Last Thursday the High Court ruled against Tony Nicklinson, asserting that the attempt to end his life at a time of his choosing raised ethical, moral, religious and social issues too profound to be decided without their proper consideration by Parliament. The decision has caused much distress to Mr Nicklinson who describes his life as "pure torture” and a “living nightmare”. Another man with locked-in syndrome was also denied the right to have volunteers help him get to Switzerland where he would have been able to end his life.
Such high profile cases have kept the debate on assisted dying very much in the media spotlight. At the beginning of the year, the controversial Falconer Report published its recommendations to legalise assisted suicide in Britain. In Scotland, Margot Macdonald has also been campaigning in the Scottish Parliament to legalise euthanasia.
Public opinion appears to favour a change in legislation, but the medical profession in the UK, in the main, still opposes any such change, as was demonstrated at the annual British Medical Association Conference. Additionally, the Royal College of Physicians unequivocally stated their opposition to any attempt to legalise assisted dying in the UK. Whilst it might be argued that this is unsurprising given that doctors traditionally tend to view themselves as life-savers, perhaps their opposition to assisted dying stems from unique insight into the wider dangers a change in legislation might have on society.
Having the ability to make an informed decision on a fundamental issue such as life and death is crucial, if we consider the legacy to be left behind for future generations. Perhaps a good starting point is to clarify the jargon, as the terms assisted dying, euthanasia and assisted suicide seem to be used interchangeably by mainstream media. The term assisted suicide describes the participation of an individual (usually a healthcare professional) helping a patient end their life. However the onus is on the patient to perform the final act of killing, such as self administering a lethal injection. This differs from euthanasia in which the ‘assistant’ performs the final act which ends a patient’s life. Both actions come under the overarching term known as assisted dying. Whilst the focus of lobby groups has been to legalise assisted suicide in the UK, the case of Tony Nicklinson is one in which, if successful, would have gone one step further and legalised euthanasia.
An informed decision on this matter must be based primarily on assessing the issues dispassionately and at the societal level. Even though the cases of Mr Nicklinson and others are sobering, we must ask whether the existence of a handful of such cases justifies a change in law which will considerably impact wider British society.
It has been argued by leading medical ethics specialists that legalising assisted dying while adequately protecting vulnerable individuals would be hopelessly cumbersome. This point is well illustrated by the Falconer Report, which suggests that assisted suicide should only be made available to those who have 12 months to live. However, the problems are distinctly apparent when one considers how inaccurate doctors can be with their prognostic estimations.
Indeed, the issue of protecting vulnerable individuals such as children and the disabled should be carefully considered. There have been reports from Belgium and The Netherlands of euthanasia taking place without patients’ consent, and perhaps more worryingly, a number of these cases included infants. This further illustrates the difficulties in drafting legislation that allows for assisted dying while adequately protecting vulnerable individuals.
A worry in the legalisation of assisted dying is the slippery slope it may lead to. Although the case is currently being made for allowing assisted dying on the grounds of terminal illness, a change in legislation may open the door for assisted dying to extend from the terminally ill to other persons such as the chronically depressed university student or alcoholic.
The longer term implications of allowing assisted dying must also be considered before implementing a statute which would notably affect society. More specifically, how might a change in legislation affect our perception of death? If societal values change to the extent that assisted suicide is seen as a reasonable course of action, this might lead to the conclusion that all forms of suicide are rational actions in certain circumstances. Assisted suicide might come to be viewed as an extremely noble act, so much so that those who decide against assisted suicide may be viewed as cowardly, selfish, or perhaps an economic burden.
It is for these reasons that the decision taken by the High Court in the case of Tony Nicklinson must be commended, especially as it resisted the temptation to exceed its competency as an implementer of the law and not its architect. The judge rightly deferred the matter to the proper organ for such a profound and fundamental matter: Parliament. Given that the issue was debated in 2006 and again in 2009, another debate at present would be unproductive. Politicians as well as those from the legal and medical profession have all made an informed decision on this contentious issue taking a stance that ultimately reflects the best interests of British society.
 B Steinbock. The case for physician assisted suicide: not (yet) proven. J Med Ethics 2005; 31:235-241
 Physician-assisted deaths under the euthansia law in Belgium: a population-based survey’: Kenneth Chambaere et al, CMAJ June 15, 2010 • 182(9
 End-of-Life Practices in the Netherlands