Introduction
Assisted dying is a death technique that permits dying individuals to control their death when they feel their suffering is no longer bearable. With only 14 countries across the globe legalizing Euthanasia, the United Kingdom still considers it illegal despite many attempts to make it legal. Consequently, those who have been found to assist others in dying in the UK stand a risk of 14 years imprisonment. Between 1 April to 31 March 2022, 174 cases of assisted deaths were filed by the police forces in England and Wales. However, all except 26 cases have been withdrawn. By March 2022, there were eight active cases in Wales and England, four of which had been prosecuted successfully.[1]. Despite many attempts to pass a bill legalizing Euthanasia, the UK parliament has not yet succeeded.
Overview of Attempts to Pass Assisted Dying Bill
The debate about assisted death in the UK started in the 1930s. In 1931 a bill for incurable ailments to be allowed was proposed by Dr. Millard Killick.[2]. It was the doctor’s plea for the right to easy death, as he collaborated with Lord Moynihan to establish the British Voluntary Euthanasia Society. However, the House of Lords rejected the Bill proposed by Dr. Millard through Lord Moynihan in 1936. In response to Dr. Millard’s plea, the House of the Lords tightened the illegality of assisted death in the UK- the suicide Act was passed in 1961, and assisted death and suicide were made punishable and could attract 14 years imprisonment. The attempt by Lord Raglan to reintroduce Voluntary Bill was rejected in 1969[3] One year later, this Bill was debated but with no success. In 1976, there was a debate about the incurable patients’ Bill in the House of the Lords, but the aftermath was still negative. The Doctor’s Assisted Dying Bill, MP Ashton Joe had proposed, ended in rejection by the House of the Commons in 1997. This Bill was, however, reviewed by the House in 2003.
In 2004, the Assisted Dying for terminally ill Bill was debated in the House of the Lords and later forwarded before a special committee. Unfortunately, this Bill was rejected by the House in 2006; thus, assisted death remained punishable by the law. In 2014, Lord Falconer reintroduced Assisted Dying Bill, which outlined that any adult projected to have a lifespan of fewer than six months could be allowed to end their life. However, this Bill was never successful in the House of Lords. One year later, this Bill was introduced in the House of the Commons by Labour MP Marris Bob to legalize assisted death in Wales and England.[4]. This Bill was, however, defeated by more than half of the House’s votes. In 2016, Lord Hayward reintroduced the Assisted Dying Bill. This Bill did not succeed, just like Lord Falconer’s Bill in 2020. In 2021, Lord Forsyth introduced an amendment to the House of the Lords to compel the government into drafting an assisted suicide Bill to lay before the parliament. Unfortunately, this proposal also suffered a defeat of 179 votes against 145 votes.[5].
Why The Bill Has Failed Severally in Both Houses
There are myriad reasons why the Lords and MPs have rejected the Assisted Dying Bill by voting against it. Many of these MPs and Lords consider the effect passing the Bill will have on doctors and health professionals. Although in the proposed Bill, no doctor would be forced to end the patient’s life. However, it is highly believed that it would become a norm for all doctors to make their patients who are terminally ill to be aware of the option to end their lives voluntarily. It would significantly affect the doctors who believe assisted dying is wrong, and consequently, such doctors may end up quitting their jobs, thus, creating a shortage of doctors. MPs and Lords are, however, concerned with the welfare of individuals in the UK- when the country runs short of doctors due to uninformed decisions, the blame will be on these MPs and Lords.[6].
Moreover, the proposed Bill assures that the decision to make an individual would only depend on their consent. However, with the sophisticated medical sector of the UK, once the House passes the Assisted Dying Bill, there is a high chance that doctors will be instructed to ensure that all terminally ill patients are aware of the option of assisted suicide. Legal cases may be filed against doctors who failed to inform the patients of their life expectancy and the option to end their lives. Even if the doctor feels that it is inappropriate to inform a patient about the option of assisted death, it would be considered negligence. However, every individual, including the terminally ill, has the right to live; hence the Houses felt that passing the law would, to some extent, violate the right to live. When the Bill has not been adequately reviewed, considering its effect on doctors and medical provisions, it will remain unsuccessful for longer.
Assisted Dying Bill of 2021-2022 (HL Bill 13)
According to Meacher’s proposed Assisted Dying Bill of 2021-2022 (HL Bill 13), “Every adult who is perceived to be terminally ill is to be provided on requesting; an assistance to end their life, and with valid reasons.” This Bill tries to solve the critiques many MPs and Lords believe when voting against the previous Assisted Dying Bills. The Bill would require the patients to provide official documents and reasons for wanting to be assisted with death. This Bill is considered more diverse and considers the reasons for rejecting the previous bills.
According to subsection (2) of HL Bill 13, assisted dying is subjected to the consent of the High Court, where a terminally ill individual has the right to request assistance to end their own life lawfully. However, subsection (1) of this Bill ascertains that a high court would only grant an individual a permit to be assisted to die if: the person has a clear and informed wish to terminate their life; the declaration is made in accordance with section 3[7]; and when the person makes the declaration, he is over 18 years, can make their own decisions. The individual should also have been an England and Wales resident for at least one year.
In this Act, an individual is considered terminally ill if a qualified medical professional diagnoses that the individual has an inevitable and deteriorating health condition and any kind of treatment is incapable of reversing the illness. The Bill also explains that treatment that temporarily relieves the pain caused by the illness is not considered a treatment that can reverse the condition. In addition, the doctor tasked with terminating the life of an individual who has declared his consent may prescribe lethal drugs for that individual to end his own life. Under subsection (1) of this Bill, any prescribed drugs should only be delivered to the person to whom they are prescribed by the responsible doctor or another qualified medical professional or nurse strictly authorized by patient’s doctor. In addition, the Bill also stipulates that a person mandated to assist a terminally ill patient in ending their life should not have any criminal history.
Based on the requirements of the Bill, it is considered a more sophisticated one and protects both the vulnerable and medical professionals. With the convincing reason and rules to be followed based on this Bill, it tends to be different from previous bills. Meacher considers this Bill as the one which will soon make Assisted Dying in the UK legal. Unlike the assisting dying Bill proposed by Labour MP Marris Bob in 2015, the Bill by Meacher is more details with sentiments of protecting both doctors and terminally ill patients. with the kind of developments that come with the recently proposed Bill; the current parliament would end up passing the Bill and hence giving people the right to assisted death- perhaps in two years.
The majority of people in the entire UK are proponents of a change of law to legalize assisted dying for terminally ill and mentally challenged adults. At least 84% of the public unanimously supports legalizing assisted death[8]. On the other hand, 54% of the qualified doctors are either supportive or neutral to legalizing assisted dying. An overwhelming 86% of people with disability also support changing the law on government-assisted death[9].
There exist some cases which have informed the opinions of the public. The first case is about Tony Nicklinson, who suffered a stroke in 2005 and was paralyzed and could only move his eyes and head. He wished to end his life but could not do so without assistance. Martin, who also suffered a brainstem stroke in August 2008 and was utterly unable to move, wished to end his life and, since it was illegal in the UK, had to travel to Switzerland, where assisted dying is legal. Another case was Diane Pretty, who was diagnosed with motor neuron disease. She wanted to control how she died, but it was not possible since assisted death was illegal. Debbie Purdy also was diagnosed with Multiple Sclerosis in 1995 and thought of how to choose and control her death which was not possible with the illegality of assisted death.[10]. These are but a few cases that show how people have substantially suffered because of the illegality of assisted death. Since those suffering are members of the public, the public’s opinion on Euthanasia has been intensely impacted by these cases to push for legalizing assisted death.
Definition of Capacity
According to the Mental Capacity Act (MCA) of 2005, an individual would be assumed to have the capacity to make his own decisions until proven otherwise, which only applies to people of 16 years and above.[11]. MCA stipulates that individuals are incapable of making their own decisions if they cannot understand the information needed to make a decision, retain it, and utilize it as part of the decision-making process. People incapable of making their own decisions are also provided with independent advocates to assist in making decisions. Whenever appropriate, people should always be allowed to make their own decisions.[12]. Before concluding that an individual lacks the capacity, it is essential to take steps to enable individuals to try making their own decisions.
Compatibility With Assisted Dying Act and its Impact on Patients
According to the proposed Assisted Dying Bill, stable mental health is essential when deciding to get assisted death. In addition, before being granted permission to get death assistance, any person must consent to High Court. Mental Capacity Act also requires an individual to have an independent advocate who would assist him in making informed decisions. While the Assisted Dying Act stipulates that there must be a sure diagnosis that an individual’s life is at its terminal stage before deciding to assist him to die; MCA stipulates that before helping others make a decision, steps of enabling such individuals to try making their own decisions should be considered- after which he may be considered to have no capacity of making own decision. MCA would also be an essential constituent of Assisted Dying Act since those seeking death assistance are mentally challenged. Referring to MCA would be necessary when the death assistance is towards mentally incapable individuals rather than terminally ill individuals. MCA would also be necessary to mentally ill patients since they would receive highly genuine help from independent advocates.
Legislation Regarding Assisted Dying
Belgium and Comparison to the Proposed Bill
The Belgium Act on Euthanasia 2002 came into effect on September 2002. It permitted doctors to prescribe lethal drugs to mentally stable and terminally ill adults. This Act was initially applicable to adults only. However, with time, its application has widened.[13]. The idea that terminally ill minors would also wish to end their lives has been vehemently opposed. In parallel, scientific data affirms that a child’s brain is not fully developed to help them make an informed decision. However, in 2014, the Belgian parliament did approve the amendment to the 2002 Belgium Act on Euthanasia to allow for assisted death for children who are terminally ill with the consent of their parents.[14]. Therefore, the euthanasia law in Belgium allows everyone to seek death assistance regardless of age. However, the law has some restrictions: a minor to be accorded assisted death should be terminally ill and in severe pain. Even though the proposed Assisted Dying Bill in the UK follows the same suit of allowing mentally stable and terminally ill individuals to seek assistance with death, the proposed Bill is restricted to individuals of 18 years and above. One famous case in Belgium was the death of 38 years Tine Nys, in April 2010[15] Despite being conducted in violation of the guidelines of Euthanasia, her case remained a case of Euthanasia.
Netherlands and Comparison to the Proposed Bill
Assisted dying was first made non-criminal activity by the court of law in 1984. The Dutch parliament later passed the Act in 2001. The termination of life on request and assisted suicide Act 2001 permitted doctors to prescribe lethal medications for hopeless and unbearable suffering. approval of this Act saw 1882 deaths recorded in the first year of the Act working as a law. The figure has increased to 6,938 deaths in 2020, accounting for at least 4% of the total annual deaths in the Netherlands.[16]. Another development of the Act was the 2018 Euthanasia Code of Practice which allowed assisted death to be granted to the elderly who are not terminally ill but suffer from normal deteriorating conditions, which are considered severe suffering with no possibility of improvements[17]. In April 2020, the supreme court of the Netherlands ruled that advanced dementia patients who made an advanced request for assisted death would be able to receive it. The 2001 approved Dutch bill has the same constituents as the proposed UK Assisted Dying Bill. Nonetheless, the proposed Bill does not mention the 2018 code of practice that allows assisted death for the elderly. One of the Assisted deaths in the Netherlands is the death of a 17-year-old Dutch Girl-Noa, Pothoven, who suffered from anorexia.[18].
Canada and Comparison to the Proposed Bill
The Federal Government passed Medical Aid in Dying (MAiD) in June 2016. based on this legislation, doctors can administer lethal medications to mentally stable and terminally ill adults. However, in 2020, the Canadian government amended the MAiD law to abolish the requirement that assisted death had to be reasonably foreseeable- after the condition was successfully challenged to allow assisted death even for non-terminal conditions.[19]. This challenge was presented in the Superior Court of Quebec. While Canadian law follows the same suit of allowing assisted death of terminally ill individuals, it has more diverse legal issues which are not included in the proposed UK Assisted Dying Bill. This oversaw that one of the reasons for seeking a MAiD was the loss of ability to engage in meaningful life activities. 10.2% of the MAiD cases, however, were a result of neurological conditions.
Consequently, only 5% of MAiD patients were referred for psychiatric tests in 2020. After the amendment of the MAiD in 2020, 81.7% of the cases were as a result of the incapability to do daily life activities; 57.4% of the cases as a result of uncontrolled pain and suffering; and 35.9% of the assisted deaths were conducted on the basis that they were a significant burden to the family[20]. One of the assisted death cases in Abbotsford was the death of a 61-year-old woman. The case of assisting this woman to die is under police probe since it is believed that the woman’s mental health was still stable when her daughter requested assisted death.[21].
Conclusion
The number of countries legalizing Assisted death continues to increase, with the current number standing at 14 countries, and more countries are expected to legalize Assisted death. Despite many attempts by the Houses of the Lords and Commons to pass the Bill of Assisted Dying, it has not been successful. After thorough benchmarking with other countries such as Netherlands and Belgium, Meacher’s recently proposed Assisted Dying Bill has raised the public’s hope about legalizing assisted death. Passing this Bill will mean that people would no longer sneak out of the country to seek assisted death. Indeed, passing this law would be a great revolution of the UK laws as the public desires assisted death to be legalized.
References
Best, Jo. “Doctors’ organizations, neutrality, and the assisted dying debate.” bmj 374 (2021).
Boztas, Senay. “Three Euthanasia Cases Face Investigation in the Netherlands.” (2019). Retrieved from https://www.theguardian.com/world/2019/jun/23/three-netherlands-euthanasia-cases-investigated
Colburn, Ben. “Disability‐based arguments against assisted dying laws.” Bioethics 36, no. 6 (2022): 680-686.
Curtice, Martin. “The Mental Capacity Act 2005 and autoerotic asphyxiation: pleasure versus the risk of harm.” BJPsych Advances (2022): 1-10.
Dignity In Dying. “Assisted Dying in the UK.” (2022). Retrieved from https://www.dignityindying.org.uk/assisted-dying/the-law/
Gallagher, James. & Roxby Philippa. “Assisted Dying Bill: MPs Reject ‘Right to Die Law” (2015). Retrieved from https://www.bbc.com/news/health-34208624
Hurley, Richard, Tessa Richards, and Fiona Godlee. “Assisted dying: a question of when not if.” bmj 374 (2021).
Reingold, Rebecca. “Child Euthanasia in Belgium.” (2020). Retrieved from https://oneill.law.georgetown.edu/child-euthanasia-in-belgium/
RightTo Life. “Assisted Suicide and Euthanasia” (2022). Retrieved from https://righttolife.org.uk/knowledgebase/assisted-suicide-and-euthanasia?gclid=CjwKCAjw5P2aBhAlEiwAAdY7dDYvCvKt53UnAwQbbbzjvV9_X1tyRzzq7f8xfhogm2wbn7UZwxgYixoCM0UQAvD_BwE
Webster, Paul. “Worries grow about medically assisted dying in Canada.” The Lancet 400, no. 10355 (2022): 801-802.
[1] Dignity In Dying. “Assisted Dying in the UK.” (2022). Retrieved from https://www.dignityindying.org.uk/assisted-dying/the-law/
[2] RightTo Life. “Assisted Suicide and Euthanasia” (2022). Retrieved from https://righttolife.org.uk/knowledgebase/assisted-suicide-and-euthanasia?gclid=CjwKCAjw5P2aBhAlEiwAAdY7dDYvCvKt53UnAwQbbbzjvV9_X1tyRzzq7f8xfhogm2wbn7UZwxgYixoCM0UQAvD_BwE
[3] RightTo Life. “Assisted Suicide and Euthanasia” (2022). Retrieved from https://righttolife.org.uk/knowledgebase/assisted-suicide-and-euthanasia?gclid=CjwKCAjw5P2aBhAlEiwAAdY7dDYvCvKt53UnAwQbbbzjvV9_X1tyRzzq7f8xfhogm2wbn7UZwxgYixoCM0UQAvD_BwE
[4] RightTo Life. “Assisted Suicide and Euthanasia” (2022). Retrieved from https://righttolife.org.uk/knowledgebase/assisted-suicide-and-euthanasia?gclid=CjwKCAjw5P2aBhAlEiwAAdY7dDYvCvKt53UnAwQbbbzjvV9_X1tyRzzq7f8xfhogm2wbn7UZwxgYixoCM0UQAvD_BwE
[5] RightTo Life. “Assisted Suicide and Euthanasia” (2022). Retrieved from https://righttolife.org.uk/knowledgebase/assisted-suicide-and-euthanasia?gclid=CjwKCAjw5P2aBhAlEiwAAdY7dDYvCvKt53UnAwQbbbzjvV9_X1tyRzzq7f8xfhogm2wbn7UZwxgYixoCM0UQAvD_BwE
[6] Gallagher, James. & Roxby Philippa. “Assisted Dying Bill: MPs Reject ‘Right to Die Law” (2015). Retrieved from https://www.bbc.com/news/health-34208624
[7] Gallagher, James. & Roxby Philippa. “Assisted Dying Bill: MPs Reject ‘Right to Die Law” (2015). Retrieved from https://www.bbc.com/news/health-34208624
[8] Dignity In Dying. “Assisted Dying in the UK.” (2022). Retrieved from https://www.dignityindying.org.uk/assisted-dying/the-law/
[9] Dignity In Dying. “Assisted Dying in the UK.” (2022). Retrieved from https://www.dignityindying.org.uk/assisted-dying/the-law/
[10] Dignity In Dying. “Assisted Dying in the UK.” (2022). Retrieved from https://www.dignityindying.org.uk/assisted-dying/the-law/
[11] Curtice, Martin. “The Mental Capacity Act 2005 and autoerotic asphyxiation: pleasure versus the risk of harm.” BJPsych Advances (2022): 1-10.
[12] Curtice, Martin. “The Mental Capacity Act 2005 and autoerotic asphyxiation: pleasure versus the risk of harm.” BJPsych Advances (2022): 1-10.
[13] Reingold, Rebecca. “Child Euthanasia in Belgium.” (2020). Retrieved from https://oneill.law.georgetown.edu/child-euthanasia-in-belgium/
[14] Reingold, Rebecca. “Child Euthanasia in Belgium.” (2020). Retrieved from https://oneill.law.georgetown.edu/child-euthanasia-in-belgium/
[15] Reingold, Rebecca. “Child Euthanasia in Belgium.” (2020). Retrieved from https://oneill.law.georgetown.edu/child-euthanasia-in-belgium/
[16] Colburn, Ben. “Disability‐based arguments against assisted dying laws.” Bioethics 36, no. 6 (2022): 680-686
[17] Colburn, Ben. “Disability‐based arguments against assisted dying laws.” Bioethics 36, no. 6 (2022): 680-686.
[18] Boztas, Senay. “Three Euthanasia Cases Face Investigation in the Netherlands.” (2019). Retrieved from https://www.theguardian.com/world/2019/jun/23/three-netherlands-euthanasia-cases-investigated
[19] Webster, Paul. “Worries grow about medically assisted dying in Canada.” The Lancet 400, no. 10355 (2022): 801-802.
[20] Webster, Paul. “Worries grow about medically assisted dying in Canada.” The Lancet 400, no. 10355 (2022): 801-802.
[21] Webster, Paul. “Worries grow about medically assisted dying in Canada.” The Lancet 400, no. 10355 (2022): 801-802.
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