Practice dilemma: discussing assisted suicide
One of my patients was diagnosed with progressive MS last year. In several recent consultations he has asked my views on assisted suicide. I am unsure how to handle the situation. What is the legal position?
First of all, it is important to recall that it is an offence in the UK for a person to encourage or assist the suicide or attempted suicide of another person and such offences are punishable by up to 14 years' imprisonment.
In 2009, Debbie Purdy (who also has MS) pursued legal proceedings to force the Director of Public Prosecutions to publish a policy clarifying when persons would be likely to face prosecution for encouraging or assisting a suicide and when they would not. This resulted in the "Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide". While nothing in that policy decriminalises encouraging or assisting suicide, or guarantees that someone will be immune from prosecution in certain circumstances, it does set out a long list of factors tending in favour of and against prosecution.
Of particular importance to you, one factor tending in favour of prosecution is if the suspect (the person who assisted the suicide) has acted in a professional capacity such as being a doctor, nurse or other healthcare professional.
In 2010 the GMC published its own guidance ‘Treatment and Care Towards the End of Life: Good Practice in Decision Making'. This makes clear that ‘decisions concerning treatment must start from a presumption in favour of prolonging life'. The GMC expects doctors to act within the law at all times and therefore, when patients raise the issue of assisted suicide, to explain that they cannot discuss it in case that discussion could be construed as them committing a criminal offence.
Such refusals are difficult to impart without leaving your patient feeling abandoned or compromising your obligation to act with compassion. Further helpful guidance is available from the NHS National End of Life Care Programme.
The GMC is currently working on guidance for its case examiners (who decide how fitness to practise complaints against doctors should be dealt with) to help them decide what action to take if a doctor is alleged to have assisted or encouraged a suicide. The guidance is expected by late 2012.
Being a doctor or other healthcare professional makes it especially likely that you will fact prosecution if you do encourage or assist a suicide. The GMC is clear that doctors must act within the law, whatever that says about suicide, and that any doctor convicted of a serious criminal offence is likely to be erased from the medical register.
Andrea James is head of healthcare regulatory at George Davies Solicitors LLP and a former in-house solicitor to the GMC