “slippery slope” effect.

By way of example, look at what has happened in the Netherlands. Euthanasia in the Netherlands was legalised in 2001 for mentally competent adults 16+ with unbearable physical pain and no prospect of cure also children aged 12 to 16 with parental consent.

In 2006 the Groeningen protocol enabled euthanasia for infants under one year old with parental consent.

In 2008 unbearable physical pain limitation extended to psychiatric pain.

In 2016 euthanasia for mentally incompetent patients began for dementia patients with an advanced directive.

2016 saw a public debate began about people who lived a complete life and in 2017 a draft law was published for euthanasia on request for people aged 75 and older.

In 2020 a draft law was placed before the Dutch Parliament, which proposed that euthanasia should be available for anyone 55yrs or older. This is also being considered for children under 12yrs who are physically suffering.

In Oregon, USA it has been legal for terminally ill, mentally competent adults to have an “assisted death” since 1997. Dignity in Dying (DiD) formerly the Voluntary Euthanasia Society asserts that “there have been no cases of abuse and the law has not been extended beyond terminally ill adults.

These personal stories beg to differ.

Barbara Wagner Oregon, USA

The 64-year-old woman with lung cancer had been in remission, learned the disease had returned and would likely kill her. Her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay. What the Oregon Health Plan did agree to cover, however, were drugs for physician-assisted death. Those drugs would cost about $50.

“if you want to take the pills, we will help you get that from the doctor, and we will stand there and watch you die. But we won’t give you the medication to live.”

Jeanette Hall Oregon, USA

Diagnosed with cancer in 2000 and told she had six months to a year to live. She knew about the assisted suicide law, and asked her doctor about it, because she didn’t want to suffer. Her doctor encouraged her not to give up, and she decided to fight the disease. She underwent chemotherapy and radiation and 20 years later Jeanette Hall is still alive. “I am so happy to be alive! If my doctor had believed in assisted suicide, I would be dead. Assisted suicide should not be legal”

Kathryn Judson Oregon, USA

She wrote of bringing her seriously ill husband to the doctor in the hope of getting the much-needed help and care he deserves but in a harrowing form of events overheard the Doctor giving her husband a sales pitch for assisted suicide and how much of a burden he must be on his wife.
“I was afraid to leave my husband alone again with doctors and nurses”

Roger Foley Ontario, Canada

Has cerebellar ataxia, a fatal neurological disorder that limits his ability to move his arms and legs. He launched a landmark lawsuit alleging that health officials would not provide him with an assisted home care team of his choosing but instead offered him an assisted death.
“Persons with disabilities have to initiate very lengthy and onerous legal procedures to get their rights recognised,”