QUESTION

 

‘It would not be beyond the wit of a legal system to devise a process for identifying those people, those few people, who should be allowed help to end their lives.’

Per Lady Hale, R (Nicklinson) v Ministry of Justice 2014 UKSC 38, 2015 AC 657 at para 314.

Critically evaluate whether reform of assisted suicide is desirable from the both legal and ethical perspective?

 

ANSWER

 

Introduction

An individual facing intractable pain in their life often gets influenced by the thought of ending their lives. A person dealing with mental trauma or physical pain puts them in a situation where death becomes easiest option in order to overcome those challenges. Assisted suicide is a term which is commonly used in medical field. There are many patients who suffer from painful disease for a very long time tends to intrigued by the thought of assisted suicide. In medical field assisted suicide is undertaken by taking medication of lethal doses of drugs which are supported by medical professionals.

Doctors are often accept their limitations in terms of treating a patient suffering from incurable disease and facilitate them in taking their own lives. With the rapid increase in poor nutrition as well as acute infectious disease patients are dealing with severe treatment which last for many years. As a result of which decision making in terms of ending lives with doctors assistance has now become a topic of debate for legalising it in the constitution. This essay provides an overview on reform of assisted suicide with respect to legal and ethical perspective. It also further provides argumentative analysis on whether assisted suicide should be legalised on the basis of ethical and legal perspective.

Many of the people who desired to make euthanasia legal considers it as rational decision on the basis of the scenario that might arise due to terminal illness as well as increasing disability and fear of being burden to the family¹. However, in reality it is not as easy as people might think. Many of the experts as well as social reformers consider euthanasia as completely psychological perspective of human mind. In order to justify their statement they said that human life is most valuable asset thus, by giving up on it only because if the fear of becoming burden or disable due to illness is not justified. They think terminal illness might be the most serious issue in human life however; it never should be the reason of patient’s death².

A number of case examples are prevalent that are able to highlight the fact whether assisted suicide is desirable or not. Across the globe, there are a number of cases that show the fact that there are people, who urge for euthanasia in order to get rid of the immense pain they are having in their course of life due to physical issues mainly³. Following discussion provides a brief description and analysis on some argumentative case studies and articles through which it can be evaluated whether reform of assisted suicide is desirable for both legal and ethical perspective or not. In the present time it can be seen that impact of euthanasia is rising as the patient who suffers from terminal illness or brain death are eagerly wants to commit assisted suicide. This happens because patient does not want to suffer from their tragic illness and gradually move towards the painful death.

R (on the application of Pretty) v DPP 2001 UKHL 61

Diane Pretty had been suffered terminally from diseases of motor neuron. Assistance of physician had been needed to end her life to release from the pain. She had appealed when her application for judicial review of the Director of Public Prosecution (DPP) has been dismissed. Her husband was going to assists her in her death. However, DPP had refused this application on not to prosecute her husband under section c2(1) of the Suicide Act, 1961, where her husband will assist her in her suicide⁴. After this refusal, Mrs. Pretty claimed that this refusal from Director of Public Prosecution was breech based on the articles 2, 3, 8, 9 and 14 of European Convention. So, it can be seen that the legislation is also allowing a person to end her life release from the pain. It ethically correct as well because of the pain by which the individual is going through will lead the individual and the family to suffer more and result in more painful death⁵.

R (Purdy) v DPP 2009 UKHL 45

The patient here had been suffered from primary progressive MS. This case also goes to Director of Public Prosecution (DPP) and DPP had failed here in order to provide relevant clear guidance on when a prosecution may be brought to action. The delay in taking decision and passing a prosecution can be more painful for the party to hold the death as the patient is already in pain. Due to this delay, the failure has been interfered along with her rights under Article 8 of Human Rights Act 1998.

The court at first ready to follow Pretty as well as promised that her Convention right will no be violated. However, in Hl, Lord Hope distinguished with Pretty’s decision. In my opinion, everyone has a respect for their private life and an individual should be able to take the decision of whether they can do the needful with their lives or not. Lord Hope had also departed from the decision by stating that right to respect for private life has been already engaged under Article 8. So, the possibility of derogation was still there as per Article 8(2). Along with the accordance of law, this article allows the interface of taking private decision for the sake of life. However, the Director of Public Prosecution (DPP), did not have either accessible or transparent law⁶. Due to this, Ms. Purdy was unable to understand and foresee the consequences of her action.

So, it can be seen that there is required to reform the laws related to assisted suicide by which an individual can take the decisions regarding their lives peacefully. This has an ethical consideration as well as legal consideration. In my opinion, everyone has the right to respect for their private life. By the ways that Ms. Parody decided to spend the closing moments of her life is a crucial part of act of living. As, her wish was to avoid a distressing and undignified end of life.

R v (on the application of Kenward) and others v DPP 2015 EWHC 3508

In this case, a factor had arrived in favor of the prosecution. The patient here, T Nicklinson, had been paralyzed from the neck till the leg for a stroke. So, he was almost unable to live life properly as he is not able to do anything. Along with that another patient namely Martin had been suffering from locked-in syndrome. They both need assistance in order to end their life as they are in pain and that was not the way to love life. The law regarding assisted suicide was not sufficient enough for which they are not able to take their decisions. Nicklinson had sought a declaration regarding this on which he wrote there should be an available defense for the necessities The current law was not compatible with Article 8 of European Convention in order to address the issues⁷. In this point, it can be seen that there needs to be a right of autonomy at the end of life.

Nicklinson had also raise voice regarding this. This case had been declared as an unlawful case due to which both the cases were unsuccessful. After this judgment, Nicklinson refused all the food and died in August 2012⁸. So, it can be seen that not having proper law will also lead to encounter a self-suicide that had been occurred in case of Nicklinson and Martin. Nicklinson wife and Paul Lamb at SC, both sought a declaration on which it has been written that current laws related to assisted death were not compatible with the rights under Article 8. So, these laws related to assisted death need to be reformed to rely on both legal and ethical perspectives to ensure that laws, as well as the personal rights, are not violated.

The Assisted Dying Bill No.2 2015

A report has been commissioned regarding improper laws which are already in practice within the cases of assisted death and are not ethical at all to apply the laws on the cases. It can be seen that due to the improper laws, the party’s ethical rights had been violated and they have died in an unexpected situation. Declaration about ethical and legal position of assisted dying in United Kingdom had been questioned regarding its independence. Legal and ethical perspectives of assisted dying were not supported and funded enough by the high profile public personalities. On top of that Commission had declared in this report that the law was incoherent and inadequate⁹.

It can be concluded that the reformation of assisted death can be initiated in such conditions where a person can receive assistance in dying if they have capacity of making a clear and informed intention to end their life.

Conway, R (on the application of) v The Secretary of State for Justice & Ors [2018] EWCA Civ 1431 (27 June 2018)

In the year of 2018 on November Conway had generated the right to appeal for right to die. This appeal had been rejected by three judges. The judges had told that they are not well placed as parliament so they could not determine the necessity and proportionality of his appeal. So, Conway was then intended to appeal to the Supreme Court. He had dismissed an emergency application in order to hear his case on right to die. Any change that had been made to this law would have to be initiated and established by Parliament. It was also recognized that this establishment would be in the Supreme Court’s power in order to make the declaration about incompatibility of do, such laws in context of Conway’s rights under ECHR¹⁰. So, it can be seen that the ethical perspectives always seemed to be violated in the cases of assisted death which is not good for human rights.

As per the above studies it can be seen that it is required to have adequate law to where an individual can take decisions for assisted death. In both the studies there are no such proper sections and law which can be applied to relief Nicklinson, Martin or Ms. Purdy to take their decisions to end their life peacefully. There are many loopholes in the laws which are violating the human rights under section 8. The bill that has been proposed was not portraying the proposal of introducing euthanasia in any kind of form which is the drawback of the bill. This bill was reintroduced in parliament by MP Rob Marris, however, it was strongly defeated in the year of 2015¹¹. Therefore, reformation of assisted death has to be taken into consideration especially in context of ethical perspective as legal matters are already in focus.

There are several arguments exist regarding ethical perspective of assisted death¹². John Harris argues in this context that euthanasia should be permitted because everyone has control upon life and that should be kept in mind in every perspective whether it is legal or ethical. However, this must be weighed against the societal interest as a whole. One argument can be encountered from the above-mentioned case that the patients who have been suffering from the diseases due to which they choose the assisted death were cited a loss of self-esteem within them. This is one of the primary reason due to which they had chosen physician-assisted suicide¹³. Vulnerability which is the main reason due to which assisted suicide is not legislated in the UK.

In this matter, an individual may tend to end life for duty bond or they are feeling burden upon someone. In these cases, the legislation will not do justice if there exists any as these are not the valid reasons for which assisted death has come to action. This particular matter will violate the ethical perspective of assisted death¹⁴. A common misconception can be seen regarding disability that disabled lives are not worth living. This is the main reason that the disability groups are against assisted death on a large scale¹⁵. The rising issue of autonomy and right of individuals are now a great topic of debate in national and international level in context of ethical as well as in legal perspectives. Human Rights Act 1998 in the form of human rights legislation has enhanced this debate¹⁶. In Article 2, the Right of Life indicates that the issue related to assisted death is not just about being alive; it is also pointed out how an individual rejects the right to life and die. For some people, a good death is very much important like a good life. Allowing people to have good death are not only allowing them to choose how they live bust also allowing them to how they choose to end their life. However, this matter raises the argument between legal and ethical perspectives that people with mental disabilities may choose to end life without trying to recover. So, proper legislation and law are required to set barriers between ‘good-death’ and ‘bad-death’.

In recent time, Physician-assisted suicide (PAS) laws have been enacted in various states including United Kingdom¹⁷. However, there are also various controversies has been encountered on rising of number of deaths due to assisted suicide¹⁸. There are several areas except this as well. The areas such as emergence of doctor shopping, multiple prescribing, absence of assessment process due to qualitative scrutiny are can be incorporated in the argument as well. So the need of reforming the laws regarding assisted suicide. According to Suicide Act 1961, it is still a criminal offer in United Kingdom to assist and encourage an individual to end their own life¹⁹. As per the rules of assisted law by Director of Public Prosecutions (DPP), a person will not always be prosecuted.

There have been a number of attempts which are encountered in order to change the laws both ethical and legal ways. However, there are also a number of human right challenges that exist to the current law²⁰. This argument includes the case of Diane Pretty, who was a patient of motor neuron disease as well as the case of Jane Nicklinson, whose husband was totally paralyzed due to severe stroke. Both wanted to end their lives and die with dignity with the assistance of their family. However, there were some difficulties as well with the legislation due to which they were not allowed to be a peaceful death²¹. So, these judgments again violated the ethical perspective where an individual has the right to encounter a peaceful death under proper circumstances.

In accordance with the matter of Human Rights, the court says that Human Right Convention protects the right to life, however, not protects the right to die²². So, it is time to recognize the UK law to recognize the right to die. As per many opinions, the person who has terminal illness or suffering for serious diseases should have the freedom to choose the timing and manner of their death. Assisted death should not be limited only to ending lives but also providing choices²³. In practice, there should be some flexibility in-laws in which prosecutors can take decisions on taking action. However, there is still no guarantee of immunity from legal perspective so those such as Pretty are not free to choose the physician-assisted suicide. However, legalizing assisted suicide is still a matter of concern as it will create pressure on the people who are vulnerable and can end their lives²⁴. They might choose the path for assisted death to avoid being a burden upon their families. The safest law that can be encountered to protect the right which gives blanket prohibition on assisted suicide and euthanasia.

Conclusion

It can be concluded from all the case studies and findings on assisted suicide that the people who are willing to die due to critical disease which might allow them to take peaceful death should be legalized with proper legislation. There are still some loopholes exist in the laws of Human Right in which people in need of this type of death are not allowed to take the decision of euthanasia. So, it can be seen that the reform of assisted suicide is desirable from both legal and ethical perspective. Assisted suicide is not only empowering patients to have control over death but also solidifying expressions of patient centered approach in healthcare. However, consensual request of assisted suicide still remains in doubt according to ethical perspective. Patient’s state of mind gets trembled when they suffer from long disease.

In this scenario patients consent for death becomes a contradictory subject for many doctors. An individual’s right to escape from intolerable and miserable life is not a feasible solution. As a consequence of which there will be a rise for societal imbalance which may affect the benefit of human race as a whole. Assisted suicide cannot be seen as a feasible solution to deal with mental or physical trauma in relating to ethical perspective. Legally there have been some provisions which allow a patient to have a right to commit suicide by taking lethal doses. In order to eliminate the thought of assisted suicide healthcare sector should put more focus on encouraging patients to overcome challenges of life.

Bibliography

Journal articles

De Lima, Liliana, et al. “International association for hospice and Palliative Care position statement: Euthanasia and Physician-Assisted Suicide.” Journal of palliative medicine [2017] 20 1 8, 14.

Downie, Jocelyn. “Permitting voluntary euthanasia and assisted suicide: Law reform pathways for common law jurisdictions.” QUT L. Rev. [2016] 84.

Emanuel, Ezekiel J., Bregje D. Onwuteaka-Philipsen, and Joachim Cohen. “Euthanasia and Physician-Assisted Suicide—In Reply.” Jama. [2016] 316 1600, 1601.

Iyasere, Osasuyi U., et al. “Quality of life and physical function in older patients on dialysis: a comparison of assisted peritoneal dialysis with hemodialysis.” Clinical Journal of the American Society of Nephrology [2016] 11 3 423, 430.

Kim, Scott YH, Yeates Conwell, and Eric D. Caine. “Suicide and physician-assisted death for persons with psychiatric disorders: how much overlap?.” JAMA psychiatry [2018] 75 1099, 1100.

Richards, Naomi. “Assisted suicide as a remedy for suffering? The end-of-life preferences of British “suicide tourists”.” Medical anthropology [2017] 36 4 348, 362.

Sulmasy, Daniel P., E. Wesley Ely, and Charles L. Sprung. “Euthanasia and physician-assisted suicide.” Jama [2016] 316 1600, 1600.

Tomlinson, Emily, et al. “Euthanasia and physician-assisted suicide in dementia: a qualitative study of the views of former dementia carers.” Palliative medicine [2015] 29 8 720, 726.

White, Ben, and Lindy Willmott. “Future of assisted dying reform in Australia.” Australian Health Review [2018] 42 616, 620.

Books

Keown, John. Euthanasia, ethics and public policy: an argument against legalisation. Cambridge University Press, 2018.

Paterson, Craig. Assisted suicide and euthanasia: a natural law ethics approach. Routledge, 2017.

Legislations

Human Rights Act 1998

Suicide Act, 1961, s c2(1)

The Assisted Dying Bill No.2 2015

Case laws

Conway, R (on the application of) v The Secretary of State for Justice & Ors [2018] EWCA Civ 1431

R (on the application of Nicklinson and another) v Ministry of Justice and R (on the application of AM) v The DPP and R (on the application of AM) v The Director of Public Prosecutions [2014] UKSC 38 On appeal from: [2013] EWCA Civ 961

R (on the application of Pretty) v DPP 2001 UKHL 61

R v (on the application of Kenward) and others v DPP 2015 EWHC 3508