Alex Carlile, barrister and Liberal Democrat peer (Lord Carlile of Berriew), writing in the British Medical Journal, 08 August 2009
Assisting suicide must remain a crime in order to deter the malicious and protect the vulnerable
Clare Dyer's recent feature article (BMJ 2009;339:b2868, doi:10.1136/bmj.b2868) attempts to make Lord Falconer's case for changing the law to legalise assisting the suicides overseas of terminally ill British people. As an opponent of Lord Falconer's proposed amendment to the Coroners and Justice Bill I would like to highlight some of its misconceptions.
As the Court of Appeal made clear in its February judgment on the Purdy case (BMJ 2009;338:b742, doi:10.1136/bmj.b742), not all cases of assisted suicide involve "loved ones." There is a darker side to this story as well. For example, in at least two well documented deaths at the Dignitas clinic in Switzerland the deceased people were not terminally ill.
Of at least as great concern is that, if the law's prohibition were removed, potential would be much increased for the coercion and manipulation of terminally ill people by relatives wanting to be rid of a care burden or anxious to inherit. Such abuse is not common, but it exists; and it is held in check by the penalties that the law holds in reserve to deal with people who have assisted suicides with malicious motives.
Nor should we take at its face value the rather idealised picture that is painted by the advocates of legal change: of terminally ill people who are fully resolved to end their own lives and of doctors who are fully competent and willing to assess their mental as well as physical state. In the real world most terminally ill people are not so singleminded as that: they are frightened and vulnerable, and many are susceptible to perceptions, justified or not, that they are a burden to their families or to fears, usually groundless, that they will die badly. If surveys of medical opinion are anything to go by, many doctors would be reluctant to assess patients for assisted suicide. As a result we might expect to see the "doctor shopping" that is such an unhappy feature of the Oregon scene, with assessments being carried out by a minority of physicians who are sympathetic to assisted suicide-a situation hardly conducive to objective outcomes.
Dyer records Lord Falconer's view that "the current law has no safeguards." This is nonsense. The law's prohibition of assisted suicide, along with the penalties it holds in reserve, is itself a powerful safeguard: it causes potential assisters to think very carefully before embarking on such a course and to ensure that, if they do accede to a serious request for assistance with suicide, their motives and actions can stand up to serious investigation. In contrast, Lord Falconer's proposed licence to assist the suicides of terminally ill people would have provided a "get out of jail free" card to assisters and opened the way to coercion or manipulation of people who might have had second thoughts once the licence had been issued.
Dyer argues, from the support given to Lord Falconer by Lord Low, himself a blind peer, that "not all disabled people oppose [assisted suicide]." But Lord Low is not disabled in the same sense in which, for example, Baroness Campbell, who spoke against Lord Falconer's amendment, is disabled. Lord Low is far from being in danger of being classified as terminally ill. Baroness Campbell, on the other hand, would (in her own words) "tick every box" of Lord Falconer's proposals. In any case, while there can be no doubt that disabled people who are also seriously ill would be exposed by legal change, others with loss of faculty (such as sight or hearing) could also be endangered by feelings of being a burden to others. It is hardly surprising therefore that organisations representing disabled people are worried by what they see happening.
Lord Falconer claims that his amendment would only (in Dyer's words) "reflect what happens in practice." Again, this is only half the story. It is true that no assister of an overseas suicide has been prosecuted to date on return to the United Kingdom. But the numbers involved are very small-less than one in every 50 000 deaths of British people over the past 10 years-and they have occurred against the background of a law that deters all but really serious and resolute requests. In such circumstances the risks of coercion or manipulation are small, and it is hardly surprising that the director of public prosecutions has seen no public interest case for prosecuting in a case of suicide overseas-although currently there is one case in which prosecution is being undertaken for assisting suicide within the UK.
Furthermore, the complaint that the law as it stands is unclear is nonsense. It could not be clearer. A person who assists suicide has an important exercise to perform in personal responsibility. To assist suicide is a crime. It may be prosecuted. If it is not in the public interest to prosecute, the director of public prosecutions will exercise his or her discretion accordingly. This is predictable-and a protection for the vulnerable.
Dyer says that Lord Falconer is thinking of returning to the charge after the parliamentary recess. The Coroners and Justice Bill, which is actually seeking to tighten the law's prohibition of assisted suicide, is no proper vehicle for these purposes. If there is to be legislation, it should be tested first in the elected house of parliament.
Cite this as: BMJ 2009;339:b3169
