Assisted Suicide, Dying and Euthanasia

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 by Henry Hayter


euthanasia legal (dark blue), illegal (red), 
passive euthanasia legal (light blue)

The question of assisted suicide and euthanasia is a multifaceted one, not least because of the numerous different types of assisted dying that exist in the world. Assisted dying has been legalised albeit with regulation in some US states and in some states of Australia. Assisted suicide has been practiced in Switzerland since 1942 and currently has no minimum age requirement. Voluntary euthanasia is legal in a number of Euorpean countries such as Belgium, The Netherlands, and Luxembourg. The differences between assisted dying, voluntary euthanasia and assisted suicide are in the details:[1] assisted suicide is the act of `giving assistance to die to people with long term progressive conditions and other people who are not dying, in addition to patients with a terminal illness`, assisted dying is the act of  `prescribing life ending drugs for terminally ill, mentally competent adults to administer themselves after meeting legal safeguards` and voluntary euthanasia is the act of `a doctor directly administering life ending drugs to a patient who has given consent`. Despite these countries having practiced some form of assisted dying for as long as up to 65 + years the United Kingdom still legally prevents a physician from performing any such act without receiving a prison sentence for manslaughter or potentially for murder which would see the physician face charges of up to a life sentence. Despite the practice being illegal in the United Kingdom the question of ethics surrounding the practice is still readily discussed and is deeply complex given the 4 pillars of medicine and the ways in which they are interacted with by the act of assisted dying, suicide or voluntary euthanasia.

Non maleficence is the ethical idea that a physician should in no way bring harm to their patient or to anyone else. This is broken by the idea of assisted dying or its counterparts given that the physician is ending someone's life. This ethical issue is initially easy to understand; however, when placed within the context of other ethical ideas such as autonomy the issue becomes more complex. Strictly following autonomy would lead physicians to carry out assisted dying or its counterparts if requested by a patient who had been deemed competent, however as already mentioned this would contradict the pillar of non maleficence. Further complicating things is the idea of beneficence given that many of the people who qualify for assisted dying or its constituents globally are terminally ill. Therefore, an argument for assisted dying (etc..) to be introduced to the NHS could be made. This is because the treatments for terminal illnesses are often highly expensive and as such an argument of beneficence could be made. If assisted dying was available some people who are diagnosed with a terminal illness may choose assisted dying or one of its constituents and as such the resources that would’ve gone into their treatment could be used elsewhere. This is a very utilitarian idea however, it would allow for resources which can in some cases are scarce within the NHS to be spent elsewhere. A case for the ethics of justice can also be made, justice being the equal treatment of all people no matter their status or wealth. This is because if someone truly wishes to undergo assisted dying or suicide they may travel to one of the afformentioned countries in which the service is practiced. This does however mean that impoverished people, people with physical disability or health conditions preventing or restricting travel abroad are unable to seek the treatment. This therefore demonstrates an inequality in access which calls into question the ethic of justice.

Passive euthanasia is already permitted within the United Kingdom, passive euthanasia is the withdrawal of life sustaining treatment from someone if it has been requested, examples of this are listed by the BBC[2] and include , disconnecting of a feeding tube, withholding of life extending drugs and or surgeries as well as the switching off of life support machines such as a ventilator. While passive euthanasia is legal in the UK the absence of voluntary euthanasia, assisted dying or assisted suicide prevent many people who wish for the service to be available from being able to access it.

The issue has become more relevant than ever in the UK given the introduction of the assisted dying bill[3] into the House of Lords by Baroness Meacher. The bill would resemble a similar structure to the systems employed in Belgium, however, would only be accessible to those over the age of 18 and would only be accessible with the order of the High Court’s family division.  The bill is still in its early stages of debate which raises the question as to whether it will change in content or whether we will see it implemented in the future.

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