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Health Care Analysis

, Volume 21, Issue 2, pp 85–104 | Cite as

Organised Assistance to Suicide in England?

  • Christoph Rehmann-Sutter
  • Lynn Hagger
Original Article

Abstract

Guidelines provided by the Director of Public Prosecutions suggest that anyone assisting another to commit suicide in England and Wales, or elsewhere, will not be prosecuted provided there are no self-seeking motives and no active encouragement. This reflects the position in Switzerland. There, however, no difference is made between assistance and inducement. In addition, the Swiss approach makes it possible to establish organisations to assist the suicides of both their citizens and foreign visitors. It should not be assumed that this approach is without controversy in Switzerland. Proposals for reform continue to be debated there, not least because of the concern about some of the actual practices of certain end-of-life organisations. It is likely that a few English citizens will continue to avail themselves of these services in Switzerland if they cannot find the help they require here. This paper explores the legitimacy of the current restrictive position adopted towards assisted suicide in England. It argues that the provisions within the guidelines prohibiting organisations that assist suicides, leaves some without the help they need. While legislative decriminalisation of assisted suicide and the establishment of state-sponsored suicide centres would represent the most permissive regime, this paper proposes that this would be a step too far. The preference here is for decriminalisation but adopting a ‘middle way’ between the two extremes: the more permissive approach provided by the ‘Swiss model’ is one that could be employed here, albeit within a more robust regulatory regime.

Keywords

Assisted suicide Suicide centres Right-to-die organisations Euthanasia Assisted dying 

References

  1. 1.
    Admiraal, P. (1999). Listening and Helping to Die: The Dutch Way. In H. Kuhse & P. Singer (Eds.), Bioethic: An Anthology (pp. 332–338). Oxford: Blackwell.Google Scholar
  2. 2.
    Admiraal, P. (2008). Physician-Assisted Suicide: A Doctor’s Perspective. In D. Birnbacher & E. Dahl (Eds.), Giving Death a Helping Hand. Physician-Assisted Suicide and Public Policy. An International Perspective (pp. 131–139). Berlin: Springer.CrossRefGoogle Scholar
  3. 3.
    Baezner-Sailer, E. M. (2008). Physician-Assisted Suicide in Switzerland: A Personal Report. In D. Birnbacher & E. Dahl (Eds.), Giving Death a Helping Hand. Physician-Assisted Suicide and Public Policy. An International Perspective (pp. 141–148). Berlin: Springer.CrossRefGoogle Scholar
  4. 4.
    Battin, M. P. (2010). The irony of supporting physician-assisted suicide: a personal account. Medicine, Health Care and Philosophy, 13, 403–411.CrossRefGoogle Scholar
  5. 5.
    Blocher, C. (2007). Klare Schranken für die Sterbehilfe. Neue Zürcher Zeitung. http://www.nzz.ch/2007/05/26/il/articleF7NQ3.html. Accessed 4 April 2011.
  6. 6.
    Booth, R. (2010). ‘Locked-in’ syndrome man demands right-to-die. London: The Guardian. http://www.guardian.co.uk/society/2010/jul/19/locked-in-syndrome-die-dpp. Accessed 26 March 2011.
  7. 7.
    Bosshard, G., Ulrich, E., & Bär, W. (2003). 748 Cases of Suicide Assisted by a Swiss ‘Right-to-Die’ Organisation. Swiss Medical Weekly, 133, 310–317.PubMedGoogle Scholar
  8. 8.
    Brown, D. (2009). Romantic novelist who plotted the end of her life in secret. and in fear. London: The Times.Google Scholar
  9. 9.
    Campbell, C. S., & Cox, J. C. (2010). Hospice and Physician-Assisted Death. Collaboration, Compliance, and Complicity. The Hastings Center Report, 40(5), 26–35.Google Scholar
  10. 10.
    Campbell, D. (2009). 800 Britons on waiting list for Swiss suicide clinic. London: The Observer.Google Scholar
  11. 11.
    Campbell, T. (2006). Euthanasia as a Human Right. In S. A. M. McLean (Ed.), First Do No Harm (pp. 447–460). Aldershot: Ashgate.Google Scholar
  12. 12.
    Coggon, J. (2010). Assisted Dying and the Context of Debate: ‘Medical Law’ Versus ‘End-Of-Life Law’. Medical Law Review, 18(4), 541–563.PubMedCrossRefGoogle Scholar
  13. 13.
    Coleman, D. (2010). Assisted suicide laws create discriminatory double standard for who gets suicide prevention and who gets suicide assistance: Not Dead Yet responds to Autonomy, Inc. Disability and Health Journal, 3, 39–50.PubMedCrossRefGoogle Scholar
  14. 14.
    Cooper, J., Kapur, N., Webb, R., Lawlor, M., Guthrie, E., Mackway-Jones, K., et al. (2005). Suicide after deliberate self-harm: A 4-year cohort study. American Journal of Psychiatry, 162, 297–303.PubMedCrossRefGoogle Scholar
  15. 15.
    Coyle, N. (2004). Expressed Desire for Hastened Death in Seven Patients Living With Advanced Cancer: A Phenomenological Inquiry. Oncology Nursing Forum, 31, 699–706.PubMedCrossRefGoogle Scholar
  16. 16.
    Dahl, E., & Levy, N. (2006). The case for physician-assisted suicide: how can it possibly be proven? Journal of Medical Ethics, 32, 335–338.PubMedCrossRefGoogle Scholar
  17. 17.
    Dieterle, J. M. (2007). Physician assisted suicide: A new look at the arguments. Bioethics, 21, 127–139.PubMedCrossRefGoogle Scholar
  18. 18.
    Dignitas (2010). So funktioniert Dignitas. Auf welcher philosophischen Grundlage beruht die Tätigkeit dieser Organisation? http://www.Dignitas.ch (12 Aug 2011).
  19. 19.
    Directgov. (2011). Government, citizens and rights: Your right to refuse future medical treatment. http://www.direct.gov.uk/en/Governmentcitizensandrights/Death/Preparation/DG_10029683. Accessed 26 March 2011.
  20. 20.
    Direktion der Justiz und des Innern (2009) Vereinbarung über die organisierte Suizidhilfe’ zwischen der Oberstaatsanwaltschaft des Kantons Zürich und EXIT Deutsche Schweiz vom. Published 7 July. http://www.staatsanwaltschaften.zh.ch. Accessed 27 March 2011.
  21. 21.
    Director of Public Prosecutions. (2009). Interim Policy in Respect of Cases of Assisted Suicide. London: Crown Prosecution Service.Google Scholar
  22. 22.
    Director of Public Prosecutions. (2009). Public Consultation Exercise on the Interim Policy for Prosecutors in respect of Cases of Assisted Suicide Summary of Response. London: Crown Prosecution Service.Google Scholar
  23. 23.
    Director of Public Prosecutions. (2010). DPP, Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide. London: Crown Prosecution Service.Google Scholar
  24. 24.
    Downie, R. S., Fyffe, C., & Tannehill, A. (1990). Health Promotion: Model and Values. Oxford: Oxford University Press.Google Scholar
  25. 25.
    Dunn, G. P., & Milch, R. A. (2002). Is This a Bad Day, or One of the Last Days? How to Recognize and Respond to Approaching Demise. Journal of the American College of Surgeons, 195(6), 879–887.PubMedCrossRefGoogle Scholar
  26. 26.
    Dworkin, G. (1988). The Theory and Practice of Autonomy. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  27. 27.
    Dworkin, G. (1998). Public Policy and Physician-Assisted Suicide. In G. Dworkin, R. G. Frey, & S. Bok (Eds.), Euthanasia and Physician-Assisted Suicide. For and Against (pp. 64–80). Cambridge: Cambridge University Press.Google Scholar
  28. 28.
    Dworkin, G. (2008). Should Physician-Assisted Suicide be Legalised? In D. Birnbacher & E. Dahl (Eds.), Giving Death a Helping Hand. Physician-Assisted Suicide and Public Policy. An International Perspective (pp. 3–9). Berlin: Springer.CrossRefGoogle Scholar
  29. 29.
    Edwards, S. D. (2010). An Argument in Support of Suicide Centres. Health Care Analysis, 18, 175–187.PubMedCrossRefGoogle Scholar
  30. 30.
    Eidgenössisches Justiz- und Polizeidepartement EJPD (2009) Änderung des Strafgesetzbuches und des Militärstrafgesetzes betreffend die organisierte Suizidhilfe. Published October 14. http://www.ejpd.admin.ch/ejpd/en/home/themen.html. Accessed 27 March 2011 under ‘Euthanasia’.
  31. 31.
    Ernst, K., & Ernst, C. (1995). Praktische Klinikpsychiatrie (3rd ed.). Stuttgart: Kohlhammer.Google Scholar
  32. 32.
    EXIT (2011). So viele Beitritte wie noch nie. Medienmitteilung 05. 04. 2011 (www.exit.ch; accessed 12. 08. 2011).
  33. 33.
    Finlay, I. (2009). Assisted suicide is fine in a perfect world. We don’t live (or die) in one. London: The Times.Google Scholar
  34. 34.
    Fischer, S., Huber, C. A., Mahrer Imhof, R., Furter, M., Ziegler, S. J., & Bosshard, G. (2008). Suicide Assisted by Two Swiss Right-to-Die Organisations. Journal of Medical Ethics, 34, 810–814.PubMedCrossRefGoogle Scholar
  35. 35.
    Fletcher, H. (2008). Husband is spared jail for suffocating wife who wanted to die. London: The Times.Google Scholar
  36. 36.
    Freeman, M. (2002). Denying Death its Dominion: Thoughts on the Dianne Pretty Case. Medical Law Review, 10(3), 245–270.PubMedCrossRefGoogle Scholar
  37. 37.
    Ganzini, L., & Dahl, E. (2008). Physician-Assisted Suicide in Oregon. In D. Birnbacher & E. Dahl (Eds.), Giving Death a Helping Hand. Physician-Assisted Suicide and Public Policy. An International Perspective (pp. 67–75). Berlin: Springer.CrossRefGoogle Scholar
  38. 38.
    General Medical Council. (2010). End of life treatment and care: Good practice in decision-making. London: General Medical Council.Google Scholar
  39. 39.
    Golden, M., & Zoanni, T. (2010). Killing us softly: the dangers of legalizing assisted suicide. Disability and Health Journal, 3, 16–30.PubMedCrossRefGoogle Scholar
  40. 40.
    Guillod, O., & Schmidt, A. (2005). Assisted Suicide Under Swiss Law. European Journal of Health Law, 12(1), 25–38.PubMedCrossRefGoogle Scholar
  41. 41.
    Hagger, L. (2009). The Child as Vulnerable Patient: Protection and Empowerment. Aldershot: Ashgate Publishing.Google Scholar
  42. 42.
    Hawton, K., & James, A. (2005). Suicide and deliberate self harm in young people. British Medical Journal, 330(7496), 891–894.PubMedCrossRefGoogle Scholar
  43. 43.
    Hell, D. (2006). Ergebnisse der Suizidforschung. In: C. Rehmann-Sutter, A. Bondolfi, J. Fischer, & M. Leuthold (Eds.), Beihilfe zum Suzid in der Schweiz. Beiträge aus Ethik, Recht und Medizin (pp. 85–91). Bern: Lang.Google Scholar
  44. 44.
    House of Lords Select Committee. (2005). Report of the House of Lords Select Committee on the Assisted Suicide for the Terminally Ill Bill. London: HMSO.Google Scholar
  45. 45.
    Hurst, S. A., & Mauron, A. (2003). Assisted Suicide and Euthanasia in Switzerland: Allowing a Role for Non-Physicians. British Medical Journal, 326(7383), 271–273.PubMedCrossRefGoogle Scholar
  46. 46.
    Keats, J. (1919). Ode to a Nightingale. In A. Quiller-Couch (Ed.), The Oxford Book of English Verse: 1250–1900. Oxford: Clarendon. http://www.bartleby.com/101/624.html. Accessed 4 September 2011.
  47. 47.
    Lewis, P. (2011). Informal legal change on assisted suicide. Legal Studies, 31(1), 119–134.CrossRefGoogle Scholar
  48. 48.
    Levy, N. (2008). Slippery Slope and Physician-Assisted Suicide. In D. Birnbacher & E. Dahl (Eds.), Giving Death a Helping Hand. Physician-Assisted Suicide and Public Policy. An International Perspective (pp. 11–21). Berlin: Springer.CrossRefGoogle Scholar
  49. 49.
    Manoel Bertolote, J., & Fleischmann, A. (2010). Suicide and psychiatric diagnosis: a worldwide perspective. World Psychiatry, 1(3), 181–185.Google Scholar
  50. 50.
    McLean, S. A. M. (2007). Assisted Dying: Reflections on the Need for Law Reform. Abingdon: Routledge-Cavendish.Google Scholar
  51. 51.
    Mullock, A. (2009). Prosecutors Making (Bad) Law? Decision on prosecution—the death by suicide of Daniel James, 9 December 2008. Medical Law Review, 17(2), 290–299.PubMedCrossRefGoogle Scholar
  52. 52.
    Mullock, A. (2010). Overlooking the Criminally Compassionate: What are the Implications of Prosecutorial Policy on Encouraging or Assisting Suicide? Medical Law Review, 18(4), 442–470.PubMedCrossRefGoogle Scholar
  53. 53.
    Münk, H. J. (2009). Suizibeihilfe. Zeitschrift für Medizinische Ethik, 55, 371–383.Google Scholar
  54. 54.
    National Audit Office. (2008). End of Life Care. London: National Audit Office.Google Scholar
  55. 55.
    Nationale Ethikkommission im Bereich der Humanmedizin. (2010). Vernehmlassungsantwort der NEK-CNE zu den bundesrätlichen Vorschlägen für eine Änderung von Art. 115 StGB/Art. 119 MStG. http://www.nek-cne.ch. Accessed 27 March 2011.
  56. 56.
    Neuberger, J. (2004). Dying Well: a guide to enabling a good death (2nd ed.). Abingdon: Radcliffe Publishing.Google Scholar
  57. 57.
    Ohnsorge, K., & Rehmann-Sutter, C. (2010). Menschen, die sterben möchten. Empirische Studien in der Palliativmedizin und ihre ethischen Implikationen. In A. Hilt, I. Jordan, & A. Frewer (Eds.), Endlichkeit, Medizin und Unsterblichkeit (pp. 249–270). London: Steiner.Google Scholar
  58. 58.
    Oswald, U. (2009). Ausgang. Das letzte Jahr mit meinem Vater. Zürich: Epoca.Google Scholar
  59. 59.
    Rehmann-Sutter, C., Bondolfi, A., Fischer, J., & Leuthold, M. (Eds.). (2006). Beihilfe zum Suzid in der Schweiz. Beiträge aus Ethik, Recht und Medizin. Bern: Lang.Google Scholar
  60. 60.
    Rehmann-Sutter, C. (2006). Zum gegenwärtigen Diskussionsstand um die Beihilfe zum Suizid in der Schweiz. Zeitschrift für Evangelische Ethik, 50, 49–53.Google Scholar
  61. 61.
    Rehmann-Sutter, C. (2007). Was bedeutet das, Recht auf den eigenen Tod? Schweizerische Ärztezeitung, 88, 1109–1112.Google Scholar
  62. 62.
    Runeson, B., Tidemalm, D., Dahlin, M., Lichtenstein, P., & Långström, N. (2010). Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study. British Medical Journal, 340, c3222.CrossRefGoogle Scholar
  63. 63.
    Saunders, C. (2000). The Evolution of Palliative Care. Patient Education and Counselling, 41(1), 7–13.CrossRefGoogle Scholar
  64. 64.
    Schwarzenegger, C., Patrik Manzoni, P., Studer, D., & Leanza, C. (2010). Was die Schweizer Bevölkerung von Sterbehilfe und Suizidbeihilfe hält Jusletter. http://jusletter.weblaw.ch/category/89.1. Accessed 4 April 2011.
  65. 65.
    SDA (2011). Bundesrat will Sterbehilfe doch nicht regeln. Neue Zürcher Zeitung 30 June 2011.Google Scholar
  66. 66.
    Seale, C. (2006). National survey of end-of-life decisions made by UK medical practitioners. Palliative Medicine, 20(1), 3–10.PubMedCrossRefGoogle Scholar
  67. 67.
    Seale, C. (2009). Continuous Deep Sedation in Medical Practice: A Descriptive Study. Journal of Pain and Symptom Management, 39(1), 44–53.PubMedCrossRefGoogle Scholar
  68. 68.
    Smith, S. (2005). Evidence for the Practical Slippery Slope in the Debate on Physician-Assisted Suicide and Euthanasia. Medical Law Review, 13(1), 17–44.CrossRefGoogle Scholar
  69. 69.
    Smith, S. (2005). Fallacies of the Logical Slippery Slope in the Debate on Physician-Assisted Suicide and Euthanasia. Medical Law Review, 13(2), 224–244.CrossRefGoogle Scholar
  70. 70.
    State of Oregon Public Health Division. (2010). Oregon Death with Dignity Act, Annual Report. http://www.oregon.gov/DHS/ph/pas/. Accessed 3 February 2011.
  71. 71.
    Steinbock, B. (2005). The case for physician assisted suicide: Not (yet) proven. Journal of Medical Ethics, 31, 235.PubMedCrossRefGoogle Scholar
  72. 72.
    Swiss National Advisory Commission on Biomedical Ethics. (2005). Opinion 9 Assisted Suicide. http://www.nek-cne.ch. Accessed 26 March 2011.
  73. 73.
    Swiss National Advisory Commission on Biomedical Ethics Swiss. (2006). Opinion 13 Duty-of-care criteria for the management of assisted suicide. http://www.nek-cne.ch. Accessed 26 March 2011.
  74. 74.
    Templeton, S.-K. (2009). Terminally ill opt for suicide by starvation. London: The Times.Google Scholar
  75. 75.
    World Health Organization/The World Bank (2011). World Report on Disability. Geneva: WHO (www.who.int).
  76. 76.
    Ziegler, S. J. (2009). Collaborated Death: An Exploration of the Swiss Model of Assisted Suicide for Its Potential to Enhance Oversight and Demedicalize the Dying Process. Journal of Law, Medicine & Ethics, 37, 318–330.CrossRefGoogle Scholar
  77. 77.
    Ziegler, S. J., & Bosshard, G. (2007). Role of Non-governmental Organisations in Physician Assisted Suicide. British Medical Journal, 334, 295–298.PubMedCrossRefGoogle Scholar

Statutes

  1. 78.
    Death with Dignity Act 1994.Google Scholar
  2. 79.
    Mental Capacity Act 2005.Google Scholar
  3. 80.
    Suicide Act 1961.Google Scholar

Cases

  1. 81.
    Airedale NHS Trust v Bland [1993] AC 789.Google Scholar
  2. 82.
    Osman v UK [1999] 1 FLR 193.Google Scholar
  3. 83.
    Purdy v Director of Public Prosecutions [2009] EWCA Civ 92 (Court of Appeal).Google Scholar
  4. 84.
    Re B [2002] EWHC 429.Google Scholar
  5. 85.
    R v Cox (1992) 12 BMLR 38.Google Scholar
  6. 86.
    R (Pretty) v DPP [2001] UKHL 61.Google Scholar
  7. 87.
    R (on the application of Purdy) v DPP [2009] 3 WLR 403.Google Scholar
  8. 88.
    Re T (Adult: refusal of medical treatment) [1993] Fam 95 (CA).Google Scholar
  9. 89.
    R v Wallis (1983) 5 Cr App R(S) 342.Google Scholar
  10. 90.
    Servier Laboratories Limited v National Institute for Health and Clinical Excellence & An., [2010] EWCA Civ 346.Google Scholar

Government Report

  1. 91.
    Fifth Report (2004) Safeguarding Patients: Lessons from the Past - Proposals for the Future. Published 9 December. Command Paper Cm 6394.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Institute for the History of Medicine and Science StudiesUniversity of LübeckLübeckGermany
  2. 2.School of LawUniversity of SheffieldSheffieldUK

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