In order to critically evaluate Assisted Suicide, it is important to understand the main case Conway v The Secretary of State and others. In the following case, the applicant had MND (Motor Neurone Disease) and had been predicted with six months or less to live, however, he wishes to end his life at the time of his choosing. The applicant had applied for a judicial review to seek a declaration for s.2(1); ‘if the D does an act capable if encouraging or assisting the suicide or attempted suicide of another person, and D’s act was intended to encourage or assist suicide or an attempt at suicide’.
Mr Gordon QC representing the applicant had submitted that s.2 is a blanket ban on the provision of assistance for suicide due to the fact that it interfered with the applicant’s right to respect of his private life under Article 8 ECHR. Article 8 states that ‘everyone has the right to respect for his private and family life, his home and his correspondence’. However, it is important to establish the second section of article 8 as it explains that there would not be any interference by a public authority unless it is to do with the national securities, public securities, for the protection of health and morals and etc.
The court had held that section 2 was compatible with the article 8 due to fact that they have considered everything into account and have stated that it is for the protection of the health and morals of the public. The court had considered ethical issues such as vulnerability, Dignity, respect of autonomy, the effect on elderly and disabled, and also religious belief.
‘As the conscience of the nation parliament is entitled to maintain in place a clear bright line which forbids people from providing assistance to an individual to commit suicide’, Section 2 of the Suicide act helps us understand there has been clear line set to forbid people from providing assistance to an individual to commit suicide. There are situations where a patient may think that this might interfere with their right to respect private life under Article 8 due to the fact that forbidding such important matter would be considered they do not have the power over their own life and as if someone is controlling what they can do and cannot do.
The Doctrine of Double Effect would not be classed as unlawful, this is when the doctor prescribes a pain-relieving drug which results in a speedier death for the patient. In the case of Airedale NHS Trust v Bland, the court held that the duty of care of a patient is owed would be limited by whether the given treatment is in the patient’s best interest. The effect of the giving the patient such medication would shorten their life and this should only be an incidental factor. In contrast R v Cox the defend Dr Cox was convicted with attempt of murder as he gave the patient a lethal amount of potassium chloride which caused the patient to die. The D could not argue that he gave a dangerous amount of KCl in order to reduce the patient’s pain because the drug’s sole effect was to accelerate the patient’s death. This would be considered as equivalent to euthanasia, which is illegal.
The Assisted Dying Bill 2013, the attempt of allowing assisted suicide for terminally ill had been unsuccessfully introduced to the parliament. The principle for this was made by using the Death with Dignity Act model in Oregon. There are some European countries which permits assisted suicide such as Belgium, Switzerland and Netherlands, these countries have been criticised for its liberal approach as they took a turn and looked at assisted suicide in a different way.
According to s1(2) of the ADB intends that if the patient is suffering from an ‘inevitably progressive condition which cannot be reversed by treatment’ and they have been given as 6 months to live then they should be able to receive assistance to end their life. Yet the ADB does not impose an act where the medical professional should provide the fatal drugs to a patient with the intent to cause that person’s death but to be able to make the lethal drug so that the patients can self-administer and ending their own life. The Assisted Dying Bill was put into vote on the 11th of September, where the majority of MP’s had voted again suicide, 330 to 118.
However, Guernsey could be one of the first places in the British Isles to allow assisted suicide, this would be put into vote in May. Gavin St Pier had mentioned that this is done so that it gives people the choice and a sense to have control over themselves rather than feeling out of control. This proposal is restricted to patients who are diagnosed terminally ill, mentally competent and have 6 months or less to live and also that their life should be ended with the doctors helps. They would be following the ‘Oregon Model’ rules which would be easier for them to establish the differences between patients who would be allowed to go ahead with the procedure.
The Oregon’s Death with Dignity Act allows patients who are terminally ill to end their lives through the voluntary self-administration of lethal dose of medication, however they must meet the requirements in order to undergo this procedure. The requirements that they have set up are; must be older than 18 years, a resident of Oregon, capable of making and communication health care decisions for him/herself and must be diagnosed with a terminal illness which allows them to live only under 6 months. The patient must visit and consult the physician, procedure must be reported back to OHA in order to see whether they fit these requirements. According to the DWDA report it shows that 92 physicians wrote 218 prescriptions during 2017.
Similarly, in The Pretty, Diane pretty suffered from MND and she wanted to control the time and manner of her death. However, her physical disabilities did not allow her from taking her life without assistance. Diane’s husband wanted to provide that assistance yet, under section 2 she did not want her husband to be prosecuted, therefore she wanted assurance from the DPP (Director of Public Prosecutions) so that he would not be prosecuted for assisting her. The House of Lords dismissed her claim, she therefore brought a claim to the ECtHR where they held that her rights had not been violated. The claimant had argued that right to life under article 2 expressed a similar right to die but the house of lord had rejected this claim as the right to die would not be classed as a contrast of the right to life but the consequence of it so for that reason the state has a positive responsibility to protect both right to life and death. However, it is clear that Diane’s rights under article 8 were engaged as in respect for the autonomy of an individual.
The Nicklinson’s case consisted three applicants, Nicklinson, Lamb and Martin. According to this case Nicklinson requested for an available defence of necessity and that the current law was incompatible with his article 8, he had also argued that the right of autonomy at the end of life was included. However, the request was unsuccessful and he had refused all foods after the judgement and died shortly after the judgement. However, the court was not bound to decide the Conway case in a particular way by Nicklinson’s decision due to the fact that they both were different concept. Although they both were difference scenario’s it is important to understand in both these cases, the judgement in the Nicklinson’s case mentioned some valuable discussion of the issues.
It is important to consider the pretty case and Nicklinson case in the Conway due to the fact he suffered from the same disease and also because of the fact most people who have been diagnosed with a terminal illness they would consider ending their life. However, it is better to distinguish the difference between who really needs to be assisted with suicide and who is vulnerable to just do it for their family’s sake; so that their family would not be effect emotionally nor financially.
S.2 (4) implies that the consent of the Director of Public Prosecution (DPP) is required before a prosecution can commence. The court tried to use Pretty’s case approach for Purdy’s case however the court of appeal had rejected her claim, but Lord Hope from the House of Lord had mentioned that Purdy was seeking information that she needed so that she can take a decision that affects her private life. LH had also stated that in the Pretty’s case article 8 (1) was engaged but did not engage article 8 (2). The House of lord had held that the DPP should construct a policy which would be available to the public and it would assist them in understanding the factors that would be taken into account when the DPP considering the prosecution.
One of the most important ethical issue that must be considered in favour of euthanasia or assisted suicide would be autonomy. According to John Harris, euthanasia should be permitted not because everyone should agree that it is right but to reject a person control of what must be one of the most significant decision of life is a form of tyranny which line all forms of tyranny is an ultimate denial or respect for persons, however this must be weighed against the interest of the society as a whole. In Re T 1992, it was held that a patient may refuse life sustaining treatments even if that leads to their death however a patient who is suffering from an intolerable terminal condition then they cannot choose to end their life. Reeves v Commissioner of Police metropolis allows us to understand that autonomy includes the rights to choose ways which can cause the person’s death and right to also refuse others to obstruct that choice itself.
Vulnerability would be considered as one of the important reasons why assisted suicide has not been legalised in the UK, people with disability could feel as if they are emotionally or financially burden to their family which may make them want to end their life. There are many disability group who are against the whole idea of making assisted suicide legalised due to vulnerability. This could also be one of the issues that the House of Lords may have considered in Pretty’s Case, although she was mentally aware she was not considered to be categorised as a vulnerable person. As mentioned in Conway the parliament is entitled to regard it as necessary as a protection for the weak and vulnerable.
It is important to understand the pain that the patient is going through can be eased by painkillers however, there is something called dignity which cannot be easily eased using medication. Dignity would be considered as self-respect, patients who suffer from a terminal illness would consider ending their life via assisted suicide because of indignity. Some consider that most patients would want to end their life due to pain but some case pain could be managed whereas dignity cannot. When patients need intimate care after being diagnosed with a terminal illness, such as helping them use the toilet or to shower they consider that as a shame and that they do not have dignity. Unlike Mr Conway each of the claimant from the Nicklinson case did not suffer from MND which was a terminal illness, they wanted to end their life due to the fact that they were living for many years being helpless and needing assistance, which they felt as if it was a burden on their family emotionally and financially. Financially as in the family would need to provide money for medical care which may be a big issue because it is expensive.
The effect on the doctor patient relationship is something which would one of the ethical issues because it would damage the relationship between the doctor and patient. Another issue would be that doctors make a ‘Hippocratic oath’; in this oath, it is clear that if they assist suicide then they would be violating the oath itself. The oath itself means ‘to do no harm’ and the thing that are considered to be a wrong doing would be abortion, euthanasia, sexual abuse and breach of confidentiality. It is important to understand that these ethical rules were made more than 2,000 years ago and the society has changed ever since, abortion would not be classed as a wrong doing if it is done for the right reasons and it is about time to consider whether assisted suicide is actually a threat to the protection of the public.
Another ethical issue that would be approached about would be the effect on the elderly because they may feel as if they have the duty to bound to an opt for euthanasia or assisted suicide if it is to be legalised. They would feel as they are a burden to their family and friends, thus it would be a better decision to consider assisted suicide or euthanasia.
In conclusion, both legal and ethical issues have been addressed in this essay, the legal issues arising with assisted suicide are that it is a criminal offence of assisting suicide under the Suicide Act 1961. Prior to the SA, suicide was still be considered as an offence. The Assisted Dying Bill was introduced in the parliament on 2003 however it was unsuccessful because majority of the MP’s had voted against AS. The ethical issues that were raised for AS would be vulnerability, in respect of autonomy, Death by Dignity and also effects on elderly and disabled.