England takes the first step to legalise assisted dying

Published in The Hindu on November 24, 2010

England and Wales are taking the first step to consider passing a law on assisted dying. According to a recent online news report in the British Medical Journal (BMJ), a 12-member commission will consider if such a law is required, and submit a report in October next year.

Assisted dying involves a doctor prescribing a life-ending dose of medication to a mentally competent, terminally ill adult at his request. It is the patient who administers the medication to himself.

The difference

Assisted dying is very different from euthanasia. In the case of euthanasia, the life ending medication is administered to the patient by a third party, usually a doctor. On the other hand, assisted dying refers to providing assistance to someone to die.

Former Lord Chancellor Charles Falconer, who will head the commission, was reported as saying to the BMJ that the idea for the commission came from Dignity in Dying, a national campaign and member organisation that is striving to make this legal.

Money for the commission was raised by Dignity in Dying. Despite this, Lord Falconer has made it explicitly clear that the members will act independently and that the commission will not be influenced by anybody.

Currently, it is illegal in England for doctors to help terminally ill and mentally competent patients to die. While terminally ill people can travel to Switzerland and resort to assisted dying, people in England who had helped the patient to travel to Switzerland can be punished.

Apparently, Lord Falconer had tabled an amendment in the House of Lords to provide legal protection to those who had helped terminally ill patients to travel abroad for an assisted dying. His attempt failed, though.

First in the world

Switzerland is not the only country that has legalised assisted dying. The State of Oregon in the U.S. was the first in the world to legislate assisted dying way back in 1997. Citizens there had voted for the “Oregon’s Death with Dignity Act” in 1994, but immediate implementation was delayed due to legal hurdles.

There have been 460 patients in Oregon who had died by taking advantage of the Act between 1998 and 2009.

First year score

According to a paper published in 1999 in the New England Journal of Medicine, there were totally 23 patients who received legal prescriptions for lethal medications between January 1, 1998 and December 31, 1998 in the State of Oregon. Of the 23, only 15 patients actually took the lethal medications and ended their lives.

Washington State emulated Oregon and voted for assisted dying in November 2008. Eleven people used prescribed medicines to end their lives within six months after the State law permitted assisted dying.

Three countries — Belgium, Luxembourg, and the Netherlands have legislated assisted dying. Voluntary euthanasia is forbidden in Switzerland. But the Article 115 of the Swiss Penal Code exempts people who assist someone to die, provided they have acted with entirely honourable motives. France and Spain are looking at the possibility of amending the existing law to allow assisted dying.

The policy of Dignity in Dying is to work towards legalising assisted dying so that terminally ill patients have a choice and control over the timing and manner of their deaths.

Good death

“It would allow dying adults, suffering at the end of their life, the option to substitute a bad death with a good death,” its website states.

There are some basic requirements for a patient to become eligible to receive a prescription for lethal medication from a doctor. For instance, the patient must make two verbal requests to his doctor separated by at least 15 days, and should also provide a written request. The doctors should confirm the diagnosis and prognosis of the disease.

The patient should be mentally sound. If the patient’s judgement is impaired by his mental state, even depression, he becomes ineligible. The doctor should inform the patient of the alternatives such as palliative care, pain control etc.