University of Oxford’s Regius Professor Nigel Biggar says that “Popular support for physician-assisted suicide declines dramatically from 73% to 43% when informed of the risks and the views of medical professionals…”

ON BARONESS MEACHER’S ASSISTED DYING BILL

• ‘Assisted dying’ confuses palliative care and assisted suicide (AS). Palliative care aims to relieve (‘palliate’) distress, while AS aims to help someone kill him/herself. The Meacher Bill would make it legal for a physician to assist someone to kill him/herself, as a means of relieving distress.

• Popular support for physician-assisted suicide (PAS) declines dramatically from 73% to 43% when informed of the risks and the views of medical professionals (ComRes, July 2014).

• Professional bodies
o Legalisation of PAS is opposed by the Royal College of GPs, the British Geriatrics Society, and the Association of Palliative Medicine, as well as all the major advocacy groups for the rights of disabled people in the UK.
o In 2019 the Royal College of Physicians changed its official stance to one of ‘neutrality’ on the basis of a members’ survey that found 43.4% opposed to PAS, 31.6% supportive, and 25% neutral. It has since made clear that “it does not support a change in the law to permit assisted dying at the present time”.
o In 2020 the British Medical Association also moved to a stance of ‘neutrality’ on the basis of a members’ survey that found 50% supportive of PAS, 39% opposed, and 11% neutral. Yet, asked if they themselves would administer drugs intending to kill an eligible patient, 54% said No, 26% said Yes, and 20% were undecided.

• Parliamentary opposition. The main reason for the repeated refusal of Parliament to make physician-assisted suicide (PAS) legal is that parliamentarians have been exposed to careful consideration of the attendant risks. Since the House of Commons last voted decisively against a bill to legalise PAS in 2015, those risks have not changed.

• A major risk is that safeguards against abuse, prescribed in law, will not be strictly executed in practice. In a healthcare service where demand always exceeds supply, where there is pressure to find ‘efficient’ solutions, and where medical and nursing staff are pressed for time, it is probable that what is safe in principle will not be safe in practice. All the more so in a wider social context where, according to Julia Neuberger’s Not Dead Yet (2008) and Action on Elder Abuse (today), 500,000 elderly people in the UK are being abused and manipulated, mainly by their relatives.

• Deficient end-of-life care. The 2012 report of a commission chaired by Lord Falconer, who went on to propose an ‘assisted dying’ bill in 2014, made it an “essential” condition of legalising PAS that there be provided “the best end of life care available”, including “compassionate staff with time to investigate fully the circumstances and motivations of any person seeking an assisted death and the potential for alternative options for treatment and care”. We do not have this.

• In favour of the status quo. The Suicide Act 1961 decriminalised suicide (so that a failed attempt attracts therapy, not punishment), but sought to discourage it by criminalising assistance in it. Yet, while the motives for assistance can be malicious (say, to gain a legacy), they can sometimes be well intentioned (say, to relieve distress). Therefore, the Director for Public Prosecutions has the discretion to decide that it is ‘not in the public interest’ to prosecute a case of AS, according to published criteria. This flexible arrangement has the merit of generally discouraging suicide, while allowing for cases of compassionate AS that don’t deserve prosecution. Lord Sumption, former justice of the UK’s Supreme Court, deems this “untidy compromise” the safest arrangement.

Professor Nigel Biggar, CBE