3.1 Assisted dying legislation and policy
Should individuals have the right to an assisted death? This question is central to debates about voluntary euthanasia and assisted suicide (both of which are forms of assisted dying). There are some situations where a dying person might conclude that theirs is a life ‘worth not living’. Arguably, only the person who is living that life can decide on its value to them, but they might not be able to end their life without assistance from someone else or they might be afraid of surviving the suicide attempt and end up worse off. On some occasions, the help of a relative or friend might be sought, while, on others, help might be requested from doctors involved in caring for the dying person.
At the time of writing (2018), health professionals, relatives and other people who help a dying person to end their own life in the UK run a serious risk of being prosecuted, but it is up to the discretion of the courts when the case is judged. Under the UK’s Suicide Act 1961, anyone who ‘aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide’ commits an offence and may be sentenced to up to 14 years in prison. People assisting in suicide can also be charged with attempted murder under certain circumstances (Fox, McHale & Murphy, 1997). When assisted suicide is alleged, the evidence that is available about the beliefs and intentions of the alleged ‘assistant’ is crucially important and is often what determines the outcome.
The case of Eleanor Samra
To understand the implications of this, here is a fictitious example.
Eleanor Samra lives with her daughter, Judith. Eleanor is virtually bedridden because of leg injuries sustained during recent falls. She also has bowel cancer which, her doctors say, will cause her to die quite soon. Although well cared for, she is understandably very unhappy and has, on several occasions, said to Judith (and to her other carers) that she doesn’t see any point in carrying on living, that she ‘feels like a burden’ and wishes that they’d ‘end it for her’. One evening, Eleanor asks Judith to get a box for her from the back of the wardrobe. While getting it out, Judith drops the box. The lid falls off, revealing several bottles of pills. On closer inspection, these turn out to be sleeping pills, which Eleanor – it seems – has been hoarding for some considerable time. Judith’s initial response is to throw the pills away. But after a lengthy and painful discussion with her mother, she is persuaded to leave the box on the bedside table, so that Eleanor can reach the pills easily and take them whenever she feels ready. Later that evening Eleanor takes a large overdose of the pills and dies in her sleep. In theory, Judith has probably broken the law, because she knew that her mother was contemplating suicide, knew that the pills would help her to kill herself, and intended the pills to help her mother’s suicide attempt. Successfully prosecuting Judith, however, might prove difficult in practice because of a lack of evidence. When similar cases have been brought to court, they have not necessarily attracted long sentences and have challenged the definition of ‘mercy killing’.
Carers and family members can come under very intense emotional pressure as a result of the distress and physical pain that they witness. The legislation acts as a means of protection for carers of dying people and also protects dying people from involuntary euthanasia. Moreover, legislation acts to protect people who may not be able to protect themselves. John Keown notes that, internationally, the main obstacle to legalising assisted dying, even if considered morally acceptable in some cases, is that it may be difficult to control (Keown, 2002). This is sometimes called the slippery slope argument, suggesting that once a practice is started for some people, it may begin to be used for other people who it was originally not intended for. This is of particular concern where consent (e.g. involuntary euthanasia) is not required or where there is the risk that someone may be pressured into opting for assisted dying. In the next activity, you will consider the slippery slope argument and your perspective on assisted dying.
Activity 4 The slippery slope
Part A
Look at Figure 9 below representing the slippery slope argument. Using the slider button, choose a location on that slope that you think is appropriate for policy to take. For example, you may believe assisted dying should not be allowed at all (far left) or that it should be allowed for someone who is disabled.
After you have made your selection, note down why you have placed your marker on that position of the slope. To aid your reflection, consider the following questions:
- What did you consider in making your decision?
- Do you think you may ever change your mind? Why or why not?
- What implications do you think your position has for how you view end-of-life care?
Discussion
Someone who previously completed this task marked that they would allow assisted dying for terminally ill people, but no one else. Here is a section of their reflections:
I think if a person is dying anyway, like within the next year, they should have a say about how much suffering they endure before death. Even with good end-of-life care, people may not wish to have pain (either physical or emotional) and their life is limited anyway. I realise this decision impacts others (like their family) and is not one to be taken lightly. I previously believed no one should have the ability to end their life when they wanted to, but having spoken to people who want to be able to die earlier and why they feel this way, I can sympathise with this. However, I think there needs to be very clear and strict safeguards in place, which I realise can be difficult to do legally, to protect others from being ‘forced to die’. We all value life differently but I don’t think others should be able to end someone’s life without their permission.
I think my position makes me realise that even if end-of-life care is really good, it still might not be enough for some people. One solution does not fit all. But this doesn’t mean that people who want assisted dying should not have access to good end-of-life care. I am not sure if I think assisted dying should formally be part of end-of-life care or something that is alongside of it.
The response above is just an example of one perspective on assisted dying. People will have different opinions about what policy should be about assisted dying. This will be influenced by their own beliefs about life and death, about the ethics and values that they believe in, and their own personal experiences.
While people will have differing viewpoints, the role of policy is to find a position that can be applied for the whole population. The current stance about assisted dying policy in the UK is one that promotes the ethical principle of ‘do no harm’ over personal autonomy.