Relying on common law defences to legalise assisted dying: Problems and possibilities

Medical Law Review

Volumn 21, Issue 3, 2013, Pages 337-370

  Michalowski, Sabine ^a  

^a UNIVERSITY OF ESSEX   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ASSISTED DYING; ASSISTED SUICIDE; DEFENCE OF CONSENT; HUMAN; INFORMED CONSENT; LEGAL ASPECT; MENTAL CAPACITY; NECESSITY DEFENCE; PERSONAL AUTONOMY; PHYSICIAN; TREATMENT REFUSAL; UNITED KINGDOM;

ASSISTED DYING; DEFENCE OF CONSENT; NECESSITY DEFENCE;

GREAT BRITAIN; HUMANS; INFORMED CONSENT; MENTAL COMPETENCY; PERSONAL AUTONOMY; PHYSICIANS; SUICIDE, ASSISTED; TREATMENT REFUSAL;

EID: 84883141444     PISSN: 09670742     EISSN: 14643790     Source Type: Journal    
DOI: 10.1093/medlaw/fws037     Document Type: Article

References (134)

1. Airedale NHS Trust v Bland [1993] AC 789 (HL), at 864 per Lord Goff; Re T (Adult: Refusal of Treatment) [1993] Fam 95 (CA), at 103 per Lord Donaldson MR; Re MB (Medical Treatment) [1997] 2 FLR 426 (CA), at 432 per Butler-Sloss LJ
2. B v An NHS Hospital Trust [2002] EWHC 429
3. Airedale NHS Trust v Bland, at 866 per Lord Goff
4. See s.2(1) of the Suicide Act 1961, as amended by s.59 of the Coroners and Justice Act.
5. See, for example, N Cartwright, '48 Years on: Is the Suicide Act Fit for Purpose?' (2009) 17 Med LR 467; R (on the application of Purdy) v DPP [2008] EWHC 2565; [2009] EWCA Civ 92; [2009] UKHL 44
6. See report of the debate in Hansard (HL Debates), 7 July 2009, cols 595-634
7. Regina (Purdy) v Director of Public Prosecutions [2009] 3 WLR 403 (HL)
8. CPS Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide 2010, www.cps.gov.uk/publications/prosecution/assisted_suicide_ policy.html guidelines.
9. For a discussion see, for example, P Lewis, 'Informal Legal Change on Assisted Suicide: the Policy for Prosecutors', (2011) 31 Legal Stud 119
10. K Greasley, 'R. (Purdy) v DPP and the Case for Wilful Blindness', (2010) 30 OJLS 301
11. R Daw and A Solomon, 'Assisted Suicide and Identifying the Public Interest in the Decision to Prosecute', (2010) Crim L 737
12. J Rogers, 'Prosecutorial Policies, Prosecutorial Systems, and the Purdy Litigation' (2010) Crim L 543
13. G Williams, 'Assisting Suicide, the Code for Crown Prosecutors and the DPP's Discretion' (2010) 39 CLWR 181
14. J Montgomery, 'Guarding the Gates of St Peter: Life, Death and Law Making' (2011) 31 Legal Stud 644
15. A Mullock, 'Overlooking the Criminally Compassionate: What Are the Implications of Prosecutorial Policy on Encouraging or Assisting Suicide?' (2010) 18 Med L 442
16. See, for example, the Report of the Commission on Assisted Dying, 'The current legal status of assisted dying is inadequate and incoherent...' (2011), title page, http://www.demos.co.uk/publications/thecommissiononassisteddying.
17. R (on the application of Tony Nicklinson) v Ministry of Justice, [2012] EWHC 2381 (Admin); Nicklinson v Ministry of Justice [2012] EWHC 304 (QB)
18. JK Mason and GT Laurie, Mason and McCall Smith's Law and Medical Ethics (8th edn OUP, Oxford 2011) 65
19. Re A (Conjoined Twins: Medical Treatment) [2001] 1 FLR 1, at 99 per Brooke, LJ
20. W Wilson, Criminal Law (4th edn Pearson, Harlow 2011) 256-7
21. This discussionwouldmerit an article in itself, if not amonograph. For some important texts dealingwith the difficultmoral and legal issues raised by these fundamental questions, see, for example, R Dworkin, Life's Dominion (Harper Collins Publishers, Glasgow 1993)
22. M Otlowski, Voluntary Euthanasia and the Law (OUP, Oxford 1997)
23. J Harris, 'Euthanasia and the Value of Life' in J Keown (ed), Euthanasia Examined (CUP, Cambridge 1995) 6-22
24. E Jackson and J Keown, Debating Euthanasia (Hart Publishing, Oxford 2012)
25. J Keown, Euthanasia, Ethics and Public Policy (CUP, Cambridge 2002)
26. For example, Switzerland, Oregon, Washington, and Montana allow only assisted suicide but not euthanasia, see Report of the Commission on Assisted Dying, above n 16, 65. For an ethical discussion see, for example, House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill, HL Paper 86-1, at 243-6. For the Dutch approach which allows both euthanasia and physician-assisted suicide, see J Griffiths, A Bood, HWeyers, Euthanasia and Law in the Netherlands (Amsterdam University Press, Amsterdam 1998) 111-4.
27. This is probably the most contentious issue, as consensus on limiting criteria is difficult to obtain and all choices will be open to challenges of arbitrariness and discrimination. See, for example, the discussion of the criteria of the applicant's physical condition and experience of suffering in the Report of the Commission on Assisted Dying, above n 16, 194-204
28. JL Underwood, 'The Supreme Court's Assisted Suicide Opinions in International Perspective: Avoiding a Bureaucracy of Death' (1997) 73 North Dakota LR 641
29. Y Kamisar, 'The "Right to Die": on Drawing (and Erasing) Lines' (1996) Duquesne LR 481
30. For a comparative analysis of control mechanisms in systems which allow for assisted dying, see briefing paper commissioned by the Commission on Assisted Dying: P Lewis and I Black, 'The Effectiveness of Legal Safeguards in Jurisdictions that Allow Assisted Dying' (Demos 2012), http://www. commissiononassisteddying.co.uk/wp-content/uploads/2012/01/Penney-Lewis-briefing-paper.pdf.
31. Lewis, above n 14, 134
32. Airedale NHS Trust v Bland, at 882 per Lord Browne-Wilkinson; Re T (Adult: Refusal of Treatment), at 102 per Lord Donaldson MR
33. See, for example, s.63 of the Mental Health Act 1983.
34. Mason, Laurie, above n 20, 65
35. Airedale NHS Trust v Bland, at 864 per Lord Goff; Re T (Adult: Refusal of Treatment), at 103 per Lord Donaldson MR; Re MB (Medical Treatment), at
36. per Butler-Sloss LJ
37. Re T (Adult: Refusal of Treatment), at 112 per Lord Donaldson MR
38. See, for example, St. George's Healthcare [1998] 3 WLR 936, at 951, quoting S. v. McC. (orse. S.) and M. (D.S. intervener);W. v.W. [1972] A.C. 24, at 43.
39. Airedale NHS Trust v Bland, at 864 per Lord Goff. See also D Price, 'Assisted Suicide and Refusing Medical Treatment: Linguistics, Morals and Legal Contortions (1996) 4 Med LR, 293.
40. R (on the application of Burke) v General Medical Council [2005] 3 WLR 1132
41. Airedale NHS Trust v Bland, at 882 per Lord Browne-Wilkinson; Sidaway v Bethlem Royal Hospital [1985] AC 871, at 882 per Lord Scarman. See also J Herring, Medical Law and Ethics (3rd edn OUP, Oxford, 2009) 25.
42. Airedale NHS Trust v Bland, at 827 per Lord Hoffmann
43. For a detailed discussion, see Griffiths and others, above n 26, 61-8; P Lewis, Assisted Dying and Legal Change (OUP, Oxford 2007) 76-83 and 97-108
44. Re A (Conjoined Twins: Medical Treatment), at 99 per Brooke LJ
45. R v Dudley and Stephens (1884) 14 QBD 273; R v Howe [1987] AC 417, at
46. C per Lord Griffith, and 453 D-E per Lord Mackay
47. R v Dudley and Stephens, at 287-8; R v Howe, at 439 C and at 433 C per Lord Hailsham
48. Wilson, above n 23, 259
49. A Ashworth, Principles of Criminal Law (6th edn OUP, Oxford, 2009) 131
50. D Ormerod, Smith & Hogan's Criminal Law (13th edn OUP, Oxford 2011) 370
51. Re A (Conjoined Twins: Medical Treatment)
52. Re A (Conjoined Twins: Medical Treatment), at 98 per Brooke LJ
53. R v Dudley and Stephens, at 286-8
54. Re A (Conjoined Twins: Medical Treatment), at 98 per Brooke LJ
55. See also S Ost, 'Euthanasia and the Defence of Necessity: Advocating a More Appropriate Legal Response', [2005] Crim LR 355, 365 and 367
56. Re A (Conjoined Twins: Medical Treatment) [2001] 1 FLR 1, at 61 perWard LJ. For a narrow interpretation of this statement, see Lewis, above n 45, 87-8
57. A Norrie, 'Legal Form and Moral Judgement: Euthanasia and Assisted Suicide' in A Duff and others (eds) The Structures of Criminal Law (OUP, Oxford 2011) 134
58. Re A (Conjoined Twins: Medical Treatment), at 98
59. For the argument that in the case of Re A no real conflict of duties that could have justified the killing of Mary existed, see S Michalowski, 'Sanctity of Life - Are Some Lives More Sacred than Others?', (2002) 22 Legal Stud 377, 393-4
60. Re A (Conjoined Twins: Medical Treatment), at 86, quoting G Williams, Textbook of Criminal Law (2nd edn Stevens & Sons, London 1983), 604. See also Ost, above n 59, 378.
61. That is he/she must act with the primary purpose to relieve suffering, while accepting the risk of shortening life as no more than an inevitable, though undesired, side-effect of the medication. See, for example, See Re J [1991] Fam 33, at 46 per Lord Donaldson MR; R v Cox (1992) 12 BMLR 38, at 41 per Ognall J.
62. See, for example, Airedale NHS Trust v Bland, at 820 per Butler Sloss with reference to Re J. For a discussion see also D Price, 'What Shape to Euthanasia after Bland? Historical, Contemporary and Futuristic Paradigms' (2009) LQR 142, 152-3.
63. Re J, at 46
64. See, for example, I Kennedy and A Grubb, Medical Law (3rd edn Butterworths, London 2000) 2111-7
65. Jackson, above n 25, 14-16; Keown (2002), above n 25, 15-30
66. For the administration of painkilling drugs, see Mason and Laurie, above n 20, 579
67. Jackson, above n 25, 15; for withdrawal of treatment, see Airedale NHS Trust v Bland, at 866-67 per Lord Goff
68. Mason and Laurie, above n 20, at p 65; Kennedy and Grubb, above n 73, 575
69. R v Brown [1994] 1 AC 212. In Laskey v UK (Application no. 21627/93; 21628/93; 21974/93) (1997), the European Court of Human Rights held that to regard consent to these practices as invalid was compatible with the ECHR. For a critical discussion of R v Brown, see, for example, Ashworth, above n 53, 309-314
70. M Jefferson, Criminal Law (10th edn Pearson, Harlow 2011) 518-24
71. A-G's Reference (No.6 of 1980) [1981] QB 715, at 719 per Lord Lane, quoted with approval in R v Brown, at 233 per Lord Templeman; at 243 per Lord Jauncey; and at 255 per Lord Lowry.
72. R v Brown, at 255 per Lord Lowry
73. A-G's reference (No.6 of 1980), at 719.
74. R v Brown, at 258-9 per Lord Mustill
75. Airedale NHS Trust v Bland, at 891 per Lord Mustill
76. For a discussion, see, for example, S Cooper and M James, 'Entertainment - the Painful Process of Rethinking Consent' [2012] Crim LR 188; Wilson, above n 23, 304-9
77. Cooper and James, above n 85, 191
78. Corbett v Corbett [1971] P. 83, at 99.
79. For a discussion, see PDG Skegg, Law, Ethics and Medicine (Clarendon, Oxford 1984) 36-8
80. also, more generally, A Maclean, Autonomy, Informed Consent and Medical Law (CUP, Cambridge 2009) 115-6
81. T Elliott, 'Body Dysmorphic Disorder, Radical Surgery and the Limits of Consent' (2009) 17 Med LR 149, 178-81
82. R v Wilson [1997] QB 47, at 50
83. R v Dica [2004] QB 1257, at 1269; R v Barnes [2005] 1 WLR 910, at 914; Jefferson, above n 79, 164
84. Airedale NHS Trust v Bland, at 892-3
85. Baxter v State of Montana, 54 Mont. 234 (Supreme Court of Montana 2009).
86. R v Wilson, at 50
87. Baxter v State of Montana, at 245
88. Most US courts seem to uphold the validity of the act/omission distinction, see, in particular, Vacco v Quill, 521 U.S. 793 (1997), at 800-1 per Chief Justice Rehnquist; Krischer v McIver, 697 So.2d 97 (Supreme Court of Florida, 1997), at 101-3; Sampson v Alaska, 31 P.3d 88 (Supreme Court of Alaska 2001), at 99.
89. Airedale NHS Trust v Bland, at 866 per Lord Goff; at 881-4 per Lord Browne-Wilkinson; at 887 per Lord Mustill who, while expressing dissatisfaction with this distinction, nevertheless confirmed its recognition in English criminal law. For a critical analysis of the distinction, see, for example, E Jackson, 'Whose Death Is It Anyway? Euthanasia and the Medical Profession' (2004) 57 CLP 415
90. G Dworkin, 'Public Policy and Physician-Assisted Suicide' in G Dworkin, R G Frey and S Bok, Euthanasia and Physician-Assisted Suicide: For and Against (CUP, Cambridge 1998) 64, 67; Price, above n 36, 292
91. S McLean, Autonomy, Consent and the Law (Routledge-Cavendish, London and New York 2010) 114
92. See, for example, St. George's Healthcare, at 951, quoting S. v. McC. (orse. S.) and M. (D.S. intervener); W. v. W., at 43.
93. For a critical discussion of this point, see D Orentlicher, 'The Alleged Distinction Between Euthanasia and the Withdrawal of Life-sustaining Treatment: Conceptually Incoherent and Impossible to Maintain' (1998) University of Illinois LR 837, 847
94. But see Price, above n 71, 162-3
95. But see A Meisel, 'Physician-assisted Suicide: a Common Law Roadmap for State Courts' (1997) Fordham Urban LJ 817, 850
96. Lewis, above n 45, 76
97. Griffiths and others, above n 26, 65-7
98. For a discussion, see, for example, Mason and Laurie, above n 20, 596-600
99. Above n 13
100. See Report of the Commission on Assisted Dying, above n 16, 85-86
101. See R (on the application of Pretty) v DPP; Regina (Purdy) v Director of Public Prosecutions; Nicklinson v Ministry of Justice
102. For a similar conclusion regarding a comparison between the Netherlands and the US, see Griffiths and others, above n 26, 111
103. R (on the application of Burke) v General Medical Council, at 1147-8
104. See Griffiths and others, above n 26, 171, note 41, with further references
105. J Griffiths, H Weyers and M Adams, Euthanasia and Law in Europe (Hart, Oxford 2008) 77, note 103
106. See Griffiths and others, above n 26, 171, note 41, quoting G Den Hartogh, 'Recht op de dood? Zelfbeschikking en barmhartigheid als rechtvaardigingsgronden voor euthanasie' (1996) 22 Recht en Kritiek 148, at 167
107. See, in particular, the Schoonheim decision of the Dutch Supreme Court of
108. November 1984, nr.77.091, as translated into English in Griffiths and others, above n 26, 322-8.
109. Griffiths and others, above n 124, 33
110. For the codified version of the due care criteria, see s.2 of the Dutch Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2002.
111. United States Supreme Court Amicus Brief, Washington v Glucksberg; Vacco v Quill, Brief for Ronald Dworkin, Thomas Nagel, Robert Nozick, John Rawls, Thomas Scanlon, and Judith Jarvis Thomson as amici curiae in support of respondents, at 12. See also Griffiths and others, above n 26, 168.
112. Whether this is currently limited to a right to assisted suicide or includes access to euthanasia is not clear, as the European Court of Human Rights so far has only had to deal with the former
113. R (on the application of Burke) v General Medical Council, at 1147-8
114. Ormerod, above n 53, 644
115. AP Simester and others, Simester and Sullivan's Criminal Law (4th edn Hart, Oxford 2010) 782
116. The Dutch approach involved the development of a list of due care criteria that applied to all cases of assisted dying and determined whether or not the physician's choice regarding how to resolve the conflict of duties in the individual case was legally justifiable, combined with a reporting requirement, see Griffiths and others, above n 124, 79 and 81
117. For a comparable argument in the context of a discussion of the excusatory nature of the DPP's guidelines see Greasley, above n 14, 308
118. R v Quayle [2005] 1 WLR 3642, at 3679
119. For a critical discussion of the English approach to consent, see Simester and others, above n 152, 762-6
120. H Lillehammer, 'Voluntary Euthanasia and the Logical Slippery Slope Argument' (2002) 61 CLJ 545
121. SW Smith, 'Fallacies of the Logical Slippery Slope in the Debate on Physician-Assisted Suicide and Euthanasia' (2005) 13 Med LR 224. For an interesting discussion, see Price, above n 71, 164-8.
122. Keown (2002), above n 25, 76-9. See also Price, above n 71, 168; Lewis, above n 45, 167.
123. See, for example, Griffiths and others, above n 26, 119-34; Lewis, above n 45, 127-36
124. See also Lewis, above n 45, 144 and 167
125. Airedale NHS Trust v Bland
126. For a discussion see, for example, J Keown, 'Restoring Moral and Intellectual Shape to the Law after Bland' (1997) 113 LQR 481
127. Airedale NHS Trust v Bland, at 864 per Lord Goff; Re T (Adult: Refusal of Treatment), at 103 per Lord Donaldson MR
128. Airedale NHS Trust v Bland, at 892-3 per Lord Mustill
129. See also Lewis, above n 14, 119-20; Rogers, above n 14, 548-50
130. Report of the Commission on Assisted Dying, above n 16, 194-204
131. See, for example, s.2(2)(b) of the Assisted Dying for the Terminally Ill Bill 2005 (HL Bill 36, 54/1).
132. The fact that all recommendations in favour of legalising assisted dying include qualifying criteria beyond capacity and consent is a clear indication of this
133. Report of the Commission on Assisted Dying, above n 16, 303-7
134. Mason and Laurie, above n 20, 591