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Thursday, 24 Sep 2020

Contemplating Assisted Suicide – What are the Issues?

By Dr Becky Spelman

Assisted suicide—or voluntary euthanasia—is more discussed than ever today, and typically elicits strong opinions. This is a complex issue that warrants thought and discussion.

The terms “assisted suicide” and “voluntary euthanasia” refer to the act of helping someone to kill themselves, generally in the context of choosing a managed death over a prolonged battle with terminal illness. Colloquially, the term “mercy killing” is often used. Currently, it is illegal in the UK and in many other countries, but a growing number are passing legislation to permit it under certain circumstances. Already, a small but significant number of terminally ill British patients have chosen to end their lives in other jurisdictions.

Those in favour of legislating for assisted suicide argue that it is unfair to make terminally ill people suffer for months and even years with a painful and debilitating condition rather than choosing to leave the world in a painless manner at a time of their own choosing. They believe that such patients should have the right to opt for a dignified death by means of a painless procedure, surrounded by their loved ones, if this is what they want.

Critics of assisted suicide express concern that, if legislation is passed to allow for it, it could easily be abused—for example, by the heirs of older people who might not wish to care for them in their declining years. They believe that we should, instead, invest in palliative and end-of-life care for those who are terminally ill, and in this way provide them with the comfort and care that they need.

While some countries have been providing voluntary euthanasia for years, and certainly in this way have eliminated a great deal of suffering and pain, they have also had to grapple with complex and distressing ethical issues.

For example, can one ever get informed consent for voluntary euthanasia from someone who lives with a crippling mental illness? What if an older person says that they wish to go through assisted suicide if they become ill, but then withdraws consent after beginning to display symptoms of dementia? Are mental illnesses such as depression, or conditions such as anorexia, ever valid reasons for assisted suicide? Is it ever okay to use voluntary euthanasia to end the lives of terminally ill children who are, by definition, unable to give informed consent? Can patients with intellectual disabilities such as Down syndrome give informed consent? How can we ensure that patients opting for assisted suicide are not being pressured by their families?

These questions are not theoretical at all, but are real-life dilemmas that patients, families, and legislators have already had to grapple with in the countries that currently offer assisted suicide. Plainly, this is not a simple matter at all.

Given behavioural and medical trends, it seems likely that legislation for assisted suicide will be introduced in a growing range of contexts and jurisdictions in the not too distant future. In drawing up a protocol, it will be essential to balance the patient’s right to a dignified death, minimising anxiety, pain, and suffering as much as possible, with their right to make an informed, conscious choice, free of pressure, about such a momentous matter.

***If you would like to talk to someone about issues relating to terminal illness, end of life care, or assisted suicide and think you might benefit from speaking to someone, we offer a FREE 15-MINUTE CONSULTATION with one of our specialists to help you find the best way to move forward. You can book yours here.


  • Davis, Nicola (15 July 2019),“Euthanasia and assisted dying rates are soaring. But where are they legal?”,The Guardian.
  • Ganzini, Linda; Harvath, Theresa A.; Jackson, Ann; Goy, Elizabeth R.; Miller, Lois L.; Delorit, Molly A. (22 August 2002),“Experiences of Oregon Nurses and Social Workers with Hospice Patients Who Requested Assistance with Suicide”,New England Journal of Medicine. 347 (8): 582–588.
  • Mayo, David J.; Gunderson, Martin (July 2002), “Vitalism Revitalized: Vulnerable Populations, Prejudice, and Physician-Assisted Death”. The Hastings Center Report, 32 (4): 14–21.
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