The assisted suicide debate

It is illegal to assist a person to commit suicide, but those who do are rarely prosecuted. What message does this send disabled people and the terminally ill, asks Amy Taylor

The decision to help a relative or loved one commit suicide is one of the most heart-wrenching anybody may have to face. It is also illegal. Under the Suicide Act 1961, aiding and abetting suicide is punishable with up to 14 years in prison. There is no such legislation in Scotland but those who help someone commit suicide can be charged with culpable homicide.

Despite this, there have been no prosecutions of anyone who accompanied the 100 or so Britons who have died at the Swiss assisted-suicide clinic run by Dignitas.

Three separate cases that have been in the news headlines over the past few months have failed to clarify the situation. In October Debbie Purdy, who has multiple sclerosis, went to the High Court to ask the director of public prosecutions (DPP) to review the law on assisted dying and to outline what the law considers to be assisted suicide. She was worried that if her husband helped her to travel to Dignitas he would be prosecuted after her death.

The judge said it was a matter for parliament and Purdy lost her case. Six weeks later the wife of motor neurone disease sufferer Craig Ewert was filmed with him as he ended his life at Dignitas in a controversial Sky documentary. While in December, the DPP announced he would not be prosecuting the parents of Daniel James, a 23-year-old tetraplegic paralysed from the chest down in a rugby accident, who had helped him to attend the clinic.

Moral issues

It is the James case that has raised the most moral issues. The DPP statement says that, despite “sufficient evidence” to prosecute James’s parents, based on the facts of the case it “would not be in the public interest” to do so.

James had been disabled for 18 months before his death and had made three attempts to kill himself. A psychiatrist found that James was both clear in his wish to die and understood that this was against everybody else’s wishes. His parents, along with health professionals, had repeatedly tried to talk him out of wanting to commit suicide at Dignitas, but to no avail, and so eventually decided to help him.

Jane Campbell (right), chair of the disability committee at the Equality and Human Rights Commission, believes the case sends out a dangerous signal. She says that while it may seem like a personal matter the drip, drip effect of letting such cases go has big implications for society.

“While I completely understand the family have to live with the consequences of their actions, [the Crown Prosecution Service] has got to start prosecuting otherwise it sends out a message that it’s OK to help people die,” she says.

Lives worth less

Campbell says any change in the law in relation to disabled or terminally ill people would be open to abuse and would just reinforce the view that their lives are worth less than others.

“We are all subject to society’s views of disability and serious illness – that it’s terrible and negative – when actually the reality is our lives are no more tragic than a lot of people in society who for whatever reason don’t do so well in life,” she says.

Liz Carr (right), a disabled comedian, actor and broadcaster, agrees. She argues that media focus on individual cases such as James’s presents a distorted view of disability with no counterbalance.

“A film on what can be done for disabled people who live is not sexy, unlike the Sky documentary,” she says. “We all like a bit of murder and a bit of mystery. Can you imagine an hour and forty minutes talking about palliative care or the state of social care?”

18 months not long enough

Carr says that she sympathises with the James family but 18 months is not long enough for someone to come to terms with their disability and see how their lives can remain worthwhile.

“In terms of the terrible loss that anyone will feel when they first become disabled, 18 months is no time at all to refind yourself and make the decision that life is pointless,” she says.

In Purdy’s case she was looking for immunity for those helping someone with a terminal illness rather than a disability. Purdy, who takes her case to the Appeal Court next month, was supported by campaigning organisation Dignity in Dying. Its head of legal strategy and policy Davina Hehir says that the lack of prosecutions suggests that a decision has been made behind the scenes and if this is the case people have a right to be informed.

“The law is saying one thing and perhaps there’s a policy at work behind that which isn’t being publicised,” she says. “If people could know what the policy was it would be much easier for them. It would allow them to make decisions about timings and it would give them much better peace of mind.”

While nobody has been prosecuted some have been questioned and investigated and one has been arrested and charged distressing experiences that she says could be avoided.

Law change

Dignity in Dying is campaigning for the law to be changed only for the terminally ill and doesn’t support such a move for disabled people. Hehir says the organisation sees the two groups as very separate.

Carr disagrees. She says the James case shows the debate is not just about terminal illness but also about disability and that society’s negative view of disabled people means any change in the law for the terminally ill would be in danger of being extended to this group.

“In a world that valued disabled people and their lives maybe the legislation could be safe for just terminal illness but it’s not,” she says.

For Campbell, assisted suicide is wrong in both instances: “While we continue to live in a world where disability or end-of-life care are seen as negative, we will never get to a situation where people can take their own lives in a non prejudicial way,” she says.

Right to die “red herring”

Giving disabled people a right to die is a phrase often heard in the assisted suicide debate but Carr describes the rights argument as a “red herring”. It is the reasons why disabled people want to die that need to be explored.

Research has found that for many this is the fear of becoming a burden rather than fear of their condition. Carr says this feeling increases in times of economic difficulty.

“I don’t think it is a fluke that this is hitting the headlines again at a time of economic crisis,” she says. “People are going to be hit hard in every sense. The pressure on people to contribute or not to be a burden is going to increase and that will mean there’s a tendency for assisted suicide.”

Parliament is unlikely to offer any help soon for those seeking clarification. In 2006, the Lords blocked Lord Joffe’s bill on assisted dying for the terminally ill while last month the prime minister spoke of his objection to any relaxation of the laws. So we are in a situation where assisting someone to kill themselves is illegal but prosecutions don’t take place, which leaves both sides of the debate deeply dissatisfied.

Published in the 15 January 2009 edition of Community Care under the headline ‘Time to Lay Down the Law’

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