New Internationalist

Should assisted suicide be legalized?

March 2012

Right-to-die campaigner Debbie Purdy and palliative medicine professor Ilora Finlay go head-to-head.

Every month we invite two experts to debate, and then invite you to join the conversation online.


The current situation in Britain, that forbids assisted dying yet permits it if the act is motivated by love and compassion without providing safeguards and opportunity for full discussion on the issue, is surely not the best we can come up with.

I agree with your letter in The Times last summer that palliative care is not a blanket panacea, and therefore believe that we must be prepared to open up a discussion about what we expect and want at the end of life. This is especially true given that the current situation is leading to early assisted deaths abroad and people living their final months full of suffering and extreme desperation due to a lack of choice.

A properly considered law with safeguards would enable doctors, social workers, families and even the clergy better to support the patient, and ensure they have considered every alternative.

I see it as I do voting: I despise people who put their cross next to the BNP but I wholeheartedly defend their right to do so. We don’t have to agree with the choices people make, but if we don’t like their choices our duty is to ensure that the alternatives are appealing. We should not prohibit choices just because we wouldn’t make them.


It’s not a question of agreeing or disagreeing with the choices that people express. I fully understand the argument that there could be highly exceptional circumstances where it might be acceptable to accede to a request to hasten someone’s death. But I would not legalize such acts any more than I would legalize other potentially understandable breaches of the law that might be committed in extreme circumstances – such as stealing food for your hungry child.

Legalization produces normalization. Look at the US State of Oregon. Since physician-assisted suicide (PAS) was legalized in 1997, such deaths have quadrupled. Oregon’s current PAS death rate would produce more than 1,000 assisted suicides in England and Wales every year. Yet with our law as it stands, fewer than 20 cases of assisted suicide cross the desk of the Director of Public Prosecutions (DPP) each year.

It’s easy to talk of choices, but decisions need accurate information, correctly understood. Safeguards for ‘assisted dying’ can help, but only if they provide a challenging process to screen out less-than-serious applicants. The safeguards so far proposed seem to be designed primarily to facilitate ‘assisted dying’ for a small minority of highly determined and strong-minded people rather than protect the vulnerable – from themselves and from others. Don’t forget that the law exists first and foremost to protect the weak and the vulnerable. It manages to do that while dealing sensitively with cases where genuinely compassionate circumstances have been present.


I’m glad you see some circumstances that would render assistance to die acceptable. How can society find solutions or even alternatives if it doesn’t talk about the situation? Surely a full, frank and honest discussion is needed to explore people’s needs in the 21st century.

The ‘20 cases that cross the DPP’s desk’ are, as you know, all patients who have travelled to Switzerland, but many don’t. Each year in Britain hundreds of people attempt suicide because they cannot cope with the pain or indignity of a medical condition. Some succeed, others result in further problems. Either way, I don’t believe this is a situation that people are prepared to brush under the carpet, much as parents being forced to steal to feed their children was one of the building bricks of our union movement and later the welfare state.

Your suggestion that PAS deaths in Oregon have increased uncontrollably is misleading. The Death with Dignity Law was passed in 1997. Ten years later, in 2007, 85 people received the medication to end their lives, 49 used it.

About 10 per cent of patients accessing palliative care (that’s approximately 1,500 people), had initially contacted their doctor about assisted death. The patients using PAS have remained at about 0.2 per cent of deaths (65 in 2010) but as their concerns have become more ‘public’ through complying with Death with Dignity laws, palliative care has become more accessible and Oregon has leapt up the table of quality providers in the last decade (it’s now second). Far from being an alternative to the provision of good-quality palliative care, the legal framework for assisted death has been a huge motivation for its improvement. If ‘normalization’ means we improve quality of end of life care and better communication between carers, patients and their family, I welcome it.


No-one is suggesting that we shouldn’t discuss how to relieve the suffering of terminally ill people. That is precisely what modern palliative care does, supporting people and working to maximize quality of life. But based on my experience of caring for thousands of dying people over 25 years, I don’t think helping them to kill themselves is the right way to deal with their suffering.

The cases that cross the DPP’s desk are not just those of people who have gone to Switzerland for assisted suicide (take the recent Gilderdale case, for example). They are cases where there is evidence that a suicide has been assisted, contrary to the law. You seem to imply that some seriously ill people commit suicide because assisted suicide is prohibited, but what evidence do you have for this linkage? We are not discussing suicide, but whether the law should be changed to allow some suicides to be assisted.

It’s unclear what point you are making about the number of physician-assisted suicides in Oregon. What I am saying is that the number of such suicides in 2010 was four times the number in 1998 and that the current death rate from PAS in Oregon would produce more than 1,000 such deaths in England and Wales every year.

Of course, palliative care has improved in Oregon: it has improved in most parts of the world, as a result of advances in care of the dying. Much of this progress has been spearheaded by Britain, which – unlike Oregon – recognizes palliative medicine as a clinical speciality. It is spurious to attribute Oregon’s improvement in palliative care to its legalization of physician-assisted suicide.


Gaeten Bally / PA Images
A room rented by euthanasia organization Dignitas, where those who have decided to die spend their last moments. Gaeten Bally / PA Images

I understand your point of view but thousands of people in Britain are discussing assisted dying and politicians need to catch up. Twenty-two Britons went to Dignitas last year, and 10 per cent of the 5,000 annual suicides are people with terminal or chronic illnesses – the link between illness and suicide needs to be explored. Kay Gilderdale had to face a charge of attempted murder (she was acquitted), and pleaded guilty to assisted suicide. That a compassionate mother who spent 17 years helping her daughter live – and when her daughter decided to end her life, supported her – found herself facing life imprisonment, is a clear signal that the law is not working.

If I had lost my legal case, I would have gone to Dignitas in 2009. So I strongly believe that if society had more open, honest discussion prior to a patient’s death, lives would be improved and saved.

I would campaign against legalization of assisted dying if I saw any evidence that people would suffer or be pressured into early deaths. Residents of Washington voted for assisted dying in greater numbers than those of their neighbour state of Oregon because they’d seen the decade-long positive experience of Oregon, with improving palliative care, high numbers taking comfort from the law and low numbers using it. There are fewer lawful assisted deaths in Oregon than unlawful ones in unregulated states. Legalization shines a light on end of life decision-making, allows doctors and patients to be safer and, more importantly, feel safer. Patients know they have a choice if their suffering is unbearable, without having to resort to suicide or overseas travel for assistance.

Your use of the word ‘killing’ in relation to dying people controlling the timing of their death suggests you have a personal objection. Campaigners for assisted dying want conscientious objection clauses ensuring the choices of healthcare professionals are respected. And patients’ wishes should also be respected.


Oregon’s population is small; if 1,500 patients asked for assisted suicide to access palliative care, that perhaps calls into question their referral systems.

Parliament discussed ‘assisted dying’ in considerable depth on at least five occasions in recent years and rejected the proposal as unsafe, and I agree. As a palliative care physician I see requests vanish when suffering people get the support they need; many are glad to be living well months or years longer than they believed possible. Listening to patients is core to care. There is nothing to prevent ‘open, honest discussion prior to a patient’s death’ – indeed, exploring patients’ feelings, fears and wishes at the end of life is a major feature of good palliative care. What the law prohibits is encouraging or assisting suicide.

You say you’d change your mind about legalizing assisted suicide if you saw evidence that society would suffer. But what sort of evidence would you accept? There is plenty of it: it’s just that it is interpreted in different ways by people with different views of the issue. I know of no evidence that supports your statement that legalization of assisted suicide ‘shines a light on end of life decision-making, making doctors and patients safer’.

It’s all very well to talk about choice. But let me suggest a parallel. Some youngsters say they would like to carry knives because it makes them feel safer. But the law doesn’t allow that. Why? Because letting them have their choice would not be safe for the rest of us. One person’s choice can easily become another person’s risk.

Debbie Purdy is an activist with primary progressive multiple sclerosis. In 2009 she won a ruling from the Law Lords (now the Supreme Court) requiring the Director of Public Prosecutions to publish his policy on the prosecution of cases of assisted suicide. Ilora Finlay is a professor of palliative medicine at Cardiff University and a member of the British House of Lords. She chairs the All-Party Parliamentary Group on Dying Well.

Front cover of New Internationalist magazine, issue 450 This feature was published in the March 2012 issue of New Internationalist. To read more, buy this issue or subscribe.

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  1. #1 Traveller 14 Feb 12

    Both arguments added nothing knew to this argument and missed a lot points that need raised.

  2. #2 John_ 15 Feb 12

    The problem with Ilora's argument is that, taken to its conclusion, that people should not have certain rights if they cause harm, means that a utilitarianism argument trumps other values systems.

    I would argue personal freedom that does not directly impinge on the rights of others should be balanced against utilitarianism, not only because the cost/benefit analysis of allowing things such as assisted suicide are not clear, but also because too often is it the case that utilitarian arguments are put forward by the Government maintain current inequalities of power, criminalising the weak to avoid having to address deeper issues.

    Ilora's says that ’Some youngsters say they would like to carry knives because it makes them feel safer. But the law doesn’t allow that. Why? Because letting them have their choice would not be safe for the rest of us.’

    This highlights my point. One could argue that banning people from carrying knives produces utilitarian benefit, and indeed it probably does. But that does not mean that is why the Government bans people from carrying knives. The fact is that poverty and inequality cause social unrest and crime. Criminalising carrying knives or taking drugs allows the Government to prosecute young people, brand them as criminals, and claim that poverty and inequality are caused by people being lazy, greedy or violent. They can then ignore the underlying causes of why people would want to carry knives in the first place or become an addict, and maintain their privileged power status. It's not like the Government does this deliberately, they are not wilfully evil. Its just that their neoliberal ideology that justifies this propogates itself by helping those who adhere to this view to maintian power.

    I expect that many health professions involved in policy would agree with this analysis, and yet like Ilora, they naively take up the governments discourse of producing health benefits in society by impinging on peoples rights. Not allowing people to have assistance in ending their life is an extension of this discouse. It takes power away from the weak and elderly, focusing the debate away how we view people with disabilities, and what power they have in society to demand that they are not neglected, to instead focus on an area of controversy.

    Unfortunately this will only propagate inequality and poverty, and that has far greater health impacts than allowing people to choose how and when they die.

  3. #3 Sasha 28 Feb 12

    Ilora seems to take it as read that the increase in physician-assisted deaths in Oregon is bad. Surely this is putting the cart (several miles) before the horse; if people who previously wanted something and were forbidden from getting it are given access to it without hurting others, we would normally celebrate the change.

    The is basically the old argument that divorce should be illegal because legalising would (shock) mean more divorces. Imagine two people should rationally conclude that they want to separate, or that one person should rationally conclude that her own life is not worth living - God forbid! And that phrase seems to be the crux of this; one needs a quasi-religious view on the sanctity of life/marriage to object to the principle that some people could make such choices.

    Certainly we might err on the side of caution when offering patients suicide - and any such law would surely do so - but we should temper this with perspective. Simply stating that people sometimes recover to the point that they're grateful to continue living is disingenuous, unless we also hear how many don't reach such a point. What proportion of people need to get better in order to justify Ilora's 'Dying Well' group forcing thousands of them (by her own implication) to live a life of agony and humiliation?

    If near half of them see such an improvement then perhaps she has a case - but if it's much less then it seems barbaric to force people to extend such suffering for the sake of a lucky few.

  4. #4 Tom Ash 29 Feb 12

    I wrote a lengthy article for openDemocracy on [a href=’’]assisted suicide and euthanasia more generally, back when Terry Pratchett's documentary pulled the subject into the news. I won't rehash all the arguments made there, which go deep into the philosophical weeds. But I think the 'argument from beneficence' - that death can be a good thing - has to be at the core of any case for euthanasia.

    Like many campaigners, Debbie shies away from this and focuses on arguments from autonomy. This lets Ilora shift the discussion onto the ’vulnerable’ who need protecting ’from themselves and from others’, and thus by implication would not benefit from suicide. But if we rest the case for assisted suicide on beneficence rather than autonomy then we can create safeguards for such people, and their existence will not undermine our argument. Given the way the debate went, Ilora doesn't engage with this argument, but it would take a lot to outweigh assisted suicide's potential to end a horrendous amount of suffering.

  5. #5 Elizabeth Bloor 02 Mar 12

    I would like to help people campaign for the legalisation of voluntary euthanasia.It is about time people did talk about this subject. It is about time people realised that ALL the problems on the planet are caused by population growth. We should stop people having more than two babies in EVERY country of the world and at the other end allow people to die when they want to. My mother is 93. She has been bed ridden for 2 years. My dad who is 90 looks after her. She wants to die.
    We do not know what is on the other side. WHY do we keep these people alive? I suggest it is to do with the living, the relatives or some odd notion we are going against someone's 'god'I am not religious but I do believe in other dimensions. I would like my mother to be in a better place. Everyone that comes and sees my mother agrees that out of humanity you would shoot a dog if it was in my mothers condition. Does this mean we are inhumane to our own species. I think the answer is yes.

  6. #6 William L Hill 04 Mar 12

    Sir, My wife and I are members of Dignity in Dying and we believe strongly that the State should not be able to determine when and why we should die. Debbie Purdy is a brilliant spokesperson for the cause of Assisted Suicide and it is time the parliamentarians took on the responsibility of clarifying the Suicide Act 1961. This Act needs to include the legal framework to assist the many terminally ill people who wish to end their lives in a humane way. Why, in a modern democracy, should the State be able to restrict a citizen, under strict circumstances, from seeking help in their own demise?

  7. #7 Samuel Clark 08 Mar 12

    I would think that everyone should have their own freedom to chose what they want to do what they want with their own lives, especially in common cases when in so much pain. Although Ilora argues that pallative care could be a solution, the medicines and resources used would be wasted on those who may not even want to live, and be used to those who do.

  8. #8 Samuel Clark 08 Mar 12

    I would think that everyone should have their own freedom to chose what they want to do what they want with their own lives, especially in common cases when in so much pain. Although Ilora argues that pallative care could be a solution, the medicines and resources used would be wasted on those who may not even want to live, and be used to those who do.
    However, where there have been incidents that have effected the brain, then the patient should be in no fit condition to be able to make a choice of ’life or death’.

  9. #9 Gabi Duigu 15 Mar 12

    Of course assisted suicide should be legalised. And it will be - it's just a matter of time for people to accept the simple logic of it. Protecting people from themselves is not the business of the law if it doesn't harm others. Smoking is discouraged, not illegal, for the excellent reason that in harming themselves smokers (and other drug addicts for that matter) are using up the society's health facilities. But suicide? If sick, or indeed healthy, old people are urged to commit suicide by greedy offspring, for example, what quality of life do they have anyway? Why prolong life for people who don't want to prolong it, for whatever reason? Nobody is advocating assisting the suicide of teenage boys, depressed young mothers etc. etc. We are talking about people at the end of their lives. I know people who have committed suicide rather earlier than they needed to, while they were still competent to do so, rather than have to submit themselves to palliative care, however good it might be. Some people have simply had enough, and it's not up to any busybody to decree that they should continue to live when they don't want to. We all deserve to be assisted out, if we want to be.

  10. #10 merle lester 15 Mar 12

    we must have is puts pets down when they are suffering..and they do not have a say in the matter.
    .folk who are suffering and wish to end their lives must continue to suffer no matter what..
    it's absurd..who are making the rules?
    where is freedom of choice

  11. #11 merle lester 15 Mar 12

    we must have is puts pets down when they are suffering..and they do not have a say in the matter.
    .folk who are suffering and wish to end their lives must continue to suffer no matter what..
    it's absurd..who are making the rules?
    where is freedom of choice

  12. #12 Stuart Ridgway 15 Mar 12

    The heirs of that person receive no benefits of that person's will for a fair period of time, say 10 years, 12, maybe even 15, to lessen any murders, coercion etc.

  13. #13 Steven Stewart Australia 15 Mar 12

    Many people in the world do not know about Natural Therapies and of the 5000 disease states labled collectively under the term ’Cancer’ more than just a few of these are ’Curable’ and when anyone states this they automatically become the target of the Billionaires and Millionaires who derive their wealth from everyones stupidity and ignorance for being stupid enough to listen to them and their Health fraternity B.S.
    Death would seem pleasent compared with having their so called treatments and unfortunately many people never question the idiots and DIE!!
    Who am I ? I'm the person who started his own liver!! after it stopped because I had bought a $45 book called The Nature Doctor 4 years before this event!I also beat /survived Botulism and cured the Super Flue and also went on to defeat the Human Parvo Virus also.......not bad for a person who has never been to a medical School!
    Contacts for you:.........Dr.Vogel nature Doctor(Internet) Health Science Institute ( Internet) Real Health News (Internet) now listen up everyone! go to Internet and type in CURE TOOTH DECAY Ramiel Nagel and find out all the reasons why your teeth never had a chance! and they don't want yu to have this information okay!!
    To any of my detractors...... I have the Certificate in Natural Therapies and i paid for this in poverty and got great marks.

    Cheers everyone bye for now!

  14. #14 Rhonda Andrews 18 Mar 12

    Yes assisted suicide should be legalized.Religions should stop dictating to the people the terms by which we live & die.

  15. #15 Emily Bowman 20 Mar 12

    Personally I agree with Debbie, if you already have a terminal illness and you're suffering, then why continue in the suffering? Personally I don't see a point of it, if you are ready to go and your family is alright with it, then just do it. I would rather be dead than be suffering every single day for the rest of my life until I die. Wouldn't you?

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This article was originally published in issue 450

New Internationalist Magazine issue 450
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