MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

SHOULD UK LAW BE CHANGED TO PERMIT DEATH WITH

DIGNITY AND STILL PROTECT THE VULNERABLE?
This essay will explore whether the law on assisted dying in the United Kingdom should be
changed to permit death with dignity, whilst ensuring that vulnerable people are also
protected. The terms euthanasia and assisted suicide will be explored with respect to how
they differ and the way that they are used. The case of Debbie Purdy will be discussed in
relation to the new guidelines issued by the Director of Public Prosecutions (DPP) on the
prosecution of assisting a suicide; how the guidelines have affected recent cases will also be
considered. The essay will also look at cases and legislation on assisted dying from other
countries and will be compared to the current law in the UK and the recent Bill debated in
UK Parliament. Arguments in favour and against a change in the UK law will also be
discussed with reference to palliative care and how legalisation could be implemented whilst
ensuring the protection of vulnerable people.
The Law on euthanasia, or assisted suicide, is an incredibly controversial issue that has been
debated for many years, and consists of legitimate concerns for both sides of the argument.1
The word euthanasia comes from the Greek words eu (good) and thanatos (death)
meaning good death; to many a good death would constitute dying in ones sleep, dying
quietly, with dignity, being pain free and being comfortable and surrounded by loved ones.2
Euthanasia is the act of deliberately ending a persons life to relieve suffering and is carried
out by a Doctor. Under UK law, euthanasia is classed as murder and carries a sentence of life
imprisonment.3
When discussing euthanasia it is important to understand the different types of euthanasia and
their legal standing. Euthanasia can be classified as active and passive; active euthanasia is
where a person deliberately intervenes to end someones life, for instance a Doctor injecting a
patient with a lethal amount of sedatives. Passive euthanasia is different to active euthanasia;
it is where a person causes death by withholding or withdrawing treatment that is necessary
to maintain life, such as withdrawing artificial hydration and nutrition from a person who
cannot eat or drink by themselves. Euthanasia can also be classified as voluntary, nonvoluntary and involuntary. Voluntary euthanasia is where a person makes a conscious
decision to die and asks for help to do this. Non-voluntary euthanasia is where a person is not
able to give consent, this could be because they are in a coma or severely brain damaged, and
another person makes the decision on their behalf; the decision is often based on a wish
previously expressed by the person, or is determined to be in the best interests of the patient.
1

Kailash Chand, 'Why we should make euthanasia legal' (Joe Public Blog, Assisted Dying, 1st July)
<http://www.theguardian.com/society/joepublic/2009/jul/01/euthanasia-assisted-suicide-uk> accessed 12 November 2015
2
Payne SA, Langley-Evans A and Hillier R, 'Perceptions of a 'Good' Death: A Comparative Study of the Views of Hospice
Staff and Patients' [1996] 10 (4) European Association of Palliative Care
<http://pmj.sagepub.com/content/10/4/307.abstract> accessed 5 December 2015
3
Jackson E, Medical Law: Text, Cases and Materials (3rd edition, Oxford University Press, Oxford) 872 - 874

1|Page

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

Unlike voluntary and non-voluntary euthanasia, involuntary euthanasia is where a person is

killed against their will; this is almost always regarded as murder.4
In the United Kingdom all forms of euthanasia are considered illegal and carry prison
sentences, although it is at the discretion of the Director of Public Prosecution as to whether
cases of assisted suicide are prosecuted. In English law there is a difference between acting
and refraining to act, this is known as an omission. If death follows an omission by a doctor
or healthcare professional, a murder charge can still be brought, however there are two points
that need considering. Firstly, where a patient is incompetent, a doctor must treat the patient
in their best interests, however, a doctor is not legally required to give treatment which is not
positively in the patients interests, and therefore it must be acknowledged that sometimes it
is in the best interests of the patient for the doctor to withdraw treatment. Secondly, where a
patient is competent and has refused treatment, it would be unlawful for the doctor to give the
patient the treatment; this extends to the refusal of life-saving treatment.5
The case Re B (Adult: Refusal of Medical Treatment) 20026 discussed when a competent adult
can refuse treatment. Ms B, aged 41, suffered paralysis from the neck down and was
dependent on a ventilator. She requested that the ventilator be switched off, knowing full well
that she would die without it. Although the medical team accepted that Ms B was competent,
they felt unable to comply with her wishes as they believed she still had a valuable life. It was
held that an adult of competent mind has an absolute right to refuse treatment, and although
the medical team thought her decision was not in her best interests, that factor was irrelevant.
In this case it was established that Ms B was competent and fully aware of all of the
information and alternative options; legally her decision had to be respected and the
ventilator was switched off.
Lord Donaldson MR stated in a similar case, Re T (Adult: Refusal of Treatment) 19927 This
situation gives rise to a conflict between two interests, that of the patient and that of the
society in which he lives. The patients interest consists of his right to self-determination his
right to live his own life how he wishes, even if it will damage his health or lead to his
premature death. Societys interest is in upholding the concept that all human life is sacred
and should be preserved if at all possible. It is well established that in the ultimate the right of
the individual is paramount.8 The right to refuse treatment comes from the right to life, and
therefore should include a persons right to die, whether that means the refusal of treatment or
a request to end their life; death is naturally a part of life and therefore should be given the
same amount of respect as life.
4

National Health Service, 'Euthanasia and Assisted Suicide' (NHS Article 2014)
<http://www.nhs.uk/Conditions/euthanasiaandassistedsuicide/Pages/introduction.aspx> accessed 12 November 2015
5
Herring, J, Medical Law (4th edition, Pearson Education Limited, London) 112
6
Re B (Adult: Refusal of Medical Treatment) [2002] 2 FCR 1
7
Re T (Adult: Refusal of Treatment) Court of Appeal: Lord Donaldson M.R., Butler-Sloss and Staughton L.JJ.; [1992] 3
W.L.R. 782.
8
Stauch M, 'Special Clinical Ethics Symposium: The Case of Ms B' [2002] 28 (4) Journal of Medical Ethics
<http://jme.bmj.com/content/28/4/232.full#ref-1> accessed 5 December 2015

2|Page

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

Assisted suicide is not the same thing as euthanasia. In cases of euthanasia, it is the Doctors
actions that cause the patients death, but in the case of assisted suicide, the patient causes
their own death with the assistance of another; assisted suicide is the act of deliberately
assisting or encouraging another person to kill themselves. It usually involves a family
member obtaining the necessary medication or materials whilst knowing that the person
intends to use them to end their life. Assisted suicide is also a criminal offence under Section
2(1) of the Suicide Act 1961 whereby a person who aids, abets, counsels or procures the
suicide of another, or an attempt by another to commit suicide, shall be liable on conviction
of indictment to imprisonment for a term not exceeding 14 years.9 However due to the
inconsistencies between the law and prosecution of such cases, Ms Purdy10 launched a case to
determine whether or not her husband would be prosecuted if he helped her travel to a
Dignitas Clinic in Switzerland in order to die.
Debbie Purdy suffered with primary progressive Multiple Sclerosis (MS), for which there is
no known cure, and foresaw a time when she would want to end her life with dignity and on
her own terms; however due to her condition she would need the help of her husband to carry
out her wishes. Ms Purdy argued that the Director of Public Prosecutions (DPP) was
infringing on her human rights by failing to clarify how the Suicide Act11 is enforced. Ms
Purdys particular concern was to discover if any actions her husband took in assisting her
suicide would lead to his prosecution.
Ms Purdys case ended on the 30th August 2009 following a decision made by the House of
Lords that a persons decision to end their life fell within Article 8 of the European
Convention on Human Rights. The House of Lords also stated that although the decision to
commit suicide fell within Article 8, the law could interfere in the exercise of that right if it
was deemed necessary to protect vulnerable people who might otherwise be pressurised into
committing suicide. The Lordships also decided that the law had to be clear, and agreed with
Ms Purdy that it was insufficiently clear when the DPP would prosecute. As a result of the
ruling in Purdy v DPP, the Director of Public Prosecutions had to clarify how the Suicide Act
1961 is to be enforced in England and Wales,12 and under what circumstances cases will be
prosecuted.
In response to the House of Lords judgement in the Purdy13 case, the Director of Public
Prosecutions outlined the factors considered when making a decision on assisted suicide
cases.14 The DPP issued guidelines in February 2010 setting out situations where a
prosecution would not be deemed to be in the public interest, and therefore unlikely to
9

Section 2(1) Suicide Act 1961

R (Purdy) v DPP [2009] UKHL 45
11
Suicide Act 1961
12
R (Purdy) v DPP [2009] UKHL 45
13
R (Purdy) v DPP [2009] UKHL 45
14
Jackson E, Medical Law: Text, Cases and Materials (3rd edition, Oxford University Press, Oxford) 872
10

3|Page

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

happen. Two factors which point towards a public prosecution not being in the public interest
are that the victim had reached a voluntary, clear, settled and informed decision to commit
suicide; and that the suspect was wholly motivated by compassion.15 Other factors to be taken
into account include how ill the would-be-suicide was, and whether the assister would gain
financially from the death.16 The DPP guidelines were revised in 2014 to update the public
interest factors tending against and in favour of prosecution; this resulted in six reasons
against prosecution compared to sixteen reasons in favour of prosecution. The updated
guidelines outlined the strict requirements which must be satisfied in order for a person to not
face prosecution when assisting a suicide; the sheer divide between the amount of reasons for
and against prosecution mimic the division of societys views on changing the law to legalise
euthanasia and assisted suicide.
The decision in the Purdy17 case followed a similar case in December 2008. Daniel James, a
young man of 23, who was paralysed in a Rugby accident died at a Dignitas Clinic in
September 2008 after travelling to Switzerland with the aid of his parents. The Department of
Public Prosecutions determined that to prosecute the parents would be against the public
interest as there was sufficient evidence to support that Mr James was not coerced in any way,
and that it was wholly his decision.18 The decision made in the case of Debbie Purdy also
highlighted that by 2009 ninety-two Britons had travelled abroad for assisted suicide; the
DPP had not prosecuted any of the family members involved.
Following the guidelines published by the Director of Public Prosecutions in 2010 (revised in
2014), the Policy for Prosecutors in respect of Cases of Encouraging and Assisting Suicide,
there have been numerous cases of assisted suicide, however only a small percentage of
prosecutions have been made by the Crown Prosecution Service (CPS). Between April 2009
and October 2015, there have been 117 cases of assisted suicide referred to the CPS; 75 cases
were not prosecuted and 24 cases were withdrawn. One case of assisted attempted suicide
was successfully prosecuted in October 2013, one case of assisted suicide was charged and
acquitted after trial in May 2015 and six cases have been referred onwards for prosecutions of
homicide or other serious crimes.19
A large percentage of assisted suicide cases have not been prosecuted, therefore indicating
that the guidelines issued by the DPP are bearing some weight on peoples decisions to die; it
could also be assumed that the majority of assisted suicides are carried out through
compassion and after much consideration by all parties involved. It could also be argued that
15

Director of Public Prosecutions, 'Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide' (The
CPS: Assisted Suicide Policy 2010) <http://www.cps.gov.uk/publications/prosecution/assisted_suicide_policy.html>
accessed 23 November 2015
16
Herring, J, Medical Law (4th edition, Pearson Education Limited, London) 114-115
17
R (Purdy) v DPP [2009] UKHL 45
18
BBC News, 'No Charges Over Assisted Suicide' (News Article 9 December 2008)
<http://news.bbc.co.uk/1/hi/england/hereford/worcs/7773540.stm> accessed 23 November 2015
19
The Crown Prosecution Service, 'The CPS: Assisted Suicide' (Crown Prosecution Service Document 2010)
<http://www.cps.gov.uk/publications/prosecution/assisted_suicide.html> accessed 2 November 2015

4|Page

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

legalising euthanasia and assisted suicide in the UK would permit more people to make
decisions about how they die, but would be controlled through strict criteria and requirements
therefore making it difficult to abuse, but also providing protection for vulnerable people who
may be easily coerced.
In another CPS case of suspected assisted suicide it was decided that there was insufficient
evidence to bring charges against any individual in relation to the death of Jane Hodge on 17th
June 2009. Michael Jennings, the reviewing lawyer for the CPS Special Crime Division said:
Mrs Hodge ingested a large amount of prescription drugs and lapsed into unconsciousness.
She never regained consciousness, dying at home on the 17 June Mrs Hodge acted
independently. There is no suggestion anyone procured or assisted in the administration of the
drugs. I decided there was insufficient evidence to proceed with the offence of assisting
suicide Mrs Hodge had [previously] signed an advance decision ... If unable to make her
own decisions, with little chance of recovery, she did not wish to be treated, resuscitated or
kept alive artificially. I was satisfied this advance decision was valid and applicable.20
An Advance Decision is a declaration a person can make to refuse a specific type of
treatment at some point in the future in case they are unable to communicate their wishes at a
later date. The advance decision must name all of the treatments a person wants to refuse and
must clearly identify under which circumstances the treatments are to be refused. A person
may only create an advance decision if they are deemed to be mentally competent. The
Mental Capacity Act 2005 provides a statutory basis for advance decisions; advance decisions
must be respected by medical professionals should a patient become mentally or physically
incapacitated.21 Although an advance decision does not permit the use of euthanasia or
assisted suicide, it is a legally binding document which outweighs any decisions made in a
persons best interests and provides a degree of control over end of life decisions.
In the case of R (Nicklinson) v Ministry of Justice22 Mr Nicklinson was suffering from a
severe physical disability and wished to die, however, his disability meant that he could not
easily kill himself, and would therefore require help to die. Mr Nicklinson applied to the High
Count for (i) a declaration that it would be lawful for a doctor to kill him or assist him in
terminating his life, or, if that was refused, (ii) a declaration that the current state of the law in
that connection was incompatible with his right to a private life under Article 8 of the
Convention.23 Mr Nicklinson stated that by criminalising euthanasia and assisted suicide, his
human rights had been infringed; he argued that the law was not compatible with his right to

20

The Crown Prosecution Service, 'CPS Decides No Charges Following the Death of Jane Hodge' (Crown Prosecution
Service Document 2010) <http://www.cps.gov.uk/news/latest_news/106_-_10/> accessed 2 November 2015
21
National Health Service, 'End of Life Care: Advance Decision' (NHS Article 2014) <http://www.nhs.uk/Planners/end-oflife-care/Pages/advance-decision-to-refuse-treatment.aspx> accessed 30 November 2015
22
R (Nicklinson) v Ministry of Justice [2013] EWCA Civ 961
23
R (Nicklinson) v Ministry of Justice [2013] EWCA Civ 961

5|Page

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

respect for private life as it imposed a mandatory life sentence for cases of genuinely
compassionate voluntary active euthanasia.24
It was held that the current law in the United Kingdom was clear; it is unlawful for one
person to kill another unless an established defence such as self-defence is applied. It was
also held by the Supreme Court that, according to the case law of the European Court of
Human Rights, the question whether to impose a general ban on assisted suicide lies within
the margin of appreciation of the United Kingdom. Whether the current law is incompatible
with Article 825 is, therefore, a domestic question for the United Kingdom courts to decide
under the Human Rights Act 1998. The decision in R (Nicklinson) v Ministry of Justice26 also
stated that it would be wrong for the courts to develop the defence of necessity to apply to
cases of euthanasia and assisted suicide; assisted dying is a controversial issue, and if the law
was to be changed it should be done through Parliament and not the courts.
There are numerous accounts of disabled people going abroad for assisted suicide as they are
unable to end their lives without help and cannot access the assistance they desire in the UK.
If the law was to be changed to legalise euthanasia and assisted suicide, a decision would
have to be made about whether to include disabled patients as well as terminally ill patients.
In other countries where legislation permitting euthanasia and/or assisted suicide has been
introduced, only terminally ill people have the opportunity to access it, and people with
disabilities do not appear to be considered; this exclusion could be seen as infringing a
disabled persons human rights and equality.
Although it is illegal to practice euthanasia and assisted suicide in the United Kingdom, there
are several countries that have adopted legislation to permit euthanasia or physician assisted
suicide including Belgium, Luxembourg, The Netherlands, Switzerland, and five US states.
The Netherlands is one of the few countries that have legislation in place to legalise
euthanasia. The Termination of Life on Request and Assisted Suicide (Review Procedures)
Act was created in 2001 following a series of court decisions which produced a set of
guidelines to protect healthcare physicians from criminal liability. The act permits euthanasia
if it is performed under certain circumstance (a) the patient should be incurably ill; (b) the
patient should be experiencing unbearable suffering; (c) the patient should have requested
that his or her life be terminated; and (d) the termination is performed by the patients own
doctor, or in consultation with him or her.27 The guidelines were adopted by the Public
Prosecutors Office as the criteria to determine whether or not cases of euthanasia or assisted

24

Sumpreme Court, 'R (on the application of Nicklinson and another) (Appellants) v Ministry of Justice (Respondent); R
(on the application of AM) (AP) (Respondent) v The Director of Public Prosecutions (Appellant) [2014] UKSC 38'
(Sumpreme Court Press Summary 2014) <https://www.supremecourt.uk/decidedcases/docs/uksc_2013_0235_presssummary.pdf> accessed 2 November 2015
25
Article 8 of the European Convention on Human Rights
26
R (Nicklinson) v Ministry of Justice [2013] EWCA Civ 961
27
(EC) The Termination of Life on Request and Assisted Suicide (Review Procedures) Act [2002]

6|Page

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

suicide would be prosecuted; each case is considered by a regional review committee which
consists of a lawyer, doctor and ethicist. 28
Similarly to the United Kingdom, euthanasia is illegal throughout the United States, however
physician assisted suicide is legalised in certain states. Oregon was the first state to legalise
assisted suicide with the introduction of the Death with Dignity Act (DWDA) which came
into force in 1998. The DWDA allows terminally ill Oregon residents to obtain and use
prescriptions from their physicians for self-administered, lethal medications; the act
specifically prohibits euthanasia, where a physician or other person directly administers a
medication to end anothers life. The requirements to request a prescription for lethal
medications are as follows:
(i) An adult (18 years of age or older), (ii) A resident of Oregon, (iii) Capable (defined as able
to make and communicate health care decisions), and (iv) Diagnosed with a terminal illness
that will lead to death within six months.
Patients meeting these requirements are eligible to request a prescription for lethal medication
from a licensed Oregon physician. To receive a prescription for lethal medication the
following steps must be fulfilled:
(1) The patient must make two oral requests to his or her physician, separated by at least 15
days, (2) The patient must provide a written request to his or her physician, signed in the
presence of two witnesses, (3) The prescribing physician and a consulting physician must
confirm the diagnosis and prognosis, (4) The prescribing physician and a consulting
physician must determine whether the patient is capable, (5) If either physician believes the
patients judgement is impaired by a psychiatric or psychological disorder, the patient must
be referred for a psychological examination, (6) The prescribing physician must inform the
patient of feasible alternatives to DWDA, including comfort care, hospice care, and pain
control, and (7) The prescribing physician must request, but may not require, the patient to
notify his or her next-of-kin of the prescription request.29
To date, five states in the United States have legalised some form of euthanasia or assisted
suicide; the state of Washington adopted the Death with Dignity Act in November 2008;
Montana introduced Article 2, Sections 4 and 10 of the Montana Constitution in December
2009; Vermont introduced Act No.39. An Act Relating to Patient Choice and Control at End
of Life in May 2013; and California is the newest state to legalise assisted suicide with the
End of Life Option Act which will come into effect in January 2016. All five American States
have similar requirements to access physician assisted suicide; the patient must be 18 years
old or above, have six months or less to live, and must make two oral requests (at least 15
days apart) and one written request.30 These specific requirements form part of the legislation
28

Jackson E, Medical Law: Text, Cases and Materials (3rd edition, Oxford University Press, Oxford) 931-932
Oregon Public Health, 'Death with Dignity Act Requirements' [2014] Oregon Health Authority
<https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/requirem
ents.pdf> accessed 2 November 2015
30
Pro Con Community, 'State-by-State Guide to Physician-Assisted Suicide' (ProCon.org 2015)
<http://euthanasia.procon.org/view.resource.php?resourceID=000132#legal_states> accessed 19 November 2015
29

7|Page

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

to ensure the safety of patients and to protect vulnerable people from being coerced into the
decision and to ensure that all of the options and alternatives have been wholly understood
and considered by the patient.
The UK has recently rejected a Bill in Parliament to permit assisted dying based on the
criteria and requirements in the Oregon Death with Dignity Act. The Bill would have enabled
anyone thought to have no more than six months to live in the opinion of two doctors to be
given help to end their life. A High Court judge would also have to rule that the person had
voluntarily expressed a clear intention to die. Sarah Wootton, the Chief Executive of Dignity
in Dying said the vote only goes to show just how ridiculously out of touch MPs are with the
British public on the issue By rejecting the Bill, Parliament has in effect decided to
condone terminally ill people ending their own lives but refused to provide them the adequate
protection they need.31
There are many arguments which promote the legalisation of euthanasia and/or assisted
suicide. One of the main arguments is patient autonomy; many people think that individuals
should have the right to control their body and life, and should therefore have some form of
control about when and how they die. The principle of patient self-determination has become
more dominant in recent years, and it could be argued that a patient has an implied right to
die due to having the right to life; it is possible to argue that other human rights ought to be
taken to include this right. Sylvia Law suggests that giving patients a degree of control over
how they die could appear to be an important part of respect for autonomous decisionmaking: The dying patient has lost control of most significant aspects of his or her life. The
assurance that assisted death is an option provides a measure of autonomy and control.32
Death is an intimate part of life and therefore should be controlled by the individual if that is
what they choose; it is not a case of legalising assisted dying to force it upon people, but to
give people the option to make their own end of life decisions.
Another argument for legalising euthanasia and assisted suicide is compassion; ending a
persons life relieves unbearable suffering and allows them to have a degree of dignity in
dying. Using the argument of compassion as opposed to patient autonomy for the justification
of legalisation allows restrictions to be implemented; legalisation could also prevent people
seeking assisted suicide from travelling abroad to clinics such as Dignitas, instead it would
allow people to die in the comfort of their own homes, surrounded by family and friends;
which is ultimately deemed to be a good death.
Inconsistency of the law is another argument used to promote the legalisation of euthanasia
and assisted suicide. It is argued that if doctors are permitted to withdraw life-saving
31

Bingham J, 'Right to Die: MPs Reject Assisted Dying Law' The Telegraph (Online Newspaper Article 11 Septemer 2015)
<http://www.telegraph.co.uk/news/uknews/assisted-dying/11857940/Assisted-dying-vote-in-House-of-Commons.html>
accessed 12 November 2015
32
Law A, Physician-Assisted Death: An Essay on Constitutional Rights and Remedies (1996) 55 Maryland Law Review
292

8|Page

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

treatment and give lethal doses of pain relief, then the notion of allowing a painless lethal
injection should not be rejected. This inconsistency introduces the Doctrine of double effect
which differentiates between the actions of the doctor where death is either foreseen or
intended; a doctor who gives a large dose of morphine knows that the patient may die but is
justifiable as it is intended to relieve pain. Under UK law doctors are permitted to prescribe
large amounts of pain relief if it is in the patients best interest, and is deemed an acceptable
amount by other healthcare professionals, even if the patients life is shortened as a result.33
Changing the UK law on euthanasia and assisted suicide could potentially stop other forms of
assisted suicide, and if regulations were implemented similar to those in the Oregon Death
with Dignity Act, people would have some control over their end of life choices and
vulnerable people would be adequately protected due to the strict requirements and guidelines
of the Act.
Although there are many arguments in favour of changing the UK law on euthanasia and
assisted suicide, there are also many arguments against a change in the law. The main
argument is the belief that one person killing another is a violation of the notion of sanctity
of life; it surrounds the acceptance that death can be preferred to life which contravenes the
principle that all human life in intrinsically valuable.34 It is argued that the deliberate taking of
human life should be prohibited except in cases of self-defence or the legitimate defence of
others.
People against euthanasia also argue that legalisation is unnecessary for two reasons; firstly
because palliative care is provided by way of hospices and care at home, and secondly,
doctors already have powers which enable them to help patients die. Hospices and other
forms of palliative care within the United Kingdom provide end of life care, however studies
show that people request euthanasia more for loss of autonomy and dignity as opposed to
unbearable pain35; Baroness Young also took the view that palliative care, no matter how
good, isnt always enough to ally the indignity and loss of control that people with terminal
illness experience.36 Palliative care in the UK is at a much higher standard than other
European countries; however, there is a dramatic difference between the levels of palliative
care received in hospices as opposed to palliative care at home. If improvements were made,
palliative care may become more of an option for people who consider assisted dying.
A study showed that in countries where assisted dying is legal, legal change has been
accompanied by greater investment and improvements in palliative care. Additionally, there
was evidence from individuals who stated that palliation, no matter how good, was not
33

Ministry of Ethics, 'Suicide, Assisted Suicide, and Euthanasia' (Ministry of Ethics Article 2010-2014)
<http://ministryofethics.co.uk/?p=11&q=3> accessed 19 November 2015
34
Jackson E, Medical Law: Text, Cases and Materials (3rd edition, Oxford University Press, Oxford) 917
35
Physician Assisted Suicide in Oregon
36
Nursing Times, 'Assisted Dying Would Provide Dignity in Dying' (Nursing Article 2012)
<http://www.nursingtimes.net/nursing-practice/specialisms/end-of-life-and-palliative-care/assisted-dying-would-providedignity-in-death/5040112.article> accessed 12 November 2015

9|Page

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

enough to allay the indignity and loss of control of their situation. This adds to the argument
that assisted dying provides what could be construed as a good death allowing individuals to
be in control and have dignity in dying.37
It is also argued that if euthanasia and assisted suicide are legalised, it will be difficult to
ensure that requests have been made voluntarily and views are not distorted by mental
illnesses, such as depression. Euthanasia and assisted suicide could create a risk of abuse,
especially for elderly patients, who feel they have become a burden to their families, whilst
others may be coerced into requesting euthanasia by relatives who will benefit from their
death, either financially or otherwise. A further concern is that discussions between a doctor
and patient are kept confidential and therefore cannot be monitored; it is argued that as a
result, the relationship between doctor and patient may suffer. Supporters of euthanasia and
assisted suicide would argue that patients already make decisions about dying, involving
refusal of treatments, advance decisions and DNRs (do not resuscitate forms); and that
having a doctor patient relationship offers more protection for vulnerable patients. If UK law
was to legalise euthanasia and assisted suicide, restrictions would have to be implemented to
protect the vulnerable; the five states in America have created a set of requirements which
permit death with dignity but protect vulnerable people throughout the certain stages.
Assisted dying is a controversial topic debated worldwide with arguments both for and
against legalisation. This essay has discussed the differences between the terms euthanasia
and assisted suicide and how these terms are perceived in the eyes of the law inside and
outside of the United Kingdom; the withdrawal of treatment, patient capacity and advance
decisions have also been touched upon when exploring the legalisation of euthanasia and
assisted suicide.
As it stands, all forms of assisted dying are illegal within the UK, however the guidelines
issued by the Director of Public Prosecutions have outlined under which circumstances cases
of assisted suicide will and will not be prosecuted. Since these guidelines were issued, there
have only been a small percentage of prosecutions for cases of assisted suicide, therefore
suggesting that assisted dying is carried out through compassion for the person with the
determination of the person to die with dignity and on their own terms.
It has also been established that there are no provisions in place for assisted dying for people
with severe disabilities. Although the essay explores the legislation of other countries,
assisted dying is only permitted in a handful of countries in the European Union and five
states in the US, however the criteria excludes disabilities and is only applicable to people
with terminal illnesses. The Oregon Death with Dignity Act has definitely set the legal basis
for permitting assisted dying for other states in America; the requirements and process of the
DWDA has even been seen in the UK in the recent Bill debated in Parliament in September
2015. The DWDA has outlined clear requirements which must be met before a prescription of
lethal medication will be given; these requirements seek to protect vulnerable people whilst
giving other people control over how they die.
37

Nursing Times, 'Assisted Dying Would Provide Dignity in Dying' (Nursing Article 2012)
<http://www.nursingtimes.net/nursing-practice/specialisms/end-of-life-and-palliative-care/assisted-dying-would-providedignity-in-death/5040112.article> accessed 12 November 2015

10 | P a g e

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

Arguments for and against euthanasia have been discussed, taking into account different
views and opinions on the subject of changing the UK law. The arguments in favour of
legalising assisted dying appear to outweigh the arguments against, however an improvement
in palliative care in the UK could also deter people from requesting an assisted death.
Ultimately, assisted dying offers a degree of control and dignity to the person and ensures that
they die a pain-free and comfortable death surrounded by loved ones. A change in the UK law
would allow people to die a good death, whilst proper legal safeguards could be devised to
ensure vulnerable people are not pressurised into ending their lives.

BIBILOGRAPHY
PRIMARY SOURCES
Cases
Re B (Adult: Refusal of Medical Treatment) [2002] 2 FCR 1

11 | P a g e

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE
Re T (Adult: Refusal of Treatment) Court of Appeal: Lord Donaldson M.R., Butler-Sloss and
Staughton L.JJ.; [1992] 3 W.L.R. 782.
R (Nicklinson) v Ministry of Justice [2013] EWCA Civ 961
R (Purdy) v DPP [2009] UKHL 45
Sumpreme Court, 'R (on the application of Nicklinson and another) (Appellants) v Ministry of Justice
(Respondent); R (on the application of AM) (AP) (Respondent) v The Director of Public Prosecutions
(Appellant) [2014] UKSC 38' (Sumpreme Court Press Summary 2014)
<https://www.supremecourt.uk/decided-cases/docs/uksc_2013_0235_presssummary.pdf> accessed 2
November 2015

Legislation
Suicide Act 1961
Section 2(1) Suicide Act 1961

EU Legislation
Article 8 of the European Convention on Human Rights
The Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2001

US Legislation
Physician Assisted Suicide in Oregon
Death with Dignity Act 1998
Death with Dignity Act 2008
Article 2, S4 and S10 of the Montana Constitution 2009
Act No.39. An Act Relating to Patient Choice and Control at End of Life 2013
End of Life Option Act 2016

SECONDARY SOURCES
Books
Herring, J, Medical Law (4th edition, Pearson Education Limited, London)
Jackson E, Medical Law: Text, Cases and Materials (3rd edition, Oxford University Press, Oxford)

12 | P a g e

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE

Journals
Bingham J, 'Right to Die: MPs Reject Assisted Dying Law' The Telegraph (Online Newspaper Article
11 Septemer 2015) <http://www.telegraph.co.uk/news/uknews/assisted-dying/11857940/Assisteddying-vote-in-House-of-Commons.html> accessed 12 November 2015
Law A, Physician-Assisted Death: An Essay on Constitutional Rights and Remedies (1996) 55
Maryland Law Review 292
Ministry of Ethics, 'Suicide, Assisted Suicide, and Euthanasia' (Ministry of Ethics Article 2010-2014)
<http://ministryofethics.co.uk/?p=11&q=3> accessed 19 November 2015
Nursing Times, 'Assisted Dying Would Provide Dignity in Dying' (Nursing Article 2012)
<http://www.nursingtimes.net/nursing-practice/specialisms/end-of-life-and-palliative-care/assisteddying-would-provide-dignity-in-death/5040112.article> accessed 12 November 2015
Payne SA, Langley-Evans A and Hillier R, 'Perceptions of a 'Good' Death: A Comparative Study of the
Views of Hospice Staff and Patients' [1996] 10 (4) European Association of Palliative Care
<http://pmj.sagepub.com/content/10/4/307.abstract> accessed 5 December 2015
Stauch M, 'Special Clinical Ethics Symposium: The Case of Ms B' [2002] 28 (4) Journal of Medical
Ethics <http://jme.bmj.com/content/28/4/232.full#ref-1> accessed 5 December 2015

Websites
BBC News, 'No Charges Over Assisted Suicide' (News Article 9 December 2008)
<http://news.bbc.co.uk/1/hi/england/hereford/worcs/7773540.stm> accessed 23 November 2015
Director of Public Prosecutions, 'Policy for Prosecutors in Respect of Cases of Encouraging or
Assisting Suicide' (The CPS: Assisted Suicide Policy 2010)
<http://www.cps.gov.uk/publications/prosecution/assisted_suicide_policy.html> accessed 23
November 2015
Kailash Chand, 'Why we should make euthanasia legal' (Joe Public Blog, Assisted Dying, 1st July)
<http://www.theguardian.com/society/joepublic/2009/jul/01/euthanasia-assisted-suicide-uk> accessed
12 November 2015
National Health Service, 'Euthanasia and Assisted Suicide' (NHS Article 2014)
<http://www.nhs.uk/Conditions/euthanasiaandassistedsuicide/Pages/introduction.aspx> accessed 12
November 2015
National Health Service, 'End of Life Care: Advance Decision' (NHS Article 2014)
<http://www.nhs.uk/Planners/end-of-life-care/Pages/advance-decision-to-refuse-treatment.aspx>
accessed 30 November 2015
Oregon Public Health, 'Death with Dignity Act Requirements' [2014] Oregon Health Authority
<https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/
Documents/requirements.pdf> accessed 2 November 2015

13 | P a g e

MEDICAL LAW ASSESSMENT

ESSAY PLAN
REI12056395 WORD COUNT: 5,452 PAMELA WHITE
Pro Con Community, 'State-by-State Guide to Physician-Assisted Suicide' (ProCon.org 2015)
<http://euthanasia.procon.org/view.resource.php?resourceID=000132#legal_states> accessed 19
November 2015
The Crown Prosecution Service, 'The CPS: Assisted Suicide' (Crown Prosecution Service Document
2010) <http://www.cps.gov.uk/publications/prosecution/assisted_suicide.html> accessed 2 November
2015
The Crown Prosecution Service, 'CPS Decides No Charges Following the Death of Jane Hodge'
(Crown Prosecution Service Document 2010) <http://www.cps.gov.uk/news/latest_news/106_-_10/>
accessed 2 November 2015

14 | P a g e