UK: The Right To Die Well - Dying Well Should Be A Human Right

Last Updated: 31 March 2014
Article by Karen Taylor

Most Read Contributor in UK, August 2017

Parliament is once again poised to debate the need for a law to allow assisted suicide. Based on legislation drawn up by Lord Falconer of Thoroton, politicians will be given a free vote on this sensitive and emotive issue. This week Norman Lamb, the Liberal Democrat Care Minister, is one of several high profile politicians to state his support for the change, while David Cameron and other members of his cabinet have confirmed they will vote against the move. Having recently co- authored a global report on end of life care (Dying Healed: Transforming End of Life Care through Innovation) for the World Innovation Summit for Health (WISH) held in Qatar in December 2013, I thought it would be timely to explore this issue.

The current situation in the UK is that euthanasia (in which one party takes action to end the life of a second party, at the request of the second party) is regarded as either manslaughter or murder and is punishable by law with a maximum penalty of up to life imprisonment; and assisted suicide (where physicians, or others, provide the means for patients to end their own lives) is illegal under the terms of the Suicide Act (1961), punishable by up to 14 years' imprisonment. However, grey areas have emerged, and the Director of Public Prosecutions in 2010 indicated that anyone acting with compassion on the will of a dying person was unlikely to face charges.   

Euthanasia is an issue that divides most cultures. Surveys in the UK and US show that public support for euthanasia has hovered between 60 and 80 per cent since the mid- 1970s. With similar levels of support emerging for physician assisted suicide. A report on the 2005 British Social Attitude Survey shows that people make clear distinctions between the acceptability of assisted dying in different circumstances - 80 per cent of respondents agreed that the law should allow voluntary euthanasia to be carried out by a doctor for someone with a painful, incurable, and terminal condition - but less than 50 per cent agreed for cases where the illness is painful, but not terminal. 

Yet, over 90 per cent of palliative care doctors are opposed to assisted suicide in the UK. This is largely because hospice and palliative care professionals see what they do as quite distinct from assisted suicide or euthanasia. The danger is that unless the public gains a full understanding of palliative care, and have confidence that they will have access to good quality, pain free care, euthanasia and/or assisted could become the default position.

Most people's greatest fear about dying is that they will die in severe, untreated pain. Examples where this appears to have been the case is often the trigger for a media campaign and often result in calls for euthanasia and assisted suicide to be permitted. Failure to provide adequate pain relief is often likened to torture and suggests that a more important debate should be about the need to provide equitable access to adequate pain relief as a human right – which is a key recommendation in the above WISH report.

Euthanasia is currently permitted in three European countries. In 2002, the Netherlands passed a law allowing patients suffering unbearably to request euthanasia while protecting the doctors carrying out those requests from prosecution, provided they have followed a set of strict guidelines. Belgium followed suit the same year and Luxembourg did so in 2009. In Switzerland assisted suicide—but not euthanasia—has been legal since 1941, provided assistance is given for altruistic motives. Stricter legislation is currently under discussion. The Netherlands and Luxembourg also permit assisted suicide, although Belgium does not. The numbers of people who have availed themselves of this option are a very small percentage of the people who have died during this period. 

In the UK, very few studies or debates have examined public perceptions of end of life, palliative and hospice care whereas public debates about euthanasia and physician-assisted suicide, are often played out in the media, and often supported by high profile media figures, such as Terry Pratchett.  This is despite the fact that many more people would benefit from better end of life care and by adopting the principles of good palliative care.   

Ultimately, pain control is the point from which all palliative care stems, and the availability of opioids (morphine and its equivalents) is fundamental to quality of end-of-life care. But across the world an estimated 5 billion people lack access to opioids. A lack of training is a problem, with many doctors and nurses ignorant or fearful of how to administer them. Here in the UK the furore over Dr Shipman and now the Liverpool Care Pathway has again raised questions as to what constitutes adequate or appropriate pain relief, the risk is that over the coming weeks and months with a spotlight on this issue, clinicians will run shy of providing sufficient relief for fear of being accused of hastening the person's death.

On balance, I believe we do need a debate but rather than being about an issue that affects a small minority of people we need a public debate on equitable access to palliative care, and in particular, to appropriate pain relief.  We also need to adopt a consistent, compassionate and evidence-based approach to tackle what is often a very distressing and difficult time, which few of us want to openly confront.  If we had better care of the dying for all, with appropriate pain control, we might not need to have a debate about euthanasia or assisted suicide as everyone could be assured of dying well and that they have a human right to a good death.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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