One hurdle at a time

Modern medicine has triumphed over many previously incurable and chronic diseases, with an emphasis being placed on palliative medicines. It has given many a dignified death, free from any painful symptoms. Yet many other patients continue to suffer excruciating pain, both physical and emotional, and are unable to bring about their own death unaided.

As Lord Falconer's Assisted Dying Bill (ADB) makes its way through the Lords (now at the committee stage), the question arises as to how our domestic law currently protects these individuals and what changes should be made.

The Assisted Dying Bill

The ADB would enable a terminally ill adult to request assistance to end their own life. In its present draft the Bill requires the adult to be of sound mind when first seeking assistance and, allowing for a statutory cooling off period, when they wish to die. The individual would have to administer the medication themselves, so two independent medical practitioners would need to sign a declaration confirming:

• mental capacity;

• clear and settled intention and no presence of duress or coercion; and

• awareness of the alternative options.

Lord Falconer’s bill has been based upon the US state of Oregon’s Death with Dignity Act, which has been in place for 17 years, although the ADB has more safeguards. The Bill does not seek to legalise voluntary euthanasia.

It does not go as far as Belgium and the Netherlands, where there is no requirement of the adult to be terminally ill. Instead it allows a limited and safeguarded change in law that provides the terminally ill to have a choice over how, where, and to some extent, when they die.

Fear of the ‘slippery slope’

Opponents argue that the acceptance of one standard will open the door to further reform. There are concerns that over time, the law could expand the eligibility criteria or remove the aspect of self-administration. Conversely others argue that the Bill as currently drafted does not go far enough, and fails to provide for those who face decades of suffering through debilitating and life altering illnesses.

Looking at the ramifications since Oregon introduced similar legislation suggests that this is by no means an inevitability. Evidence compiled by the Oregon Health Authority show that, since the introduction of the Act, there has been no attempt to extend the eligibility of the law.

In 2013, out of the annual 30,000 deaths in Oregon, less than 80 were the result of assisted death. More surprisingly, around 40 per cent of those who met the requirements to obtain life-ending medication never actually used it.

Sanctity of human life

It has been observed that virtually every moral code and ethical theory includes the principle of the sanctity of life; the idea that human life has an intrinsic
and innate value and is sacred in its
own right.

Opponents of the Bill concede that while extreme measures to prolong life should not always be taken, but maintain that deliberate steps to end a life should be avoided.

This is countered by the argument that to denying an individual with a terminal illness the right to end their life, fails to acknowledge and respect that person's right to self-determination. To allow people to have this choice is not rejecting the sanctity of life principle, but something that goes hand in hand with it.

Potential for abuse

There is also the worry that the Bill would create a society where the terminally ill are pressurised into ending their lives, for fear of being a financial, emotional or care burden.

The risk of coercion by others who stand to gain from a person's death can not be ignored either. This could potentially promote fear and anxiety among the terminally ill, instead of personal autonomy.

The Bill has clearly divided opinion and created deeply contrasting views, but there is growing consensus that it is a case of when the Bill will be passed, rather than if it will be passed.

Joanna Newton is a family solicitor at TLT solicitors, and Patrick Wooddisse is head of private practice at the firm