assisted suicide

No, legislating to allow euthanasia would not breach the European Convention on Human Rights

7 November 2024 by anuragdeb

Anurag Deb and Lewis Graham

Introduction

There are many well-tuned arguments both for and against the liberalisation of the UK’s strict euthanasia laws, some more helpful than others. This piece is not concerned with weighing up the policy arguments for or against such a move, nor does it consider which “side” of the argument is ultimately more convincing. Indeed, the authors do not necessarily agree with one another on the discrete question of whether Kim Leadbeater MP’s Bill should be supported.

But one curious argument has recently emerged which is of serious concern to both authors: the argument that liberalising euthanasia laws, in line with the proposed changes in Leadbeater’s Bill, should be resisted, as doing so would be to contravene the rights under the European Convention on Human Rights (ECHR). In this post, we seek to debunk this argument.

There are, we think, two main variants of ECHR-based arguments to this effect: one invoking Article 14 (freedom from discrimination) and the second relying on Article 2 (right to life). Neither is convincing.

Guest Post: Assisted Suicide on the NHS would breach the ECHR 

1 November 2024 by Guest Contributor

In this guest post, Rajiv Shah argues that the provision of assisted suicide in the England and Wales via the NHS would constitute a substantive breach of the negative obligation imposed on the State under Article 2 of the ECHR.

Introduction

Article 2 of the ECHR protects the right to life. That article contains two distinct substantive obligations: “the general obligation to protect by law the right to life, and the prohibition of intentional deprivation of life, delimited by a list of exceptions.” (Boso v Italy, at [1])

That first obligation is a positive one and requires States to take steps to protect life from third parties and even from individuals themselves. The precise content of that obligation is necessarily nebulous and the Court affords States a margin of appreciation in deciding what that obligation requires, and how it is to be fulfilled. So, in two recent Chamber decisions – Mortier v Belgium and Karsai v Hungary – the Strasbourg Court held that this positive obligation does not require States to forbid assisted suicide and euthanasia, but that if it does want to allow it, it must create legal safeguards to ensure that the decision of individuals to end their own life/or be killed by third parties is freely taken. 

Husband who escorted his wife to Switzerland not denied access to her estate under Forfeiture Rule

14 October 2024 by Rosalind English

Philip Morris v James Morris, Kate Shmuel and Gregory White [2024] EWHC 2554 (Ch)

These proceedings concerned the forfeiture rule under section 2(2) of the Forfeiture Act 1982 as it applies to the estates of people who travel to Switzerland for assisted dying (the 1982 Act). Mrs Myra Morris had ended her own life with the assistance of the staff at the Swiss clinic and the assistance of her husband Philip. She had been suffering from Multiple System Atrophy, a rare and degenerative neurological disorder with no known cure.

It was accepted between the parties that the role played by Philip engaged Section 2(1) of the Suicide Act 1961, which makes the assistance of suicide a criminal offence. The forfeiture rule under Section 1 of the 1982 Act precludes a person who has unlawful acted in the killing of another from acquiring a benefit from that killing. Section 2 of the 1982 Act allows for the modification of that rule if the justice of the case calls for such mercy.

Before Myra died, her solicitor assessed her as having the mental capacity to make an informed and voluntary decision to end her own life according to the Mental Capacity Act 2005. She said that she was satisfied that Myra was able to understand the decisions she was making and was under no undue influence, pressure or encouragement when she did so.

Her husband Philip sought advice from solicitors regarding his position should he accede to Myra’s wish for him to accompany her to Switzerland and he was reassured that, in the light of the DPP’s guidance on Section 2 of the Suicide Act, he would not be prosecuted, and indeed the Police Constable who interviewed Philip on his return from Switzerland told him that there was nothing to report and confirmed the position in writing.

Then there arose the question of the forfeiture rule. There are very few reported decisions on the approach the court should take on an application to modify the forfeiture rule, but the 1982 Act requires the court to have particular regard to the conduct of both the deceased and the person assisting the death when determining the justice of the case. In Dunbar v Plant  [1998] Ch 412, Philips LJ explained that there were clear indications in the Act that there were circumstances in which the public interest did not require the imposition of any penal sanction, a consideration which he linked directly to the proper application of the forfeiture rule:

“Where the public interest required no penal sanction, it seems to me that strong grounds are likely to exist for relieving the person who has committed the offence from all effects of the forfeiture rule.” [para 437]

Conviction of doctor under assisted suicide prohibition not in breach of Convention

13 April 2022 by Rosalind English

Lings v Denmark (Application no. 15136/20)

The European Court of Human Rights has ruled that states have a broad margin of discretion in applying their criminal law to cases of assisted suicide. The applicant’s conviction may have constituted an interference with his rights, but that interference was prescribed by the Danish criminal law, which pursued the legitimate aims of the protection of health and morals and the rights of others. Denmark had not acted disproportionately by convicting him.

Law Pod UK recently ran an episode with former Court of Appeal judge  Sir Stephen Sedley and Trevor Moore, the director of the campaign group  My Death, My Decision, in which we dealt with this difficult subject in detail. Sir Stephen is a victim of Parkinson’s disease and his contribution to the debate is profoundly important. I have therefore quoted extensively from the article Sir Stephen wrote for the London Review of Books in October 2021, “A Decent Death”.

Those campaigning for a change in the law in this field object to the use of the word “euthanasia” and I have respected this position in the following case report. It should be noted at the outset that the applicant physician was a member of an association called “Physicians in Favour of Euthanasia”. This is the English translation. The Danish suggests something closer to “assisted dying”: ” Aktiv Dødshjælp”.

Physician assisted dying: latest developments

22 March 2019 by Rosalind English

Update: 

Today (21 March) the Royal College of Physicians (RCP) has dropped its opposition to assisted dying and moved to neutrality. The RCP has opposed assisted dying since 2006 but has now brought its position in line with the range of views held by its members, and with the 82% of the public who want greater choice at the end of life. Today’s result is a great victory for patients and for the campaign group Dignity in Dying. Their full press release can be found on their website and a breakdown of the results is available on the RCP website.  

DID’s report has been covered by the British Medical Journal and Politics Home so far.  You can read the full report here, and their press release here.

On 20 March Dignity in Dying released a report exposing the fact that those behind the legal challenge to the RCP (detailed below) have a long history of campaigning for pro-life causes and connections to American pro-life lobbyists, the Alliance Defending Freedom (ADF).

DID’s report has been covered by the British Medical Journal and Politics Home so far.  You can read the full report here, and their press release here.

See our last update on these events since our podcast interview with CEO of Dignity in Dying Sarah Wootton.

Physician assisted dying: latest developments

26 February 2019 by Rosalind English

Update:

On 20 March Dignity in Dying released a report exposing the fact that those behind the legal challenge to the RCP (detailed below) have a long history of campaigning for pro-life causes and connections to American pro-life lobbyists, the Alliance Defending Freedom (ADF).

DID’s report has been covered by the British Medical Journal and Politics Home so far.  You can read the full report here, and their press release here.

In January we published episode 63 of Law Pod UK featuring Sarah Wootton, Chief Executive of Dignity in Dying. DID campaigns for a change in the law to allow doctors to prescribe lethal drugs for terminally ill people to hasten their own death in specific situations. Sarah referred in that interview to a poll that was about to be conducted of the members of the Royal College of Physicians, who have hitherto opposed assisted dying. The members are being asked whether they individually support a legal change to permit assisted dying, and what they think the RCP’s position should be. The RCP has said that it will move to a neutral position unless at least 60% of votes in a poll being sent out in the first week of February are either in favour of or opposed to a change in the law. The results will be announced in March but the poll has had a bumpy ride, including a threat of judicial review by one of its members for conducting the exercise as a “sham poll with a rigged outcome.” The Christian charity Duty of Care has called for signatures from doctors and medical students to a petition objecting to the poll.

While that has been going on, DID has supported the family of a man suffering from motor neurone disease. On 7 February Geoff Whaley travelled to Dignitas in Switzerland to end his life.

Before he died, Mr Whaley wrote an open letter all MPs to impress upon them the need for a change in the law after his wife was reported to the police, in an anonymous phone call, as a person potentially assisting someone to end their life. The Whaley’s MP Cheryl Gillan raised the family’s story in the Commons during Business of the House.

Geoff [and his wife] had to suffer the added mental anguish of facing a criminal investigation at a time when the family, and most of all Geoff, wanted to prepare his goodbyes and fulfil his last wish in peace. May I ask the Leader of the House if we can have a debate in Government time so that we can re-examine this area of law, particularly in the light of this amazing man’s efforts to give terminally ill people a choice over the way they leave this world, and to afford protection to their loved ones?

Does someone who assists with journey to Dignitas risk losing benefit of deceased’s estate?

26 February 2019 by Rosalind English

Ninan v Findlay and others [2019] EWHC 297 (Ch), 21 February 2019

The claimant, Mrs Ninian, is the sole beneficiary of the residue of the estate of her late husband Mr Ninian under his will. Mr Ninian, who suffered from a progressive incurable disease, died on 16 November 2017 with the assistance of Dignitas in Switzerland. Mrs Ninian was with him throughout the trip to Switzerland, his assessment by representatives of Dignitas and the occasion of his suicide.

Shortly before the trip to Dignitas, Mrs Ninian applied for relief against forfeiture under section 2 of the Forfeiture Act 1982 on the basis that steps taken by her may have amounted to encouraging or assisting her husband to commit suicide which brought in play the forfeiture rule.

Right to die case allowed to proceed

13 April 2017 by Rosalind English

Conway, R(on the application of) v The Secretary of State for Justice[2017] EWCA Civ 275

The Court of Appeal has overturned the refusal of the Divisional Court to allow a motor neurone disease sufferer to challenge section (1) of the Suicide Act. He may now proceed to seek a declaration under section 4(2) of the Human Rights Act 1998 that the ban on assisted dying is incompatible with the European Convention on Human Rights. The background to this appeal can be found in my post on the decision from the court below, which focussed on the vigorous dissent by Charles J.

Briefly, Mr Conway wishes to enlist the assistance of a medical profession to bring about his death in a peaceful and dignified way at a time while he retains the capacity to make the decision. His family respect his decision and choices and wish to support him in every way they can, but his wife states she would be extremely concerned about travelling to Switzerland with Mr Conway so he can receive assistance from Dignitas.

The main argument in support of the permission to appeal was that it was self-evident from the division of opinion in the Divisional Court that there would be a realistic prospect of success. Mr Conway’s legal team also argued that the issues raised about Mr Conway and those in a similar position to him were of general public importance and that this was a compelling reason for the appeal to be heard.
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Judges once again avoid right to die issue

2 April 2017 by Rosalind English

Conway, R (on the application of) v Secretary of State for Justice [2017] EWHC 640 – read judgment

Noel Douglas Conway, 67, is a victim of motor neurone disease. He has just been refused permission to seek judicial review of the criminalisation of physician-assisted suicide under the Suicide Act 1961. The High Court considered that Parliament has recently examined the issue following the Supreme Court decision in the 2014 Nicklinson case , and two out of three judges concluded that it would be “institutionally inappropriate” for a court to declare that s.2(1) of the Suicide Act  was incompatible with the right to privacy and autonomy under Article 8 of the ECHR. Charles J dissented (and those who are interested in his opinion might want to look at his ruling last year in the case of a minimally conscious patient).

Background facts and law

The claimant, whose condition worsens by the day, wishes to enlist the assistance of a medical professional or professionals to bring about his peaceful and dignified death. But Section 2(1) of the Suicide Act criminalises those who provide such assistance. The question of whether someone would be prosecuted for assisting suicide is governed by a detailed policy promulgated by the Director of Public Prosecutions. That policy was formulated in 2010 in response to the decision in R. (on the application of Purdy) v DPP [2009] UKHL 45, and was refined in 2014 following the decision of the Supreme Court in Nicklinson. A similar declaration of incompatibility had been sought in Nicklinson, but by a majority of seven to two the court refused to make the declaration on the grounds that it was not “institutionally appropriate” to do so. The court, however, encouraged Parliament to reconsider the issue of assisted dying.

In the instant case, the court had to determine whether the circumstances which led the Supreme Court to refuse to grant the declaration in Nicklinson had changed so that a different outcome was now possible.

The Court concluded – with an interesting dissent from Charles J – that  this was a matter for parliament.  A declaration of incompatibility would be institutionally inappropriate in the light of the recent Parliamentary consideration of Nicklinson. The claim was unarguable and permission was refused.

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Court of Protection orders continued reporting restrictions after death

27 April 2016 by Rosalind English

In the matter of proceedings brought by Kings College NHS Foundation Trust concerning C (who died on 28 November 2015) v The Applicant and Associated Newspapers Ltd and others [2016] EWCOP21 – read judgment

The Court of Protection has just ruled that where a court has restricted the publication of information during proceedings that were in existence during a person’s lifetime, it has not only the right but the duty to consider, when requested to do so, whether that information should continue to be protected following the person’s death.

I posted last year on the case of a woman who had suffered kidney failure as a result of a suicide attempt has been allowed to refuse continuing dialysis. The Court of Protection rejected the hospital’s argument that such refusal disclosed a state of mind that rendered her incapable under the Mental Capacity Act.  An adult patient who suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment (King’s College Hospital NHS Foundation Trust v C and another  [2015] EWCOP 80).
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Court of Session rejects challenge to prosecution policy on assisted suicide

22 February 2016 by Thomas Raine

Ross v Lord Advocate [2016] CSIH 12, 19^th February 2016 – read judgment  

The Inner House of the Court of Session has rejected a reclaiming motion (appeal) from a decision of the Outer House in which it was held that the Lord Advocate’s refusal to publish specific guidance on the circumstances in which individuals would be prosecuted for assisted suicide did not violate Article 8 of the European Convention on Human Rights (ECHR).

Factual and Legal Background

The petitioner, Gordon Ross, suffers from Parkinson’s disease. He anticipates that there will come a time when he will not wish to continue living but, because of his physical state, he would require assistance to end his own life. Mr Ross was apprehensive that anyone who assisted him would be liable to criminal prosecution and therefore sought clarification from the Lord Advocate (the head of the prosecution service in Scotland) as to the factors that would be taken into account in deciding whether or not to prosecute.
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The “socialite” who rejected life saving treatment

3 December 2015 by Rosalind English

King’s College Hospital NHS Foundation Trust v C and another  [2015] EWCOP 80 read judgment

A woman who suffered kidney failure as a result of a suicide attempt has been allowed to refuse continuing dialysis. The Court of Protection rejected the hospital’s argument that such refusal disclosed a state of mind that rendered her incapable under the Mental Capacity Act.  An adult patient who suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment. Continuation of such treatment is unlawful, even if the refusal seems irrational to others. As the judge said, this rule

reflects the value that society places on personal autonomy in matters of medical treatment and the very long established right of the patient to choose to accept or refuse medical treatment from his or her doctor (voluntas aegroti suprema lex). Over his or her own body and mind, the individual is sovereign (John Stuart Mill, On Liberty, 1859).

The Trust’s further application to be allowed to restrain C “physically or chemically” from leaving the hospital where she was receiving the dialysis was therefore rejected.

Background facts

The coverage of this case reflects a certain level of social disapproval. “Right to die for socialite scared of growing old” – “Socialite allowed to die was terrified of being poor” run the headlines. Behind them lurks an essentially religious consensus that people should not be allowed to opt out of senescence and its associated poverty and suffering, such matters being for God alone.  There is also a measure of censoriousness behind the  details brought to court regarding C’s attitude to motherhood and men, the news that she had breast cancer, her love of “living the high life” and her dread of growing old “in a council house”.
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Challenge to prosecution policy on assisted suicide in Scotland fails – Fraser Simpson

10 September 2015 by Fraser Simpson

Ross, Re Judicial Review, [2015] CSOH 123 – read judgment

The Outer of House of the Court of Session has refused an individual’s request for clarification of the prosecution policy relating to assisted suicide in Scotland.

by Fraser Simpson

Factual Background

The Petitioner, Mr Ross, suffers from Parkinson’s disease and currently resides in a care home due to his dependence on others. Although not wishing to currently end his life, Mr Ross anticipates that in the future he will wish to do so and will require assistance.

In July 2014, the Petitioner requested from the Lord Advocate – the head of the prosecution service in Scotland – guidance on the prosecution of individuals who assist others to commit suicide. The Lord Advocate replied that such cases would be referred to the Procurator Fiscal – the Scottish public prosecutor – and dealt with under the law of homicide. The Lord Advocate further stated that decisions regarding whether prosecution would be in the public interest would be taken in line with the published Crown Office and Procurator Fiscal Service Prosecution Code (“COPFS Code”). However, he admitted that it would often be in the public interest to prosecute such serious crimes as homicide.
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More bad news in the fight for a right to die

22 July 2015 by Isabel McArdle

R (o.t.a A.M) v. General Medical Council [2015] EWHC 2096 (Admin) Read the full judgment here

The High Court has rejected the argument made by “Martin”, a man with locked-in syndrome who is profoundly disabled and wishes to end his own life. This comes shortly after Strasbourg’s rejection of the Nicklinson and Lamb cases, for which see my post here.

Philip Havers QC, of 1COR, acted for Martin, and has played no part in the writing of this post. 

Martin would like to travel to a Swiss clinic to end his life, but wishes to obtain a medical report, from a doctor, to assist. He would also like to take medical advice on methods of suicide.

There is no dispute that a doctor advising him in this way will likely break the law, by committing the crime of assisting suicide. However, Martin argued that in practice, the Director of Public Prosecutions (DPP) has relaxed guidelines on when it is in the public interest to bring a prosecution against a doctor in these circumstances.

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Strasbourg rejects right to die cases

20 July 2015 by Isabel McArdle

The European Court of Human Rights has ruled that the applications to the ECtHR in Nicklinson and Lamb v UK, cases concerning assisted suicide and voluntary euthanasia, are inadmissible.

This is the latest development in a long running series of decisions concerning various challenges to the UK’s law and prosecutorial guidelines on assisted suicide and voluntary euthanasia. You can read the press release here  and the full decision here.
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