3 Assisted dying

Figure 6 The debate on assisted dying is polarised and often features in the news media.

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Two images of sticker badges that people wear either to demonstrate their support or opposition for assisted dying. One reads ‘My life. My death. My choice.’ And the other picture includes the badges ‘Got second thoughts?’ and ‘Assist Hope, not suicide’.

Figure 6 The debate on assisted dying is polarised and often features in the news media.

Assisted dying is currently not a feature of end-of-life care policy in the UK. The assisted dying debate is one that continues to divide opinions and is now regularly debated within the courts and parliaments. In countries that do allow it, it is offered alongside palliative and end-of-life care (e.g. the Netherlands).

Figure 7 In 2002, Terminally ill Diane Pretty (here with her husband Brian) lost her petition for her right to die. She took this to the European Court of Human Rights but the petition was denied.

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An image of a smiling Diane Pretty accompanied by her husband Brian, in front of a background which outlines the URL to their campaign website for the right to die: www.justice4Diane.org.

Figure 7 In 2002, Terminally ill Diane Pretty (here with her husband Brian) lost her petition for her right to die. She took this to the ...

Some people argue that if end-of-life care was better, people would then not want assisted dying because their pain and other symptoms, including psychological and social, would be managed. Others argue that even with such holistic care, some individuals may wish to choose when and how they die. However, research suggests that requests for assisted dying or euthanasia actually increase among people receiving hospice (i.e. end-of-life) care (Chapple et al., 2006; Lawton, 2000; Seale and Addington-Hall, 1995). A number of reasons for this have been suggested, including the greater openness of expression encouraged in hospices, the distress of witnessing other people’s deaths and wanting to avoid a similar experience, and the wish to remain physically independent and ‘in control’ (Chapple et al., 2006). In countries where assisted dying is legal, there is some evidence to suggest that not everyone who requests assisted dying follows through with the act (Warnes, 2014).

Before you look into the reasons for and against assisted dying in more detail, it is useful to understand the range of terminology that is used within this topic. As with end-of-life care, there are several terms used to describe a range of subtle differences. This is explained in Figure 8.

Figure 8 Different terminology relating to dying and end-of-life care.

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This is an infographic, displaying the following text:

• Assisted dying –someone who is dying or has a terminal condition is helped to die earlier by another person and through other means (i.e. their death is not caused by their disease).
• Assisted suicide – the person who dies administers the means of death to themselves but is helped by another person (e.g. acquire the drug needed). The person who dies may not have had a terminal condition prior to the suicide.
• Euthanasia - death is brought about for the sake of the dying person, because it is thought to be in their best interests, and the means of bringing about death are administered by someone other than the dying person. The word euthanasia is derived from a Greek term for ‘good death’ or ‘well death’ (i.e. dying well).
• Involuntary euthanasia - euthanasia on a person who would be able to provide informed consent, but does not, either because they do not want to die, or because they were not asked.
• Voluntary euthanasia- euthanasia on a person who has consented to it. The means of bringing about death are administered by someone other than the dying person.
• Passive euthanasia– when death is brought about by an omission (i.e. when someone lets someone die)

Figure 8 Different terminology relating to dying and end-of-life care.

Note how there are differences in these terms about who does the action, the intention of the action, and if the person who dies had a choice about the matter. In the media, there are often debates around legalising assisted dying. For example, assisted dying may be seen to some as more ethically defensible than prolonging a slow or painful death. Also some believe that it is an individual’s right to choose their death (personal autonomy) and achieve the death that they want at a time that they want which might allow them to have a dignified death (Rodgers, Booth, Norman, & Sowden, 2016). The debate about the right to die is often covered in the news media, such as when Paul Lamb (who was a paralysed former builder) and Jane Nicklinson (a widow of a man who had locked-in syndrome) lost their legal fight to allow disabled people the right to die. This issue was covered and reported in the news (ITV News. Hope remains despite Supreme Court rejection of right to die campaign, 2014). In the entertainment media, the UK TV drama Coronation Street has also included a storyline in which a long-standing character, Hayley Cropper, die in an assisted suicide (ITV News, Coronation Street shows controversial right to die scene, 2014).

In the next activity, you will be asked to watch a video featuring Actress and Activist Liz Carr who is speaking against legalising assisted dying.

Activity 3 A case against legalising assisted dying

Timing: Allow approximately 30 minutes.

Watch this video featuring British actress Liz Carr describe why she opposes legalising assisted dying:

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Transcript: Video 4

[TEXT ON SCREEN: Liz Carr talks to Tasmania about Euthanasia]

LIZ CARR

Hi. I'm Liz Carr. I'm an actor, a comedian, a disability rights activist, and I'm also a disabled person who opposes the legalisation of assisted suicide and euthanasia. And this is a message from me, here in Melbourne at the Melbourne International Comedy Festival, to all of my friends, all of our friends, Down Under.

Really, it's a message to implore you to be incredibly cautious about introducing medically or physician-assisted suicide into your state or your country. It's a scary thing for disabled people. Why? Many people say this has got nothing to do with disability. This is about mentally competent terminally ill people only.

But you know what? There is such a fine line between terminal illness and disability, both medically and in public perception, that we become one and the same. And that means then that assisted suicide is seen by the public, by the medical profession, as a compassionate, a rational solution even, to the problems of anyone who is ill and disabled.

We've discovered this in the UK, where in 2015, our Parliament got to debate for the first time in 16 years whether we should introduce this into our country. Now, it was a hard-fought-over law, first debated in the Lords, then debated in the Commons. Ultimately, the vote went this way: 330 MPs of all persuasions voted to oppose legalising physician-assisted suicide. Only 118 supported it.

Because ultimately, there is no proof - no proof - from the jurisdictions where it's been legalised, that vulnerable people, that people at risk, that the silent voices, the more silent voices of older, disabled and ill people will be heard and will be protected, or will not be protected, through these laws. And that's the thing - do we introduce a law for the benefit of the few at the risk to the many? We can't do that.

Most countries do not have capital punishment. Because even after a court case, investigations, there were miscarriages of justice. Now, we're talking about two doctors and a checklist deciding on whether somebody should be helped to end their life. That said, those same doctors will assess the person. Those same doctors will evaluate it afterwards.

It's no wonder that in the countries where it's been legalised, there's very little feedback on what actually happens. Because the same doctors that do it are the same doctors that feed back.

Anything can happen in that doctor's waiting room and that doctor's consultation room. And I'm not saying that doctors are bad people. Hell, I wouldn't be alive here. I love the medical profession. But the British Medical Association, the Australian Medical Association, do not support assisted suicide. And these are the people which will be licenced to help you to end your life, the very people.

So look, at a time where there are increasing pressures and cuts financially and rationing in terms of social care, and welfare, and health care for many different people, is this the right time to be introducing medically assisted suicide onto the menu of treatment options in your state or country? No.

And you know what? As long as we value certain lives differently - and we do - we value the lives of disabled and ill people and those who have greater dependence - we value those lives less. And as long as that's true, and as long as that's happening, we cannot enshrine that inequality in a law.

End transcript: Video 4

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Video 4

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Make a few notes about what problems or issues Liz Carr thinks that legalising assisted dying might raise.

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Discussion

Liz Carr argues that there is often a fine line between what people consider terminal illness and disability and that legalising forms of assisted dying may mean that people who are disabled may inadvertently be subject to subtle or direct coercion. Liz raises many points, including how there is no evidence to assure vulnerable people (older and disabled people) that their voices will be heard if assisted dying was legal. There is little or no evidence about how this is done successfully in places which have already legalised some forms of assisted dying. Liz highlights that assisted dying offers benefit for the few but is a risk to many (vulnerable) people. Liz also explains that in the cases of physician-assisted deaths, it is often the same doctors who assess the patient, who will carry out and evaluate whether the death was a good death – which doesn’t allow for much oversight. You may have written down other points.