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Are We Moving Towards Assisted Suicide

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Student Name: David Mc Namara.

Title: Are we moving towards Assisted Suicide?

“Those who have exhausted the end seek the right to die with dignity, this is a choice to die, which allows the body to speak its end rather than have that end dictated by the voice of an expert, legal or medical” (Hannifin. 2009, p.84) The person who seeks to die is, to paraphrase Foucault, ‘the Passenger par excellence: that is, the prisoner of the passage’ (Foucault. 1967, p.11)

The European Convention on Human Rights sets out a number of fundamental rights and freedoms, right to life, prohibition of torture, prohibition of slavery and forced labour, right to liberty and security, right to a fair trial, no punishment without law, right to respect and family life, freedoms of thought, conscience and religion, freedom of expression, freedom of assembly and association, right to marry, right to effective remedy, and prohibition of discrimination

The Council of Europe produced the European Convention on Human Rights and Fundamental Freedoms in 1950. This body was formed in the aftermath of the Second World War to achieve unity among its members in such matters as the protection of fundamental rights. The Convention was drafted after the atrocities of the Second World War. The Convention was signed by the High Contracting Parties in 1950, and came into force in1953. It was ratified by the United Kingdom in 1957.

Article 2 of the Convention for the Protection of Human Rights and Fundamental freedoms protects the right to life.[1] The right to life is the first substantive right proclaimed in the convention because it is the most basic human right of all; if you could arbitrarily be deprived of your life; all other rights would become illusory.

The Convention does not clarify what life is or when it starts. In the absence of a European or worldwide legal or scientific consensus on the matter, the European Court of Human Rights is unwilling to set precise standards; the issue of when the life begins comes within the margin of appreciation which the Court generally considers that States should enjoy… The reasons for this conclusion are, firstly, that the issue of such protection has not been resolved within the major contracting states, and that there is no European consensus on the scientific and legal definition of the beginning of life….[2]

In the last two decades, many countries have grappled with the dilemmas associated with advanced technology, greater life expectancy, and the difficulties of unbearable suffering (Bamgbose, 2004. p111). The Universal Declaration of Human Rights (1948), The United Nations Charter (1945), European Convention for the Protection of Human Rights and Fundamental Freedom (1950), American Convention of Human Rights (1969) and the African Charter on Human and People Rights (1969) are some of the instruments that explicitly and implicitly prohibit the unlawful taking of life.

When it comes to the medical profession, The Hippocratic oath of 400 BC declares “I will give no deadly medicine to anyone if asked, nor suggest such council”, the modern version of the oath states “I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing, to have the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life”.[3] The Statement of Marbella (1992) states, “Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession” (Myers, 2000). Article 2 of the Convention for the Protection of Human Rights and Fundamental Freedoms protects the right to life[4]. Apart from the death penalty, the Convention states only limited circumstances in which a person can be deprived of this right; none of these refer to suicide or euthanasia.

The whole approach to protecting this right has changed considerably with scientific and medical advances. Whereas traditionally the concern was to protect life from all threats, today there are the additional very prominent issues of human – scientific and medical – intervention in life-giving process in such forms as abortion, procreation, embryo research cloning and euthanasia” (Mathieu, 2006). In our societies, the voices that insist that everyone must have the right to die with dignity are growing steadily louder, but euthanasia still raises numerous questions that remain controversial.

As per Srinivas “The legality of the ban on assisted suicide and euthanasia and the scope of prosecutorial discretion have recently come under scrutiny, especially as British citizens have begun to take advantage of the more liberal suicide laws in neighboring European countries like Switzerland” (Srinivas 2009 pp. 111 –112.).

In May of 2011 in Switzerland, voters rejected the proposal to ban assisted suicide to non-residents by 78%. Assisted suicide is legal in Switzerland, and has been since 1941, provided the helper isn’t a medical doctor and doesn’t personally benefit from a patient’s death. Article 115 of the Swiss penal code considers assisting suicide a crime if and only if the motive is selfish. It condones assisting suicide for altruistic reasons. Article 115 does not require the involvement of a physician nor the patient to be terminally ill. The Swiss law does not consider suicide a crime or assisting suicide as complicity in a crime.
Euthanasia was exempted from criminal law in the Netherlands on April 1st 2002 under certain circumstances. The Termination of Life on Request and Assisted Suicide Review procedures Act formalized the situation that had existed in The Netherlands since 1973.

According to Manzione, a recent movement to legalize assisted suicide and euthanasia has swept across some of the globe’s wealthier industrialized nations (Manzione, 2002).
While a handful of jurisdictions in Europe and the United States have legalized assisted suicide with varying degrees of restriction, laws that allow the practice remain the exception rather than the rule in most of the developed world.

On April 1st 2002, legislation regarding the practice of euthanasia and assisted suicide became effective in the Netherlands.[5] This new law made the Netherlands the first country to legalize euthanasia. As per Manzione, (2002) The Northern Territory of Australia passed an act on May 25th, 1995 authorizing euthanasia, which came into effect on July 1st, 1996. The Act was in force for less than a year. On March 25th, 1997 the Australian National Assembly invalidated it.

Stedman’s Medical Dictionary (1990) defines euthanasia as: “A quite, painless death, the intentional putting to death of a person with an incurable or painful disease” (p.544). The literature frequently refers to euthanasia as meaning something different depending on whether the argument is for or against euthanasia (Johnstone, 1996). The terms suicide and euthanasia are concepts with blurred boundaries, because it is often considered unclear whether a certain act counts as suicide or whether it is an instance of euthanasia (McMahan, 2002).

The Irish Council of Bioethics detail that the word euthanasia stems from the Greek words “euthanatos” meaning “good death”, and refers to the action of a third party usually a doctor deliberately ending the life on an individual. The individual must give consent for the procedure, which is known as voluntary euthanasia.

Non-voluntary euthanasia occurs when the individual is unable to ask for the procedure e.g. if the patient is unconscious or otherwise unable to communicate and another person makes the decision on the patient’s behalf. In such cases the final decision may be based on an advanced directive or living will. Assisted suicide refers to the practice of an individual taking his own life on the bases of information, guidance and / or medication provided by a third party. As an example a doctor might prescribe a lethal dose of medication for an individual, who then administers the medication him or herself

It is currently illegal in the United Kingdom to perform any act intended to end another person’s life, to be present at or to aid someone’s suicide.[6] Any person who performs euthanasia may be prosecuted for murder.[7]

Until 1961, suicide was a crime in England and Wales, reflecting a common Christian morality that condemned the act of self-murder. With the suicide Act of 1961, Parliament formally decriminalized the act of suicide. It also asserted that while providing assistance in another person’s suicide attempt should remain a criminal offence, no prosecution could be brought for assisting a suicide except by, or with consent of the Director of Public Prosecutions (DPP) (O’Neill, 2010).

The United Kingdom’s Suicide Act 1961, provides that 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 on indictment to imprisonment.

This act broadly covers all aspects of assisted suicide, and like many other governments, the UK government dropped criminal sanctions for the person attempting suicide in the 1961 Act. The amendment to the Act did not confer a right for anyone to do so; the policy of the law remained firmly adverse to suicide. Assisted suicide is a particularly unique offence being the only act in the English jurisdiction that is legal to carry out but illegal to assist.

Parliament in the United Kingdom repeatedly defeated attempts to change the Suicide Act of 1961. In 2002 and 2003, Lord Joffe tried unsuccessfully to legalize assisted suicide by proposing the Patient (Assisted Dying) bill, also known as the Assisted Dying for the Terminally Ill Bill.

Parliament again rejected pro-suicide proposals in 2005 and in 2006.[8] In May 2006 Lord Joffe argued in an address to the House of Lords that every year in the United Kingdom some doctors do break the law and perform some form of assisted dying. A number of surveys were understood to demonstrate this, one survey according to Tate and Ward, (1994) on General Parishioners and Consultants found that 12 per cent of respondents claimed to have complied with a request to prematurely end a patient’s life. Lord Joffe argued that these results are a risk to patients and a danger to doctors and careers[9]. In the 2005 bill Lord Joffe proposed that palliative care should always be the first option for someone who is terminally ill and that assisted death should be the last resort (London: The Stationary Office. 2005 p.87) On the issue of palliative care, the Parliamentary Assembly of the Council of Europe recommends that the member states should: (pp2-4) Ensure that, unless the patient chooses otherwise, a terminally ill or dying person will receive adequate pain relief and palliative care, even if this treatment as a side effect may contribute to the shortening of the individuals life.[10]

The law on assisted suicide in the United Kingdom came under increasing pressure following some very high profile cases form 2001 onwards.

In October 2001, Mrs. Diane Pretty was a forty-three English citizen who was in the advanced stages of motor neuron disease (MND) that had caused her to become a quadriplegic. She was very aware that in time she would loose muscle control and eventually die of respiratory failure. Mrs. Pretty’s mental abilities were un-affected by the MND.

Mrs. Pretty wanted to end her suffering and pain but due to her MND she was physically incapable of committing suicide, which is not illegal under English law.
Mrs. Pretty sought a guarantee from the Director of public Prosecutions (DPP) that her husband, if he helped her to commit suicide, would be immune from prosecution. The DPP refused to give an undertaking under section 2 (1) of the 1961 suicide act. Mrs. Pretty applied for judicial review of the DPP’s refusal. On the 17th October 2001, the Divisional Court refused the application holding that the DPP did not have the power to give the undertaking not to prosecute and that section 2 (1) of the Suicide Act 1961 was not incompatible with the Convention. Ms Pretty had alleged infringement of Article 2[11] on the right to life, article 3[12] on the prohibitions of torture and degrading treatment, article 8[13] on the right to respect for private and family life, article 9[14] freedom of thought, conscience and religion and article 14 on non-discrimination.[15]

Ms Pretty took her case to the House of Lords who communicated their decision on 29th November 2001. They again refused her appeal under section 2 (1) of the 1961 Suicide Act.[16] In rejecting Mrs. Pretty’s claim, the House of Lords relied upon traditional views express in the sanctity of life doctrine and established definitions of key terms in the Article.
The House held that Article 2 guarantees a right to life and embodies the sanctity of life doctrine with the result that no one can be deprived of life by methods involving deliberate human interference.

Article 3 was held not to impose a positive obligation on the United Kingdom to ensure Assisted Suicide to a person who was terminally ill or to guarantee that the person providing Assisted Suicide would not be prosecuted. In addition the Lords felt that this case did not involve inhuman or degrading treatment. Article 8 the Lords stated, related to how a person lives his life and not how they depart from it, Article 9 entitled Mrs. Pretty to believe in assisted suicide but the house could not authorize assisted suicide that was an illegal act. The Lords also contended that Article 14 did not come into play, as Mrs. Pretty was not discriminated under any of the articles.

Five months later, the European Court of Human Rights ruled unanimously that the refusal of the government to allow Mrs. Pretty’s husband to help her to die did not violate the Convention.[17] Apart from receiving submissions from the applicant and the respondent government the court also allowed third-party interventions by the Voluntary Euthanasia Society, and by the Roman Catholic Bishops’ Conference of England and Wales.

The Court was not persuaded that Article 2 “the right to life” could be interpreted in the negative. The court stated that “Article 2 cannot, without a distortion of language, be interpreted as conferring the diametrically opposite right, namely the right to die; nor can it create a right to self-determination in the sense of conferring on an individual the entitlement to choose death rather than life”. The Court accordingly found that no right to die, whether at the hands of a third person or with the assistance of a public authority, could be derived from Article 2 of the Convention.[18] In terms of Article 3, the court felt that it must be construed in harmony with Article 2, and the state did not have to facilitate the death of a person, that the state did not have a positive duty to prevent degrading treatment by allowing a person to take their own life. It was beyond dispute the UK Government had not inflicted any ill treatment on Mrs. Pretty. Under Article 9 the court claimed – not all opinions or convictions constitute beliefs in the sense of this provision and Mrs. Pretty’s claim did not involve a form of manifestation of religion or belief.

According to Wada (2005. p276) Although the ECHR did not expressly discuss the role of the margin of appreciation in its decision-making process, its application to the issue raised in Pretty v United Kingdom is the quintessential illustration of its proper usage. The Pretty case was the first time the ECHR confronted the issue of whether Article 2 of the Convention guaranteed the right to die. The court did however invoke the margin of appreciation in Article 2 of the Pretty case[19]; the court stated, “The margin will vary in accordance with the nature of and the importance of the interests at stake”.

The court disagreed with Pretty that the margin was too narrow, it stated that Article 2 is adamant about lawfulness, the right to life is supreme and must be protected, furthermore it stated that the requirement of “absolute necessity” in Article 2 means that any force used for any purposes mentioned in Article2 must be strictly proportionate to the achievements of any of the aims set out in paragraph 2.[20]

The Margin of appreciation is a concept developed by the ECtHR when considering whether a member state of the European Convention of Human Rights has breached the convention. The margin of appreciation doctrine allows the court to take into account the fact that the convention will be interpreted differently in different member states (range of discretion). Judges are obliged to take into account the cultural, historic and philosophical differences between Strasburg and the nation in question.[21]

Any international or regional human rights agreement can pose a treat to national sovereignty and to the political, cultural, and social differences that pertain in each country. The notion of flexible enforcement in each member state appears to contradict the universal nature of rights, but the notion of the margin of appreciation is essential and has to recognize the autonomy of each state and the differing cultures among member states. The EctHR developed the concept to take into account the broadly drawn principles to the Convention and how they are interpreted in different societies. The margin of appreciation should not be confused with the term subsidiarity, where the smallest, lowest or least centralized authority handles matters.

In controversial topics such as bioethics or assisted suicide, the court will not make definitive stances, as this would mean ignoring the social and cultural values of the contracting nations. According to Cameron and Eriksson (1995) a lack of consensus among Member States suggests to the EctHR that the matter is best left to individual states.

In a second well-published case in the UK the appellant Debbie Purdy who suffers form multiple sclerosis for which there is known no cure wished her husband to be able to take her abroad to a jurisdiction such as Switzerland or Belgium that allowed assisted suicide. Such action would contravene section 2(1) of the 1961 suicide act in the UK (aiding and abetting the suicide of another). The penalty if convicted is imprisonment for a term of up to 14 years. Section 2(4) of the act provides that proceedings can only be brought with the consent of the DPP. According to Beckford, Its reported that more than 100 Britons have traveled to Dignitas, a suicide clinic in Switzerland, to end their lives and over 700 Britons are currently thought to be registered as members, there is some indications that the number of Britons making such a voyage is on the increase with reports of more than 30 individuals making the trip alone in 2009 (Beckford, 2010).[22]

The criminal prosecuting service had said it would not create a specific policy for assisted suicide but would consider each case on an individual basis and decide if prosecution was necessary. Ms Purdy sought a judicial review of the Director of Public Prosecutions (DPP) decision not to reveal details of how cases of assisted suicide are prosecuted in England and Wales. Ms. Purdy’s solicitor stated “ we are arguing that the right to life and the right to a private and family life under the European Convention of Human Rights should be interpreted broadly (margin of interoperation) and should include decisions about quality of life, including decisions about death if the quality of life is no longer good enough”
“On a practical level it is argued that the DPP should prepare a prosecution policy which tells the public what factors he will take into account when prosecuting in this area. It is only right that the public should know if they are likely to be charged with a criminal offence” (House of Commons Library 2010 P.8)

It was argued as per Mitchels, that the DPP had acted unlawfully either in failing to promulgate a policy or by failing to disclose the criteria which he applies in cases of this kind, whether he calls it a policy or not. Ms. Pretty believed that the prohibition in section 2 (1) of the 1961 Suicide Act constituted an interference with her right to respect for her private life in Article 8 (1) of the Convention for the Protection of Human rights and Fundamental Freedoms that was not in accordance with the law as required by Article 8 (2) in the absence of an offence-specific policy by the Director setting out the factors that would be taken into account under section 2 (4)
The court in their considerations departed from the Pretty case, stating that Article 8(1) was engaged, and the principle of legality in 8(2) required the court to consider whether the law was sufficiently accessible and sufficiently precise to enable a person affected by it to understand the scope and foresee the consequences of their conduct so as to regulate their conduct. (Mitchels, 2010 p2).

In July of 2009 Debbie Purdy obtained a House of Lords Ruling ordering the DPP (Keir Starmer QC) to formulate an offence-specific policy setting out the factors he will consider when deciding whether to prosecute assisted suicide offences.[23]

On the 23 of September 2009, the DPP published an interim policy and opened a 12-week public consultation on its contents. The final policy was published on the 25 February 2010. The policy sets out a variety of public interest factors that the Crown Prosecution Service (CPS) will consider when deciding whether to bring a prosecution for assisted suicide, focusing in particular on the motivations of the suspect.

This paper has discussed in some detail two very similar cases with some major differences in outcomes. The first major difference is that Diane Pretty died age 43 in a hospice shortly after the hearing in the European court. In a statement from her husband Brian said, “ Diane had to go through the one thing she had foreseen and was afraid of – and there was nothing I could do to help” (Speaking on BBC News 12 May 2002).[24]
The detail of both cases shows the progression of the debate on assisted suicide from a starting point of zero tolerance to a point at which the DPP has set out the legal reasons where a prosecution will follow on those who assist in a suicide.

Diane Pretty had found the quality of her life unbearable; she would have been the only person to make judgment on the quality of life she was living. As per Caplen, “quality means fitness for purpose” (Caplen, 1988 p1). Mrs. Pretty had asked for immunity for her husband, based on article 2. “The right to life” or in this case the inverse “the right to death” as she had no quality of life. Under the European Convention the right to life is paramount and as discussed earlier “The right to life is the first substantive right proclaimed in the convention because it is the most basic human right of all; if you could arbitrarily be deprived of your life; all other rights would become illusory”. Mrs. Prettys “appeal” to the DPP not to prosecute her husband had little hope of success, based on the scaticity of life. The DPP stated, “He could not grant immunities that condone, require, or purport to authorize or permit the future commission of any criminal offence, no matter what the circumstances”.

The EctHR in my opinion will not widen the margin of appreciation in cases where article 2 in being challenged. The diversity in cultures, religion and moral standings is so vast as to make it impossible to find agreement among the member states. Having said that, after The Assisted Dying Bill was defeated in May 2006, the Select Committee recommended that any future should make a distinction between Assisted Suicide and Assisted Voluntary Suicide. The Committee recommended that doctors’ powers should be better articulated, define ‘terminal illness’ and ‘competence, to reflect modern practice; consider changing ‘unbearable suffering’ to ‘unbelievable’ or intractable’ suffering; and abandon the requirement that a medical practitioner who objects to Assisted Voluntary Suicide or Assisted Suicide have to refer the patient to another doctor[25]. This has in my opinion advanced the possibility of another Bill for the Lords to review in the near future. The Lords have basically set out a template to follow for the development of the next Bill that seems they may accept. In 2009 there were two more attempts to legalise assisted suicide with a proposal to amend the coroners and Justice Bill, this goes to prove that the subject matter is still up fro debate. Lord Falconer proposed a bill to decriminalise the offence of assisting a person to travel to another jurisdiction to commit suicide where that person was terminally ill. The bill was again defeated by 194 votes to 141 votes.[26] Lord Alderdice proposed an amendment that would allow assisted suicide to a person who was suffering a ‘confirmed, incurable and disabling illness’ and had gotten certification from the Coroner who was satisfied that the person had a free and settled wish to end their life.[27] Had the Pretty’s waited until such a time, as Diane was ready to die with the assistance of her husband what would have been the outcome? Would The DPP have brought changes against him? I don’t believe so. In an NOP poll in October 2002 people were asked “Do you think that a person who is suffering unbearably from terminal illness should be allowed by law to receive medical help to die, if this is what they want, or should the law not allow them to receive this medical help to die”
81% said “yes’ the law should allow them to receive medical help to die, 12% said no, with 6% don’t know (House of Lords, Select Committee on the Assisted Dying for the Terminally Ill Bill. 4th April 2005. p.512) The report went on to say at page 513 “ The opinion polls give us a picture of what the public thinks but we should also look at informed public debate, and these suggest similar conclusions”.[28] It’s quite clear that public opinion was with the Pretty family at this time and that a charge was highly unlikely from the DPP but the risk of a charge was still there if Mr. Pretty helped Mrs. Pretty to die, this was the risk Mrs. Pretty was not willing to take.

The second case of Debbie Purdy may not have opened the door on assisted suicide but has maybe put a crack in the door to shine light on the situations in which the DPP will prefer charges. Spencer suggests, “The main significance of this case is that it makes a step along the road towards making assisted suicide legal” (Spencer, 2009. p495). Ms Purdy knows what her future is and it’s not a pretty one. The DPP has given her and many others like her a glimmer of hope. She is now aware under which circumstance she can be assisted in death by her husband with a much reduced risk that he will be prosecuted. The DPP has basically set out the criteria to be followed to prevent the prosecution, is it a case that the DPP has brought some discretion into the prosecutorial decision making process? It’s clear that the guidelines amount to a change in the law because they alter the way the law now operates. The policy provides a list of public interest factors that will be taken into account, alongside the Code for Crown Prosecutors when a decision is made on whether to prosecute or not. The law on assisted suicide has not changed, but it is now clearer from the DPP’s policy when prosecutions would and would not be pursued. As per Baroness Campbell “they are not just guidelines; they are the beginning of the process. Once you open the door a crack, you’re beginning to sanction or say to a culture ‘yes’ in some circumstances it is right to mercy kill disabled or terminally ill people. I would say to you; that’s very dangerous”.[29] In the case of Ms Purdy, she can now stay in the United Kingdom for much longer and not have to travel alone to a country such as Switzerland where assisted suicide is legal. A case was tested under the new law in March 2010. The son of Lady Downs and Sir Edward accompanied them to Dignitas in July of 2009 the case was considered but no prosecution followed.[30]

In another case prior to the publication of the DPPs policy document, a retired policeman Mr. Brian Blackburn helped his wife to die by cutting her wrists. Mrs. Blackburn was in agoinising pain with advanced stomach cancer. Mr. Blackburn tried to kill himself but failed. He was arrested and charged with murder. He spent three months in prison awaiting trial. At his trial, Judge Hawkins told Mr. Blackburn that he had acted as a ‘loving husband’ when his wife had begged him to kill her, the judge went on to say ‘ that was the last loving thing you could do for her’. Mr. Blackburn received a nine month suspended sentence. It seems even the judiciary have a sympathetic view around the subject of assisted suicide.

The question to be asked at this juncture is “were the responses of just 5000 people enough from a population of 54 million in England and Wales to draw a reasonable conclusion on public opinion on assisted suicide. Why the question of assisted suicide is is not put the population as a whole? If the NOP public opinions of 2008 were any reference to go by it seems the introduction of assisted suicide would be carried. In another survey of 1002 UK doctors in all specialties in 2004, it was found that 56% thought physician assisted suicide should be permitted when a person has a terminal illness with uncontrollable physical suffering. (Medixuk.com 2004). It’s critical to keep in mind that Voluntary Euthanasia Society sponsored this particular survey and so I would question its credibility and validity. If the survey is credible we may be seeing a sea change in the medical profession towards assisted suicide.

The debate on euthanasia, assisted suicide and physician-assisted suicide from a multidimensional perspective will continue for sometime to come. The different arguments from various stakeholders will linger. In an Article by Elizabeth Cleary, it showed just how topical the subject of euthanasia has become. A search conducted of the Lexis-Nexis data base of all UK newspapers in 1990 showed around 100 articles that referred to assisted dying, euthanasia or assisted suicide. In 2005 in contrast over 2,600 articles appeared (Clery et. al. 2007). Moral norms change over time, it’s not so long since homosexuality, same sex marriage, abortion and many other debated issues were frowned upon. As circumstances change people will find ways to justify their moral changes. Advances in modern technology and the prolonging of life may be that catalyst for change.

The economic circumstance in which we find ourselves today may play a very important role in the debate on assisted suicide in the future. Because of medical advances in technology and drugs people will live longer. Older people by nature require more medical attention at higher costs to society. The harsh economic facts of life are that we may not be able to financially support the costs of an ageing population in the future.
It also seems that there may be a change in the attitudes of medical profession that runs in contrast to the Hippocratic Oath as detailed earlier. The law currently allows patients to refuse life sustaining treatment, or to request it to be removed even if the doctors do not believe it to be a rational decision. As many as 177,000 patients die each year from no treatment decisions (Dignity in Dying report, 2006. p15)[31] Dr. Michael Wilkes, Chair of the British Medical Association’s Ethics Committee asked “If competent people can now make legally binding decisions to refuse life-saving treatment knowing that treatment will lead to their death, to then go a little further where people could make competent decisions to determine the time and the way they die, how big a step is that?”[32] . On page 16 of the same report a survey of healthcare professional in the UK shows a small majority of medical are supporters of assisted suicide.

Religious disapproval of suicide according to Steinbock has become less relevant as an arbiter of ethics and policy. In democratic societies that might be best described as secular with Christian heritage, the view of religious groups should not restrict the liberty of individuals in society, (Steinbock 2005, p.236). If Steinbock is correct then why did the Court Of Human rights allow submissions from the Roman Catholic Bishops’ Conference of England and Wales in the Pretty case? In an NOP survey in 2004 of religious respondents (n= 790) supporting and opposing medically assisted dying , 82% supported medically assisted dying. 81% of both catholic and protestant respondents agreed with it while Muslim respondents were split 42% for 49% against with 9% don’t know.[33] It’s clear from these results that Steinbeck is correct that the church has less influence on individuals in relation to assisted suicide.

It may be the case that revision of penal codes and laws will have the greatest impact over time. It may be possible to learn from others countries such as Switzerland and the Netherlands where euthanasia and assisted suicide a legal to some extent, but with differences in moral, social, and even religions it may be more beneficial to engage the public in a wider debate on the issue. The fear of double effect and the slippery slope will always be an issue for anti assisted suicide campaigners, but it’s essential that the UK Government use good Governance to monitor any changes to the suicide act that allow any form of assisted suicide.

It seems clear from recent surveys from the general British public, medical professionals, and religious groups that there is a move towards acceptance of assisted suicide under certain circumstances. This is a far cry from the Pretty case where Article 2 of the Convention for the Protection of Human Rights and Fundamental freedoms protected life indisputably. “Article 2 cannot, without a distortion of language, be interpreted as conferring the diametrically opposite right, namely the right to die; nor can it create a right to self-determination in the sense of conferring on an individual the entitlement to choose death rather than life”.

The question we need to ask ourselves is “should people be allowed to dictate their own life and death”? Should this question of life and death be a personal choice? Should the church, state and judiciary be involved in decisions of self determination?

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The Telegraph, February 22 2010. Record Number of Britons ended their lives in Dignitas last year.

Wada, E. (2005) a Pretty Picture. The Margin of Appreciation and The Rights of Assisted Suicide. Loyola International and Comparative Law Review. Volume 27

Webster’s 2 New College Dictionaries. (1995). Boston; Houghton Mifflin.

http://conventions.coe.int/treaty/en/treatis/html/005.htm Accessed 12/06/11 http://www.medterms.com/script/main/art.asp?articlekey=20909 Accessed 14/06/11 http://www.dyingwell.org.uk Accessed11/06/11 www.parliament.uk Accessed 11/6/11. http://www.publications.parliament.uk/pa/id200304/idbills/017/2004017.pdf Accessed 11/06/11 http://www.perliament.the-stationery-office.co.uk/pa/ld199900/ldhansard/pdvn/lds06/t Accessed 11/06/11 http://cmiskp.echr.coe.int/tkp197/view.asp?action=html&documentld=698325&portal=hbkm&source=externalbydocnumber&table=1132746FF1FE2A468ACCBCD1763D4D8149 Accessed 12/06/11 http://news.bbc.co.uk/2hi/uk_news/946390.stm Accessed 13/06/11 http://www.bioethics.ie/uploads/docs/Euthanasia.PDF Accessed 11/06/2011 http://www.bioethics.gr/media/pdf/biolaw/nomologia/VOSUMMARY.pdf Accessed 18/06/11 http://eprints.bbk.ac.uk/820 Accessed 20/06/11 http://www.publications.parliament.uk/pa/ld200102/idjudgmt/jd011129/pretty-1.htm Accessed 27/06/11 http://hrlrc.org.au/files/ZLRJZJNUI/McCann%20v%20United%20Kingdom.pdf Accessed 17/06/11 http://eprints.bbk.ac.uk/820 Access 14/06/11 http://www.bailli.org/eu/cases/ECH/2004/326.html Accessed 17/6/2011 http://bailii.org/eu/cases/ECHR/2002/427.html Accessed 10/06/2011 http://comissiononassisteddying.co.uk Accessed 10/06/2011 http://www.cps.gov.uk/publications/assisted_suicide.html Accessed 22/06/11 http://muse.jhu.edu Accessed 01/06/2011 http://news.bbc.co.uk/2/hi/health/1983457.stm Accessed 24/06/11 http://www.publications.parliament.uk/pa/ld200405/idselect/idasdy/86/86ii.pdf Accessed 26/06/11 http://www.telegraph.co.uk/news/uknews/crime/7271008/Record-numbers-of-Britons-ended-their-lives-at-Dignitas-last-year.html Accessed 26/06/11 http://www.cps.gov.uk/news/press_statement/the_death_of_sir_edward_and_lady_downes/ Accessed 26/06/11

http://www.publications.parliament.uk/pa/ld200809/ldbills/069/2009069.pdf Accessed 28/06/11

http://www.dignityindying.org.uk/includes/spaw2/uploads/files/Dignity%20in%20Dying%20Report.pdf Accessed 27/06/11

-----------------------
[1] See the Convention for the Protection of Human Rights and Fundamental Freedoms at http://conventions.coe.int/treaty/en/treatis/html/005.htm accessed 12/06/11
[2] See Vo V France 08/07/2004 EctHR Application no. 53924/00. Paragraph. 82 http://www.bailli.org/eu/cases/ECH/2004/326.html Accessed 17/06/2011

[3] http://www.medterms.com/script/main/art.asp?articlekey=20909 Accessed 14/06/11
[4] Convection for the Protection of Human Rights and Fundamental Freedoms, Nov. 4,1950, art.2, 213 U.N.T.S. 222, 224
[5] Termination of Life on Request and Assisted Suicide (Review Procedures Act) 1st April 2001, Staatabald 2001, 194.
[6] All Party Parliamentary Group for assisted dying Home page. http://www.dyingwell.org.uk Accessed11/06/11
[7] The House of Lords Select Committee Report on The assisted Dying for the terminally ill Bill. 2005. www.parliament.uk accessed 11/6/11. http://www.publications.parliament.uk/pa/id200304/idbills/017/2004017.pdf accessed 11/06/11
[8] ibid at 6.
[9] Lord Joffe’s address to the House of Lords May 2006. http://www.perliament.the-stationery-office.co.uk/pa/ld199900/ldhansard/pdvn/lds06/t accessed 11/06/11
[10] See Pretty v The United Kingdom, European Court of Human Rights Judgment. Paragraph 28.
[11] Law shall protect everyone’s right to life. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction for a crime for which this penalty is provided by law.
[12] No one shall be subjected to torture or to inhuman or degrading treatment or punishment.
[13] Everyone has the right to respect for his private life and family life, his home and correspondence.
[14] Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, in worship, teaching, practice and observance,
[15] The enjoyment of rights and freedoms set forth in this Convention shall be secured without discrimination on any ground such as sex, race, color, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status.
[16] Judgments – The Queen on the Application of Mrs. Diane Pretty v Director of Public Prosecutions and Sectary of State for the Home Department. Session 2001 – 2002 UKHL 61. Paragraph. 10 Available at http://www.publications.parliament.uk/pa/ld200102/idjudgmt/jd011129/pretty-1.htm
[17] Pretty v United Kingdom Application no. 2346/02[2002] ECHR 427. Paragraph 31. http://bailii.org/eu/cases/ECHR/2002/427.html Accessed 10/06/2011
[18] ibid. Paragraph 40
[19] ibid. Paragraph 18.
[20] The Court was referring to McCann V United Kingdom In, which the SAS used force to kill and IRA active team in Gibraltar. The challenge was the SAS (UK) had used disproportionate force contravening Article 2. No. 19009/04 ECHR 2008 (13-05-2008) See case notes at http://hrlrc.org.au/files/ZLRJZJNUI/McCann%20v%20United%20Kingdom.pdf Accessed 17/06/11
[21] BBC News UK human Rights Act, How it Works.

http://news.bbc.co.uk/2hi/uk_news/946390.stm accessed 13/06/11
[22] Available at http://www.telegraph.co.uk/news/uknews/crime/7271008/Record-numbers-of-Britons-ended-their-lives-at-Dignitas-last-year.html Accessed 27/06/11
[23] Available at http://www.cps.gov.uk/publications/assisted_suicide.html Accessed 22/06/11
The Policy provides guidance to prosecutors on the public interest factors to take into account in reaching decisions in encouraging assisted suicide. (DPP. Keir Starmer, CPS Home Page: Publications: Prosecutions & Guidelines: Assisted Suicide)
[24] Available at http://news.bbc.co.uk/2/hi/health/1983457.stm accessed 24/06/11

[25] House of Lords Select Committee on the Assisted Dying for the terminally ill Bill (2005) p91
[26] See Coroners and Justice Bill: p119. Lords Amendments http://www.publications.parliament.uk/pa/ld200809/ldbills/069/2009069.pdf Accessed 28/06/11
[27] ibid Amendment 66
[28] http://www.publications.parliament.uk/pa/ld200405/idselect/idasdy/86/86ii.pdf Accessed 26/06/11
[29] BBC 1 Panorama 1/02/2009. I helped my daughter to die.
[30] Statement from the DPP. Available at http://www.cps.gov.uk/news/press_statement/the_death_of_sir_edward_and_lady_downes/ accessed 26/06/2011
[31] http://www.dignityindying.org.uk/includes/spaw2/uploads/files/Dignity%20in%20Dying%20Report.pdf Accessed 27/06/11 p.15

[32] Ibid. p.15
[33] See assisted dying for the Terminally Ill Bill: House of Lords Report 2004-2005 Vol.1 in Appendix 7 p121.

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