Social work and end-of-life care

Social work is important in end-of-life care

Assisted dying: summary of the existing legal position

with 3 comments

Summary of the legal position

I’m continuing with my posts on material drawn from this summer’s Supreme Court judgment on assisted dying. A useful contribution is made by Lord Sumption when at Para 255, gives useful practical guidance and summarises the current legal position, with citations to the cases. Lord Neuberger associates himself with this summary (at Para 137), so it has great credibility and might help us present the argumeents to patients and their families.

This is useful for practitioners who often need to confirm to themselves, and also be able to explain to others, what the position is. It also explains where an advance decision, as part of advance care planning, fits into this.

255. The current position may fairly be summarised as follows:
(1) In law, the state is not entitled to intervene to prevent a person of full capacity who has arrived at a settled decision to take his own life from doing so. However, such a person does not have a right to call on a third party to help him to end his life.
(2) A person who is legally and mentally competent is entitled to refuse food and water, and to reject any invasive manipulation of his body or other form of treatment, including artificial feeding, even though without it he will die. If he refuses, medical practitioners must comply with his wishes: Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital [1985] A.C. 871, 904-905; In re F (Mental Patient: Sterilisation) [1990] 2 A.C. 1; Airedale NHS Trust v Bland [1993] AC 789. A patient (or prospective patient) may express his wishes on these points by an advance decision (or “living will”).
(3) A doctor may not advise a patient how to kill himself. But a doctor may give objective advice about the clinical options (such as sedation and other palliative care) which would be available if a patient were to reach a settled decision to kill himself. The doctor is in no danger of incurring criminal liability merely because he agrees in advance to palliate the pain and discomfort involved should the need for it arise. This kind of advice is no more or less than his duty. The law does not countenance assisted suicide, but it does not require medical practitioners to keep a patient in ignorance of the truth lest the truth should encourage him to kill himself. The right to give and receive information is guaranteed by article 10 of the Convention. If the law were not as I have summarised it, I have difficulty in seeing how it could comply.
(4) Medical treatment intended to palliate pain and discomfort is not unlawful only because it has the incidental consequence, however foreseeable, of shortening the patient’s life: Airedale NHS Trust v Bland [1993] AC 789, 867D (Lord Goff), 892 (Lord Mustill), R (Pretty) v Director of Public Prosecutions [2002] 1 AC 800, 831H-832A (Lord Steyn).

In his final point, Lord Sumption also deals with the argument, which we often hear, that this is an increasingly difficult problem, that is becoming hard to handle:

(5)Whatever may be said about the clarity or lack of it in the Director’s published policy, the fact is that prosecutions for encouraging or assisting suicide are rare. Between 1998 and 2011, a total of 215 British citizens appear to have committed suicide with medical assistance at the Dignitas clinic in Switzerland. Not one case has given rise to prosecution. Although cases of assisted suicide or euthanasia are periodically reported to the police (85, we were told, between 1 April 2009 and 1 October 2013) there has been only one recent prosecution for assisting suicide, and that was a particularly serious case.


Written by Malcolm Payne

29 September 2014 at 11:01 am

3 Responses

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  1. Hi Malcolm. Thank you for all your posts on this subject. They are timely in all settings but in particular for palliative care social workers where I am finding that more clients are wanting to discuss some of these issues. It’s good to remind us of the position of social workers Any discussion of course is tricky depends -so much on the management and accountability structure in which the social worker works.

    Pam Firth

    29 September 2014 at 11:42 am

  2. Hi Malcolm. Your posts are incredibly informative, given that I am just doing a dissertation on assisted dying and the implications for social work. Re: the above. Could it be reasonable assumed that the same would apply for social workers in regards to discussions, or would there be some ethic/value distinctive to social work that stops us from engaging in such discussions?

    Andy (@andrewmw83)

    29 September 2014 at 2:06 pm

    • Yes, my assumption is that social workers would need to follow the guidance given here. And yes, my experience is that social workers are often engaged in discussions about assisted dying. This is because they are often asked by families or patients at the end of life to find out information about how to, for example, go to Switzerland, or simply to discuss the decisions that families are wrestling with. They will also often be asked to participate in medical or nursing discussion with patients and relatives, or reinforce of go over again discussion that medical and nursing staff have had. Often a doctor or nurse will be the most trusted professional, and may be the most relevant to assisted dying decisions, but sometimes a social worker who has worked through other difficult aspects of the situation with a patient or family will be approached for working on this difficult decision too.

      Malcolm Payne

      29 September 2014 at 4:58 pm

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