Overlooking the criminally compassionate: What are the implications of prosecutorial policy on encouraging or assisting suicide?

Medical Law Review

Volumn 18, Issue 4, 2010, Pages 442-470

  Mullock, Alexandra ^a  

^a UNIVERSITY OF MANCHESTER   (United Kingdom)

Author keywords

Assisted suicide; Compassion; Discrimination; Healthcare professionals; Prosecutorial policy; Suffering; Suicide tourism

Indexed keywords

ARTICLE; ASSISTED SUICIDE; CULTURAL FACTOR; EMPATHY; ETHICS; EUTHANASIA; FAMILY; HUMAN; LAW ENFORCEMENT; LEGAL ASPECT; MEDICAL TOURISM; MOTIVATION; NETHERLANDS; PERSONAL AUTONOMY; PHYSICIAN; POLICY; PSYCHOLOGICAL ASPECT; SWITZERLAND; TERMINALLY ILL PATIENT; UNITED KINGDOM;

CROSS-CULTURAL COMPARISON; EMPATHY; EUTHANASIA; FAMILY; GREAT BRITAIN; HUMANS; LAW ENFORCEMENT; MEDICAL TOURISM; MOTIVATION; NETHERLANDS; PERSONAL AUTONOMY; PHYSICIANS; PUBLIC POLICY; SUICIDE, ASSISTED; SWITZERLAND; TERMINALLY ILL;

EID: 78649652822     PISSN: 09670742     EISSN: 14643790     Source Type: Journal    
DOI: 10.1093/medlaw/fwq027     Document Type: Article

References (146)

1. Ms Purdy, who suffers frommultiple sclerosis, made her application for Judicial Review (with the support of Dignity in Dying), commencing in the High Court with R (On the Application of Purdy) v DPP [2008] All ER (D) 284, then proceeding to the Court of Appeal; R (On the Application of Purdy) v DPP [2009] All ER (D)197, culminating in R (on the application of Purdy) v Director of Public Prosecutions (Society for the Protection ofUnborn Children Intervening) [2009] UKHL 45, [2009] WLR 403; [2010] 1 A.C. 345(HL).
2. HL decision at para 55
3. Available at .
4. Where the potential offence under s 2 of the Suicide Act 1961 occurred on or after February 1 2010, the amendment provided by s 59 and Schedule 12 of the Coroners and Justice Act 2009 applies. Thus, the prosecution must prove that the suspect did an act capable of encouraging or assisting the suicide or attempted suicide of another person; and the suspect's act was intended to encourage or assist suicide or an attempt at suicide.
5. S 2(1) of the Suicide Act 1961 provided that 'A person who aids, abets, counsels or procures the suicide of another or an attempt by another to commit suicide, shall be liable on indictment for a term not exceeding 14 years'
6. R (On the Application of Dianne Pretty) v DPP (2001) WL 1171775 (HC); R (On the Application of Dianne Pretty) v DPP (2001) WL 1423045 (HL); Pretty v UK Application no.2346/02 (ECtHR) (2002) 35 EHRR1, ECHR.
7. Art. 8 of the European Convention on Human Rights (ECHR) provides that; (1) Everyone has the right to respect for his private and family life, his home, and his correspondence. (2) There shall be no interference by a public authority with the exercise of this right except such as in accordance with the law and is necessary in a democratic society in the interests of national security, public safety, or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.
8. Purdy HL at para 106 (n 2, above)
9. Interim Policy for Prosecutors in respect of Cases of Assisted Suicide, Issued by The Director of Public Prosecutions, September 2009. Available on .
10. John Coggon, 'Doctors and Assisted Suicide' (2010) 340 BMJ 547
11. At para 6 of the policy (see n 4, above), the DPP states: 'This policy does not in any way "decriminalise" the offence of encouraging or assisting suicide. Nothing in this policy can be taken to amount to an assurance that a person will be immune from prosecution if he or she does an act that encourages or assists the suicide or the attempted suicide of another person'.
12. John Coggon has observed that none of the factors '... is necessarily 'heavier' than others, and no one can find an answer simply by totting up factors for and against and seeing which list is longer'.
13. See J Coggon, 'Prosecutorial Policy on Encouraging and Assisting Suicide - How Much Clearer Could It Be?' (2010) JME 36(7) 381-82
14. Such as the victim lacking capacity or being pressured into committing suicide
15. J Keown, 'Dangerous Guidance' (2009) 159 New LJ 1718
16. Glenys Williams is also critical of the decision in Purdy, arguing that '... ordering the DPP to publish a policy guidance document which effectively decriminalises assisted suicide, is not the way in which the law can or should be changed in the UK'.
17. See 'Assisting Suicide, the Code for Crown Prosecutors and the DPP's Discretion' (2010) 2 Common Law World Review 2010 181-203
18. See also J Finnis, 'The Lords Eerie Swansong: A note on R (Purdy) v DPP' (2009) Oxford Legal Studies Research Paper No.31/2009 .
19. Thereby rationalising why no prosecutions have followed on from suicides which have occurred abroad
20. In his article, 'Suicide in Switzerland: Complicity in England?', [2009] Crim L R 335, Professor Michael Hirst argued that the suicide would have to occur in this jurisdiction in order for an offence to be committed under the Suicide Act
21. This issue has been disputed, see for example, J Coggon, 'Assisting Death Tourism: Possible Prosecution or Pragmatic Immunity' .
22. In Purdy, the House of Lords considered the issue of territoriality and were divided on the issue, however, in his policy, the DPP states (see n 4, at para 8) that the act which may constitute criminal assistance or encouragement must be committed in England/Wales, although the suicide or attempt may take place anywhere in the world including England and Wales. It may be argued, however, that this is merely the DPP's opinion and the question has yet to be legally resolved.
23. See also, the former Lord Justice of Appeal, Richard Buxton's case comment on Purdy, 'Complicity in Suicide Abroad' (2010) 126 LQR 1-5
24. Prior to the appointment of the current DPP (Keir Starmer), the office of his predecessor, Sir Ken McDonald, determined that in none of the cases involving an assisted suicide abroad was it in the public interest to pursue a prosecution
25. Mr Crew, who was terminally ill, travelled to Dignitas with the obvious assistance of his wife in 2003. The DPP concluded that it was not in the public interest to prosecute Mrs Crew.
26. According to Lord Hope in Purdy, (see n 2 above, at para 30) at the time of the hearing (July 2009), 115 Britons had travelled abroad for an assisted suicide. Of those cases, eight had been referred to the DPP for a decision as to whether the assistors should be prosecuted. In six of these cases, the DPP determined that there was insufficient evidence and in two cases, despite there being sufficient evidence, it was decided there was insufficient public interest. Other cases appear to have been discontinued by the police on public interest grounds.
27. A 23-year-old man who sustained serious spinal injuries resulting in tetraplegia from a rugby accident
28. There being, according to the DPP, sufficient evidence to justify a prosecution on the basis that there would be a realistic prospect of conviction
29. See Decision on Prosecution - The Death By Suicide of Daniel James, 9 December 2008, .
30. For comment, see A Mullock, 'Prosecutors Making (Bad) Law?', (2009) 17 Med L R 209-99
31. At the time (December 2008), Ms Purdy had just failed in the High Court in her first attempt to have the DPP promulgate a code pertaining to those who assist in a suicide abroad
32. See n 22
33. See Purdy HL, (n 2, above), Lord Brown at para 85. Lords Neuberger and Brown agreed that whilst the decision in James made it '... pretty clear... how the Director approaches these cases... ' (at para 97), the decision also highlighted just how inapplicable the Code provisions are.
34. See respectively; para 43(11), (12), (14), (16) of the Policy (see n 4, above)
35. Para 45(3) of the Policy (see n 4, above). We might assume that providing the method/means of suicide, for example, helping to collect pills or helping an incapacitated person to consume a fatal overdose, would not constitute 'minor encouragement or assistance'. Evidence suggests that the DPP has a strict approach to any form of determinative assistance in suicide. For example, Kay Gilderdale was prosecuted for attempted murder for her role in her daughter's suicide.
36. See BBC news 'CPS Defends Charging Gilderdale over ME Daughter Death' 26 January 2010, .
37. Following Gilderdale's acquittal, the trial judge was scathing of the decision to pursue such a prosecution and in response to this criticism the DPP published a statement in defence of his decision
38. See .
39. Indeed, this was one of the arguments put forward in Purdy. See HL decision, para 31 (see n 2, above).
40. Art. 115 of the Swiss Penal Code states; 'A person who, for selfish motives, aids, or abets another person in suicide will be punished with imprisonment up to 5 years'.
41. For a full examination of the Swiss law, see J Griffiths, H Weyers and M Adams, Euthanasia and the Law in Europe (Hart Publishing 2008)
42. A doctor writing a prescription for assistance in suicide must act according to Art. 11 of the narcotics law, which requires that the drug be used, dispensed and prescribed according to the established rules of medical practice. An administrative court ruling in Zurich in 1999 (Verwaltungsgericht des Kantons Zurich, Entscheid der 3 Kammer VB Nr 99.00145, 1999) added the requirement that there be 'a condition indisputedly leading to death'; however, the court failed to specify which conditions should be covered by this term and even raised the question of whether mental conditions might be included. In 2006, the Swiss Federal Supreme Court (Schweizerisches Bundesgericht, Entscheid 2A. 4812006, 2006) ruled that a incurable, permanent, serious mental disorder can be comparable with a serious physical condition, thus a doctor who prescribes lethal drugs for a mentally ill patient does not necessarily violate the rules of medical practice in this regard.
43. Founded in 1998 by the Swiss lawyer, Ludwig Minelli, Dignitas is a nonprofit organisation set up to assist those with 'medically diagnosed hopeless or incurable illness, unbearable pain or unendurable disabilities'
44. See for example, 'Murky truth behind Swiss suicide 'clinic' Dignitas', Times Online (Oct 25 2008) .
45. C Seale, 'Do It Properly or Not at All' (2010) 340 BMJ C1719
46. For example, Robert and Jennifer Stokes, who died at Dignitas in 2003, were both relatively young and neither suffered from a terminal or even serious illness. More recently, an 85-year-old man, Sir Edward Downes, who suffered from only age-associated health problems, died at Dignitas together with his terminally ill wife, aged 74. While Mr and Mrs Stokes travelled unaided to Dignitas, the Downes' son, Caractacus Downes, was investigated following his role in accompanying his parents to Dignitas. Despite being a beneficiary to his parents' considerable estate, Caractacus was deemed by the DPP to have been 'wholly motivated by compassion'.
47. See 'No assisted suicide charge for son of Sir Edward Downes', BBC news, March 19 2010 .
48. For example, the policy indicates that a person acting in their capacity as a healthcare worker is more likely to be prosecuted than a relative who assists in suicide
49. R v Hough (1984) 6 Cr App Rep (S) 406 at 407
50. See n 27, above
51. Kay Gilderdale was alleged to have assisted her daughter by initially passing morphine to her and then later, after Lyn lost consciousness, to have continued administering morphine until Lyn died
52. Michael Bateman's wife had been bedridden for years due to an undiagnosed condition. For details of the Bateman decision, see 'Assisted Suicide Charge Not in the Public Interest', .
53. See also .
54. See n 33, above
55. Referring to the factors mentioned above (see n 26, above), and the factor regarding healthcare workers, which is discussed further below
56. For example, a terminally ill man, William Stanton, recently survived a suicide pact in which his wife, who was healthy, died
57. See 'I Botched Our Suicide Pact', The Sunday Times, November 1 2009. At .
58. Liezl Van Zyl, Death and Compassion: A Virtue-based Approach to Euthanasia (Ashgate Publishing, Aldershot, 2000) 165
59. See n 4, above, para 43(6) of the Policy
60. (1977) 66Cr App Rep 97, discussed by R Huxtable in Euthansia, Ethics and the Law: From Conflict to Compromise (Routledge Cavendish, 2007) 60
61. McShane was recorded telling her mother to take an overdose and also not to tell anyone of her role in assisting the suicide for fear that she might lose her inheritance. In fact, the potential victim did not want to commit suicide and no attempt was made.
62. See n 4, above, para 43(7) of the Policy: 'the suspect pressured the victim to commit suicide'
63. As Norrie remarked, 'Having insisted upon a strict legal code so as to protect the liberty of the individual, it transpires that the individual's liberty is ultimately dependant not upon the rule of law at all but on a group of men operating with a wide discretion at the sentencing stage'
64. See A Norrie, 'From Criminal Law to Legal Theory: The Mysterious Case of the Reasonable Glue Sniffer' (2002) 65 Modern LR 538
65. Norrie also argues that when it is convenient, motive may be considered relevant, for example in permitting doctors to prescribe the contraceptive pill to girls under the age of 16 (see Gillick v West Norfolk AHA [1985] 3 All ER 402 (HL))
66. See also, A Ashworth, 'The Treatment of Good Intentions', in A Simester and A Smith, Harm and Culpability (Oxford University Press, Oxford, 1996)
67. The double effect doctrine was first outlined in the case of R v Adams [1957] Crim LR 365. Devlin J (as he then was) famously said that a doctor, '... is entitled to do all that is proper and necessary to relieve pain and suffering, even if the measures he takes may incidentally shorten life'. More recently however, experts in palliative care have argued that it is a fallacy to say that appropriate use of analgesia and/or sedative medication causes death.
68. See for example, N Sykes and A Thorns, 'Sedative Use in the Last Week of Life and the Implications for End-of-life Decision Making' (2003) 163 Archives of International Medicine 341-344
69. See R v Woollin [1998] 4 All ER103. Interestingly, J Keown opined that Woollin might have a 'chilling effect on the provision of much needed palliative care and leave patients dying in pain and distress'.
70. (See Euthansia, Ethics and Public Policy: An Argument Against Legalisation (Cambridge University Press, Cambridge 2002) 28-9
71. However, there is no evidence to suggest that Keown's post Woollin fears have transpired. For example the double effect doctrine was successfully relied upon by Dr Howard Martin in 2005.
72. See 'Doctor Cleared of Murder Investigated Over 12 Other Deaths', The Independent, Friday, December 16 2005
73. More recently, Martin has apparently confessed to hastening the deaths of a number of other patients
74. See 'GP 'admits hastening' terminal patient's death', June 19 2010, .
75. Also, in relation to a doctor withdrawing life-sustaining treatment, motive is central to a rather curious provision of the Mental Capacity Act 2005 relating to the withdrawal of life-sustaining treatment. S 4(5) states, 'Where the determination relates to life-sustaining treatment he must not, in considering whether the treatment is in the best interests of the person concerned, be motivated by a desire to bring about his death'.
76. See J Coggon, 'Ignoring the Moral and Intellectual Shape of the Law after Bland' (2007) 27(1) Legal Studies 110
77. The Law Commission (2006) Murder, Manslaughter and Infanticide'. Project 6 of the Ninth Programme of Law Reform; Homicide (Law Com No 304, London).
78. Arts 211-3 of the German Penal Code
79. Art 106 of the Columbian Penal Code. For further consideration of the Columbian legal position, see Sabine Michlowski, 'Legalising Active Voluntary Euthanasia Through the Courts: Some Lessons from Columbia' (2009) 17 Med L Rev 183-218.
80. See P Lewis, Assisted Dying and Legal Change (Oxford University Press, Oxford 2007)
81. Also P Lewis, 'The Evolution of Assisted Dying in France: A Third Way?' (2005) 13(4) Med L Rev 44
82. Comite Consultatif National d'Ethique (CNNE)
83. See Lewis (n 58, above) 109
84. P Boucard, 'Commentary on the Opinion of the CNNE of 27 January 2000 entitled "end of life, ending life, euthanasia" ' (2000) 48(6) Laennec 10 at 15
85. Purdy HL (n 2, above) at para 59
86. K Greasley, 'Case comment: R (Purdy) v DPP and the Case for Wilful Blindness' (2010) 30(2) Oxford Journal of Legal Studies 301-326, at 307
87. See, for example, the case of Gilderdale, discussed below and at n 38. Given that, as R Huxtable has observed, any 'jury will be drawn from a population apparently in thrall to the idea of assisted suicide' (Huxtable, n 29 at 67) jury nullification is likely.
88. Re A (Conjoined Twins) [2001] Fam 147, 239, 211
89. See the Assisted Dying for the Terminally Ill Bill - First Report, Sessions 2004-05, .
90. Lord Joffe's Bill began its journey embracing voluntary euthanasia but was later considerably diluted to include only PAS
91. In 1994, a House of Lords Select Committee on Medical Ethics firmly opposed any relaxation in the law. (See 'Report of the Select Committee on Medical Ethics', HL Paper 21, London: Her Majesty's Stationary Office.) Thus, the neutral stance adopted by the Committee convened to consider the Joffe Bill demonstrates some shift in Parliamentary attitudes.
92. Or at least having ascertained, for example, that the person wanting to die is suffering unbearably from a terminal illness and that there are no other means of alleviating the suffering
93. For example, a degree of tolerance in relation to the personal use/consumption of illegal drugs has not resulted in legalisation
94. For example, Greasley (n 64, above) argues that in compelling the DPP to promulgate such a Policy, the House of Lords have taken a retrograde step. Greasley's contention is that the previous practice of turning a blind eye to assisted suicide, in a climate of uncertainty as to what exactly constituted prosecutorial policy, was a preferable state of affairs.
95. Identified by R Inglehart, The Silent Revolution (Princetown University Press, Princetown, NJ 1977), who argued that there is a connection between prosperity and value orientation, such that people living without threat to their livelihood move beyond concerns over safety and security, focusing instead on freedom, self-expression, and quality of life
96. Discussed in J Griffiths, H Weyers and M Adams, Euthanasia and the Law in Europe (Hart Publishing, Oxford 2008) 15
97. In conclusion to their discussion of which countries are most likely to legalise some form of assisted dying, and notwithstanding that 'prediction is very difficult', Griffiths and Weyers predict that England is likely to be the next country to legalise some form of assisted dying
98. For example, Debbie Purdy and, for very different reasons, Kay Gilderdale
99. For example, a recent BBC poll, carried out for a 'Panorama' programme on the Gilderdale case, suggests that almost three-quarters of people support the assisted suicide in cases where the person wanting to die has a terminal illness. Support falls to just below half if the illness is painful but not terminal.
100. See Poll Support for Mercy Killings, at .
101. These results are similar to the results of other such polls. As the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill reported, following consideration of a number of polls, 'It is evident that there is a great deal of sympathy, at least for the concept of euthanasia'. See n 67, above, at para 218.
102. More than 1500 respondents argued that it may be discriminatory to include factors relating to the health and disability status of the victim
103. See the 'Public Consultation Exercise on the Interim Policy, Annex B - Equality and Diversity Impact Assessment', para 25 .
104. Perhaps also pertinent to this aspect of the final Policy is that following publication of the interim guidelines in September 2009, an Early Day Motion 302 was laid in the House of Commons calling for the policy to be withdrawn on the basis that it overrides the will of Parliament by indicating to would-be offenders how to avoid prosecution, and also puts vulnerable people at grave risk
105. For example see J Keown, Euthanasia, Ethics and Public Policy: An Argument against Legalisation (Cambridge University Press, Cambridge 2002)
106. For a response to Keown's treatise, see S Smith, 'Evidence for the Practical Slippery Slope in the Debate on Physician-assisted Suicide and Euthanasia' (2005) 13(1) Med L Rev 17-44
107. And 'Fallacies of the Logical Slippery Slope in the Debate on Physician-assisted Suicide and Euthanasia' (2005) 13(2) Med L Rev 224-43
108. See also, H Lillehammer, 'Voluntary Euthanasia and the Logical Slippery Slope Argument' (2002) 61 (3) Cambridge LJ 545-50
109. Greasley, n 64, above, 321
110. See for example, JAC Rietjens and others, 'Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain?' (2009) 6 Bioethical Enquiry 271-83.
111. See also, MP Battin and others, 'Legal Physician-assisted Dying in Oregon and the Netherlands: Evidence Concerning the Impact on Patients in "Vulnerable Groups" ' (2007) 33 JME 591-7
112. S McLean, 'Assisted Dying: Reflections on the Need for Law Reform' (Routledge Cavendish, Oxford, New York 2007) 64
113. See, M Nussbaum, 'Compassion: the Basic Social Emotion' (1996) 13(1) Social Philosophy and Policy 27-58
114. Interestingly, this account of pity/compassion infers that compassion is to some degree a self-centred emotion, because it is invoked partially because of fear that the same fate could befall the person feeling compassion
115. Although it may be argued that a person suffering emotionally, from grief, terrible personal problems or professional disgrace for example, might equally be seen to experience serious suffering. I concede that there may be extremely rare cases where a person assisting in the suicide of such an emotionally troubled victim might be viewed as having been wholly motivated by compassion, but the likelihood of this is extremely low.
116. Para 43(2) of the Policy refers to capacity as defined by the Mental Capacity Act 2005. S 3 provides that a person lacks capacity if he or she is unable to make decisions because of being unable to; (1)(a) understand the information relevant to the decision, (b) retain that information, (c) to use or weigh that information as part of the process of making that decision, or (d) communicate that decision.
117. In Switzerland, non-selfish or altruistic assistance in suicide is not an offence irrespective of the health of the deceased, provided that the deceased had decisional capacity. Interestingly, unlike other jurisdictions in which assisted dying is permitted, Swiss law on assisted suicide (codified in 1918) was shaped upon motivations of 'honour and romance' rather than motives relating to health and suffering.
118. See SA Hurst and A Mauron, 'Assisted Suicide and Euthanasia in Switzerland: Allowing a Role for Non-physicians' (2003) 326(1) BMJ 271-3
119. The Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2002
120. See also J Griffiths, H Weyers and M Adams, Euthanasia and the Law in Europe (Hart Publishing, Oxford 2008) 84
121. The unbearable suffering must be attributable to a medically diagnosed physical or psychiatric condition
122. The Oregon Death with Dignity Act 1994
123. HL decision in Purdy (n 2, above), para 66, citing evidence from the National Centre for Social Research, British Societal Attitudes, The 23rd Report (London, 2007) ch 2
124. See Policy, para 14, n 4, above
125. See 'Public Consultation Exercise on the Interim Policy for Prosecutors in Respect of Cases of Assisted Suicide Issued by the Director of Public Prosecutions Summary of Responses', at s 3 (New Factors Identified in favour of Prosecution) (www.cps.gov.uk).
126. The interim guidelines had included as a factor in favour of prosecution; (14) The suspect was paid to care for the victim in a care/nursing home environment
127. C O'Neill and others, 'Attitudes to Physician and Family Assisted Suicide; Results from a Study of Public Attitudes in Britain' (2002) 28 J Med Ethics 52
128. See C Dyer, 'Doctors Face Greater Risk of Prosecution than the Public for Assisting Suicide' (2010) 340 BMJ 1167
129. For more details of the application process for Dignitas, together with discussion of suicide tourism generally see, R Huxtable, 'The Suicide Tourist Trap: Compromise Across Boundaries' (2009) 6 Bioethical Enquiry (2009) 327-36
130. Evidentially, the doctor's act in providing/releasing the information would be capable of assisting or encouraging a suicide or attempt, thereby satisfying the actus reus of the offence. Acting in the knowledge (with the foresight) that the attempt/suicide would be virtually certain to follow (see R vWoollin [1998] 4 All ER103) would suffice to demonstrate that the doctor had the mens rea for the offence of assisting or encouraging suicide.
131. See A local Authority v Z (An Adult: Capacity)[2004] EWHC 2817, [2005] 1 W.L.R. 959, 3 All ER 280, in which a local authority attempted to prevent a patient from travelling abroad for an assisted suicide.
132. For case comment, see P de Cruz, 'The Terminally Ill Adult Seeking Assisted Suicide Abroad: The Extent of the Duty Owed by a Local Authority' (2005) 13(2) Med L Rev 257-67
133. For example, Dr Michael Irwin escaped prosecution following his attempt to assist a friend, although the GMC struck him off
134. See 'Euthanasia Doctor is Struck Off', BBC News, September 27 2005, .
135. In fact, Irwin's friend, who was suffering from cancer, died without taking the pills. Dr Irwin was also questioned by police in 2006 for assisting May Murphy to travel to Switzerland for an assisted suicide. He had previously admitted advising five other Britons who were considering travelling to Dignitas. (See R Huxtable, n 29, above.) It should be noted, however, that as a prominent right-to-die campaigner, Irwin's (former) occupation as a physician was perhaps only incidental to his involvement in allegedly assisting in suicide.
136. Such an act being only of minor assistance (see para 45(3) of the Policy)
137. With only illicit advice being available, for example, an Australian doctor, Nitschke, has organised suicide workshops for the over 50s in English seaside retirement havens, as well as publishing advice on the internet and even offering for sale suicide drug testing kits
138. See "Dr Death' Philip Nitschke reveals secrets of a peaceful exit', The Times, May 6 2009
139. Also, despite the inclusion of a factor (para 43(11)) designed to discourage people from using the internet as a means of obtaining information/advice about suicide, it remains very difficult to prevent such information from being made available
140. See n 64, above
141. S Ost, 'The De-medicalisation of Assisted Dying: Is a Less Medicalised Model the Way Forward?' (2010) 18(4) Med L Rev ??
142. For example see C Seale, 'Legalisation of Euthanasia or Physician-assisted Suicide; Survey of Doctor's Attitudes' (2009) 23 Palliat Med 205, 209
143. The survey revealed that the majority of doctors were opposed to any legalisation of PAS or voluntary euthanasia. Interestingly, in 2009, the Royal College of Nursing dropped its opposition to assisted dying in favour of neutrality on the issue.
144. See 'RCN neutral on assisted suicide', BBC news, July 25 2009 .
145. The amendment to the Bill, which was defeated in 2009, required that two medical practitioners would assess that the person seeking suicide was both terminally ill and mentally competent. Additionally, the person would have to make a declaration of their intention to die in writing witnessed by an independent person.
146. Nick Cartwright, '48 Years On; Is the Suicide Act Fit for Purpose?' (2009) 17(3) Med L Rev 467