The Insidious Impact of Assisted Suicide

14 Sep 2015

Physician assisted suicide has been the subject of an historic vote in the United Kingdom. Professor David Albert Jones, director of the Anscombe Bioethics Centre in Oxford describes the significance of the vote and their contribution to the debate.

STI Experts

What in your view was the significance of the vote on “assisted dying” in the UK Parliament on 11 September 2015?

This vote was both significant and decisive. The House of Commons rejected the Assisted Dying No. 2 Bill by 330 votes to 118 with broad opposition across the political parties.

The bill would have applied to England and Wales, not to Scotland or Northern Ireland. However, it is impossible that such a law in England would not have an indirect impact on Scotland and Northern Ireland and both Scottish and Northern Irish MPs took part in the vote. The Scottish Parliament had in fact discussed a very similar bill earlier in the year, and had rejected it by a similar margin. On 27 May 2015 the Assisted Suicide (Scotland) Bill was defeated by 82 votes to 36. 

Similar bills have also been debated in the House of Lords over the last ten years, sometimes being voted down and sometimes running out of time. However, these are less significant because the upper chamber is not elected and, while it provides important scrutiny for bills, it does not have the democratic mandate of the House of Commons or of the Scottish Parliament. The vote on 11 September was thus an emphatic rejection by the UK Parliament of a change in the law on assisted suicide or euthanasia.

When did the House of Commons last consider this topic? Has a lot changed since then?

The last time the House of Commons voted on euthanasia or physician assisted suicide was in December 1997. At that time there were only two countries where these practices where legal and for which we had data: the Netherlands and Switzerland, and assisted suicide in Switzerland was confined to Swiss citizens. A change in the law in Oregon came into force in 1997 but there were no deaths under the Death with Dignity Act until 1998. Since 1997 the Oregon model of physician assisted suicide has been taken up by Washington and Vermont; the Netherlands model of euthanasia has been taken up by Belgium and Luxembourg; and Switzerland has begun to offer its services to non-Swiss citizens, creating the phenomenon of ‘suicide tourism’. 

Seemingly much has changed. Nevertheless, while euthanasia and assisted suicide have expanded, both in the number of countries and in the number of deaths, the circumstances and terms of the debate remain remarkably similar to those twenty years ago. It is still the case that the overwhelming majority of countries in the world have resisted or rejected calls to legalize euthanasia or assisted suicide. It is still the case that advocates portray assistance with suicide as a form of self-determination and as a means to relieve suffering. It is still the case that a change in the law is opposed by groups representing disabled people and by doctors, especially doctors in palliative care. The expansion of euthanasia and assisted suicide is presented by advocates as evidence that change is inevitable and that it represents progress. However, the number of countries remains tiny and, as the practice has expanded, it has expanded into increasingly controversial areas, euthanasia for children, euthanasia or assisted suicide on the basis of mental illness (including depression, anorexia and autism), euthanasia or assisted suicide for those ‘tired of life’.

It is not altogether surprising then that opinion in the House of Commons in 2015 has hardly changed since 1997. Then an assisted dying bill was rejected by 72% of MPs who voted, while in 2015 it was rejected by 74% of MPs who voted.

Why has the United Kingdom been so consistent in resisting euthanasia and assisted suicide?

The United Kingdom is no stranger to these debates as it was the first country in the world to found a national right-to-die association (the Voluntary Euthanasia Legalisation Society, founded in 1935, now renamed Dignity in Dying). Furthermore, religious influence is marginal in the United Kingdom (less than 10% attend church regularly) while the UK tends to be liberal in its legislation: it has a National Health Service free to all at the point of delivery; it has abolished the death penalty; it has permissive abortion legislation that effectively provides access to state-funded elective abortion up to 24 weeks; and it has recently legalized same-sex marriage. Why then has the UK resisted euthanasia and physician assisted suicide for the past 80 years? 

In my view, the main three reasons are: the UK has been a pioneer of hospice care, and palliative care physicians remain strongly opposed to physician assisted suicide; the UK has a well-developed disability rights movement (indeed London hosted the precursor of the Paralympic games back in 1948), which has been a major source of opposition; finally, the increasing cost of healthcare and a number of recent scandals relating to inadequate health or social care, especially of older and vulnerable people, have made people concerned that cost-pressures are already having an adverse effect on the delivery of care. In the context of such pressures it seems especially dangerous to legalize assisted suicide as a form of affordable healthcare. Thus while the United Kingdom has seen numerous attempts to legalise assisted suicide and euthanasia these have failed in the face of effective and organised opposition.

What part did the Anscombe Bioethics Centre play in the debates leading up to the recent votes?

The Centre took an active part both in the debate in Scotland and in England. We gave evidence to the Health and Sport Committee of the Scottish Parliament. As director, I was also invited to give oral evidence and was quoted a number of times in the report of that Committee, a report highly critical of the bill.

As a contribution to public discussion leading up to the vote in the House of Commons, the Anscombe Bioethics Centre produced a guide to the evidence on assisted suicide and euthanasia. It was made available online and has become our most visited page

In addition to the evidence guide, the Centre produced two briefing papers, in one I set out eight reasons against assisted suicide. A second briefing paper is by Professor John Finnis, Emeritus Professor of Law and Legal Philosophy at Oxford University and Biolchini Family Professor of Law, University of Notre Dame du Lac, Indiana. He discusses what the courts are saying about allowing assistance in suicide. Professor Finnis also generously made available online the author’s corrected proofs of his Casenote for the Law Quarterly Review on the key legal case Nicklinson v Director of Public Prosecutions. 

What does the evidence guide contain?

In the debate over assisted suicide both sides have appealed to opinion polls. The guide examines the best evidence for public opinion including qualitative research and evidence published in peer review journals. This shows that most polls have been designed to achieve statistics for media consumption rather than seeking to achieve a comprehensive understanding of public and health sector attitudes. Public opinion should be analysed carefully and should not be thought of as something fixed. People can and do change their minds when presented with evidence and with the best arguments on both sides. Public opinion is not so strongly in favour of assisted suicide as is sometimes supposed.

The guide aims to help people assess - and judge for themselves whether they are reassured or whether they are alarmed by - the experience of countries where euthanasia or assisted suicide are legal. The evidence from all these countries shows a steady increase in deaths by assisted suicide or euthanasia, a steady expansion to include patients with different conditions, and a steady decrease in the use of safeguards such as psychiatric assessment. 

In Oregon there is evidence that people are given lethal medication despite suffering from depression. In Belgium suffering from depression is a positive reason in favour of euthanasia. In Switzerland a study showed that in 23% of cases people died by assisted suicide less than a week after their first contact with the organisation EXIT and in 9% of cases the assisted suicide occurred on the same day that they made contact! In the Netherlands the latest figures show that euthanasia for multiple geriatric syndromes increased 46% in one year, euthanasia for dementia increased 130%, and euthanasia for mental disorders increased 200%. 

The Netherlands has twice been criticised by the United Nations Human Rights Committee for its practice of euthanasia and assisted suicide. The guide gives links to both Human Rights Committee reports. 

The debate over assisted suicide frequently generates more heat than light, and arguments are often based on anecdotes or appeal to emotion rather than evidence. When people do appeal to evidence, they often do so selectively or in broad terms, and it is not always easy to check their sources. The aim of this guide is to provide easy access to the official data from the Netherlands, Belgium, Luxembourg, Switzerland, and the states of Oregon and Washington, as well as links to the UK parliamentary reports and to empirical research published in journals. 

While this evidence guide has been written to inform the debate in the United Kingdom, most of the sources cited are also relevant to the debates on assisted suicide or euthanasia in other counties. You can skim to get a sense of the different issues at stake and where to find further information, especially the most reliable information that is freely available online. The guide aims to be useful for students, scholars and research assistants to officials or parliamentarians. 

More than this, it is offered to anyone who is concerned about the prospect of assisted suicide or euthanasia being legalized. In our view the evidence demonstrates that such laws have a profound, insidious impact on health and social care, and that such an impact is evident in each of the countries that have legalised the practice. However, the fundamental aim is not to provide ready-made conclusions but allow you to check the sources of the various claims people are making in the debate, and to judge the evidence for yourself.


Download "Assisted Suicide and Euthanasia: A Guide to the Evidence" by The Anscombe Bioethics Center 
Download Prof. David Albert Jones' 8 reasons against assisted suicide
Download "Allowing Assistance in Suicide: What are the Courts Saying?" by Prof. John Finnis
Download Prof. John Finnis' corrected proofs of his Casenote "A British “Convention Rrigh” to Assistance in Suicide?"
Visit Prof. David Albert Jones' expert profile