In a surprising move, the Director of Public Prosecutions (DPP), Keir Starmer, has given an interview to the Telegraph today in which he discusses the interim policy on which a team at the Crown Prosecution Service (CPS) are working following the House of Lords’ decision in Purdy v. DPP ( UKHL 45) last week.
Mr. Starmer told the Telegraph: “This is not a policy that’s going to apply only to those who go abroad. Newspapers are saying that, but they’re wrong. . . . This policy is going to cover all assisted suicides. The same broad principles will apply. They’ve got to apply to all acts, in the jurisdiction or out of it. We won’t have separate rules for Dignitas.”
As I wrote last week, one of the key questions about the policy is whether it will apply only to those providing relatively minor assistance with travel to a country where assisted suicide is lawful (as Lord Hope envisages at ), or apply more broadly to all offences which could be prosecuted under s.2(1) of the Suicide Act 1961 (as could be inferred from the speeches of Baroness Hale at [63-, Lord Brown at - and Lord Neuberger at -).
Now that the DPP has stated that the policy will apply to assisted suicides which take place in the UK, the question remains whether it will include acts more proximate to the suicide than travel arrangements, such as providing medication, writing a prescription, setting up an intravenous drip which is then triggered by the patient, or other technical or practical assistance with the act of suicide itself? From the tone of the DPP’s interview, the answer appears to be ‘yes’, but this is an answer which would undoubtedly surprise Lord Hope, the author of the leading speech in Purdy v. DPP.
If these types of assistance are not to be prosecuted when other requirements (autonomous, competent, voluntary request etc.) are met, then the healthcare professions will be forced to decide how to respond to healthcare workers who choose to provide such assistance. The General Medical Council is currently revising guidance on End of Life Treatment and Care. This may need to be rewritten to take into account the DPP’s policy on assisted suicide prosecutions, just as the draft guidance “takes account of, and is consistent with, current law across the UK, in particular the law prohibiting killing (including euthanasia) and assisted suicide”.
While the DPP’s decision (and his public announcement of it) may be designed to push Parliament into action, as the law lords also attempted to do (, ), it must be asked whether a CPS team given only a month or two in which to work is the ideal body to achieve this kind of legal change on assisted suicide? Crucial issues to be decided when creating a regulatory environment for assisted suicide include:
- should only doctors be permitted to provide direct assistance with suicide, and if so, should there be a mandatory consultation with a second doctor (as in the Netherlands)?
- what kinds of patients or persons should be eligible for assistance with suicide? should it be restricted to those with a terminal illness or to those who are experiencing a certain level of suffering?
- should there be a palliative filter (a requirement that the patient be provided with advice by a palliative care team prior to consideration of a request for assisted suicide)?
- what kind of screening should there be for psychiatric or psychological disorders including depression?
- should there be a waiting period between the request and the assisted suicide?
None of these are issues suitable for resolution in the kind of policy to be drafted by the CPS team, which will likely contain factors to be considered in any prosecution decision.
Finally, and slightly ironically, the BMJ has recently reported that the Swiss government is contemplating legislation which would make it more difficult for non-Swiss residents to access assisted suicide in Switzerland.