Physician-Assisted Suicide: Can the Doctor and Patient Escape the Slippery Slope, Together?
| Author | Vijay Chohan |
| Pages | 41-62 |
S.S.L.R Phy sician -Assisted Su icide: Esca ping the Slipp ery Slope Vol.4
Physician-Assisted Suicide: Can the Doctor and Patient
Escape the Slippery Slope, Together?
Vija y Chohan
The Assisted Suicide debate h as been controversial and longstand in g with et hical,
medical and legal complexities. Assisted Suicide remains illegal in England and
Wales after several Com m ission Rep orts a nd Reform Proposals. The current legal
framework is confusing an d inappropriate in the mod er n , dem ocratic society. The
media uproar in respon se to high profile cases, including Diane Pr etty, Debbie Purdy
and most recent ly, Tony Nicklin son, have spa rked interest from the legislature which
is yet again under pr essu re to produce clarification in th is con voluted area. This
Dissertation will con sider th e recen t All Party Parliamen tary Group ‘Safeguar ding
Choice’ Draft Assisted Dying Bill (20 12), Lord Joffe’s ‘The Assisted Dying for the
Terminally Ill Bill’ (20 0 4) and Dir ector of Public Prosecution Policy for Prosecutors
in respect of Cases of Encouragin g and Assist in g Suicide (2010). With th orough
analysis of these documents, combin ed with acad emic com m entary, the need for a
more specific, pat ient -led guid ance, aim ed solely at qualified physicians will be
evalua ted. Both eth ical an d pr actical consid erat ions will be deliber ated, in an attem pt
to creat e a justified balance.
The concep t of patien t autonom y m ust be enshrined in any proposed system,
allowing the terminally ill to choose a dignified death , within lim it s. The traditional
libertarian views an d mor e mod ern opinion s of au tonom y will be discu ssed in ligh t of
physician -assisted su icide (PAS) and how they have d eveloped to ou r modern way of
thinking. The patien t’s au tonomy remains cen tral to th e legalisation process, where a
balan ce must be str uck between th e sufferer’s choice to die and the protection of
society as a whole.
Part icu lar emphasis will be placed on the doctor-patien t relationship an d how it can
be u tilised to cr eate a sa fe process, em phasisin g equalit y and control. Th e histor y and
developm ent of the relationship will be analysed an d brought forwar d to the mod ern,
efficient , patient-focused relationship that creates a unique mutual trust and
con fidence.
Finally, the ‘slippery slope’ argumen ts against legalisation will be addr essed and
reconciled with various, substantial safeguards. Delving into th e logical, empir ical
and psychological ‘slippery slopes’, provides an underst anding of the need for certain
safeguards that attem pt to minimise th e prevalen ce of specific risks, inh erent in the
PAS pr ocess.
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[2014] Sou tha mpton Student La w R eview Vol.4
This Dissertation will conclude with a proposal, building on the DPP Policy an d
APPG Draft Bill to create a unified system th at will clarify the eligibility cr iter ia an d
safeguards, n ecessary in any legal PAS process. The various argumen ts stemming
from consideration of the patien t autonomy, the doctor-patient relationship and th e
slippery slop es will be incor pora ted to provide a th orou gh and inn ovative proposa l.
It is essential that the law is reform ed, to pr ovide clarity and comfort in a scenar io
th at rest s on t he fine lin e between morality and im mor ality, or legality an d illegality.
Introduction:
t is n ot for the court to decide whether the law about assist ed dying sh ould be
cha nged an d, if so, wh at sa feguar ds sh ould be pu t in p lace. Und er ou r syst em of
gover nmen t these are matters for Parliam en t to decide, rep resenting society as
a whole, after Par liam en tary scrutiny, and n ot for the cou rt on the facts of an
individu al case or cases’1
Lord Justice Toulson (Tony Nicklinson v Ministr y of Justice)
Wh at i s a ss ist ed su icid e?
‘If D arranges for a person (“D2”) to do an act that is capable of en couraging or
assist in g the su icide or attem pted suicide of another person and D2 does that act, D
is also t o be treat ed for th e pur poses of t his Act a s havin g don e it’.2
Assist ed suicide is the act of one in dividu al pr oviding another with the m eans to end
their life, eit her by offering the fatal medicat ion itself or taking the person to a place
where it can be carr ied out. It is not the same as euthan asia, which involves a person
actively ending the life of another. Physician -assisted su icide (PAS) includes a
qualified medical practition er as the ‘assistor’, who guides th e patien t th rough the
pr ocess, from th e initial diagn osis, t o the pr escript ion of th e life-ending medication.3
Assist ed suicide is illegal in England, un der section s59 of Coroners and J u stice Act
20 0 9 which am ends s2 of the Suicide Act 196 1. There has been enor m ous debate
over the past few decades, which have questioned the classification of PAS as a
‘crime’ and the possibility of a legalised procedure. The debate is particularly
controversial, combining a number of ethical, medical an d legal argum ents, as well
as t he gr eatly influential H uman Rights perspective. The media uproar over the past
decade h as attracted en ormous public interest. Th e case of Regina (Purdy) v Director
of Public Prosecu tions (Society for the Pr ot ection of Unborn Children in terven in g) is
very relevant as the House of Lords held that t he DPP should prom ulgate specific
guidance to produce some kind of clar ity an d coherence for those con tem plating
assisted suicide, in regards to the factors that th e prosecution will consider when
deciding a case. Pr etty v The Un ited Kingdom was also a seminal judgement as the
1 The Queen on the Application of Tony Nicklinson v Ministry of Justice [2012] EWHC 2381 (Admin) [150]
(Lord Toulson)
2 Coroners and Justice Act 2009, s59 (amends s2 of the Suicide Act1961)
3 John Keown, Euthanasia, Ethics and Public Policy: An Argument Against Legalisation (Cambridge University
Press, 2002) 31
‘I
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