About Assisted Dying

Assisted dying is supported by approximately 80-90% of people in Britain.

85% Support

Currently in Scotland there is no legislation governing assisted dying. Friends at the End works to support people to have greater choice at the end of life and to legalise assisted dying in Scotland.

We support the right of every individual to die at a time and place of their choosing. This can be a very emotive debate with powerful and sincerely held beliefs on both sides. We fully respect the views of others, equally informed by compassion and concern.

The Law

In Scotland there is no legalisation governing suicide or assisted suicide. In England & Wales under the Suicide Act 1961 and in Northern Ireland under the Criminal Justice Act 1966, it is a crime to encourage or assist suicide. The maximum penalty for this is 14 years imprisonment. The legislation in England, Wales and Northern Ireland does not apply to Scotland.

We assume assisted dying is illegal in Scotland. This is based on statements from the Lord Advocate that he/she would regard such actions as deliberate killing and thus a charge of murder or culpable homicide would be brought.

The Lord Advocate has refused to produce specific guidelines on when he/she would/would not prosecute. Thus we must simply wait and see what the Lord Advocate chooses to do – and how the courts respond – after the fact. This is despite all other UK jurisdictions having produced offence specific guidance in light of a court judgment (Debbie Purdy v DPP 2010) which said that offence specific guidelines were necessary to comply with the European Convention on Human Rights.

Legal experts have described the landscape in Scotland as ‘shameful’ ‘should embarrass any legal system’ and showing an ‘alarming lack of clarity’.

Gordon Ross case

Scotland operates under a common law system. The case of Gordon Ross, which was supported by Friends at the End, is the only piece of case law Scotland has on assisted dying. It arguably muddied the waters further as Lord Carloway stated, ‘it is not a crime to assist in a suicide’ and this includes ‘taking persons to places where they may commit, or seek assistance to commit, suicide’ (i.e. Dignitas in Switzerland). Lord Carloway gave no references to back up the foundation of these statements and reiterated the fact that in Scotland assisting in someone’s death is considered homicide. Thus, whilst this judgement is contradictory and confusing, it is heartening to know that Scotland’s most senior judge does not consider assisting someone’s death to be a crime. 

Public Support

For over 30 years research has shown that people in the UK support the view that a doctor should be able to assist a patient, with a terminal or incurable disease, to end their life at the patient’s request. Polls consistently show that approx. 80-90% of the British public support assisted dying. This support comes from all sections of society regardless of socio-economic status, race, ethnicity, political and religious persuasions.

“There is nothing noble about excruciating pain and I think we need as a nation to give people the right to decide their own fate.”
– Lord Carey, former Archbishop of Canterbury

Why are we working to legalise assisted dying?

The overriding principle in this debate is compassion for human suffering. We believe that in a civilised society, nobody should suffer the unnecessary effects of a bad death. We are driven by a desire to reduce pain, indignity and a loss of autonomy at the end of life. Below are some other reasons why we advocate for assisted dying.

Choice

As adults we are able to make our own life choices without interference. This means we have the right to accept, refuse or discontinue medical treatment. However, some people have no treatment to refuse/withdraw and their options for a peaceful death are extremely limited. We should have the right to decide when and where our lives end without interference from the State.

Choice in a civilised society should include the right to request medical assistance to die at a time and in a manner of our choosing for the terminally ill and incurably suffering. Giving autonomy to people suffering at the end of life is extremely important. We believe that all mentally competent adults should have the option of a guaranteed peaceful death.

Limited Options

If you are receiving curative treatment you are allowed to request that it be stopped. Similarly, you can request that curative treatment does not start.

However, many people do not have this option. The only choice they are left with is death from refusing food and fluid, essentially dehydration and starvation. We believe that having your options so limited that refusing food and fluids is the only choice is not a dignified, humane and compassionate way to die. The process can take anything from a few days to weeks and is often painful and drawn out.

Many people attempt to end their life with failed suicides, which is distressing for the person, their loved ones and the emergency services who attend the scene. Approx. 300 terminally ill people die alone by suicide every year.

Travelling abroad

There is an increasing number of UK citizens travelling abroad to have an assisted death. People must be physically able to travel and afford the costs of such arrangements, roughly £10,000. This means it’s not an option for many people. Organisations such as Dignitas and Eternal Spirit in Switzerland, are struggling to cope with the demand from overseas citizens, requesting the peaceful death promised by them. The UK is outsourcing dying and bad deaths to compassionate countries and this must stop.

Palliative Care

Many dying people cannot have their suffering adequately relieved, even with the best palliative care. Pain is not the only issue. Many people find severe weakness and total dependence on others incredibly distressing. The final stages are often treated by increasing pain killers and by giving sedatives which induce sleep, the patient slides into comma and then death occurs. This is know as ‘terminal sedation’. Often the patient takes no part in these decisions. Research shows that during 2008-2009 16.5% of all deaths in the UK took place after continuous deep sedation.

Assisted dying is not the same as terminal sedation. Assisted dying avoids a whole period of suffering, loss of consciousness and dignity. It’s a very different experience for both patients and their families and is the result of a competent request from a capacious person, not a doctor acting in their best interests.

Doctors who truly want to do their best for their patients, by responding to a request to end their suffering are forbidden from doing so. Yet many surveys have shown that some already help their patients to die and risk their professional careers by doing so. This help to certain patients takes place out with a legal framework to regulate or record. Increasingly progressive countries around the world opt to legislate responsibly for Assisted Dying in the interests of transparency and accountability. We believe UK should do so too.

Religion and Assisted Dying

  • If the underlying opposition to assisted dying is theological, no amount of legal safeguarding will be persuasive to people whose position is based on dogmatic and fixed religious scripture.
  • Britain’s increasingly secular outlook on life means that theological perspectives are no longer accorded the automatic respect they once enjoyed. The religiously motivated are therefore couching their arguments in secular language.

 ‘More palliative care is needed, not Assisted Dying’

  • For many people more medicalised care will not help. We have excellent palliative care in Scotland, but many are still experiencing a bad death.
  • In the US, almost 90% of patients who request AD are already in hospice care.[1] Assisted Dying is used as a last resort once all curative options have been exhausted.
  • We advocate for palliative care and AD – they are not mutually exclusive. People should be encouraged to take all the care they wish but when that is no longer working or cannot cure their suffering, they should be allowed the option to end their life peacefully and swiftly by their own accord.
  • More than half of GPs think organisations such as the Royal College of General Practitioners and British Medical Association should drop opposition to assisted dying and adopt a neutral stance.[2] Opposition is a blunt instrument of little value in a debate that deserves a much more nuanced approach. An increasing number of medical bodies are adopting a neutral stance, including the Royal College of Physicians, Royal College of Nursing, Royal College of Psychiatrists, Royal Pharmaceutical society etc.
  • The profession with the highest overall suicide rate is the medical profession.[3] They do not accept the aggressive treatment or care that they offer patients.
  • Suicide is traditionally viewed as a cause for grief. But the number of rational suicides (where no mental illness is present) geriatricians are being presented with shows that the number is increasing and set to do so.[4] The alternatives for those who want to end their lives are often traumatic or violent[5] and an increasing number are turning to the internet to buy DIY drugs for reassurance.[6]

‘Life is Sacred’

  • Life is sacred but that very sanctity is precisely why it is right to help people avoid suffering. AD is not ‘killing’ – the person is already facing death; they do not have a choice whether to live or die. AD results in fewer people suffering, not in more people dying.
  • “AD is accepting that a person has lost all value, worth and meaning in life.” It is quite the opposite, it is a respect to the person and the life they have lived to allow them to go out on their own terms in a peaceful way, free from pain and indignity without encroaching their autonomy with our own beliefs on how they should lead their lives. Yes, we are not completely autonomous and live as part of communities and a wider society but AD allows for more peaceful compassionate deaths in our communities and removes the pain and suffering families and communities are left experiencing after a bad death.[7]

 Religious people support Assisted Dying

  • The majority of religious people in the UK support AD. The 2010 British Social Attitudes Survey found that 71% of religious people are supportive of assisted dying.
  • Groups such as the Inter-Faith Leaders for Dignity in Dying have formed to change the portrayal of religion as being opposed.
  • Perhaps the most high-profile religious supporters are Desmond Tutu and Lord Carey, the former archbishop of Canterbury.
  • FATE Patron and COS minister Reverend McKenna said: “The Church is very keen not to do harm, and that’s reasonable. But the truth is that by prolonging agony, we are doing harm. From a Christian perspective, Jesus embodies compassion, and he taught that there is not a single religious rule that is more important than meeting human need and suffering. I think the Church needs a new ethic, a new Scriptural ethic and a contemporary ethic. I think it’s looking backwards rather than looking at the 21st Century.”
  • Rabbi Dr Jonathan Romain MBE has been convinced by the rigour of safeguards and said “Until now, religious groups have been opposed to it. However, there is a growing number whose faith impels them to support such a move in circumstances where the person is terminally ill, in great pain and requests the right to die.”

‘Weak and vulnerable’

  • 79% of disabled people support a change in the law on assisted dying. [8] People oppose AD in the name of protecting vulnerable people. It is the people who are dying in pain and indignity that are most vulnerable in our society and who want this choice. The most reprehensible insult to them is paternalism; the taking away of my ‘God-given gift’ to make my own moral decisions and be responsible for them. No one else can decide the value of my life for me.

Scripture

  • Nowhere in the old testament is there anything to forbid suicide as a way of avoiding a dishonourable or painful death. No old testament suicide is disapproved of in any way.  The old testament approves of voluntary death as a way of avoiding indignity.  Ecclesiastes Chapter 13 says that death is better than mortal sickness. The law code of the ten commandments was never thought of as absolute – the commandment against killing was subject to a huge number of exceptions and there were a large number of capital offences, many horrible, but the overall idea was that to take away an innocent person’s life against their will is wrong.
  • Professor Hans Kung said that death should be chosen if the alternative is living under conditions no longer consistent with human dignity.
  • Jesus chose to die by going to the cross knowing that it would end his life. He also taught that the basis of morality is to treat people as you would wish to be treated yourself. At the present time 90% of Scots believe that those suffering unbearably should be helped to die when they are terminally ill.[9]
  • The argument that God chooses the hour of our death is no longer seen as invariably true in today’s society. God’s decisive consistently approves of medical intervention to sustain life against a natural end, but not approve intervention so that a patient can find death when that patient no longer wants to be kept alive. We do all we can to resuscitate people who otherwise would die and overtreatment is such an issue in Scotland that the CMO is encouraging a Realistic Medicine approach.
  • Many people continue to accept that suffering has a place in God’s plan of salvation. This at one time included the pain of childbirth, which no one feels applies today.
  • The church is not beyond changing its mind on matters, for instance, family planning, which almost all the churches except the Catholic church now accept.
  • The ‘number one reason’ for rejecting AD is the ‘slippery slope’ argument but the evidence is contrary to the idea that doctors are less trusted in countries where euthanasia is allowed. Research have shown that the country where doctors are most trusted is the Netherlands,[10] where AD as a legal procedure has been accepted longest.

Summary

We must look to the credible, longitudinal data from jurisdictions that have assisted dying laws. Claims cannot be made without solid empirical evidence to back them up. Religious arguments are belief not knowledge, they eschew empirical evidence and rely on moral intuition, adopting loaded language as a fallacious appeal to emotion. Getting fundamental facts right when debating assisted dying laws is paramount to sound public policy. The current legal position causes heart-rending suffering and provides dying adults with no choice or control over their death, with tragic consequences for dying people and their families. We can’t afford hypothetical scenarios and religious dogma to outweigh the actual real lived experiences of dying people.

References

[1] California Department of Public Health, CALIFORNIA END OF LIFE OPTION ACT 2017 DATA REPORT. See: https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/2017EOLADataReport.pdf

[2] Nick Boston, 2019. Most GPs think medical organisations should drop opposition to assisted dying. GP Online. at: https://www.gponline.com/gps-think-medical-organisations-drop-opposition-assisted-dying/article/1524830

[3] Office for National Statistics

[4] Balasubramaniam, M. 2018. Rational Suicide in Elderly Adults: A Clinician’s Perspective. See: https://www.ncbi.nlm.nih.gov/pubmed/29500824

[5] Prior to his death at the Dignitas clinic in Switzerland, Daniel James, a 23-year-old man paralyzed by a rugby accident, attempted suicide three times, twice by overdose and once by stabbing himself. Four times he was assessed by psychiatrists and each found him to be rational, not depressed and with the mental capacity to make decisions about his treatment. See also the cases of Simon Binner who attempted hanging before travelling to Dignitas.

[6] See the cases of Avril Henry, Kay Carmichael etc.

[7] The CPG EOLC has heard evidence from citizens who have been left emotionally scarred, suffering with PTSD from caring for their relatives who were terminally ill and wished to die. The helplessness and despair at not being able to help their loved ones for fear of breaking the law is profound.

[8] The Times, 2013. Disabled back law to allow assisted dying. See: https://www.thetimes.co.uk/article/disabled-back-law-to-allow-assisted-dying-rnl9hvjjxft

[9] A survey of 1057 adults in Scotland was conducted by Populus between 11th and 24th March 2019

[10] GfK Trust Index, 2008. GfK Custom Research reported that 88% of respondents in Belgium and 91% in the Netherlands trust their doctors.

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