FAQs

The term ‘assisted dying’ has no meaning in English law.  It is a euphemism used by campaigners for legal change.  It can mean either physician-assisted suicide or physician-administered euthanasia.  At the time of writing the term ‘assisted dying’ is being used by campaigners for legalisation in England and Wales as meaning physician-assisted suicide for terminally ill people.

Physician-assisted suicide (PAS) would allow a doctor to prescribe or supply lethal drugs to a requesting patient in the knowledge and with the intention that those drugs would be used by the patient to end his or her life.  Physician-administered euthanasia (PAE) would allow a doctor, at the request of a patient, to administer lethal drugs to that patient with the intention of ending the patient’s life.

It is a criminal offence in England and Wales, under Section 2(1) of the 1961 Suicide Act, to encourage or assist the suicide or the attempted suicide of another person.  Anyone convicted of such an offence is liable, on conviction, to imprisonment for a period not exceeding 14 years.

There is no specific criminal offence of euthanasia.  Bringing about the death of another person deliberately, for whatever reason, is regarded as murder, carrying a penalty, on conviction, of life imprisonment.

No. In 1961 the act of committing or attempting to commit suicide was decriminalised, meaning that charges were no longer to be brought against anyone who attempted suicide.

Legalisation of an act implies that, as a society, we approve of it – or at least have no objection to it. It was made clear in Parliament when the 1961 Act was being debated that decriminalisation did not imply that suicide was regarded as acceptable. Society’s attitude to suicide has not changed – it is not something to be encouraged or assisted.

No.

Refusing treatment isn’t the same thing as expressing a suicide wish. Such refusals usually derive from a willingness to let nature take its course without the burden that further treatment may involve. It’s the difference between accepting death and seeking death.

The custodial sentence for which the 1961 Act provides is not automatic. Every case has to be considered on its merits. The judgement as to whether a prosecution is warranted in any individual case is made by the Crown Prosecution Service (CPS). These judgements are guided by a policy which was published in 2010 and which can be accessed online. Prosecutorial discretion is a feature of all criminal laws and there are published prosecution policies covering a range of criminal offences.  Where a decision to prosecute is taken and the defendant is found guilty, the courts have discretion to award a sentence which is appropriate to the circumstances of the offence.

The policy published in February 2010 is intended as a guide to prosecutors considering cases of encouraging or assisting suicide. It makes clear that all acts of encouraging or assisting suicide are unlawful and it describes how decisions are taken on whether or not in individual cases a prosecution is required in the public interest. As part of this, the policy lists 16 circumstances where a prosecution is more likely to be required and 6 circumstances where a prosecution might be less likely. The policy states clearly, however, that “assessing the public interest is not simply a matter of adding up the number of factors on each side and seeing which has the greater number” and that “each case must be considered on its own facts and on its own merits”. It also states that “nothing in this policy can be taken to amount to an assurance that a person will be immune from prosecution if he or she does an act that encourages or assists the suicide or the attempted suicide of another person”.

The law acts as a deterrent. With the serious penalties it holds in reserve to deal with malicious or manipulative assistance, it makes anyone minded to assist a suicide think very carefully indeed before proceeding. The effect of this is both to minimise the number of cases and to ensure that the few cases that do occur are generally those where assistance with suicide has been given reluctantly, after much soul-searching, in response to persistent requests and from genuinely compassionate motives. Such cases are unlikely to call for prosecution and they are not usually prosecuted.

The Royal College of Physicians, the Royal College of General Practitioners, the Royal College of Surgeons and the British Medical Association are opposed to a change in the law to legalise these practices.  In a recent consultation, the findings of which were published in February 2014, 77% of GPs endorsed the position of the Royal College of General Practitioners. The Royal College of Physicians has advised the Director of Public Prosecutions that in its view a doctor’s duty of care for patients “does not include being in any way part of their suicide”. Surveys of medical opinion regularly show that at least two out of three doctors are opposed to a change in the law.  Among doctors who specialise in treatment and care of the dying opposition to legalisation is much higher.

Some are opposed because they consider that licensing doctors to hasten the deaths of seriously-ill patients is not a proper part of medical care and is inconsistent with the ‘do no harm’ principle that underpins clinical practice.  Others – including most of those with day-to-day experience of caring for terminally ill people – are opposed because they know at first hand that seriously ill patients are often vulnerable.

Yes, there would be. But a recent survey indicated that only one in seven GPs would be prepared to consider a request for assisted suicide.  So, with the majority of doctors refusing to participate in such practices, those providing assistance with suicide would in many cases be doctors who had only recently been introduced to the patient and who would have no long-term knowledge of the patient’s susceptibilities – for example, to depression or despair or mood swings. Nor would they have any real knowledge of the patient’s personal or family situation and they would not therefore be well-placed to judge whether there might be any background pressure or other issues which could be influencing the request.

The law applies to doctors as it does to everyone else.  However, the prosecution policy on assisted suicide published by the Crown Prosecution Service in February 2010 makes clear that assistance with suicide will be regarded as aggravated if provided by a medical practitioner, a nurse or another person under whose care the deceased person had been.

The prosecution policy does not encourage any kind of assistance with suicide – it makes clear that any act of encouraging or assisting suicide is a criminal offence. The listing of professional medical involvement as an aggravating consideration reflects the need to protect people who are under the care of others; and it also draws a distinction between one-off acts which are unlikely to be repeated and others which might be seen as a professional service.

It depends at what range the prognosis is being offered. In 2004 the Royal College of General Practitioners told a parliamentary select committee that “it is possible to make reasonably accurate prognoses of death within minutes, hours or a few days” but that “when this stretches to months, then the scope for error can extend into years”. More recently, the self-styled ‘commission on assisted dying’ was told by one leading doctor that prognosis was “fraught with difficulty”.

Any doctor who knowingly hastened a patient’s death would be committing a criminal offence. There are some anonymous surveys of doctors which suggest that there might be a small margin of deaths where doctors may have acted against the law.  Independent research in this field has concluded that the incidence of illegal action of this nature by doctors in Britain is “rare or non-existent”. The self-styled ‘commission on assisted dying’ was told by Professor Clive Seale that “there is a kind of joint quality to decision-making in UK medical practice that is very marked compared to other countries” and that “with that situation decisions don’t go unscrutinised”.

The Liverpool Care Pathway (LCP) is a set of guidelines to guide doctors, nurses and other health care professionals in providing good care for dying patients in the last hours or days of life. It was developed by the Marie Curie Palliative Care Institute in Liverpool as a means of transferring the high standards of end-of-life care found in hospices into hospitals and community health care. It has been in use, both in Britain and in many countries overseas, for the last decade. It does not prescribe treatments or care regimes but prompts doctors and nurses caring for patients who are considered to be close to dying to consider a range of options for maximising comfort and dignity. It is designed to support, but not to replace, clinical judgement.

The allegations which have appeared in some parts of the media have been investigated by an inquiry established by the Government. This concluded that “when the LCP is operated by well-trained, well-resourced and sensitive clinical teams, it works well” but that there have been instances where patients cared for on the LCP were treated with less respect that they deserved and that the LCP may sometimes have used as a tick-box exercise rather than as a guide to good care at the end of life.  The inquiry made a number of recommendations to correction these and other deficiencies.

Doctors aren’t standing in the way of legalisation.  Parliament could license assisted suicide over the heads of doctors if it thought that was appropriate. But it hasn’t thought that. If doctors are to be asked to assess patients for assisted suicide and to supply lethal drugs to them, it’s only right to listen to what they have to say about it. There is an old saying: ‘no decision about me without me’.  

Whenever the Medical Colleges have consulted their members, the answer has been the same – that the majority do not want physician-assisted suicide to le legalised.  The BMA has regularly debated this issue at its annual conferences with the same result.

The law acts as a deterrent. With the serious penalties it holds in reserve to deal with malicious or manipulative assistance, it makes anyone minded to assist a suicide think very carefully indeed before proceeding. The effect of this is both to minimise the number of cases and to ensure that the few cases that do occur are generally those where assistance with suicide has been given reluctantly, after much soul-searching, in response to persistent requests and from genuinely compassionate motives. Such cases are unlikely to call for prosecution and they are not usually prosecuted.

The Westminster Parliament has debated this subject at length on several occasions over the last 10-15 years and, on the three occasions when proposed legislation has been put to a vote, it has firmly rejected it. Most recently, in 2015 the House of Commons rejected Rob Marris MP’s Assisted Dying Bill by 330 votes to 118.  The Scottish Parliament has twice considered bills of this nature in recent years and similarly rejected them, most recently in 2015.

In 2004-05 the House of Lords commissioned an inquiry by a select committee into Lord Joffe’s Assisted Dying for the Terminally Ill Bill.  The sat for none months, during which time it took oral evidence from over 140 expert witnesses in four jurisdictions – the UK, the US State of Oregon, The Netherlands and Switzerland. It considered written evidence from over 60 interested organisations, including the Attorney-General, the Medical Royal Colleges and the British Medical Association; and it received letters and emails from over 12,000 members of the public. The committee’s report and the evidence it received were published and can be accessed online.

The committee had been established to examine a Private Member’s Bill tabled by Lord Joffe. The committee noted that there was unlikely to be sufficient parliamentary time for the bill to proceed. It therefore presented a balanced account of the expert evidence it had received and drew attention to a number of issues which it believed would need to be addressed in any subsequent bill which may be presented to Parliament.

The Hansard records of the debates in Parliament show clearly that most of the concerns expressed about legalisation have related to public safety rather than personal morality.  

It is not Parliament’s role simply to rubber-stamp opinion polls. Opinion polls provide a snapshot of what a sample of the public say they feel about a given issue in response to specific questions at a particular time. Opinion polls can show public support for other controversial issues (on, for example, membership of the European Union, capital punishment or immigration). Law-making has to be conducted with care, especially where, as in this case, there are life-or-death issues involved. Parliament has to take into account the facts and to weigh the evidence. Legalisation of assisted suicide or euthanasia is a highly complex question, covering as it does a wide range of legal, medical, ethical and societal issues. Parliament has had the facts and the evidence presented to it.   Moreover, some of the polls dealing with this subject are commissioned by campaigning groups and can feature misleading data and selective reporting of the results.

Four of the 50 States of the USA – Oregon, Washington, Vermont and California – have passed laws legalising physician-assisted suicide (PAS). In Switzerland, there is no law legalising assistance with suicide, but Swiss law allows for such assistance not to be prosecuted if it can be shown that the assistance was not provided for self-serving reasons. In The Netherlands both PAS and physician-administered euthanasia (PAE) have been legalised. Belgium and Luxembourg have legalised PAE.

In both Oregon and Washington there has been a steadily rising trend in the number of deaths from legalised PAS.  There are also weaknesses in the safeguards put in place.  Most doctors are not willing to participate in helping to end patients’ lives, so applicants have to search out, or to be vectored onto, a minority of physicians willing to participate.  These may not have any knowledge of the applicants beyond the case notes they bring with them.  As such, they are ill-placed to assess their degree of mental competence, vulnerability to mood swings or depression or the presence of personal or family issues in the background to a request. There are, moreover, no post-event audit systems in place to examine how cases are being handled in practice.  The annual reports which appear are largely statistical analyses.  No reports have appeared to date on the working of Vermont’s PAS law.  California’s legislation was passed only in 2015.  In The Netherlands and Belgium the number of cases of legalised assisted suicide and euthanasia has risen sharply and the eligibility criteria of the present laws are being interpreted with considerable elasticity. In Holland there are increasing numbers of people receiving assisted suicide or euthanasia who are suffering from psychiatric problems, while Belgium’s euthanasia law has recently been extended to encompass children. Copies of these documents can be found in the Overseas section of this website.

In Oregon, the death rate from PAS has risen steadily between 1998 (the first complete year of the law’s operation) and 2015, when the number of deaths was more than eight times the number in 1998.  Orgeon’s death rate from PAS in 2015 is the equivalent of nearly 2,000 deaths annually from PAS in England and Wales if we were to have a similar law here.  A similar trend is observable in neighbouring Washington State.  No data are available from Vermont or California.

In The Netherlands the number of deaths from legalised PAE and PAS has risen from 1,882 (in 2002) to 5,306 (in 2014) . In 2014 approximately 1 in 26 of all deaths in The Netherlands was the result of PAE or PAS. Similar rises in euthanasia rates are being seen in neighbouring Belgium.  

To an extent that may be true: a rise in cases can be expected in the immediate wake of legalisation. However, the rising trend in Oregon has continued for 18 years and the annual increases have become greater since 2013.  The rising numbers are also important because they give us an indication of where laws legalising PAS or PAE can lead. Legalisation is usually portrayed by its advocates as likely to affect only a very small number of seriously ill people. The reality is that it affects many more. Oregon’s current death rate from physician-assisted suicide is the equivalent of nearly 2,000 such deaths annually in England and Wales, while Holland’s death rate from PAE and PAS is equivalent to some 19,000 such deaths annually here.

Different jurisdictions have different laws on all sorts of issues. We cannot simply license assisted suicide here in Britain because the practice is legal in another country and some Britons are going there to avail themselves of it. In fact, the number of people from this country who travel to Switzerland to end their lives at the Dignitas suicide facility is very small: in the last ten years around one in every 25,000 deaths of Britons has taken place there.

Legalisation of assisted suicide or euthanasia is a complex issue, transcending many fields of expertise including the law, medicine, ethics, mental health and society.  Opinion polls tell us what a sample of people, who may have little or no knowledge or experience of a subject, think on a particular day and in response to questions posed without a context. Opinion polls favoured going to war in 1914 and appeasement in the 1930s: today they regularly indicate support for such causes as the restoration of the death penalty. Opinion polls can give us interesting snapshots of what people think on specific issues at any particular time, but it is not the job of Parliament simply to rubber-stamp them. Parliament has to look at the wider picture and to focus on the evidence.

Surveys of medical opinion – of the people who know what ‘assisted dying’ actually involves and who would be in the front line of implementing any such law – invariably show opposition to licensing physician-assisted suicide.  In a poll of 1,000 GPs in 2015, for example, only one in seven of respondents said they would be willing to assess an applicant for assisted suicide.

The issue here isn’t about dying, it’s about involving someone else in bringing about our death. There already exists a ‘right to die’: what is being proposed is something different.  In a responsible society our ability to live – and die – as we choose has to take into account the risks that our actions may pose to other people – ie whether giving a minority of individuals what they want would put less resolute and more vulnerable seriously ill people at risk of self-harm.

We are talking here about a law with (literally) life-or-death consequences. The safeguards therefore have to be very stringent indeed. Principal among the defects in the bills we have seen is their failure to make clear what safeguarding system would govern the assessment of requests for assisted suicide. The bills we have seen have contained only vague-worded qualifying criteria with no indication of how any safeguarding system might work.  It is insufficient to say, as these bills have done, that these difficult matters would be addressed by the relevant Whitehall departments after Parliament has agreed to change the law.  Safety is of the essence of any proposal to legalise assisted suicide and Parliament must be able to see what safety system would be in place and to examine its robustness before it takes a decision on whether such practices could be legalised.

The eligibility criteria are that the applicant should be terminally ill (with a six-months-or-less prognosis of life remaining), mentally competent, have a settled wish and make a voluntary request which is not being influenced by others.

Most doctors are familiar with the question: how long have I got?  The answer to that question is likely to be an important ingredient in any decision to request physician-assisted suicide or physician-administered euthanasia.  Yet it’s a question that is impossible to answer with any degree of accuracy at the sort of ranges that are being proposed.  As the Royal College of General Practitioners told the select committee on Lord Joffe’s ‘Assisted Dying for the Terminally Ill’ Bill, at six months range the scope for error can extend into years.  In Oregon, it’s not uncommon for people who have been supplied with lethal drugs on the basis that they had less than six months of life remaining to live for longer before either committing suicide by taking those drugs or dying of natural causes.  How long they might have lived if they hadn’t chosen suicide is impossible to say.  What can be said is that a prognosis which is expressed in terms of months is unreliable as a safeguard.