Many health professionals are not comfortable with the implications of assisted dying. Neil Grant warns legislators to be cautious when considering the bill

Medical tray with syringe, pills and water

If enacted, the Assisted Dying Bill would give doctors the ability to prescribe a lethal dose of medication to patients deemed to have less than six months to live.

The bill contains a number of safeguards designed to prevent abuse of the system.

The major ones are:

  • two doctors - independent from each other - must both countersign the patient’s declaration to end their life;
  • both doctors must be satisfied that the patient has the capacity to make the decision to die; and
  • both doctors must be satisfied that the patient has made the decision to die voluntarily and without coercion.

Assisted dying laws around the world

The bill is based largely on a law in Oregon: the Death with Dignity Act 1997, which allows terminally ill patients with less than six months to live deemed mentally competent to request a prescription for life ending medication.

While Lord Falconer’s Assisted Dying Bill is based largely on this act, Oregon is not the only place in the world with this type of law. Indeed, there are a number of countries worldwide with laws that permit assisted dying.

Switzerland, 1941

  • Suicide is allowed as long as there are no self-seeking motives.
  • Organisations exist which provide death for a fee, such as Dignitas and Exit.

Belgium, 2002

  • Patients must either be suffering unbearable pain or entering a coma or vegetative state. 
  • A total of 1,807 people took life ending medication in 2013.

Netherlands, 2002

  • The patient must be suffering unbearable pain, be terminally ill and able to make the decision independently.
  • In 2010, 3,136 people took life ending medication.

USA, 1997-2013

  • Five states allow assisted dying; Oregon, Washington, Vermont, Montana and New Mexico.
  • Oregon was the first, and the subsequent four follow the Oregon model.
  • Last year, 230 people died after taking life ending medication.

Progress through Parliament

The bill is currently in the early stages of progression through the House of Lords, having only received its second reading on 18 July.

The second reading lasted nearly ten hours and saw opinions of the bill divided opinion in the House of Lords.

Many individuals who presented themselves as being “against” assisted dying agreed with the fundamental nature of the bill, but believed that the present safeguards were vague and inadequate.

‘Many of those “against” the bill believe the present safeguards are inadequate’

These speakers believed the bill should progress but not in its present format, and major alterations needed to be made in order for them to approve it.

The assisted dying bill, having passed its second reading, will now go to a parliamentary committee which will analyse it in great detail and propose changes to the core structure and foundation of the bill.

Arguments for and against

Those is favour of the bill argue that:

However, those opposed argue that:

  • it is unclear how doctors will be able to judge if somebody is of sound mental health, how long someone has left to live, or if they are being coerced;
  • assisted dying devalues the life of the disabled and changes the public’s perception of death; and
  • the option of death would lead to impulse decisions for the terminally ill, which is unfair considering their situation.

Proceed with caution

In its present state, the bill would likely do more harm than good.

The argument citing that death is an individual’s “personal choice” is, on the surface, a compelling one: surely as free citizens in a liberal democracy, everybody should be able to choose to end their lives?

‘When dealing with matters as final as death, it is better to err on the side of caution’

However, this argument falls flat when one considers the weak safeguards of the bill.

If a patient is not of sound mental condition, which is often very difficult to detect, then arguably their choice to die has been influenced by their condition, and is not that of a rational mind.

Also, in its current form the bill places a huge amount of pressure on doctors and medical professionals to accurately gauge a number of nebulous factors including the patient’s mental capacity and whether they are being coerced. If the doctor fails to accurately assess these factors, the patient in question will die.

The finality of death

It is important to stress the finality of death: the medical professional makes a mistake, it will likely be too late to rectify it.

The fact that the majority of healthcare professionals are vehemently opposed to the bill shows how uncomfortable doctors are at the possibility of becoming “killers”.

The lack of court involvement in the bills present also indicates that doctors are vulnerable, as they will be the only individuals involved in the death of the patient. 

‘While 70-80 per cent of the public might support the bill, they will largely not be the ones administering a lethal dose’

Although Lord Falconer has admitted that the inclusion of courts will be considered at committee stage, the present incarnation of the bill solely focuses on doctors being the one’s involved in the process of assisted death.

Whilst the bill is still in its early stages, and significant changes will be made at committee stage, it will arguably be impossible to introduce strong enough safeguards to ward off unwanted deaths.

Doctors simply do not have the capability to evaluate the variety of vague factors currently stated in the process of assisted death, which leaves the system vulnerable to mistakes and abuse.

It is, on the whole, safer to avoid such a risky area of the law – especially when the proposed bill has such trivial methods of avoiding abuse.

Neil Grant is a partner of Ridouts LLP