The meeting was introduced by Trevor Moore. He showed a film, Endgame, that explores the issues around assisted dying and then led a lively discussion to which most of those present contributed. It is clearly a contentious topic.
Many phrases are used in the context of assisted dying and Trevor provided an explanation of the most common:
- ‘Assisted dying’ is a generic term that covers both self-administered life-ending drugs (suicide) or drugs administered by a medical professional;
- ‘Assisted suicide’ refers to a person wanting to end their own life administering the drugs that will end their life. In the most well-known clinic, Dignitas in Zurich, the person must be able to swallow the medication, at Lifecircle in Basle the drugs are infused via a cannula and the person must turn a tap to begin the infusion;
- ’Voluntary euthanasia’ refers to someone other than the person dying administering the drugs. For example, in the Netherlands a doctor can give a lethal injection if the relevant conditions are met.
It follows from just these three examples that using the term ‘assisted dying’ can cause confusion. Most countries that allow assisted dying refer to assisted suicide because the person must be able to administer the drugs themselves.
Endgame, made by director Andi Reiss during 2017/18, tells the stories of four British people, all of whom are suffering from incurable medical conditions and who, for various reasons, wish to end their lives. In the edited version that we saw, Andi followed two of them: Omid, who suffers from multiple systems atrophy and awaits the hearing of a case he has brought in the English courts to allow medical help to die; and Marie, who has suffered from Crohn’s Disease since she was a teenager. Andi accompanied her all the way to the Lifecircle Clinic where she eventually turns the switch that will infuse her bloodstream with a life-ending drug and she dies in front of the camera.
Trevor explained that, although suicide is no longer a crime in the UK assisting a person to commit suicide (or, as Trevor prefers, ‘to end their life’) is a crime. However, several European countries and various states in the USA permit assisted dying, but generally only for their own citizens. Switzerland is one of the few countries that has open borders for assisted dying, hence the growth of so-called ‘suicide tourism’ to either the Dignitas Clinic in Zurich or the Lifecycle Clinic in Basle. For some people the wish to end their lives is due to unbearable pain but for others, such as those incapacitated by accident or illness, the reason may be that they see no point in living.
He said that Humanists UK supports assisted dying and that there are two organisations campaigning specifically for changes in UK law to support assisted dying. These are:
i) Dignity in Dying, which campaigns to change the law to allow assisted dying for
terminally ill, mentally competent adults. ‘Terminally ill’ currently means ‘diagnosed to have less than six months to live’;
ii) My Death My Decision, which campaigns to change the law to allow mentally
competent individuals who are either terminally ill or suffering unbearably from incurable health problems, to be allowed to receive a physician’s assistance to die, if this is their persistent request.
Points raised by those present during the subsequent discussion included:
Every mentally competent adult should have the right to determine how and when they should die;
A person wishing to die should have access to counselling and support to ensure that their decision to die is well-founded and persistent;
Their decision to die should not be taken from them by doctors or lawyers, although such people might well be consulted over the validity of the decision;
Experience in the US State of Oregon, where assisted dying has been lawful since 1998, suggests that the proportion of people wishing to end their lives fell after the right-to-die legislation was introduced;
Although the fundamental right to die is ethically clear there is great confusion around the ‘red lines’ that might be included in legislation: e.g. is six months the right time limit, should there be provisions to allow people to change their minds?
Although Advanced Decisions/Living Wills are a very good idea there is the possibility that their provisions might be ignored if the individual loses mental competence, such as through dementia;
Right to die proposals, based on the need to end unbearable pain, are often opposed by those who claim that pain can be controlled with appropriate medication, as in a hospice. This leads to conflicts between right-to-die proponents and supporters of the hospice movement. These two approaches are not in conflict but should be seen as complementary.
The UK has some of the best hospices in the world but they are rarely available for everyone who might benefit from them.
The total cost of assisted dying at a Swiss clinic is in the region of £10,000 so this option is restricted to the reasonably well-off;
The UK medical profession, which used to be opposed to assisted dying, seeing it as contravening the Hippocratic Oath, is now officially neutral. But many doctors support assisted dying.
To end the meeting Trevor asked how many of those present would support the position of Dignity in Dying – all except one would. He then asked how many would support the wider provisions proposed by My Death My Decision – all except two would.
This was a very interesting and thought-provoking meeting.
Review by Tony Brewer