The debate around Assisted Suicide and Assisted Dying has brought about new interpretations of language, which, for some people, are crucial to their understanding and involvement in the issues.
It is interesting and significant to note the terminology of the Assisted Suicide (Scotland) Bill and Lord Falconer’s Assisted Dying Bill in England that perhaps reflects a difference in how people in Scotland and England relate to the terms.
Some people use the terms interchangeably where others prefer to be more specific. Given that language can alienate supporters from the argument we offer some interpretations below of the key terms.
Suicide The act of taking your own life, often associated with desperation and a tragic outcome.
Rational suicide The reasoned taking of your own life.
Assisted suicide Someone helping you to die at your request.
Assisted dying Same as assisted suicide.
Voluntary assisted dying Emphasising the decision of the individual in the process of taking medication to end their life.
Physician or doctor assisted dying/suicide A doctor helping you to die at your request.
Euthanasia The original Greek meaning of a ‘good death’ has been lost and in English there are no positive connotations associated with its use. The term is used more in European languages generally with the meaning of voluntary euthanasia.
Voluntary euthanasia Sometimes used in situations where you have given your informed consent to allow a doctor to administer a lethal injection. However physician or doctor assisted suicide/dying are more generally used.
Suicide has never been illegal in Scotland and has been allowed in England and Wales since 1961, but it is a crime for anyone else to be involved.
This means that if you are too ill or disabled to take your own life, the person who helps you may be charged.
However, in 2010, the Director of Public Prosecutions issued the Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide. Whilst it does not change the law, it does give formal recognition that in certain circumstances people should not be prosecuted for helping someone to die. It distinguishes between compassionate and malicious acts of assistance and it seems that someone who assists from wholly compassionate motives would not be charged.
Each case is dealt with individually and the public interest factors in terms of who may be prosecuted are also significant.
You can view the policy on the Crown Prosecution Service website at www.cps.gov.uk.
Most people die peacefully but some suffer greatly before they die. Care for the dying has improved a lot in recent years, but medical technology has also enabled life to be extended even when the person is past being able to enjoy it. We believe that we should be able to ask for help when we feel we have suffered enough.
Opposition to assisted suicide and assisted dying comes mainly from those with religious convictions saying life is a gift from god and is sacred but there are now interfaith as well as disability groups who are supportive of the campaign to change the law to allow assisted dying with strict safeguards.
Arguments for assisted suicide
Choice We choose our partner, when to have a child and whether to continue with an unplanned pregnancy. We have the right to accept, or refuse, medical treatment. We should have the same right to decide when and where to die. The present law is based on traditional beliefs that are no longer held by many UK citizens and should not be imposed on those who do not share them.
Terminal suffering Even with the best palliative care, 5% to 10% of those dying, cannot have their suffering adequately relieved. Pain is often a major problem, but not the only one. Nausea, vomiting, coughing, breathlessness, incontinence, and other distressing symptoms can be difficult to treat. Severe weakness and total dependence on others are inevitable and many people find this the most distressing thing to bear. The final stages are often treated by increasing the dosage of pain-killers such as morphine and also by giving sedatives which induce sleep which slides into coma and death — known as ‘terminal sedation’ — and often the patient takes no part in the decision to use it.
Doctors’ duty of care Those who truly want to do their best for their patients by responding to a request to end their suffering are forbidden by law from doing so. Many surveys of British doctors have shown that some already help their patients to die and risk their professional careers by doing so. Doctors are also able to give painkillers in such high doses that people die more quickly. This is known as the ‘double effect’ — the intention is to relieve suffering, but the side effect is death.
Public opinion More than four out of five people believe that relatives should be allowed to help terminally ill loved ones take their own lives according to a 2012 poll by YouGov for the British Humanist Association.
World opinion Assisted dying has been accepted in several countries in the world — in The Netherlands and Belgium in 2002, Luxembourg in 2010 and in the United States, from 1997 in Oregon, Washington, Montana, Vermont and most recently New Mexico and Quebec in 2014.
Arguments against assisted suicide
The sanctity of life This phrase has little meaning unless both ‘sanctity’ and ‘life’ are defined. Sanctity means ‘sacredness’, something that must not be interfered with, but to us life is a continuum. Life starts with the egg and sperm that are biologically programmed to be lost in their hundreds and millions throughout the life time of the individual; from the embryo; the foetus; the infant; the child; the man and woman, to life without functioning faculties.
Brainless old age is what we all fear, but it is possible to lose one’s ‘biographical life’, one’s individual personality, in childhood or adolescence. The result is a Permanent Vegetative State, the brain is so damaged that ‘life’ is a coma. Decisions by the authorities to end the biological life can take years.
Unnecessary and unnatural Palliative care is so good that life can end ‘naturally’ with the minimum of suffering. This is not always true. Some people die in intensive care, being fed intravenously, attached to a ventilator with tubes coming out of every orifice. How can this be regarded as natural?
The slippery slope Once assisted dying is legalised it will open the door to abuse and will allow unscrupulous relatives to put the elderly and infirm to death. Old people will feel pressurised to ask for assisted dying so that they are not a burden. Evidence from places where assisted dying is legal, shows that over a period of years less than 3% of all deaths per year are by assisted dying.
Doctor must preserve life They have sworn the Hippocratic oath — the trust between them and patients would be destroyed if they were allowed to perform assisted suicide. Few doctors practising today have been asked to swear this ancient Greek oath, but they do have a professional duty to care for their patients to the best of their ability with compassion and skill.
The vulnerable If assisted dying legislation existed, those who are elderly, disabled or sick would feel under pressure to end their lives for fear of being a financial, emotional or care burden on other. In countries where legislation does exist research indicates that those who choose to end their lives give reasons of loss of autonomy, decreasing ability to participate in activities that make life enjoyable and loss of dignity, rather than being a burden as their motivation. A report from Oregon in 2012 also states that any fear that vulnerable adults are at risk from this legislation is unfounded.
There must be safeguards to prevent abuse
Proposed legislation in Scotland and England would include a range of safeguards. Below are the guidelines used effectively in The Netherlands since 2002:
1. There must be unbearable physical or mental suffering.
2. The suffering and the desire to die must be lasting.
3. It must be the patient’s own decision.
4. The patient must have a clear understanding of their condition and prognosis.
5. They must be capable of assessing the options and must have done so.
6. There must be no other acceptable solution.
7. The time and the way the patient dies must not cause avoidable misery to others (eg the next of kin should be informed and the patient’s affairs put in order).
8. The doctor involved must consult another professional.
9. A medical doctor must be involved in prescribing the right drugs.
10. The decision process and the actual treatment must be carried out with the utmost care.
11. The person receiving help to die does not have to be terminally ill, but must be suffering unbearably.
With safeguards people who do NOT wish to die will be better protected than they are without any law.
Let those who believe in the ’sanctity of life’ die ‘naturally’, but let the rest of us choose how, when and where we make our exit when we believe we have suffered enough.