What Is Assisted Dying?

Introduction

Assisted dying is dying with the help of another person. It is a very controversial and broad topic, which medical professionals and the public have debated for years now; with a consensus being difficult to reach. 

Assisted dying encompasses various practices and is defined by different terminologies including assisted dying, assisted suicide, physician-assisted dying (PAD), physician-assisted suicide (PAS) and euthanasia (voluntary and non-voluntary). There have been profound conflicts over these practices' ethical, moral and societal aspects.¹ Therefore, it is important to understand each of these practices and their respective processes and legal status to avoid confusion and navigate the complex landscape surrounding end-of-life care. 

This article will explain each of these terminologies to help readers understand the practice of assisted dying better. 

Types of assisted dying 

When one mentions assisted dying it is sometimes difficult to understand what they’re exactly referring to as this term is defined differently across different debates and different countries. Since not everyone, proponents and opponents, agree on the same terminology used to describe this process, it is important to define all current terminologies of this process but to keep in mind that they all refer to assisted dying.

Assisted dying 

Assisted dying is the process of prescribing life-ending drugs to terminally ill patients with intact mental health, for self-administration, while ensuring strict legal safeguards.¹ In this practice, a doctor or another medical professional will prescribe the patient a drug such as a sedative or an analgesic (pain medication), knowing that taking this medication will end the life of the patient.² Although the medical professional prescribes this medicine, it will be the patient themselves who takes the medication. This is done to alleviate pain and suffering for the terminally ill patient.

Additionally, it is important to emphasise that this is done only for mentally competent adults who can make choices themselves. For example, a mentally competent adult suffering from end-stage cancer can choose to ask his doctor for a prescription for a drug that he takes himself that will end his life. The doctor in this case is legally allowed to do so and this wouldn’t count as manslaughter or murder. However, performing a similar practice for a patient with dementia or Alzheimer’s disease would not be allowed. 

In some regions of the world, the term physician-assisted dying or PAD is used to explain this same practice. The only difference is the fact that physician-assisted dying or PAD can also involve cases in which a medical professional is administering the lethal dose of drugs to the patient instead of the patient doing it themselves. 

Assisted dying as explained above is legal in nine states in the US including, California, Colorado, Hawaii, Montana, Oregon, Vermont, Washington and Washington, DC. It is also legal in Victoria, Australia.¹ However, It is illegal in the UK.³ 

Assisted suicide

Assisted suicide is the process of intentionally helping any person who wants to die. This can include people with terminal illness, progressive conditions and people who are not dying. This assistance could be in the form of obtaining a lethal dose of drugs for self-administration or other methods.¹ 

Unlike the term described above, in this practice the individual assisting in suicide doesn’t have to be a doctor or a medical professional and the individual seeking assistance to die doesn’t have to be terminally ill. Therefore, some individuals debating this topic choose to use the term “assisted suicide” rather than “assisted dying”. An example of this practice would be if a relative of a person wanting to commit suicide obtains a lethal dose of drugs such as an overdose of muscle relaxants or sedatives, and gives them to the individual to take to end his/her life. In this example, the relative is assisting in suicide. 

If assisted suicide involves a medical professional it is called physician-assisted suicide (PAS). In some regions of the world and some debates, this term is used as the primary term to explain assisted suicide. Assisted suicide is allowed in Switzerland.¹ However, it is illegal in the UK under the terms of the Suicide Act (1961) and punishable by up to 14 years in prison.³ The difference between the two is that in some cases, PAD and PAS also refer to when the doctor administers the medicine, rather than self-administration by a patient.  

Euthanasia 

Euthanasia is the process of intentionally ending a person’s life to relieve suffering, categorised as voluntary and non-voluntary euthanasia. 

Voluntary euthanasia 

This is the process in which a physician administers life-ending drugs to a patient who has given consent to die. It is very similar to assisted suicide with the difference that in this practice, the doctor administers the lethal dose of drugs himself. In this practice too, patients do not necessarily have to be terminally ill. This is allowed in Belgium, the Netherlands, Luxembourg and Canada.¹ It is illegal in the UK and can be regarded as manslaughter or murder, with the maximum penalty of life imprisonment.³ 

Non-voluntary euthanasia

This is the process in which a doctor administers life-ending drugs to a patient who can’t give consent. For example, if a patient is in a coma and can’t make the choice to live or end his life himself, the doctor can make this decision for him. 

Why is this topic so controversial?

Opponents and proponents of assisted dying present contrasting perspectives on the proposed change in legislation. 

Proponents, like Baroness Meacher and Dame Esther, advocate for a change in the law to permit assisted dying, citing factors such as patient autonomy, the inevitability of progressive terminal illnesses, and shifts in medical associations' stances.^2,5 They argue for patients' rights to end their suffering with dignity, emphasising the importance of evolving medical practices to meet changing societal needs.⁵

Opponents, including the Royal College of Surgeons of England and the British Medical Association (BMA), emphasise maintaining the sanctity of the doctor-patient relationship, expressing concerns about potential shifts in the dynamics of care and the ethical implications of prescribing drugs for suicide. They highlight the risks of coercion, the difficulty in predicting life expectancy accurately, and the challenges in regulating assisted dying to prevent abuses.⁵ Moreover, there are concerns about whether the criteria for assisted dying could extend to non-terminally ill patients, such as those with disabilities, dementia and depression.² Additionally, they stress the importance of palliative care as a humane alternative, focusing on alleviating suffering without directly ending lives. Finally, they focus on the need for further debate and exploration of alternatives to address end-of-life suffering while upholding the principles of medical ethics and patient care.⁵

Summary

Assisted dying is a topic that has been discussed throughout history. The reason for the great controversy around this topic and its importance is that assisted death mainly falls within the scope of life as a human right and like every other human right, this too should be discussed carefully because many people would like to have a choice and control over how they manage the process of how they die.⁴ 

Like other dilemmas, it is very difficult to pick a right or wrong answer. Therefore,  to make an informed decision, it is necessary to know what assisted dying means. The general public and medical professionals can vote for this action and choose their rights.