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First British research on assisted suicide announced

Alison Britton & Sheila McLean

Alison Britton, LLB, Dip LP, M.Phil, is a researcher in medical law at the Glasgow University, and the principal full-time researcher on the Physician Assisted Suicide Project made possible with a grant from VESS. International Bar Association Professor Sheila McLean is the Director of the Institute of Law & Ethics in Medicine at Glasgow.

As this article goes to press, it is impossible to describe the enormous interest that the project on physician assisted suicide has generated. We have been inundated with materials and positive support for our research. As well as making our task more interesting and rewarding, it also emphasises the fact that many people welcome a chance to debate the subject and be given the opportunity to express their views.

With just a couple of months until completion of our final report on the project, we thought it may be of interest to give an idea of the report's outline as well as some of our research to date.

Our initial task was to build a framework; a starting point upon which our subsequent research and writing could be based. Our general "structure" therefore, in the early months, was to raise awareness of the fact that this research was being undertaken. Through extensive letter writing, we made our contacts and sought opinions. We wrote to organisations, institutions, Royal Colleges, government departments and anyone who we thought could provide information relevant to the project.

Meanwhile, an extensive literature search was underway. Again, we were surprised at the amount of material available. The number of articles, notes, statutes and cases we have is in the thousands.

As to the report itself, it has been divided into ten chapters. In the next few paragraphs, we have provided quite a bit of detail as to what is covered in the chapters. Hopefully, you will find it thought provoking or at least, interesting.We have begun by tracing the history of, and the rationales for, the prohibition of suicide itself and bringing it up-to-date.

With this in place, the second chapter will explore the tradition of medical ethics, which at first sight seems to prohibit clinical involvement in suicide or providing assistance. The argument will be that the principles of Hippocrates have stood the test of time only in part, and that over the centuries in word and in deed to take account of changes that have occurred. Why these changes have occurred will also be examined. Moreover, the more recently re-stated principles place primary emphasis on the rights and interests of the patient rather than the physician. Thus, they value autonomy, beneficence and non-maleficence. Although autonomy is a clearly definable concept, beneficence and non-maleficence have shown themselves to be subject to interpretation. It is arguable, that the latter two could encapsulate the clinicians' agreement to facilitate an autonomous choice by the patient, as is done in cases such as respecting competent treatment refusals and advance directives, where the outcome is the foreseeable death of the patient.

Chapter 3 will address and analyse the arguments against permitting patients to make such choices at the end of their lives. The chapter will explore the validity of these arguments using both a legal and ethical perspective. Areas of law tangential or parallel to the questions raised by patient choice will be introduced and scrutinized in order to clarify whether or not they are accepted by the law, as well as whether or not they are inherently consistent, philosophically.

Chapter 4 will undertake a similar exercise in respect of the arguments in favour of patient control of these decisions. Once again, the arguments will be approached from a legal and ethical perspective. This chapter will include a summation of chapters three and four concluding that the arguments in favour of patient choice are stronger and more compelling than those raised against it.

Having reviewed all of the above arguments, chapter 5 will seek to define physician assisted suicide. In doing so, attention will be paid to cases, for example, such as that of Sue Rodriguez which have been considered by the courts and elsewhere, and to their arguments and conclusions. Physician assisted suicide will be distinguished from all three possible forms of euthanasia, and the moral differences will be highlighted and analysed.

Chapter 6 will ask whether or not there is a reason why doctors should be involved at all. A number of possible reasons against clinical involvement will be explored, before analysis is made of the medical role. It will be argued that there are strong reasons, which donot conflict with medical ethics, why the clinician is best placed to provide the means, and make the assessment of the appropriateness of, physician assisted suicide.

Chapter 7 will review what went before and explore the areas of the law and professional ethics which require to be modified or changed if physician assisted suicide were to be legalised. The aims of these reforms would be to ensure the lawfulness of the actions of the doctor, the rights of the person seeking assistance and the protection of all others who might be involved.

...will draw together all of the above into a draft bill which would be suitable for the legislative process of the United Kingdom. The Bill will be permissive in nature, and will incorporate all of the consequential legal changes outlined...

Chapter 8 may arguably be the one to cause most discussion. It will review the literature already available in respect of attitudes to choices at the end of life. It will include our recent independent research and questionnaire of healthcare professionals and public opinion which was commissioned especially for our report.

Chapter 9 will take a comparative view of those jurisdictions whose legislature or courts have addressed the question of physician assisted suicide. Analysis will be made of their laws, the arguments which preceded or followed their passing and the style of legislative and other intervention utilized.

Chapter 10 will draw together all of the above into a draft bill which would be suitable for the legislative process of the United Kingdom. The Bill will be permissive in nature, and will incorporate all of the consequential legal changes outlined in chapter 7, above.

Following the Frontline Scotland programme which used the findings of our questionnaire, the response rate to it rose to approximately 50%. Such a response rate is almost unheard of in surveys...

Following the Frontline Scotland programme which used the findings of our questionnaire, the response rate to it rose to approximately 50%. Such a response rate is almost unheard of in surveys, and it is most gratifying to realise how many people are willing to share their opinions with us. Some respondents went further and supplied us with an additional two or three pages of their individual views. Such enthusiastic participation is going to be a great asset to our final report, allowing us to analyse a broad spectrum of professional and general public opinion.

It was not only the response rate which rose after the programme. The programme gave rise to a huge amount of interest which was by no means confined to Scotland, or for that matter, Britain. The project had coverage from first thing in the morning on breakfast television to the later viewing of Newsnight. Sky Television and American NBC also carried a report. This publicity was well supplemented by every form of media you could imagine; radio broadcasts and newspapers alike besieged our office and jammed the university switchboards.

Things have calmed a little now and we are doing the last of our rounds of letters; this time to the churches, political parties and the Scottish and English Law Commissions. The aforementioned publicity should stimulate a response. Whether the response is of a positive or negative nature is less certain.

As to the next few months and completion, we can only hope that our final report generates as much interest as our preliminary findings.