Euthanasia, Terminal Sedation and Assisted Suicide

by Lucie-Anne Rhodes - Law Graduate

This guide explores the differences between euthanasia, terminal sedation and assisted suicide and considers how the laws on euthanasia and assisted suicide in England and Wales differ from those in the Netherlands, Belgium and Switzerland.

The subjects of euthanasia, terminal sedation and assisted suicide are highly controversial and opinions on whether they should be legalised are split. On the one hand is the argument that a person of sound mind who, for example, is terminally ill or suffered an extreme personal injury and may be in a great deal of pain should be allowed the right to choose whether he or she lives or dies. On the other hand however, are arguments about the sanctity of life and the need to protect against potential abuse, for example by ensuring that vulnerable people are not pressurised into taking the decision to end their lives prematurely on the premise that they have become a burden.

The Differences between Euthanasia, Terminal Sedation and Assisted Suicide

In England and Wales the term euthanasia is used colloquially to mean “mercy killing”, and refers to the act of terminating another’s life to end some form of incurable suffering to which that person is subject. If this act is carried out with the informed consent of the person whose life is being ended it becomes known as voluntary euthanasia. Conversely euthanasia without such consent, for example if a person is incapable of making a decision to end their own life and another person makes that decision for them, is known as involuntary euthanasia. As will be seen below the laws in England and Wales prohibit euthanasia.

Assisted suicide is in effect a form of euthanasia, and describes the situation whereby a person wishing to end their own life is provided with the means to commit suicide (i.e. drugs and/or equipment), usually because they are incapable of doing so without such assistance.

Terminal sedation on the other hand does not refer to a practice of ending another’s life, but rather is a process used to ease suffering in the final days or hours of the life of a terminally ill person who would otherwise experience considerable pain during that time. Usually this is done by continuously administering sedatives to the patient so that they remain in a state of unconsciousness and can no longer feel pain. Terminal sedation is not of itself unlawful in England and Wales, although there has been some media debate as to whether this process is effectively being used by doctors as an alternative to euthanasia.

The Law in the Netherlands

In the Netherlands euthanasia is taken to mean the termination of life by a doctor at the request of a patient and this definition encompasses assisted suicide.

Although euthanasia is still a criminal offence in the Netherlands, Dutch law incorporates an exemption for doctors who report their actions and who satisfy specific criteria requiring them to take “due care”. The due care criteria is set out in the Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2002.

Euthanasia has also been legalised in Belgium, and in Switzerland assisted suicide may be lawful provided there is no selfish motive.

The Law in England and Wales

Euthanasia is illegal in the UK and a person found guilty of active euthanasia (i.e. by an act as opposed to an omission) may be liable for murder. Despite this there are certain circumstances where inactive euthanasia will not result in prosecution, for example where life support is discontinued.

Although suicide itself is not illegal, the act of encouraging or assisting the suicide or attempted suicide of another person is a crime punishable by up to 14 years’ imprisonment. It is important to note however that proceedings against a person on the grounds of assisted suicide can only be brought by or with the consent of the Director of Public Prosecutions (“DPP”). The DPP will only take the decision to prosecute if it is in the public interest to do so, and therefore a person who assists another person to commit suicide will not always be prosecuted despite that an criminal offence will have been committed.

The high profile case of Debbie Purdy raised the important question of whether a person commits an unlawful act by helping another person to travel abroad to commit suicide in a country where the law permits assisted suicide. Briefly the facts of Debbie Purdy’s case are that she suffered from incurable motor neurone disease, which is degenerative in nature. Ms Purdy therefore wanted the option of determining when and how her life should come to an end, but her condition was such that she required the assistance of her husband to do this. Ms Purdy thus fought tirelessly to seek unequivocal assurance from the DPP that her husband would not be prosecuted for aiding Ms Purdy’s suicide after her death.

Ultimately no specific assurance was given by the DPP to the effect that Mrs Purdy’s husband would not be prosecuted. However Ms Purdy did succeed in persuading the DPP to produce guidance on the law on assisted suicide in England and Wales. This resulted in the introduction of an interim policy on “assisted suicide” which sets out various issues that the DPP will take into consideration when determining whether or not to prosecute for assisted suicide. The full policy can be found on the Crown Prosecution Service website (www.cps.gov.uk).

Whilst it may in certain circumstances provide persuasive evidence against prosecution, it should be noted that this policy does not change the law. Euthanasia and assisted suicide remain unlawful in England and Wales and so the policy can not be taken as a conclusive assurance as to whether a prosecution will be brought in any given case.

Summary

In England and Wales euthanasia and assisted suicide are illegal. However in the case of assisted suicide proceedings can only be taken by or with the consent of the Director of Public Prosecutions which will only be given where it would be in the public interest to prosecute. As a result of this where a person clearly wishes to commit suicide but requires assistance to do so it may be less likely that the DPP will prosecute a person providing such assistance. This position is very uncertain and can cause a great deal of stress for people considering whether to end their lives in this way.

In other parts of the world, in particular the Netherlands, Belgium and Switzerland, euthanasia and/or assisted suicide will not necessarily constitute criminal offences. As a result many people from the UK who are unable to commit suicide independently now travel to such countries with the intention of ending their lives. This poses the crucial question of whether a person commits a criminal offence in England and Wales by helping another person intending to commit suicide to travel abroad to a country where assisted suicide is lawful.

The DPP has provided an interim policy on assisted suicide which gives some guidance on when a person may be prosecuted for this offence. However the policy does not change the law and therefore fails to create any real certainty as to whether a prosecution will be brought in a particular case.

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