The editorial by Ira Byock (1) commenting on the report from van den Block et al (2) correctly says that only 22 cases of euthanasia or physician-assisted suicide (PAS) occurred (1.3% of all 1690 non-sudden deaths), suggesting that this means these actions ‘occur relatively infrequently’. However, there were a further 26 cases of 'life ending drugs without patient request'. Readers should know that this latter category consists of doctors who answered the same question in the same way as the doctors who are counted as having provided euthanasia or PAS, except that in a subsequent question the doctors indicated that the patient had not asked for euthanasia at the time.
Elderly people should be allowed to end their lives with the help of a doctor even if they are not terminally ill, according to a new campaign group that claims to have widespread support. The Society for Old Age Rational Suicide, led by a former GP known as “Dr Death”, says that pensioners should have the human right to declare “enough is enough” and die with dignity.
There is evidence from outside the UK to show that physicians’ religious beliefs influence their decision making at the end of life. This UK study explores the belief system of consultants, nurse key workers & specialist registrars & their attitudes to decisions which commonly must be taken when caring for individuals who are dying. Results showed that consultants’ religion & belief systems differed from those of nurses & the population they served. Consultants & nurses had statistically significant differences in their attitudes to common end of life decisions with consultants more likely to continue hydration & not withdraw treatment. Nurses were more sympathetic to the idea of PAS for unbearable suffering. This study shows the variability in belief system and attitudes to end of life decision making both within and between clinical groups. The personal belief system of consultants was not shown to affect their overall attitudes to withdrawing life-sustaining treatment or PAS.
Results: Laws on assisted dying in The Netherlands and Belgium are restricted to doctors. In principle, assisted suicide (but not euthanasia) is not illegal in either Germany or Switzerland, but a doctor’s participation in Germany would violate the code of professional medical conduct and might contravene of a doctor’s legal duty to save life. The Assisted Dying for the Terminally Ill Bill proposed in the UK in 2005 focused on doctors, whereas the Proposal on Assisted Dying of the Norwegian Penal Code Commission minority in 2002 did not. Conclusion: A society moving towards an open approach to assisted dying should carefully identify tasks to assign exclusively to medical doctors, and distinguish those possibly better performed by other professions.
The Commission on Assisted Dying, set up in September 2010 and chaired by former Lord Chancellor Charles Falconer, has issued its monumental report on assisted dying in England and Wales. The Commission was funded by two supporters of assisted suicide, author Terry Pratchett and businessman Bernard Lewis, and despite reassurances that the running and outcome of the Commission were independent, some individuals and groups opposed to the practice regrettably refused to give evidence to the Commission. Still, the range and quantity of the evidence, which included evidence gathered from international research visits, qualitative interviews and focus groups, commissioned papers, and seminars, is impressive and can be read and watched here.
ACPO lead on homicide responds to the Mail on Sunday making it clear that where we recieve information or intelligence about assisted suicide cases, these investigations are pursued The police service is responsible for investigating cases of encouraging or assisting suicide involving British nationals whether it takes place in the UK or abroad. Whenever we receive information or intelligence about such a case, these investigations are pursued. It is therefore entirely misleading to suggest that ACPO is advising police officers not to investigate deaths abroad (“Assisted suicide 'is legalised' by police: Secret new guidelines from senior officers mean deaths are not investigated”, 24 Feb). The very purpose of such guidance is to assist investigation, by outlining specific considerations for investigators including the legal context and the need to engage with the CPS at earliest stages of an encouraged or assisted suicide inquiry. This is a complex area of investigation and over-si...
The police service is responsible for investigating cases of encouraging or assisting suicide, whether the actual suicide takes place in the UK or abroad and whenever we receive information or intelligence about such a case, these investigations are pursued. Following renewed guidance from the CPS, ACPO has developed specific guidance for police officers investigating such cases. The guidance encourages investigators to engage with the CPS at the very early stages of an encouraged or assisted suicide inquiry. When the police are informed of suicides that have taken place abroad this involves enquiries that lead to consideration of jurisdictional issues which can be complicated by other nations legal systems. Furthermore the progress of any investigation in part relies on the co-operation of foreign police services and agencies. It also requires any UK police force to be able to prove beyond reasonable doubt the circumstances under which the person died and this can be difficult...
An act by an individual ("D") is not to be treated as capable of encouraging or assisting the suicide or attempted suicide of another adult ("T") if— (a) the act is done solely or principally for the purpose of enabling or assisting T to travel to a country or territory in which assisted dying is lawful;
The book strives for as complete and dispassionate a description of the situation as possible and covers in detail: the substantive law applicable to euthanasia, physician-assisted suicide, withholding and withdrawing treatment, use of pain relief in potentially lethal doses, terminal sedation, and termination of life without a request (in particular in the case of newborn babies); the process of legal development that has led to the current state of the law; the system of legal control and its operation in practice; and, the results of empirical research concerning actual medical practice.
Two high court judges rejected Debbie Purdy's request for guidelines from the Director of Public Prosecutions on when assisted suicide cases would be prosecuted, saying it was a matter for parliament and not the courts.
Assisted dying should form part of a good palliative care service for terminally ill people in the United Kingdom, said Ann McPherson, a GP and founder of a new group of medical professionals called Dignity in Dying: Healthcare Professionals for Change (BMJ 2010;341:c5498, doi:10.1136/bmj.c5498). Speaking at a debate hosted by the Medical Journalists’ Association last week on assisted dying and whether the law should be changed, Dr McPherson, who is herself dying from pancreatic cancer, called for the law on assisted dying to be changed in a “narrow way” so that people who are dying and who are able to make the decision on how and when they would like to end their life can do so. “Without a change in the law it will make it much more difficult for some people to have a dignified death, which is what everybody is entitled to,” she said.
Campaigners fear assisted suicide is being legalised by the back door as record numbers of Britons end their lives at Dignitas – while their relatives escape investigation for helping them. The Swiss suicide clinic helped 33 people from this country to die last year – the highest ever annual figure – pushing the total during the past decade close to 250. But police passed only a handful of files to prosecutors over the assistance provided by loved ones, and no one was charged. A police worker even accompanied her mother to Switzerland but faced no sanction. The Association of Chief Police Officers (ACPO) has recently issued new guidelines to every force in the country about how they should investigate assisted suicides. Although the document is restricted, this newspaper has been shown the section that deals with deaths abroad. It highlights how tough such inquiries can be because of the difficulty in obtaining evidence from foreign authorities.
Assisted suicide Some concern has been expressed in the media today about the effect of the CPS's policy for prosecutors in respect of cases of encouraging or assisting suicide. Assisting or encouraging suicide remains a criminal offence. The CPS guidelines do not, and could not, replace the law. While no prosecutions have been brought since the guidelines were issued, each case is considered on its own facts and merits and any inference that the CPS has implemented a blanket policy of not prosecuting for this offence is wrong.
Today I am publishing the Crown Prosecution Service’s policy on encouraging or assisting suicide. When it passed the Suicide Act 1961, Parliament specifically required discretion to be exercised in every case and my consent is needed before any prosecution for assisted suicide can be brought. In the case brought by Debbie Purdy last year, the House of Lords understood that. It did not question whether there should be a discretion to prosecute or not. But, accepting that discretion, it required me, as DPP, to “clarify what [my] position is as to the factors that [I] regard as relevant for and against prosecution”.