The question of assisted dying has not been out of the media spotlight in recent months. In July 2009, campaigner and MS sufferer, Debbie Purdy, won an historic battle for clarity over assisted suicide laws when the Law Lords agreed that her husband would not be prosecuted if he assisted her in her venture to commit suicide by taking her to the Swiss clinic Dignitas [Ref: Dignitas]. A spate of campaigns, sympathetic TV dramas and documentary films on the subject, with Gordon Brown’s announcement that he is firmly opposed to assisted dying, have revived the debate about introducing a change to the law to assist terminally ill patients who request the ‘right to die’. Proponents of assisted dying aim to give people the ability to control their destiny, but there is also concern that loosening the law would be a slippery slope and fear that a change in the law would lead to an increasing prevalence of assisted suicide and could open the door to euthanasia. Critics, both secular and religious, oppose any new legalisation. They emphasise the value of life and argue for a focus on prolonging life or palliative care. Advocates of assisted dying retort that legalisation would allow the practice to be publicly regulated and scrutinised. They point to what they say are successful changes to the law in Belgium, Holland, Switzerland and the US state of Oregon. Ultimately, the debate is a moral one which, aside from the legal and medical issues, asks us to decide whether it is ever right for doctors to assist someone in bringing about their own death.

What are the terminological distinctions to be aware of?
Debates over assisted suicide and euthanasia involve a complex array of distinctions; different sides in the debate use different terms to describe the same practice. A useful framework for this debate is provided by the campaign group Dignity in Dying (formerly the Voluntary Euthanasia Society), which campaigns for ‘medically assisted dying’ and was joint author of the Assisted Dying for the Terminally Ill Bill [Ref: BBC News]. When a doctor indirectly assists a patient to die by prescribing medication that will enable the patient to end his own life, it is known as patient assisted dying, also commonly described as physician assisted suicide. When a doctor directly assists a patient to die by administering lethal medication at a patient’s request it is known as voluntary euthanasia. In practical terms some argue that assisted dying and voluntary euthanasia are indistinguishable. Fundamental moral arguments tend to apply to both, but some feel there is less moral responsibility involved, on the part of the doctor, in physician assisted suicide.

Should the law change?
Whilst the proposed amendment to the Coroners and Justice Bill demands a change in law to protect those who help terminally-ill relatives and friends travel abroad for an assisted suicide, campaigners admit that the long term aim is to provide the terminally ill with the choice of a physician assisted death in the UK. The Assisted Dying bill would have permitted patient assisted dying but not voluntary euthanasia. It sought to allow a doctor to give a prescription for lethal drugs to a legally competent patient who had requested them and who was suffering ‘unbearably’ from a terminal illness, likely to result in death within six months. A survey suggested that three-quarters of the public were in favour of the legislation [Ref: epolitix]. Proponents pointed to the Bill’s stringent safeguards and they continue to argue that legalisation would prevent ‘back-street suicides’. Opponents remain concerned about pressure being exerted on the elderly and infirm to choose death. Disability rights campaigners argue that in a society where disabled people are not treated as equal citizens, a ‘right to die’ would endanger disabled people’s right to live and have their lives seen as of equal value.

Would a change in the law undermine the role of doctors?
Many doctors are concerned about assisting people to die, feeling it goes against the idea in the Hippocratic Oath that doctors should not cause harm [Ref: BBC News]. Some doctors feel that a change in the law would turn them into ‘executioners’ and so poison doctor-patient relations. Advocates counter that a major part of a doctor’s role, particularly in terminal cases, is to ease pain. Individual doctors who disagreed with assisted suicide could ‘conscientiously object’, advocates argue, while those who carry it out would be protected.

What are the moral arguments?
The most straightforward argument in favour of assisted dying is that the right to die at the time and in the manner that one wishes follows directly from the right to choose how one lives. Fundamentally, proponents argue, the case for a change in law rests upon the ideas of mercy and autonomy. Opponents retort that life should be preserved at all costs, that suicide should always be discouraged and that pain and depression are largely resolvable issues. A number of commentators are also concerned about a change in social values, for example, the idea of courage changing from resilience in the face of adversity to ‘giving up’ or ‘letting go’. The concept of dignity is crucial to the debate: opponents insist that dignity must not be reduced to ‘bodily integrity’ whereby life is seen as no longer worth living once someone is no longer able-bodied. In contrast, advocates argue for ‘dignity in dying’ and very often see assisting someone to die as an act of kindness and compassion.