Assisted suicide: Uncertainty goes on

Doctors need clarity on assisted suicide

The issue of how to care for the terminally ill is one that has rarely dropped out of public debate. The recent cases of Debbie Purdy and Daniel James have only served to raise public awareness even further and, together with the increased profile of Swiss clinic Dignitas, the subject of end-of-life care continues to inflame emotions.

The issues faced by any individual connected to such a situation are traumatic and complex. These include the fear of prosecution for helping a loved one to carry out a passionately-held wish. It is against this highly charged background that the Director of Public Prosecutions (DPP) published interim guidelines this September, outlining what would be taken into account when making a prosecution decision over assisted suicide.

The policy guidelines apply to acts that allegedly assist a suicide or an attempted suicide, even if the actual suicide or attempted suicide takes place outside England and Wales.

Much of what has been debated has focused, understandably, on whether relatives or spouses will face prosecution for assisted suicide. But we would like o see more clarity about the circumstances in which doctors might face prosecution.

Doctors’ involvement in assisted suicide may be limited to the obvious methods such as prescribing drugs. But there are other types of “assistance” that a doctor could be accused of employing – such as giving advice on the issues surrounding it, which could be seen as an indirect way of enabling a patient to end their own life. A patient may also seek a medical report, or their records, to arrange an assisted suicide. If a doctor agrees to participate in any of this, it could be deemed a criminal act – so it is important that doctors understand what is expected of them if they become aware that suicide is being contemplated.

Issues that need clarification

Under Swiss law, Dignitas can only accept people who are terminally ill or suffering unbearably from incurable symptoms. To ensure these conditions are met, Dignitas requests a patient’s medical records and a certificate of fitness to travel before an appointment can be made. Does providing this information constitute “assisting” suicide?

There are other situations where a doctor could be deemed to be “assisting” a suicide – issuing prescriptions when there is scope for medication misuse. If a doctor suspects that a patient is considering suicide, what are his/her obligations? Is the next move to inform the authorities – either in the UK or overseas?

Next steps

Decisions about ending lives give rise to complex legal and ethical issues and it is important that healthcare professionals are given as much clarity as possible about their potential roles in the matter.

MPS plans to submit a detailed response to the DPP’s consultation on the interim guidelines, which closes on 16 December. The finalised policy is expected to be issued in spring 2010.