By Nataly Papadopoulou.
As a society and as individuals, we face challenges in dealing with debilitating, horrible diseases causing suffering, indignity, and loss of autonomy. With increased emphasis on individual autonomy in a clinical but also in a legal setting, some patients wish to control the end of their lives. Perhaps one of the most controversial of these control mechanisms is that of assisted suicide.
This is a criminal offence in England and Wales, but prosecutions are rare. The law slowly came to recognise that, in most cases, those who assist do so out of compassion. But police investigations continue for people like Geoffrey Whaley and his wife Ann who assisted her husband to travel to Switzerland to die. Travelling abroad to be assisted in dying is a ‘popular option’ for those who want to retain some control of when and how they die. Dignitas reported that in 1998-2019, Britons hold the second place in ‘accompanied suicides’, while research by Dignity in Dying reports that the average cost is £6,500-£15,000m begging the question of whether this ‘option’ is financially viable, or indeed acceptable.
For some, the obvious option for those who want to retain control would be suicide (an unassisted one). But this is rightly not accepted by many, including campaigner Omid T, as a desirable or acceptable ‘option’. Another ‘option’ is one taken by Debby Purdy and Tony Nicklinson who opted for self-starvation. This is a prolonged exercise involving considerable pain and distress. Others resort to ‘euthanasia kits’ or ‘drugs’ and ‘gas’ without the supervision and care of healthcare professionals, and the protection of legal and procedural safeguards.
These ‘options’ are unacceptable in a society that prioritises individual autonomy.
So, why should we care? Why should we continue to care about a matter that has been so extensively discussed and debated?
Public support for legalization in England and Wales is rising. Medical associations have recently taken active steps to poll their members, and attitudes now seem less divided for the Royal College of Physicians, Royal College of General Practitioners, and British Medical Association. Although a majority remains opposed, the matter is far from settled, while the BMA is planning to discuss results in 2021. Other countries continue to pass legislation. The most recent example is New Zealand, the first to put the question into a referendum during General Elections. Legislation is expected by November 2021. In England and Wales, legalization attempts have failed, while litigants continue to challenge the criminal prohibition. For these reasons, it is time to take a fresh look at the law and practice on assisted suicide. It is time for a new inquiry.
Such inquiries are not new (1994, 2005, 2012). Some, including myself, have until recently doubted whether yet another inquiry would be of much benefit to the debate. However, I am now clear in my view that a new inquiry will keep the debate live. This is supported by key actors in the debate: litigants and their families, campaign groups, 18 Police and Crime Commissioners, some parliamentary debates,and by certain prominent MPs. Asked about the impact of Covid-19 restrictions and travelling abroad for an assisted death, the Secretary of State for Health and Social Care, Matt Hancock in November 2020, also acknowledged the need for a review.
A new governmental inquiry must put at its heart the views of patients, and views of medical bodies (and their members). Patients will voice their concerns and what motivates them to seek assistance, while healthcare professionals will articulate views on the feasibility of such options. It is vital to ask what mechanisms can be put in place to ensure, primarily, the decision-making capacity of patients, an informed decision, and the absence of external influences.
It is time to stop ignoring the pleading of patients who want control by means of assisted suicide. It is time to stop exporting the problem, it is time to give people a choice during the most difficult time of their lives. But is also time to think carefully on how we can best protect all involved. An inquiry is the way forward, and should have at its heart the voices of patients and healthcare professionals. How we die is a matter that concerns us all, and assisted suicide is only one aspect of it. In confronting our mortality, we need also to look at the bigger picture. It is time to think about how best to care about those terminally ill, improve access to mental health services and reduce suicides, and to ensure that quality palliative care remains an option. We need more open conversations about death and dying, we need to record our preferences for when things may go bad, communicating what we value most when pain and suffering takes over. This is one way to create a more compassionate, caring society. How we die is as important as how we live our lives.
Author: Nataly Papadopoulou.
Affiliation: Leicester Law School
Competing interests: None
Social media account of post author: @NPapadopoulou_