What is assisted dying and where is it legal? MPs say allowing assisted dying does not worsen end-of-life care

Assisted dying is illegal in the UK and can be treated as murder or manslaughter (Lynne Cameron / PA Wire)
Assisted dying is illegal in the UK and can be treated as murder or manslaughter (Lynne Cameron / PA Wire)

End-of-life care doesn’t worsen by allowing assisted dying, according to the House of Commons' Health and Social Care Select Committee, which has studied evidence from other countries with the practice.In such countries, the group found that more investment into end-of-life care goes hand in hand with assisted dying, resulting in better overall care.

However, the committee did not rule on changing the law in England, but rather provided insight and evidence for debate around the issue.

People should have a choice about "the way we want to end our lives", says campaigner Dame Esther Rantzen.

The group of MPs went on to state that, as it stands in England at the moment, hospices in England need more funding to deliver higher levels of care.

Hospices currently receive just a third of their funding from the NHS, despite providing the majority of the palliative care for those at the end of their lives.

The committee’s report comes in response to some concerns that a change in the law would lead to poorer support at the end of life.

However, the evidence showed that changing the law in other countries was actually linked to improvement in palliative care, with evidence showing more investment went to healthcare institutions providing end-of-life care.

So what is assisted dying and where in the world is it allowed? Read on to find out.

What is assisted dying?

Assisted dying, also known as physician-assisted suicide (PAS), refers to a situation in which a person receives assistance, typically from a medical professional or someone else, in ending their own life. This assistance might involve providing the person with the means to end their life, such as prescribing or administering lethal medication.

The purpose of assisted dying is to allow individuals who are suffering from a terminal illness or experiencing unbearable pain to have some control over the timing and manner of their death.

Assisted dying is a controversial and ethically complex issue that involves considerations of individual autonomy, quality of life, medical ethics, religious beliefs, and societal values. Different countries and regions have varying laws and regulations regarding assisted dying, ranging from complete prohibition to legalisation under certain conditions.

It's essential to note that the terms "assisted dying," "physician-assisted suicide," and "euthanasia" are sometimes used interchangeably, but they can have distinct legal and ethical implications. In some places, assisted dying may be legal only under specific circumstances and with various safeguards in place to protect against abuse and ensure the voluntary nature of the decision.

Is assisted dying legal in the UK?

Assisted dying is illegal in the UK. Both euthanasia (the act of intentionally causing someone's death to relieve suffering) and assisted suicide (assisting someone in ending their own life) are criminal offences.

The Suicide Act 1961 specifically criminalises assisting or encouraging suicide in England and Wales. In Scotland, assisting suicide is also illegal under common law. Attempts to change the law to allow assisted dying or assisted suicide have been the subject of debate and discussion in the UK, with various proposals and campaigns advocating legislative changes.

Assisted suicide is punishable by up to 14 years' imprisonment in the UK.

Where is assisted dying legal?

Worldwide, assisted dying is allowed in:

  • Switzerland

  • The Netherlands

  • Belgium

  • Luxembourg

  • Canada

  • New Zealand

  • Australia

  • Washington, USA

  • Oregon, USA

  • California, USA

What is euthanasia?

The NHS defines euthanasia as the act of deliberately ending a person’s life to relieve suffering. It says, for example, that it could be considered euthanasia if a doctor deliberately gave a patient with a terminal illness a drug they do not otherwise need, such as an overdose of sedatives or muscle relaxants, with the sole aim of ending their life.

Euthanasia and assisted dying are related concepts but not the same. Euthanasia can take several different forms:

Active vs. passive

Purposely giving someone a lethal dose of a sedative, often administered by a doctor, is considered active euthanasia.

Passive euthanasia is sometimes described as withholding or limiting life-sustaining treatments so that a person passes more quickly. A doctor may also prescribe increasingly high doses of painkilling medication. Over time, the doses may become toxic.

Palliative care focuses on keeping people as comfortable as possible at the end of their life. For example, a palliative-care doctor might allow someone approaching death to stop taking a medication that causes unpleasant side effects or take a higher dose of medication to treat their pain.

Voluntary vs. non-voluntary

Voluntary euthanasia is described as someone making a conscious decision to seek help with ending their life. But the person must give their full consent and show that they fully understand what is about to happen.

Non-voluntary euthanasia involves someone else deciding to end someone’s life, often a close family member. This is generally done when someone is completely unconscious or permanently incapacitated. It often involves passive euthanasia, such as withdrawing life support from someone who is showing no signs of brain activity.

Self-administered euthanasia

This is when the patient administers the means of death.

Other-administered euthanasia

Someone other than the patient administers the means of death.

Assisted suicide

Assisted suicide is not euthanasia. But like it, it is the other form of assisted dying.

Assisted suicide is the act of deliberately assisting another person to end their life. If a relative of a person with a terminal illness obtained strong sedatives, knowing the person intended to use them to kill themselves, the relative may be considered to be assisting suicide.It is also sometimes referred to as physician-assisted suicide (PAS), which means a doctor knowingly helps someone to end their life. This person may be experiencing pain and suffering or may have received a terminally ill diagnosis. Their doctor should use the most effective, painless method.

Where is euthanasia legal?

In the UK, euthanasia is illegal and can be treated as murder or manslaughter.

“Assisting or encouraging” another person’s suicide is illegal in England, Wales, and Northern Ireland. There is no specific offence for assisting or encouraging suicide in Scotland.

Worldwide, euthanasia is allowed in the following places:

  • Belgium

  • Canada

  • Colombia

  • Luxembourg

  • The Netherlands

  • New Zealand

  • Spain

  • Several states of Australia (New South Wales, Queensland, South Australia, Tasmania, Victoria and Western Australia)

Why is assisted dying so controversial?

The issue of assisted dying is a divisive one, with some people believing humans have a right to decide how we want to die. In cases of terminal illness or chronic pain, assisted dying is seen as a form of mercy or palliative care by many.

However, on the other side of the argument, others fear that assisted dying may result in pressure from family members or loved ones, with elderly or ill people choosing it when they don't really want it, or even having it decided on their behalf, in the case where a relative has power of attorney. This means a relative makes all decisions for you, on your behalf. Some question whether ulterior motives – for example, financial – would influence the decision to end life.

There is also the worry that assisted dying could put too much power in the hands of doctors, who could also be influenced by politicians, without the necessary protection for patients and their families. Another fear is that it could lead to worse end-of-life care, something the cross-party report sought to investigate.