Read the paper: Twenty questions on assisted dying and suicide prevention
David Albert Jones
The following comments touch on themes that I explore in more depth in, ‘Twenty questions on assisted dying and suicide prevention’ (link above), a paper written to inform the current debate in the House of Lords on the Terminally Ill Adults (End of Life) Bill.
November is the month of remembrance of the dead. As autumn leaves fall and the darkness of winter approaches we are reminded of our common mortality. We will all die as a matter of natural necessity. However, it is not necessary that any of us will die by our own hand.
Many of us have felt overwhelmed at some time or times in our lives, and have thought of taking our own life, perhaps one in four of us. Thankfully, few of us will lose our lives by suicide. Suicide is not inevitable and that people find a way through is often due to the help and support of others, to professional help, and because practical measures have been put in place to reduce access to the means of suicide.
Suicide prevention is an expression of solidarity, of the belief that every suicide is a tragedy and that each avoidable death diminishes all of us. Suicide prevention is a fundamental human right, an aspect of the universal right to life.
This right is threatened by Bills that are nearing the end of the Parliamentary process in the House of Lords (Committee Stage beginning 14 November) and the Scottish Parliament (Stage 2 continuing 18 November). This is the last opportunity to make these Bills safe or else to show them unsafe before finally rejecting them.
Neither Bill expressly permits a doctor to administer a lethal dose directly, but both permit a doctor to provide a ‘terminally ill’ patient with a lethal drug so they can take their own lives. In other jurisdictions (and in a previous Bill in Scotland) this is known as ‘assisted suicide’. It is suicide, with the assistance of a doctor. This is why the Terminally Ill Adults (End of Life) Bill amends the Suicide Act 1961, to permit doctors to ‘encourage or assist suicide’ in certain circumstances.
During the debates in the House of Lords several Peers objected that the Bill was not about ‘suicide’ because the people seeking ‘assisted dying’ did not want to die. They were dying and just wanted a choice of how to die. However, the choice enabled by the Bill is precisely a choice to take your own life, that is, to die by suicide.
It is a neglected truth that suicide does not only afflict the young and the physically health but also afflicts older people and people with serious illness. Indeed people with a recent terminal diagnosis are at increased risk of suicide (remembering that in no circumstances is suicide inevitable).
These Bills are an inherent threat to the ethos of suicide prevention. They promote what it seeks to prevent. This threat could be mitigated, at least to some extent, however, if the Bills overtly recognised that what they legalise is assisting suicide and that people who are eligible in the Bills for assistance in suicide retain a right to suicide prevention measures.
Even if people may legally, on request and under certain conditions, obtain the means of suicide from a doctor, it should remain a crime (in England and Wales) or become one (in Scotland) for a doctor to encourage someone to end their life. Doctors, who wield considerable influence, should have, in addition, a legal duty to ask why the patient is seeking to hasten death, and a duty to seek first to address these reasons by means other than providing them with the means of suicide. If assistance in suicide is to be legalised it must be patient led and lethal means provided by a doctor only as a last resort. Not everything that is legally permitted should be legal to promote, to advertise, or to encourage.
Whether either or both of these Bills pass, and whether this is substantially amended or virtually unamended, it is essential to remember that everyone has a right to reasonable steps to prevent them from taking their own life. Suicide prevention is for all.