The only absolute certainty in life is the inevitability of death. Except for those who commit suicide, driven by depression, delusion, disease, drugs (including alcohol), or depraved beliefs, most people choose to die involuntarily, without prior knowledge of the time and place of their demise. There are, however, a small number of terminally ill people, known to be dying from incurable conditions, who voluntarily, and reportedly without coercion, accept lethal medication to end their lives before natural death ensues, claiming intolerable physical and psychological suffering.
The Assisted Dying in England and Wales Bill was introduced in the House of Lords by Baroness Meacher, a crossbench peer, as a Private Member’s Bill on 26 May 2021. The Bill is designed to allow dying adults in England and Wales, deemed to be of sound mind, to request assistance to die when they have six months or less to live and their last days have become intolerable. This request would then have to be approved by two independent doctors and a High Court Judge before receiving the go-ahead. The Bill was passed unopposed at its Second Reading on 22 October, allowing it to move on to the Committee Stage. The last Assisted Dying Bill in the House of Lords was sponsored by Lord Falconer and had its Second Reading on 18 July 2014. Despite further debates in November 2014 and January 2015, that Bill was not taken forward. A subsequent Private Member’s Bill, sponsored by Rob Marris, a Labour MP, was rejected in September 2015 by the House of Commons, by 330 votes against to 118 in favour.
Assistance with death has been allowed in Switzerland since 1942. The Dignitas clinic was founded in May 1998 by Ludwig Minelli, a human rights lawyer, and has become the favoured destination for British citizens seeking an assisted death. It is estimated that around fifty people go to Switzerland each year as ‘death tourists’, despite the risk of prosecution for any accompanying and complicit persons. Since the Swiss initiative, physician-assisted dying (PAD) has been legalised in Victoria (Australia), Belgium, Canada, Colombia, Luxembourg, the Netherlands, and ten American states (including Oregon) along with Washington DC, and more recently in New Zealand, Spain, and four more states in Australia (Queensland, South Australia, Tasmania, Western Australia).
It is important to distinguish between assisted dying, which applies to terminally ill adults, from assisted suicide, which is offered as an option for people with long-term progressive conditions who are not about to die naturally, and voluntary euthanasia, which applies to anyone, irrespective of health status, who has consented to receive lethal drugs to end his or her life.
The question of physician-assisted dying (PAD) is highly controversial and generates diametrically opposed views. A belief in the sanctity of life and a fear that PAD marks the start of the erosion of safeguards against the unjust taking of life conflicts with the views of those who believe in autonomy and freedom of choice at the end of life. Past experiences of involuntary euthanasia, such as in Nazi Germany, which targeted defenceless members of society are often cited as reasons not to accept voluntary PAD. Fears are often raised that value judgements may be made about vulnerable people, including those with dementia or disability, who are deemed to be a burden on society and then coerced to accept a form of involuntary PAD. Certain religious faiths are particularly opposed to PAD, including the Anglican and Roman Catholic churches, Orthodox Jews, and some sects of Islam, based on the belief that the moment of death can only be divinely ordained.
The medical profession itself remains divided over the matter of PAD, with many believing that it contravenes the Hippocratic oath and the mandate to preserve life whenever possible. Palliative care doctors, as well as the British Medical Association (BMA) and the Royal College of General Practitioners (RCGP) have consistently opposed the legalisation of PAD, although views are changing. Most recently, at its annual representative meeting on 14 September 2021, thee BMA narrowly decided in favour of adopting a neutral position on PAD. Assisted dying particularly conflicts with the ethos of palliative care medicine, whose practitioners do not accept the premise that palliative care cannot successfully relieve distressing symptoms in a small number of patients. Some royal colleges and specialist associations have stayed opposed or neutral, while others have yet to clearly state their position on PAD.
There is, however, growing public support for legalisation of PAD in the UK, with 73 per cent of British people supporting the proposal in a YouGov poll in August 2021. Members of the public have been joined by several religious leaders, most notably George Carey, former Archbishop of Canterbury (1991-2001) and Rabbi Jonathan Romain, minister of Maidenhead Synagogue, in their support for PAD. The Religious Alliance for Dignity in Dying has brought together representatives of various Christian churches, as well as Liberal and Reform rabbis, to support measures to relieve intolerable suffering, without contradicting an overriding belief in the sanctity of life.
Assisted dying is a choice that applies to only a very small number of people, and by no means undermines the role of palliative care, which is the correct option for the vast majority of dying adults. It seems appropriates that mentally competent adults with terminal illnesses and an irretrievably poor quality of life should be given the option to end their lives in a dignified manner, as of their own choice and dependent on their specific circumstances. It is now up to the UK Parliament to decide what they consider to in the best interests of the citizens of England and Wales.
Ashis Banerjee