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Doctors face greater risk of prosecution than the public for assisting suicide

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1167 (Published 26 February 2010) Cite this as: BMJ 2010;340:c1167
  1. Clare Dyer
  1. 1BMJ

    Doctors face a greater risk of prosecution if they assist a patient to commit suicide than do the individual’s family members or friends, under final guidelines on assisting a suicide in England and Wales issued by the director of public prosecutions.

    The decision to make it a factor in favour of prosecution that the suspect was a doctor, nurse, or other healthcare professional caring for the person who committed suicide is a change from the interim policy, issued last September, which treated doctors and nurses the same as anybody else (BMJ 24 September 2009, doi:10.1136/bmj.b3935).

    The final guidance follows nearly 5000 responses to interim guidance outlining the factors that would influence the chief prosecutor in deciding whether or not to prosecute for assisting a suicide, a crime in England and Wales carrying a maximum sentence of 14 years in jail.

    The director of public prosecutions, Keir Starmer, was required to make the policy clear as a result of a ruling by the law lords in the case of Debbie Purdy, who has multiple sclerosis and wanted to make sure, as far as possible, that her husband would not be prosecuted if he helped her travel to the Dignitas assisted suicide centre in Zurich.

    The final policy incorporates other important changes from the interim policy, and now focuses more on the motivation of the suspect than on characteristics of the person who has committed suicide—described in shorthand as the “victim.”

    The factors against prosecution are that the victim had reached a “voluntary, clear, settled and informed” decision to commit suicide; the suspect was wholly motivated by compassion, gave only minor assistance and attempted to dissuade the victim; the suspect’s actions could be characterised as “reluctant” assistance; and the suicide was reported to police.

    One factor against prosecution in the interim policy—that the victim had a terminal illness, a severe and incurable physical disability, or a severe degenerative physical condition—has been removed altogether after representations that it discriminated against disabled people or suggested that their lives were less valuable than those of the able bodied.

    And the guidelines no longer make it a factor against prosecution that the suspect was a spouse, partner, close relative, or close personal friend of the victim.

    Some 34% of answers to a question in the consultation seeking additional factors that should incline towards prosecution suggested the fact that the suspect was a health professional caring for the victim.

    The BMA in its response to the consultation argued that the interim policy could be interpreted as treating physician assisted suicide more leniently, because one factor said to militate against prosecution was that the assistance was given in the course of the suspect’s usual lawful employment. This was intended to cover, for example, public transport workers who drove the victim to the suicide location but the director of public prosecutions accepted that it was ambiguous and dropped it from the final policy.

    The Medical Defence Union said it had “grave concerns” about how the final policy would be applied to doctors. Ian Barker, a solicitor with the MDU, said, “Doctors who are usually legally required to provide reports and/or medical records when requested to do so by patients may find themselves in some difficulty when the patient who is requesting them is contemplating assisted suicide.

    “The MDU’s advice to its members remains that doctors approached by patients for advice about suicide should not engage in discussion which assists the patient to that end. Members who are faced with requests for help from patients, including for example the provision of medical reports, should contact us for advice.”

    The 16 factors in favour of prosecution include that the victim was under 18 years, lacked capacity, had been pressurised by the suspect, or had not clearly and unequivocally communicated the decision to commit suicide.

    Mr Starmer stressed that the guidance covers only those cases where someone takes his or her own life with assistance, and not cases of mercy killing.

    “The policy does not open the door for euthanasia or so-called mercy killings. They are quite different from assisted suicide and fall to be considered as murder or manslaughter,” he said.

    “The act of suicide requires the victim to take his or her own life. Euthanasia and mercy killing are where the suspect takes the life of another.”

    Notes

    Cite this as: BMJ 2010;340:c1167

    Footnotes

    • The final guidance, the Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide, can be seen at www.cps.gov.uk

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