Page last updated at 04:59 GMT, Wednesday, 2 September 2009 05:59 UK

A matter of life or death

Dr James Armstrong
VIEWPOINT
Dr James Armstrong
Medical Defence Union medico-legal adviser

Debbie Purdy and husband Omar Puente outside the High Court in London
Debbie Purdy and husband Omar Puente are challenging the law on assisted suicide

It is not just friends and family who want clarity about potential criminal prosecutions for helping someone travel abroad for an assisted suicide - doctors too may face criminal proceedings for offering advice or assistance under the current law.

In this week's Scrubbing Up, the Medical Defence Union's Dr James Armstrong warns that doctors may be putting their livelihood and liberty on the line by becoming involved.

In the early 1960s, parliament took the decision to decriminalise suicide in England and Wales and at the same time created a new statutory offence of assisting a suicide.

The Suicide Act 1961 says "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 Director of Public Prosecutions (DPP).

This law has been the subject of much debate in recent years, particularly in the context of patients, often terminally ill, who may wish to travel to a jurisdiction where assisted suicide is legal such as Switzerland.

Doctors could face a criminal investigation if alleged to have assisted with the act

Because in many cases the patient would be unable to travel without the help of loved ones, the concern arises that friends and family members might face prosecution for aiding and abetting a suicide.

But a related area that has received less coverage concerns doctors being approached by patients for advice about ending their lives with the help of assisted suicide groups abroad.

Closely involved

The MDU has received queries from doctors seeking advice about how to respond to such requests.

Examples include patients asking for a medical report on their condition, either to assist with travel arrangements or because it has been requested by the organisation that is providing the assisted suicide service.

In other cases, patients have asked their doctors for a letter confirming that they have sufficient mental capacity to make a decision to end their own life.

Doctors will often be closely involved in the care of a terminally ill patient and may sympathise with the patient's predicament - and such requests can create a considerable dilemma for them.

But assisting a suicide is illegal in England, Wales and Northern Ireland and doctors should not give advice or assistance to patients to help them travel abroad to take their own lives.

Doctors could 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.

Even if criminal proceedings do not follow, the General Medical Council might still decide to investigate the doctor's fitness to practise.

Appeal

Although amendments to the law have been put forward and debated more than once in Parliament over recent years, the law remains unchanged.

However Debbie Purdy, who has multiple sclerosis, recently won her appeal to have the prosecution policy on assisted suicide clarified.

She is 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 MDU's advice to doctors to tread very cautiously indeed will remain unchanged

The Law Lords unanimously decided that Mrs Purdy, and those who find themselves in a similar situation, should have some clearer indication of how prosecution discretion is likely to be applied.

The DPP, Keir Starmer, is to publish an interim policy outlining the principal factors for and against prosecution by the end of September, before putting the issue out to public consultation in advance of a finalised policy to be published in spring 2010.

It is not known whether the DPP's policy will address the issue of doctors who are approached for advice or assistance by patients who wish to travel abroad for an assisted suicide.

But in the absence of a clear and unambiguous statement of policy or a change in the law, the MDU's advice to doctors to tread very cautiously indeed will remain unchanged.




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