CRITIQUE OF GUIDELINES FOR PROSECUTORS IN ENGLAND AND WALES
CONCERNING WHETHER OR NOT TO PROSECUTE
A POSSIBLE CASE OF 'ASSISTED SUICIDE'.
The following 22 guidelines were copied from
the website of the Crown Prosecution Service: http://www.cps.gov.uk/publications/prosecution/assisted_suicide_policy.html.
They first appeared as an interim policy in September 2009.
Then they were re-published in a slightly-revised form in February
2010.
These guidelines were published with the following title
by the Director of Public Prosecutions for England and Wales:
Policy for Prosecutors in Respect of Cases
of Encouraging or Assisting Suicide
The guidelines appear below in red
or green.
The text of each guideline appears in these distinctive colors.
The comments and critique appear in black.
These comments were created in October 2009
by James Park, advocate of the right-to-die with careful safeguards.
And they were slightly amended in March 2010.
The new comments for 2010 are in a different
color---violet,
where slight changes in the guidelines led to a different comment or
critique.
Additional comments were added in December 2013.
These appear in blue.
The policy was
slightly undated in October 2014.
The main change of emphasis asks if there is any public benefit
from prosecuting a specific case of 'assisting or encouraging suicide'.
Also included for the first time is encouraging suicide
by means of a public website.
Even if no one dies,
the crime of encouraging suicide might still have been committed.
16 FACTORS FAVORING PROSECUTION FOR ASSISTED SUICIDE
(1) The victim was under 18 years
of age. 1. This guideline remains
exactly the same as the original guideline number 1.
When end-of-life care is being considered,
the age of the patient is not a relevant consideration.
Rather, the physical condition of the patient should be presented to
the prosecutor
to show that help in dying is a wise course of action.
For example, children and teen-agers can also be
terminally ill.
Wise life-ending medical decisions should not be prohibited
merely because of the age of the patient.
When the patient is a minor, then all medical
decisions
must be made by the patient's parents or other legal guardians.
These would include all medical decisions that will lead to the death
of the child.
For example, the parents can decided to remove life-support systems
from a child who is permanently unconscious.
(2) The victim's capacity to reach
an informed decision was adversely affected by a recognised mental
illness or learning difficulty.
revised formulation:
2. the victim did not have the
capacity (as defined by the Mental Capacity
Act 2005) to reach an informed decision to
commit suicide; Whenever the
patient has limited capacity to make medical decisions,
those decisions must be made by duly authorized proxies for the patient.
And such decisions would include all choices that would bring the
patient's life to an end.
The decision-making capacity of the patient
does not limit the medical options that can be considered.
It merely determines that other fully-capable persons must make the
medical decisions.
(3) The victim did not have a
clear, settled & informed wish to commit suicide; for example, the victim's
history suggests that his or her wish to commit suicide was temporary or
subject to change.
revised
formulation:
3. the victim had not reached a
voluntary, clear, settled and informed decision to
commit suicide;
The patient has carefully considered all of the
options,
including the possibility of choosing a voluntary
death.
The patient is able to explain in his or her own terms
why dying now is
better than dying later.
If the patient has a history of attempting to commit
irrational suicide,
then special care must be exercised to make sure
that any requests
for death are firmly based in reality.
(4) The victim did not indicate
unequivocally to the suspect that he or she wished to commit suicide.
revised
formulation:
4. the victim had not clearly and
unequivocally communicated his or her decision to commit
suicide to the suspect;
This question seeks to discover the true wishes of
the patient.
Does the patient have well-grounded reasons for choosing a voluntary
death?
Even the
revised formulation does not suggest how this guideline would be applied to a situation in which someone
did help another to commit an irrational suicide. It should not be a question of
the clarify of the communication. Rather, was this decision to
die a wise choice?
(5) The victim did not ask
personally on his or her own initiative for the assistance of the suspect.
revised
formulation:
5. the victim did not seek the
encouragement or assistance of the suspect personally or on
his or her own initiative;
Sometimes other people want the death of the patient
more than the patient himself or herself.
This is the basic reason for attempting to discover
the true, well-informed
consent of the patient.
(6) The victim did not have:
- a terminal illness; or - a severe & incurable
physical disability; or - a severe degenerative physical
condition;
from which there was no
possibility of recovery.
This original number 6 dropped
entirely in the February 2010 reformulation.
Does the patient have a terminal illness or
condition?
Does the patient have an incurable physical disability
that is so severe as to justify voluntary death?
Does the patient have a physical condition that will become
progressively worse?
If the objective condition of the patient is serious
enough
to justify voluntary death or merciful
death,
then that choice is not discouraged by public policy.
The fact
that all mention of the patient's illness or condition was eliminated in 2010 might be
significant.
It originally appeared in both parts of the guidelines
(factors in favor of prosecution and factors against).
The fact that the patient was already close to death
would be very relevant for all wise medical decisions at the end of
life.
And such terminal-care decisions should never be confused
with the harmful actions of encouraging or assisting an irrational
suicide.
Does dropping this guideline mean that the prosecutor
is moving closer to embracing the view
that wise end-of-life medical decisions are so far from irrational
suicide
that nothing related to end-of-life
medical care
should be mentioned in these guidelines
about assisting or
encouraging an irrational suicide?
The most
dramatic further revision of these guidelines
would be to restore explicit
mention of the patient's medical condition.
If the patient is actively
dying,
has only a few weeks of suffering left in his or her life,
then making a wise end-of-life medical decision to shorten the process
of dying
should never be considered 'assisting or encouraging' suicide.
In actual medical practice everywhere in the United Kingdom,
life-ending decisions are being made by and for terminally-ill
patients.
Common sense would never consider ending life-supports for a hopeless
patient
to be an 'irrational suicide' by any stretch of the imagination.
Even the restoration of the exact language of the
guideline from 2009 above
would dramatically change (back) the meaning of these safeguards. Then the local prosecutors
would be explicitly authorized to take the medical condition
of the patient into account:
Does the patient have a terminal
illness?
Does the patient have a severe
and incurable physical disability?
Does the patient have a severe
degenerative physical condition?
Is it clear that there is no
possibility of recovery from this illness or condition?
These were all very reasonable considerations
in the original formulation of the guidelines.
Were the reasons for dropping these factors ever explained?
(A side-note on language:
When we are considering life-ending decisions
for a terminally-lll medical patients in a hospital,
this person should never be called a "victim of assisted suicide".
Has the 1961 law against
assisting a suicide
ever been applied to making
medical decisions at the end of life?)
(7) The suspect was not wholly
motivated by compassion;
for example, the suspect
was motivated by the
prospect
that they or a person closely
connected to them
stood to gain in
some way from the death of the victim.
revised
formulation:
6. the suspect was not wholly
motivated by compassion; for example, the suspect was
motivated by the prospect that he or she or a person closely
connected to him or her stood to gain in some way from the
death of the victim;
This guideline is one of the most problematic,
since people who are motivated by compassion for the patient who is
suffering
might also be close relatives who stand to gain financially and
emotionally
as a result of the death of the patient and the end of the patient's
suffering.
Helping other people to die should not be limited
only to strangers.
In most cases, the persons selected to be proxies for the patient
are close relatives.
And close relatives are often heirs of the patient.
This guideline would prevent them from fulfilling the role of proxy
once the medical situation degenerates to the point
where life-ending decisions should be considered.
Whenever there might be a mixture of motives in the
minds of the proxies,
the other safeguards become more important.
Press
reports of these guidelines have frequently focused on this guideline
#7.
It is not difficult for ordinary people
to recognize the difference between compassion and greed.
When the life-ending decision is made basically for the purpose
of saving the patient from further meaningless suffering,
then the local prosecutor should not charge anyone with 'assisting a
suicide'.
However, if there is evidence of relatives rushing someone into death
for their own financial gain, this might be worth investigating as a
crime.
(8) The suspect persuaded,
pressured or maliciously encouraged the victim to commit suicide, or exercised
improper influence in the victim's decision to do so; & did not take
reasonable steps to ensure that any other person did not do so.
revised
formulation:
7. the suspect pressured the
victim to commit suicide;
8. the suspect did not take reasonable steps to ensure
that any other person had not pressured the victim to commit suicide;
Someone who encourages others to commit irrational
suicide
will be subject to prosecution for that crime.
But relatives and doctors who participate in
end-of-life medical decisions
should not be treated as criminals.
new
guideline number 9:
9. the suspect had a history of
violence or abuse against the victim;
This is a
wise addition to the list of factors
favoring prosecution. If the person who encouraged or
assisted in an irrational suicide had a prior history of harming
the person who is now dead, then deep suspicions should be
raised about the wisdom of the death. Was the encouragement and/or
assistance in dying just an extension of the earlier
violence or abuse of the person now dead?
(9) The victim was physically able
to undertake the act that constituted the assistance him or herself.
10. exactly the same as the
original guideline number 9.
When the patient is physically able to do the acts
that will bring about a voluntary death,
then this fact is further evidence that it was a free choice.
When no assistance is needed,
then others who agree with the choice of a voluntary death
should limit their assistance to emotional support and presence.
(10) The suspect was not the
spouse, partner or a close relative or a close personal friend of the victim.
This guideline was dropped
entirely in the February 2010 formulation.
This guideline attempts to keep strangers out of the
loop.
But it is in direct conflict with guideline 7 above,
which says that close relatives should not participate
if they might have something to gain from the death of the patient.
If both strangers and heirs are discourage from helping patients to die,
then which other persons would be the ideal helpers?
Because of
the problem pointed out above, it was probably wise that this
guideline was dropped in February 2010.
(11) The suspect was unknown to
the victim
& assisted by providing
specific information via,
for example, a
website or publication, to the victim to assist him or her in committing
suicide.
revised
formulation:
11. the suspect was unknown to the victim
and encouraged or assisted the victim
to commit or attempt to commit suicide
by providing specific information via,
for example, a website or publication.
Aiding death from a distance is discouraged by this
guideline.
Encouraging unknown strangers to kill themselves
would necessarily be of a general nature,
not directed to any specific patient.
The patient and/or the proxies for the patient
would probably be taking advantage of any such information
about how to end the life of the patient.
Attempting to control information about how to die
is futile.
Such information has been known to the human race for thousands of
years.
Should libraries be purged of books that contain such information?
Information now easily crosses national borders.
Should we attempt to prosecute the people who create information?
What if the author of misused information is now dead?
Should medical schools be prohibited from studying the causes of death?
(12) The suspect gave assistance
to more than one victim who were not
known to each other.
revised
formulation:
12. the suspect gave encouragement or assistance
to more than one victim who were not known to each other;
This guideline attempt to prevent the development of
'suicide clinics'.
But this is an attempt to create new law
under the guise of enforcing existing law.
If such a new law were created,
it should be drafted in such a way that it does not restrict
the operation of medical institutions,
which now routinely deal with terminal care,
which usually includes the option of life-ending decisions.
(13) The suspect was paid by the
victim or those close to the victim
for their assistance.
revised
formulation:
13. the suspect was paid by the
victim of those close to the victim for his or her encouragement or
assistance;
This guideline is another attempt to legislate under
the guise of enforcing existing law.
The concern is (once again) that 'suicide clinics' will be established,
for which payment of some sort would likely be a feature.
Doctors and nurses who disconnect life-support
systems
are normally paid for such medical services
as a part of their regular salaries or fees-for-services.
Other safeguards besides the payment of money
must be used to control the behavior that is not wanted.
Wise end-of-life decisions will be separated from
foolish irrational suicide not by the payment of money
but by safeguards
that discourage premature death.
(14) The suspect was paid to care
for the victim
in a care/nursing home
environment.
revised
formulation:
14. the suspect was acting in his
or her capacity as a medical doctor, nurse, other
healthcare professional, a professional carer [whether for
payment or not], or as a person in authority, such
as a prison officer, and the victim was in his or her
care.
This guideline means that the very people
who are employed to provide end-of-life care
are not permitted to participate in any life-ending decisions.
If not people paid to provide terminal care,
then who should
disconnect the life-supports
when it has become clear that life-supports are no longer helpful?
This guideline is designed to control the behavior
of 'free-lance
angels of death'.
But we already have laws that prohibit killing other people.
When proper safeguards to prevent premature death are fulfilled,
exactly who takes the final actions is not relevant.
The revised
formulation in 2010 seems only to make more clear that everyone routinely
involved in the care of the patient must not use that position or
access as an avenue for committing a
mercy-killing or otherwise encouraging or
assisting an irrational suicide.
People involved in terminal care should never cause a premature death.
(15) The suspect was aware that
the victim intended to commit suicide
in a public place where it was
reasonable to think that members of the
public may be present.
exactly the same as the
original number 15.
Perhaps this guideline was drafted to combat
suicide-bombers.
Who else commits irrational suicide in a public place?
Wise end-of-life medical decisions always take place in private.
If terrorism is the concern,
then prosecution for aid-in-dying is probably not the best place to
address it.
New laws might be needed concerning encouraging people
to kill themselves and as many by-standers as possible.
(16) The suspect was a member
of an organisation or group,
the principal purpose of which
is to provide
a physical environment
[whether for
payment or not] in which to allow
another to commit suicide.
revised
formulation: 16. the suspect was acting in his
or her capacity as a person involved in the
management or as an employee (whether for payment or not) or an organization or group, a
purpose of which is to provide a physical
environment (whether for payment or not) in which to allow another to
commit suicide.
This guideline is an even more explicit attempt to
prohibit 'suicide clinics'.
People who establish pleasant places to die a peaceful and painless
death
would be criminalized by this guideline.
Perhaps some society will prohibit such places and practices,
but they should do so with explicit laws
rather than administrative guidelines.
It seems more likely that enlightened societies will
use some system of careful and compassionate safeguards
so that all end-of-life decisions are made in the best interest of the
patients.
13
FACTORS
AGAINST PROSECUTION FOR ASSISTED SUICIDE REDUCED IN NUMBER TO 6
GUIDELINES IN 2010
(1) The victim had a clear,
settled & informed wish to commit
suicide.
revised
formulation:
1. the victim had reached a voluntary, clear, settled and informed
decision to commit suicide;
The patient had fulfilled several other
safeguards
in the death-planning process.
(2) The victim indicated
unequivocally to the suspect that he or she
wished to commit suicide.
This guideline was dropped in
2010.
The patient was clear about the desire to end his or
her suffering.
But this
guideline was really a repeat of red
3 and 4, which remain above.
(3) The victim asked personally on
his or her own initiative for the assistance of the suspect.
This
guideline was dropped in 2010.
The patient has considered all of the options
and has decided for death now
rather than death later.
And the patient wants help in the process of dying.
But this
guideline was really a repeat of red
5, which remains
above.
(4) The victim had:
- a terminal illness; or - a severe & incurable
physical disability; or - a severe degenerative physical
condition;
from which there was no
possibility of recovery.
This guideline was dropped in 2010.
This is the same as factor 6 in favor of prosecution
for assisting a suicide.
See new
comment in red factor 6
(original numbering) concerning why the medical
condition of the dead person was removed from consideration.
(5) The suspect was wholly
motivated by compassion.
This guideline remains exactly
the same, except that is is re-numbered 2.
See factor 7
above. New numbering system: 6.
(6) The suspect was the spouse,
partner or a close relative or a close personal friend of the victim,
within the context of a long-term & supportive relationship.
This guideline was dropped in 2010.
See factor 10
above.
There is no need to formulate the same guidelines in both positive and
negative forms.
(7) The actions of the suspect,
although sufficient to come within the definition of the offence,
were of
only minor assistance or influence,
or the assistance which the
suspect
provided
was as a consequence of his
or her usual lawful
employment.
revised
formulation:
3. the actions of the suspect,
although sufficient to come within the definition of the offense,
were only minor encouragement or assistance;
Providing minor support and encouragement for
voluntary death
will not be prosecuted.
And if a health-care worker provides support and
encouragement,
then the behavior will not be punished.
These do not seem to be meaningful guidelines.
It would be better to decide whether
or not death at this time is a
wise decision.
(8) The victim was physically
unable to undertake the act that
constituted the assistance him or herself.
This
guideline was dropped in 2010.
This is the same as guideline 9 in the factors
favoring prosecution. In the positive formulation it
remains a guideline.
(9) The suspect had sought to
dissuade the victim from taking the
course of action which resulted in his or
her suicide.
This guideline remains exactly
the same, with the new number 4.
Whenever the life-ending action would result in an
irrational suicide,
then all reasonable persons will discourage such action.
But when all further medical treatment is futile,
then the wise and compassionate thing to do
is to aid the patient in choosing the best possible means and timing of
death.
This guideline gives no help in separating good terminal medical care
from helping troubled people
to kill themselves prematurely.
(10) The victim has considered
& pursued to a reasonable extent
recognised treatment & care options.
This
guideline was dropped in 2010.
This is only the second guideline which refers to
the medical context of some life-ending decisions.
(The first refers to the possible terminal illness or condition of the
patient red 6 and green 4.)
When medical treatment no longer benefits the patient,
then it is appropriate to consider life-ending medical decisions.
This is the first guideline to refer to the possibility of making wise
end-of-life decisions,
which, of course, will not be prosecuted as assisting a suicide.
This carries
forward the decision of the Director of Public Prosecutions to remove all reference to the
medical condition of the person who is now dead. Wise end-of-life medical
decisions probably should not even be mentioned in guidelines concerning
encouraging or assisting an irrational suicide. Such situations are worlds
apart. And the police and prosecutor
should never visit the bedside of a dying patient or ever attempt to apply the
law against assisting a suicide to any terminal-care decisions.
(11) The victim had previously
attempted to commit suicide & was
likely to try to do so again.
This
guideline was dropped in 2010.
This guideline says that anyone who helps with an
irrational suicide
might not be as responsible for such a choice or act
if the suicidal person had a history of suicide attempts.
This does not seem to be a wise guideline.
Especially when the suicidal person has a history of attempting to kill
himself or herself,
all others who know about this history
should make special efforts to avoid irrational suicide.
What is the point of saying that they will not be prosecuted?
(12) The actions of the suspect
may be characterised as reluctant
assistance in the face of a determined wish
on the part of the victim to commit suicide.
revised
formulation and numbering:
5. the actions of the suspect may be characterised as reluctant
encouragement or assistance
in the face of a determined wish on the part of the victim to commit
suicide.
"Reluctant assistance" is far too vague for any
criminal prosecution.
How would the person who assisted a suicide prove that such assistance
was reluctant?
People who want to prevent irrational suicide
should call upon all forms of help to discourage people from harming
themselves.
They should not 'reluctantly' help with any foolish action.
(13) The suspect fully assisted
the police in their enquiries
into the circumstances of
the suicide
or the attempt & his or her part in
providing assistance.
revised
formulation and numbering:
6. the suspect reported the victim's
suicide to the police
and fully assisted them in their enquiries
into the circumstances of the suicide
or the attempt on his or her part to provide encouragement or
assistance.
When someone has helped in a wise end-of-life
medical decision,
there is no need for any police investigation.
But if reasonable people can raise any doubts about the circumstances
of any death,
then the police and the prosecutor might become involved.
The person who has assisted in a voluntary death or a merciful death
should have nothing to fear from the police or the prosecutor.
The fulfilled safeguards will show that this life-ending decision
was for the benefit of the patient.
It was not a harm or a crime in any sense.
However, anyone who has assisted an irrational
suicide
has many things to conceal and hide from the police and the public
prosecutor.
Once public safeguards for life-ending decisions are well known to
everyone,
then aid-in-dying will come out of the shadows.
One of the least hidden safeguards calls for a report
to the
prosecutor before the death takes place.
This will require the public prosecutor to be prepared
to deal with end-of-life medical decisions.
GENERAL RESPONSE TO THESE GUIDELINES
FOR AND AGAINST PROSECUTION FOR ASSISTING A SUICIDE
What is mainly missing from these guidelines
is a clear and simple answer to this question:
What must I do when assisting a patient or a loved one to die
to ensure that I will not be prosecuted for 'assisting a suicide'?
The only explicit things I might do are:
Get an official medical certification of terminal illness or other
hopeless condition.
(red 6 or green 4)
Both of these were removed in
2010.
Show by medical records that the patient has pursued all reasonable
methods of medical cure.
(green 10)
This guideline also disappeared
in 2010. All reference to the medical
condition of the patient are now gone.
Thus, the fact that the patient was already dying is no longer considered
as a factor in defense of any action.
Nevertheless, the very existence of these guidelines
is a liberating leap
in the direction of ensuring the right-to-die.
Clearly the laws of most jurisdictions need to be
changed substantially
so as to recognize the difference between foolish irrational suicide
and wise end-of-life medical
decisions.
We all know that these are opposite poles of the spectrum of choices
for death.
But voluntary
death and merciful
death should be explicitly recognized in new laws.
Other prosecuting authorities have only very
informally recognized
that sometimes relatives should not be prosecuted
when they help their hopelessly-ill loved ones to end their suffering.
When pressed by opponents of the right-to-die,
they would not be able to defend their reluctance to prosecute.
Therefore I suggest a set of safeguards
intended to separate clearly and sharply
the foolish choice of irrational
suicide
(harmful, irrational, capricious, regrettable)
from the wise medical choice of voluntary death
(helpful, reasonable, well-planned, admirable).
These differences are set forth in explicit detail in the following
essay:
Will this Death be an "Irrational Suicide" or a "Voluntary Death"? https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-IS-VD.html
Exactly the same safeguards provide the operational
methods
for separating clearly and sharply
the foolish choice of mercy-killing (harmful,
irrational, capricious, regrettable)
from the wise medical choice of merciful death (helpful,
reasonable, well-planned, admirable).
These differences are set forth in explicit detail in the following
essay:
Will this Death be a "Mercy-Killing" or a "Merciful Death"? https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-MK-MD.html
And here are the 26 recommended safeguards
which specify the behavior to undertake
(and the documents to create proving this behavior)
that will discourage premature death
while at the same time allow wise end-of-life medical choices.
These safeguards say "NO" to irrational suicide and
mercy-killing.
The same safeguards say "YES" to voluntary death and merciful death. https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-26PROS.html
Prosecutors anywhere on Earth
are welcome to adapt these safeguards to their own situations.
And legislators in all jurisdictions are welcome to include any of
these safeguards
in new laws with regard to the right-to-die.
Here is one attempt to draft a
law against causing premature death,
which could replace the present laws against assisting an irrational
suicide: https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/PREM-DTH.html This
draft
legislation includes the 26 recommended safeguards
to distinguish irrational
suicide from voluntary
death
and to distinguish mercy-killing
from merciful death.
If prosecutors anywhere else in the world
would like to adapt these guidelines to their own culture,
they might do a better job of separating these two very different
situations:
1. Helping another person to
commit irrational suicide.
2. Helping another person to
make wise end-of-life medical decisions.
Nothing in new guidelines for prosecutors should limit wise choices
in the practice of medical care at the end of life.
Only in the most extreme and extraordinary situations
should terminal-care physicians be suspected of assisting an irrational
suicide.
Created
October 15, 2009; Revised 10-17-2009; 3-2-2010; 12-17-2010; 2-10-2011;
2-16-2011;
12-19-2013; 4-7-2015; 2-15-2019;
A detailed replacement for the guidelines criticized
above will be found here: PROSECUTORS
CAN ANNOUNCE THEIR GUIDELINES https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-A-PROS.html This
alternative presents 26 practical, realistic, & meaningful
safeguards,
which can help prosecutors anywhere on the planet Earth
to separate irrational suicides (90% or more of self-killings)
from wise end-of-life medical decisions,
here called "voluntary deaths" or "merciful deaths".
MORE DISCUSSION OF
IMPROVING OR REPLACING THESE GUIDELINES FOR AND AGAINST PROSECUTION
FOR
'ASSISTING SUICIDE' IN ENGLAND AND WALES
Only
Parliament can completely replace the 1961 law against 'assisting
suicide'. But as seen above, the Director
of Public Prosecutions can issue (and revise) guidelines to be used by local
prosecutors when deciding whether or not to charge family members (or
others) when someone might have committed suicide.
All local
prosecutors now have in their files copies of the 22 guidelines quoted
above. But probably not even the
Director of Public Prosecutions himself or herself can name all 22 guidelines from
memory. Which journalists will be the
first to embarrass a public prosecutor by asking how many of the
guidelines he or she can name from memory?
The mass
media have widely reported that these guidelines do exist. But I suspect that no media
story has listed all 22 guidelines. Most commonly, it is reported
that when relatives assist someone to die for compassionate reasons,
there will be no prosecution. And if the relatives are motivated by greed, they
might be charge with 'assisting suicide'. But so far, since the
guidelines were first put forth in 2009, there have been few prosecutions for
'assisting suicide' in England or Wales.
No matter what guidelines are put into writing,
most local prosecutors will continue to operate according to their own
rules of thumb.
When I asked my local prosecutor many years ago about the right-to-die,
he first said that deaths that take place in the hospital will not be
investigated.
This seems likely to be a good rule of thumb for public prosecutors:
Unless there is evidence to the contrary,
we can assume that almost
all deaths under modern medical care are not suspicious.
Prosecutors are lawyers, not doctors,
so they have no expertise for examining medical decisions
made by the appropriate professionals—namely the physicians.
Because about half of hospital deaths include a meaningful
element of choice,
public prosecutors just have no way to review all of these deaths.
Prosecutors are trained to detect and try murderers
not doctors and the families
they serve.
In England at least one doctor was convicted of murdering his patients.
But this is extremely rare everywhere modern medicine is practiced.
Luckily, murder is rare in the United Kingdom.
But 'assisting suicide' seems to be much more rare.
Does there even need to be a law against it?
Because English law seems to change by baby steps
rather than by sweeping innovation in thinking,
I suspect that the next small changes will take the form
of revisions to the guidelines discussed above.
As already suggested (in comments on Guideline 6),
the medical condition of the 'victim' should be restored to these
guidelines.
The Director of Public Prosecutions could simplify
the guidelines
by saying that no practice
of standard terminal medical care
should be charged as 'assisting suicide'.
This would be based on the history of the 1961 law.
When it was passed, was there any suspicion that medical practice
might help patients to kill themselves for foolish 'reasons'?
All patients eventually do die.
And life-ending medical decisions often come just before they die.
These are wise, careful decisions, based on the medical facts of each
case.
None of the following form of life-ending decisions
has been called 'committing suicide' or 'assisting suicide':
1. Comfort-care-only
or increasing
pain-medication.
Many patients receive pain-medication as they approach death.
It is entirely appropriate to increase the pain-killers
to the point where the pain is adequately controlled —as perceived by the patient.
Even when the patient has requested (or demanded) more pain-relief,
this is never recorded as a form of 'suicide',
even when the increased medication to control pain
does also shorten the process of dying.
Comfort-Care
Only:Easing
the
Passage into Death
2. Induced
terminal coma is the practice of keeping the patient unconscious
until natural death comes.
This also is not 'suicide', even if authorized by the suffering patient.
He or she decides that it would be better to be asleep all the time
rather than to suffering another moment of the torment associated with
being awake.
Induced
Terminal
Coma: Dying in Your Sleep—Guaranteed 3. Ending
curative treatments and discontinuing life-supports.
When a patient is taken off a breathing machine,
the death is recorded as having been caused by the underlying disease,
not the fact of 'pulling the plug'.
Pulling
the Plug: A Paradigm for Life-Ending Decisions.
4. Voluntary
death by dehydration is also a valid choice at the end of life.
Patients have the right to give up eating and drinking.
Often this is combined with the other methods of dying already
mentioned.
For example, when terminal sedation (terminal coma) is begun,
it is usually accompanied by giving up all food and water,
in whatever ways they might have been provided up to that time.
The process of dying will be shortened for the unconscious patient
if no artificial food or fluids are provided.
Voluntary
Death by Dehydration: Safeguards to Make Sure is a Wise Choice
All of these legal and ethical methods of choosing
death
are discussed in much greater detail in the following chapter:
"Four Medical Methods of Managing Dying": https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-L-END.html
Probably no one has even been considered for
prosecution
for having followed any of these pathways towards death.
But the legal situation will be made even more clear
if the Director of Public Prosecutions declares in the next version of
the guidelines
that local prosecutors should not consider charging
anyone when such end-of-life medical choices have been made.
And eventually the Parliament might replace the
Suicide Act of 1961
with a more comprehensive and explicit law against causing premature
death: https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/PREM-DTH.html Such a law
would tell everyone exactly what safeguards
would protect them against the charge of causing a premature death.
Since you
have read this far in a lengthy on-line document, you show deep interest in good
safeguards or guidelines for making end-of-life
decisions. Therefore you are an ideal
person to join a Facebook Seminar on Safeguards for Life-Ending
Decisions. Here is your invitation:
Would
you like to join a world-wide Facebook Seminar
See
the complete description for this seminar: https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/ED-HTD.html
The new
right-to-die
law in Quebec
endorses all of the existing methods of choosing death
and adds "medical aid in dying",
which means a physician prescribing gentle poison.