A grey area for UK medics

Doctors could be given the right to be able to help terminally-ill people to die, a British report said.

Adults who are likely to have less than a year left to live could be given the chance to ask their doctor for a dose of medication that would end their life, the year-long Commission on Assisted Dying said.

But stringent safeguards must be in place to protect those who might not have the mental capacity to make such a choice, or who might be clinical depressed or experiencing pressure from friends or relatives.

The commission, chaired by former Lord Chancellor Lord Falconer, said that, under their proposals, a terminally-ill person would need to be able to take the medication themselves, as a clear sign their actions were voluntary.

The findings will anger campaigners against a change in the law, who have warned that it would risk increasing the pressure on vulnerable people to end their lives out of fear they might become a burden for others.

It could lead to around 13,000 deaths a year, the Care Not Killing alliance said.

Since new guidelines for prosecutors in assisted suicide cases were brought in in February 2010, anyone acting with compassion to help end the life of someone who has decided they cannot go on is unlikely to face criminal charges.

But assisted suicide remains a criminal offence in England and Wales, punishable by up to 14 years in prison, and individual decisions on prosecution will be made on the circumstances in each case.

The commission called for Parliament to consider developing a new legal framework for assisted dying, saying that the “current legal status of assisted suicide is inadequate, incoherent and should not continue”.

It also called for more choice in how people die.

But one member of the 11-strong commission, the Reverend Canon Dr James Woodward, said he was unable to back its majority decision, saying it was not the right time to consider changing the law until a greater ethical, moral and social consensus had been generated on the issue.

Under the proposals, the process would involve the assessment, advice, support and independent judgements of two independent doctors, with support from other health and social care professionals where necessary.

Safeguards would also be built in to ensure the eligibility criteria were met, that the person had a “settled intention” to die, and that he or she had a reliable and supported assisted death.

Other measures would be put in place to ensure the eligibility criteria were met, that the assisted deaths were reported correctly and that the lethal medication was stored and transported safely.

In September it emerged that of more than 40 cases considered by prosecutors since the new guidelines were brought in by the director of public prosecutions Keir Starmer QC, no one has been prosecuted.

Supporters of a change in the law say the guidelines are simply not enough, but critics warn that prosecutors risk creating “legalisation by stealth”, which could “encourage more abuse and place vulnerable sick, disabled and elderly people at much greater risk”.

In 2006, David Cameron signalled his opposition to changing the law on assisted suicide in a letter to pro-life campaigners.

But MPs would expect to be given a free vote if the issue comes before Parliament.

Last month, a British woman who travelled to Switzerland to die condemned the “cowardice of politicians” which forced her to spend her last hours away from home.

Former TV producer Geraldine McClelland, 61, who was diagnosed with both lung and liver cancer, hit out in a letter published just hours after her death at the Dignitas clinic in Zurich on December 7.

The commission, which also includes the Tory MP Penny Mordaunt and Dr Carole Dacombe from St Peter’s Hospice, was set up by think tank Demos.

It has taken evidence from legal, medical and religious experts, and people with personal experience – such as Alan Cutkelvin Rees, who helped his partner Raymond Cutkelvin to travel to the Dignitas clinic in Switzerland to die in 2007, and Debbie Purdy, who has multiple sclerosis and has campaigned to know if her husband will be charged if he helps her travel to Dignitas.

A Ministry of Justice spokesman said: “The government believes that any change to the law in this emotive and contentious area is an issue of individual conscience and a matter for Parliament to decide rather than government policy.” Lord Falconer told the BBC Radio 4 Today programme: “I don’t think you can ever have a system that is completely water tight.

“We therefore looked at the current system where there is no check on whether or not you are really terminally ill.

The Church of England also criticised the commission for failing to appoint any members with a known objection to assisted suicide.

The Bishop of Carlisle, the Reverend James Newcome, said: “The commission undertook a quest to find effective safeguards that could be put in place to avoid abuse of any new law legitimising assisted suicide. Unsurprisingly, given the commission’s composition, it has claimed to have found such safeguards.”

But the bishop, who leads on health’care issues for the Church, said he was “unconvinced” by the commission’s report, saying it had “singularly failed to demonstrate that vulnerable people are not placed at greater risk under its proposals than is currently the case under present legislation”.

“Put simply, the most effective safeguard against abuse is to leave the law as it is,” he said.

“What Lord Falconer has done is to argue that it is morally acceptable to put many vulnerable people at increased risk so that the aspirations of a small number of individuals, to control the time, place and means of their deaths, might be met. Such a calculus of risk is unnecessary and wholly unacceptable.”

But Rabbi Jonathan Romain, a minister at Maidenhead Synagogue who was previously opposed to assisted dying, said he had changed his mind because he had “too often seen people spend their last weeks suffering in pain or sedated into oblivion”.

“Moreover, as someone who values the sanctity of life, I hold that we honour both God’s love and the terminally ill who want to depart with dignity by allowing them to do so rather than be reduced to departing in agony in the name of a warped understanding of faith,” he said.

“The accusation by some that assisted dying is ‘playing God’ is actually a compliment: We are constantly using our God-given abilities to overturn nature, whether it be intervening to save a premature baby or carrying out heart transplants for mature adults; reducing the pain and distress of death is equally appropriate and is nothing other than a religious response.”

A separate poll by the social policy charity Care found that almost half of the 1,000 people surveyed felt some people would feel pressurised into killing themselves if the suicide option was made legal.

Classification of euthanasia and where it is legal

Euthanasia may be classified according to whether a person gives informed consent into three types: voluntary, non-voluntary and involuntary.

There is a debate within the medical and bioethics literature about whether or not the non-voluntary (and by extension, involuntary) killing of patients can be regarded as euthanasia, irrespective of intent or the patient’s circumstances.

• Euthanasia conducted with the consent of the patient is termed voluntary euthanasia. Active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands. Passive voluntary euthanasia is legal throughout the US.

• When the patient brings about his or her own death with the assistance of a physician, the term “assisted suicide” is often used instead. Assisted suicide is legal in Switzerland and the US states of Oregon, Washington and Montana.

• Euthanasia conducted where the consent of the patient is unavailable is termed non-voluntary euthanasia. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.

• Euthanasia conducted against the will of the patient is termed involuntary euthanasia.

Procedural decision

Voluntary, non-voluntary and involuntary euthanasia can all be further divided into passive or active variants.

• Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life.

• Active euthanasia entails the use of lethal substances or forces, such as administering a lethal injection, to kill and is the most controversial means.