Assisted Dying

Over the last number of years, the topic of assisted dying for a terminally ill person has gained traction in health circles, society and legislative arenas. Assisted dying relates to prescribing life ending drugs for terminally ill, mentally competent adults to administer themselves after meeting strict legal safeguards (British Medical Journal article).

The issue is currently the focus of an inquiry by the UK Parliament’s cross-party Health and Social Care Committee, and in 2023 various hearings will explore the arguments across the debate. The committee said it intends to focus on the role of medical professionals; access to palliative care; what protections would be needed to safeguard against coercion and the criteria for eligibility to access assisted dying/assisted suicide services. 

RCS England Assisted Dying Research report

In 2021, the Royal College of Surgeons of England decided to review its position on assisted dying for terminally ill patients. The College’s previous stance of opposition has been in place since the subject was last discussed in 2014. Reflecting our commitment to engage more regularly with members in order to guide and inform Council decisions, we conducted a survey of our members to gather views.

The independent assisted dying survey was carried out across four weeks in February and March 2023 and resulted in 19% of members at all career levels sharing their views.

Of those who responded, 72% felt we should change our position of opposition to any future law that would permit assisted dying for qualifying patients.

This figure includes 52% who said the College should be supportive of a change in the law to permit assisted dying and 20% who said we should take a neutral position on the provision of assisted dying for mentally competent, terminally ill adults.

Among the respondents, 61% told us they personally supported a change in the law while 29% said they were opposed and 10% undecided.

In relation to the role of doctors in any future assisted dying process, 59% felt doctors should be involved in confirming a patient meets the eligibility criteria; 42% thought doctors should prescribe the drugs and 23% thought that doctors should be present while patients self-administer the drugs.

Following the survey, the matter of assisted dying for qualifying patients was debated by the Council in April and May 2023. A majority vote was cast in favour of adopting a neutral position on the issue.

Read the full report.

Terms

There are many different terms used in the assisted dying debate. The BMJ website provides more information on the various terms and for the purposes of this survey we understand the term “assisted dying” describes prescribing life ending drugs for terminally ill, mentally competent adults to administer themselves after meeting strict legal safeguards.

What does neutrality mean?

This means we will neither support nor oppose attempts to change the law. As a professional body we have a duty and a responsibility to reflect all members’ interests and concerns in any future legislative proposals and we will continue to engage with our members to understand their views.

What is the current law on assisted dying?

A House of Lords briefing has summarised the legal position in the following way: “Assisted dying is illegal in England and Wales under section two of the Suicide Act 1961. Under this act, a person judged to have assisted the suicide or attempted suicide of another person is liable to imprisonment for up to 14 years. The Coroners and Justice Act 2009 provided an exemption on bringing charges under section 2 of the 1961 act. This was clarified in a February 2010 policy on assisted suicide from the Director of Public Prosecutions and the Crown Prosecution Service (CPS). These guidelines advised against prosecution if “the victim had reached a voluntary, clear, settled and informed decision to commit suicide”, and any person assisting was “wholly motivated by compassion”. In addition, former Secretary of State for Health and Social Care Matt Hancock said in November 2020 that the government ‘does not take a position’ on the issue of assisted dying. As with previous governments, a vote in parliament will be a free vote, as government deems it, ‘a matter for each and every [MP] to speak on and vote according to their sincerely held beliefs’

Which countries have legalised assisted dying?

Assisted dying (prescribing life ending drugs for terminally ill, mentally competent adults to administer themselves after meeting legal safeguards) is legal and regulated in ten US jurisdictions: Washington, D.C. and the states of California, Colorado, Oregon, Vermont, New Mexico, Maine, New Jersey, Hawaii, and Washington. In 2017, similar legislation was passed in Victoria, Australia. Assisted suicide (giving assistance to die to people with long term progressive conditions and other people who are not dying, in addition to patients with a terminal illness) is allowed in Switzerland. Voluntary euthanasia (a doctor directly administering life ending drugs to a patient who has given consent) is allowed in Belgium, Luxembourg, and the Netherlands. The BMJ notes that in 2016, “Canada legalised both voluntary euthanasia and assisted dying for people whose death is ‘reasonably foreseeable’, in what it calls ‘medical assistance in dying’”.

Resources to support consideration

There are significant resources online about this issue and we would draw your attention to the British Medical Journal which has published a timeline of recent developments in the assisted dying debate, and includes articles representing views on both side of the debate. Please consult these further materials here: https://www.bmj.com/assisted-dying
The BMA website also contains important information as well as for and against arguments. Access the information pack here: https://www.bma.org.uk/advice-and-support/ethics/end-of-life/physician-assisted-dying/physician-assisted-dying-survey

Resources on assisted dying

• RCS England Assisted Dying Research Report March 2023
• ‘The question of assisted dying’ (Marsh, H 2022 RCS England Bulletin)
• ‘Assisted Dying’ (Lavy C & Yassin N 2022 RCS England Bulletin)
• Political views on assisted dying, House of Commons debate on assisted dying (July 2022)
• Public views on assisted dying, 2017 British Social Attitudes survey
• BMA report and survey on physician assisted dying
• RCS England 2018 guidance on “Caring for Patients at the End of Life”
• RCGP assisted dying survey
• RCP survey on assisted dying
• Baroness Meacher October 2021 Assisted Dying Bill & Hansard
• Assisted Dying around the world BMJ 10 October 2021
• UK Parliament POST brief September 2022 (Gajjar D & Hobbs A)
• Assisted Dying Bill, House of Lords Library
• The law on assisted dying, House of Commons Library
• Assisted Dying Legislation: North America and England and Wales, House of Lords Library