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Doctors risk prosecution over assisted suicide

By Mike Broad - 3rd March 2010 2:13 pm

Doctors face a greater risk of prosecution for assisting a patient’s suicide following new guidance, defence body MPS has warned.

The director of public prosecutions, Keir Starmer QC, has created six mitigating factors against an individual being prosecuted for assisting the suicide of another.

However, the MPS warned doctors to be extremely cautious when providing help or advice to patients who are considering assisted suicide.

The guidance, called Policy for prosecutors in respect of cases of encouraging or assisting suicide, includes a specific reference to the suspect acting as a doctor, nurse or other health professional as a factor in favour of prosecution.

In the interim policy, a suspect providing assistance to a victim in the course of their usual job was a factor against prosecution. This has been deleted from the final copy, which is now effective.

Dr Nick Clements, head of medical services (Leeds) at MPS, welcomed the clarification into the factors that will be taken into consideration when deciding whether to prosecute cases.

But he added: “We believe that the final policy on assisted suicide places doctors in a much more risky position than before. While we recognise that the law on assisted suicide has not changed, the factors for and against prosecution send a clear signal that the actions of health professionals will be carefully scrutinised and may well set a lower threshold for bringing prosecution against them.”

The MPS is concerned that doctors could face prosecution who were involved quite indirectly in an assisted suicide.

He said: “For instance, we have been contacted by doctors whose patients have requested medical or fitness to travel reports so that they can gain access to clinics such as Dignitas.

“The patient may not have initially made it clear to their doctor why they wish to have these reports but the doctor may harbour a suspicion. A doctor who helps a patient with these requests may leave themselves open to a criminal investigation and prosecution.”

Doctors are being advised by defence bodies to not to comply with requests for medical or travel reports if they suspect the patient may be planning an assisted suicide. The MPS is calling for greater clarity around the position of doctors.

Read the full document.

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Assisted suicide: families can still face prosecution

The Guardian - 26th February 2010 3:00 am

Family members involved in “mercy killings” will still face criminal charges despite the publication today of new guidelines to clarify the rules on assisted suicide.

After one of the most widespread public consultations ever carried out, the director of public prosecutions, Keir Starmer QC, has created six mitigating factors against an individual being prosecuted for assisting the suicide of another.

One of the other key changes is the removal of any reference to the condition of the victim - whether they are terminally ill or near death - as a mitigating factor. Instead, the focus has switched to examine the motivation of a suspect when considering whether to prosecute anyone for assisted suicide.

Starmer made it clear that relatives who actively help a terminally ill individual to die are not covered by the guidelines and individuals could be expected to be charged with murder or manslaughter.

The distinction means people like Kay Gilderdale - who was prosecuted for the attempted murder of her daughter who had ME - could still face criminal charges. A judge last month criticised the Crown Prosecution Service for charging Gilderdale and a jury found her not guilty in less than two hours.

Crucially Starmer has removed one key mitigating factor from his original draft guidelines published last September - the fact that the person assisting is a family member. Starmer said it had been removed after a public response raised concerns that family members could be “manipulative” or even “antagonistic” towards the individual who was sick.

Third of doctors act to shorten lives of dying patients

The Guardian - 24th October 2009 12:55 pm

Around a third of doctors say they have given drugs to terminally ill patients or withdrawn treatment, knowing or intending that it would shorten their life, research reveals.

A study of doctors in charge of the last hours of almost 3,000 people finds decisions almost always have to be made on whether to give drugs to relieve pain that could shorten life and whether to continue resuscitation and artificial feeding.

In 211 cases (7.4%), doctors say they gave drugs or stopped treatment to speed the patient’s death. In 825 cases (28.9%), doctors made a decision on treatment that they knew would probably or certainly hasten death. One in 10 patients asked their doctor to help them die faster.

What doctors do varies according to their religious beliefs, according to Prof Clive Seale, of Queen Mary, University of London, who carried out the research. But, he said, there was no evidence of a “slippery slope”: that deaths of the most vulnerable, such as very elderly women and those with dementia, are being hastened more than others.

“People sometimes say if you legalise assisted dying, then very elderly people in care homes will be pushed towards death,” Seale said. “But the paper is fairly reassuring on that.”

His survey of 3,733 doctors, published online in the journal Social Science and Medicine, finds that only 242 people out of 2,855 who died (8.5%) were given no drugs for pain or other symptoms and did not have treatment withdrawn or withheld.

In the largest proportion of deaths (1,577 or 55.2%), doctors had given pain relief or withdrawn or withheld treatment, but said it had not shortened life.

New guidance clarifying assisted suicide launched

BBC Health - 24th September 2009 8:21 am

New guidance has been issued to clarify the law on assisted suicide in England and Wales - but it offers no guarantees against prosecution.

Instead the director of public prosecutions has spelled out the range of factors that will be taken into account when deciding on cases.

These include whether there was a financial motive, and looking into how the decision to die was made.

The guidance does not represent a change in the law. Assisting suicide is illegal and carries a jail term of up to 14 years.

However, more than 100 Britons with terminal or incurable illnesses have gone to the Swiss centre Dignitas to die and none of the relatives and friends involved in the cases has been prosecuted.

No real change for doctors on assisted suicide

By Ian Barker, solicitor at MDU - 23rd September 2009 6:26 pm

The Director of Public Prosecutions, Keir Starmer QC, launched his interim policy guidance on prosecuting cases of assisted suicide today. It explains for the first time what public interest factors are relevant when deciding whether or not to prosecute the offence of assisted suicide. The guidance is in general terms and not specific to medical practitioners, though of course it can apply to them.

It lists 16 public interest factors in favour of prosecution including that the ‘victim’ was under 18 years of age; that the victim did not have a clear and settled wish to commit suicide; and that the suspect was not wholly motivated by compassion. The DPP identified eight of these 16 factors as potentially carrying less weight, including: that the suspect was not the spouse, partner, close relative, or close personal friend of the victim; that the suspect was paid by the victim for the assistance; or that the suspect was paid to care for the victim in a care/nursing home environment.

Those public interest factors which might weigh against prosecution include the victim having a clear, settled and informed wish to commit suicide; had indicated unequivocally to the suspect that he or she wished to commit suicide; and that the suspect had sought to dissuade the victim.

The new interim policy guidelines follow a decision by the Law Lords in July this year to allow the appeal of Debbie Purdy. Purdy, who has multiple sclerosis, was considering going to Switzerland in order to have an assisted suicide, but was unwilling to expose her husband to the risk of being prosecuted for helping her. The Law Lords unanimously decided that the DPP was required to publish an offence-specific policy identifying the facts and circumstances to be taken into account in deciding whether to give consent to a prosecution.

Purdy’s case was the latest in a series of high profile cases involving patients, often terminally ill, who wished to travel to a jurisdiction where assisted suicide is legal, such as Switzerland. Because in many cases the patient would be unable to travel without help, patients, family members and friend were concerned they might face prosecution for aiding and abetting a suicide. Within the medical profession too, concerns have been raised about the position of doctors who were approached by patients for advice about ending their lives with the help of assisted suicide groups abroad.

And yet, despite what might be seen by some as a softening in approach, it is important to stress that today’s announcement does not change or provide any significant clarification to the Suicide Act 1961. This created a new statutory offence of assisting a suicide, stating that “a person who aids, abets, counsels or procures the suicide of another” may be liable to imprisonment for up to 14 years, although a prosecution may not be brought without the consent of the DPP.

As Keir Starmer made clear in a statement this morning nothing in the DPP’s guidance changes the law in any way: assisting a suicide remains illegal in England, Wales and Northern Ireland. Neither does it give a guarantee that prosecution will not take place.

In addition, the guidelines do not apply to the GMC, which may decide to investigate a doctor’s fitness to practice, whether or not a prosecution is brought.

It follows that the MDU’s guidance to members must remain unchanged. Doctors approached by patients for advice about suicide should not engage in discussion, which assists the patient to that end. Doctors could still face a criminal investigation if alleged to have assisted with the act - even if that assistance was only in the form of advice to the patient.

Members who are faced with requests for help from patients, including for example the provision of medical reports, should contact the MDU for advice.

The DPP has called for public participation in a 12-week consultation on the interim guidelines. The consultation closes on 16 December and the finalised policy is due to be issued in Spring 2010.

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New guidance this week on assisted suicide

BBC - 20th September 2009 7:05 pm

Guidelines on assisted suicide law will be published by the Director of Public Prosecutions this week to clarify when people are likely to be prosecuted.

Keir Starmer QC told the BBC factors that would be considered included whether anyone helping in the suicide stood to gain financially.

He said assisted suicide would remain an offence as the law was unchanged.

Labour minister Ed Balls said he hoped Mr Starmer would “err on the side of being very, very cautious”.

The guidelines for England and Wales come after a legal battle won by Debbie Purdy, who has multiple sclerosis. The Law Lords accepted earlier this year that Ms Purdy, from Bradford, had a right to know whether her husband Omar Puente would be prosecuted if he helped her to travel abroad to commit suicide.

Clarify doctors’ role in assisted suicide

By Mike Broad - 20th August 2009 9:33 am

Doctors need clarification on how to deal with patients they know to be considering assisted suicide.

Medical defence body MPS is concerned that doctors who become aware that their patient is considering ending their life could be perceived as facilitating it by providing the patient with their medical records upon request and be liable for criminal charges.

Patients organising an assisted suicide have to travel to Dignitas, the Swiss clinic, where it is legal. According to Swiss law, Dignitas can only accept people who are terminally ill or suffering from symptoms that cannot be relieved, so they cannot help people whose condition may improve either by itself or with treatment.

To ensure these conditions are met, Dignitas requires a patient’s medical records and a certificate of fitness to travel before an appointment can be made.

The House of Lords has called on the director of public prosecutions to look at the factors which would be taken into account in deciding whether to bring a prosecution in such cases. But the recent debate has focused on the role of family members not health professionals.

Dr Nick Clements, head of medical services at MPS, said: “Although patients in the UK have a legal right to request their medical records without giving a reason, if the patient is terminally ill the doctor may suspect that the patient is considering going elsewhere for an assisted suicide. Therefore doctors need clarification over whether they are at risk of prosecution if they provide reports about the patient’s condition or fitness to travel in the knowledge that this information will be passed on to clinics like Dignitas.

“We also need clarification over whether doctors have a duty to inform the authorities, either in the UK or elsewhere, if they are aware that their patient is intending to take their own life by way of assisted suicide,” said Clements.

MPS has written to the health secretary and will raise these issues with MPs when they return to Parliament in the autumn.

Clements added: “It is clear that this is a complex legal and ethical issue and a delicate emotional matter, however, the law remains unchanged at present and doctors who find themselves in such circumstances should be cautious and seek the advice of their medical defence organisation before they take any steps.”

The former lord chancellor Lord Falconer last month tried to amend the coroners and justice bill to make assisted dying lawful if two doctors confirmed the person in question was terminally ill and deemed competent to make such a decision. His amendment was defeated in the House of Lords.

A poll of more than 1,700 people carried out for the campaign group Dignity in Dying found two-thirds supported a change in the law. The Royal College of Nursing recently changed its position on assisted suicide from one of opposition to neutrality.

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Historic victory in assisted suicide legal battle

The Guardian - 31st July 2009 9:08 am

Britain’s highest court issued a historic judgment today that could finally remove the fear of prosecution from people who travel abroad to support relatives seeking an assisted suicide.

In a unanimous ruling, the law lords ordered the director of public prosecutions to immediately draw up a policy that would spell out when prosecutions would and would not be pursued.

The ruling was strongly in favour of Debbie Purdy, 46, who has multiple sclerosis and who has been fighting to protect her husband, Omar Puente, should he accompany her to a clinic in Switzerland that specialises in euthanasia. She had argued that the law was unclear and uncertainty surrounding the issue breached her human rights.

Don’t discuss assisted suicide with patients

Pulse - 28th July 2009 12:19 pm

Doctors have been warned not to engage in discussions around assisted suicide with patients, despite the Royal College of Nursing (RCN) adopting a neutral position on the issue.

The Medical Defence Union, has warned doctors that they could face investigation by the GMC if they give advice to patients to help them travel abroad to take their own lives, and urged them not to discuss the issue during consultations.

The RCN’s decision to switch to a neutral position following a detailed consultation has provoked fierce debate over the issue, which has polarised opinions among clinicians and patients.

The BMA recently passed a motion opposing the legalisation of assisted suicide at its annual representatives meeting, and the Royal College of GPs is soon to publish a policy document on the issue, which is expected to oppose changes to current legislation.

Nurses are neutral on assisted suicide for patients

BBC Health - 25th July 2009 11:02 am

The Royal College of Nursing has dropped its opposition to the concept of helping patients to commit suicide.

The college has now adopted a neutral stance, neither supporting nor opposing a change in the law.

Health staff who provide patients with the drugs needed to kill themselves can face up to 14 years in prison.

The move comes as a survey for a newspaper suggests 74% of people want doctors to be able to help people to end their lives.

According to the survey of 1,500 people for The Times, support for assisted suicide was especially strong among those aged between 55 and 64.