In a new POSTnote briefing, co-author and Nuffield Foundation POST Fellow Devyani Gajjar examines the key ethical debates around assisted dying, stakeholder opinion and the role it plays in health services.
The term ‘assisted dying’ is used in this context to refer to the administration of lethal drugs by healthcare professionals to end the life of a patient at their voluntary request.
Assisted dying is illegal in the UK. Limited data indicates that the UK public have little understanding of the term ‘assisted dying’ but UK polls suggest that the majority of the public would support it in some form.
Legislation on eligibility and governance of assisted dying
There are at least 27 jurisdictions worldwide where some form of assisted dying is permitted, with most providing it as part of the healthcare system. Within most of these jurisdictions, assisted dying is limited to adults. In a few countries, such as Belgium and the Netherlands assisted dying is an option for children who have parental consent.
Access requirements vary a lot between jurisdictions. Some jurisdictions only allow access to assisted dying when a person is terminally ill. Others permit assisted dying in cases of ‘constant and unbearable’ suffering that cannot be relieved. In countries such as Belgium, the Netherlands and Canada (from 2023 onwards), mental as well as physical conditions are considered.
While official figures vary across different jurisdictions, there has been a general increase in the use of assisted dying. Research suggests, however, that in some jurisdictions, cases of assisted dying go underreported.
Key practical considerations
In practice, the ethical considerations around assisted dying are complex.
Perspectives differ on a range of ethical issues, including whether existing legislation should be extended to remove barriers or change access criteria. For people with mental health conditions, the focus is often on whether their suffering can be eased overtime, whether they have the capacity to make decision for themselves and if they could be vulnerable to coercion.
There is limited empirical data on assisted dying, which presents challenges when trying to examine its impact. Existing research suggests that assisted dying has no disproportionate effect on vulnerable groups, including older people and people with disabilities. However, studies have flagged potential abuse and the need for more detailed monitoring. Similarly, there is a lack of research on the wider social and cultural impact of assisted dying.
Questions have been raised about the potentially conflicting relationship between assisted dying and the principles healthcare professionals work to. Beyond ethics, evidence shows that experience with assisted dying can have varying impacts on staff, including emotional distress, strain on relationships with other doctors and an increased workload. Evidence also suggests that offering patients a ‘good death’ can help medical professionals feel more satisfied in their work and relieve their distress.
In Switzerland, where assisted dying is not provided within the healthcare system, research shows that doctors would like clearer institutional frameworks and greater collaboration with right-to-die societies.
There is an ongoing debate on whether assisted dying could be beneficial to palliative and end of life care. Evidence is mixed. The relationship between assisted dying and palliative care varies between jurisdictions. For example, evidence suggests that assisted dying legislation in Oregon facilitated more open conversation and consideration of end of life options, better palliative care and end of life training and the removal of barriers to accessing hospice care. However, other research suggests that hospice staff in Oregon felt unclear about their role and their professional boundaries.
Read the full briefing here.
Getting help
If you are affected by the themes of this briefing, you can call Samaritans on 116 123 (UK and ROI) or visit the Samaritans website to find details of the nearest branch.
Please refer to the Samaritans’ media reporting guidelines if you are reporting a suicide-related issue. Irresponsible reporting can have damaging consequences.
