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.
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.
A national survey of 3733 UK doctors reporting on the care of 2923 people who had died under their care is reported here. Results show that there was no time to make an ‘end-of-life decision’ (deciding to provide, withdraw or withhold treatment) for 8.5% of those reporting deaths. A further 55.2% reported decisions which they estimated would not hasten death and 28.9% reported decisions they had expected to hasten death. A further 7.4% reported deaths where they had to some degree intended to hasten death. Where patients or someone else had made a request for a hastened death, doctors were more likely to report expecting or at least partly intending to hasten death. Doctors usually made these decisions in consultation with colleagues, relatives and, where feasible, with patients.
Amongst the latest, and ever-changing, pathways of death and dying, “suicide tourism” presents distinctive ethical, legal and practical challenges. The international media report that citizens from across the world are travelling or seeking to travel to Switzerland, where they hope to be helped to die. In this paper I aim to explore three issues associated with this phenomenon: how to define “suicide tourism” and “assisted suicide tourism”, in which the suicidal individual is helped to travel to take up the option of assisted dying; the (il)legality of assisted suicide tourism, particularly in the English legal system where there has been considerable recent activity; and the ethical dimensions of the practice. I will suggest that the suicide tourist—and specifically any accomplice thereof—risks springing a legal trap, but that there is good reason to prefer a more tolerant policy, premised on compromise and ethical pluralism.
The House of Lords in Purdy forced the DPP to issue offence-specific guidance on assisted suicide, but Jacqueline A Laing argues that the resulting interim policy adopted last September is unconstitutional, discriminatory and illegal. In July 2009, the law lords in R (on the application of Purdy) v Director of Public Prosecutions [2009] All ER (D) 335 required that the DPP publish guidelines for those contemplating assisting another to commit suicide. The DPP produced a consultation paper (23 September 2009) seeking to achieve a public consensus, albeit outside Parliament, on the factors to be taken into account in determining when not to prosecute assisted suicide. Although the consultation exercise is hailed by proponents of legislative change as a democratic, consensus-building and autonomy-enhancing initiative, there is much to suggest that, on the contrary, the guidance is unconstitutional, arbitrary and at odds with human rights law, properly understood.
Doctors and healthcare professionals could face a higher risk of prosecution if they help patients take their own lives according to new guidelines published by the Director of Public Prosecutions Keir Starmer QC last week. The ‘Policy for Prosecutors in respect of Cases of Encouraging or Assisting Suicide’ comes seven months after the House of Lords ruling in the Purdy case which required the DPP to clarify its approach to assisted dying. The new guidelines follow a consultation which attached 4,710 responses and replace the interim policy issued in September last year with a set of 16 factors in favour of prosecution and six against. The main thrust of the new policy is that individuals driven by compassion will be unlikely to be prosecuted if this was their guiding motive. Those motivated by gain would be.
By attempting to avoid accusations that he is creating a regulatory regime, the DPP in his final policy on assisted-suicide prosecutions has wrongly exposed those with much-needed medical expertise to the risk of prosecution, says Penney Lewis
Following the House of Lords' decision in Purdy, the Director of Public Prosecutions issued an interim policy for prosecutors setting out the factors to be considered when deciding whether a prosecution in an assisted suicide case is in the public interest. This paper considers the interim policy, the subsequent public consultation and the resulting final policy. Key aspects of the policy are examined, including the condition of the victim, the decision to commit suicide and the role of organised or professional assistance. The inclusion of assisted suicides which take place within England and Wales makes the informal legal change realised by the policy more significant than was originally anticipated.
Most senior doctors in England and Wales feel that rational suicide is possible. There was no association with specialty. Strong religious belief was associated with disagreement, although levels of agreement were still high in people reporting the strongest religious belief. Most doctors who were opposed to physician assisted suicide believed that rational suicide was possible, suggesting that some medical opposition is best explained by other factors such as concerns of assessment and protection of vulnerable patients.
The total number of deaths studied was 11,704 of which 1517 involved continuous deep sedation. In Dutch hospitals, CDS was significantly less often provided (11%) compared with hospitals in Flanders (20%) and U.K. (17%). In U.K. home settings, CDS was more common (19%) than in Flanders (10%) or NL (8%). In NL in both settings, CDS more often involved benzodiazepines and lasted less than 24 hours. Physicians in Flanders combined CDS with a decision to provide physician-assisted death more often. Overall, men, younger patients, and patients with malignancies were more likely to receive CDS, although this was not always significant within each country. Conclusion Differences in the prevalence of continuous deep sedation appear to reflect complex legal, cultural, and organizational factors more than differences in patients’ characteristics or clinical profiles. Further
The focus of this article is upon compassionate killings, that is, criminal cases where a parent/spouse has killed or assisted to die a child/spouse who was suffering from severe disabilities, debilitating injury, chronic or terminal illness. We argue that the partial defence of diminished responsibility, while appropriate for some cases, fails to acknowledge the compassionate and relational nature of these acts and thus fails to identify the quality of the harm committed. We also argue that the general defences of duress of circumstances and necessity, even if they were to be become available, are inappropriate. Developing the concept of ‘compassion’, which is a consideration in relation to prosecution for assisted suicide, we argue for the introduction of a partial defence of ‘compassionate killing’ which would reduce the offence from murder to manslaughter in recognition of the killing as a responsive, relational act of care.
While assisted suicide (AS) is strictly restricted in many countries, it is not clearly regulated by law in Switzerland. This imbalance leads to an influx of people—‘suicide tourists’—coming to Switzerland, mainly to Zurich, for the sole purpose of committing suicide. Political debate regarding ‘suicide tourism’ is taking place in many countries. Swiss medicolegal experts are confronted with these cases almost daily, which prompted our scientific investigation of the phenomenon. The present study has three aims: (1) to determine selected details about AS in the study group (age, gender and country of residence of the suicide tourists, the organisation involved, the ingested substance leading to death and any diseases that were the main reason for AS); (2) to find out the countries from which suicide tourists come and to review existing laws in the top three in order to test the hypothesis that suicide tourism leads to the amendment of existing regulations in foreign countries. ...