Legal debate around end-of-life care likely to get more complex

I: How other countries approach assisted suicide

The absolute ban on assisted suicide was reaffirmed in the High Court this week in the case of Marie Fleming. The 59-year-old woman, who is terminally ill with multiple sclerosis, failed in her bid to be lawfully permitted to be helped to take her own life.

But the legal debate will not end there. Ms Fleming is expected to appeal the decision, and there are growing calls for reform. Other countries have a longer experience of grappling with the often-complex medical and ethical issues around the subject, and in many cases only interim solutions have been found.

UK concessions

In the UK, euthanasia – defined as taking someone’s life upon their request – is unlawful. Assisted suicide – whereby the person who dies takes the final action – remains illegal. However, in a considerable concession achieved through courts in recent years, the state confirmed that a person assisting will not necessarily be prosecuted.

After initial refusals, the UK’s director of public prosecutions was compelled by the courts to detail its policy so people would have a better understanding of where they stood legally.

In February 2010, following widespread consultations, the director outlined this policy, which applies to England, Wales and Northern Ireland – but not Scotland. It makes clear that assisted suicide has not been decriminalised but sets out a two-stage process to determine whether charges will be brought. First, it must be determined if there is sufficient evidence and, second, it must be decided whether a prosecution is in the public interest.

Specific factors, such as whether the person who took their own life clearly stated the intention to do so and the motivation of the person who assisted, are to be considered.

Four European countries have legalised euthanasia and/or assisted suicide: the Netherlands, Belgium, Luxembourg and Switzerland. The latter has attracted particular attention as the law allows protections to people with a terminal illness who are not Swiss residents.

At least seven Irish people are known to have travelled to Switzerland to take their own lives, using Dignitas, the Swiss-assisted suicide organisation. A further 29 Irish people were last year listed among its members.

French reform

In France, there has been a movement towards legal reform over the past decade, culminating last December in the publication of a government report recommending the decriminalisation of assisted suicide.

Hinting at a more liberal regime than other states, the report said assisted suicide might be appropriate in cases of incurable illness. President François Hollande has promised a Bill in June on end-of-life care, having also made an election pledge on the issue. The debate has been driven by high-profile cases, notably the death of Vincent Humbert who became a quadriplegic after a car crash. His mother, Marie, helped him die in 2003 but was not prosecuted.

Elsewhere, a small number of jurisdictions have relaxed their prohibitions on euthanasia. In the US, two states, Oregon and Washington, have passed laws permitting some form of physician-assisted suicide.

Campaigners point to a number of surveys showing public opinion in favour of reform. A poll by the Swiss Medical Lawyers Association found as many as two out of three Europeans support a right to die.

“In practically all European countries, many signs indicate that the prevailing legal system no longer reflects the will of large parts of the population on this issue,” it said.

However, the bulk of the medical profession in Europe – and Ireland is no exception – opposes any move towards euthanasia.