Why in news?

The Terminally Ill Adults (End of Life) Bill was introduced in the UK to provide terminally ill patients with the option to seek assistance to end their lives. The Bill addresses ethical and humanitarian concerns for patients with no hope of recovery, ensuring dignity in their final days.

The Bill was backed by a majority of 330 to 275, with 38 MPs not voting. The Bill will now be sent to a public bill committee which will vote on any proposed amendments before being voted on again in the House of Commons.

It will then be sent to the House of Lords, where further changes could be made, before a final vote is held.

What’s in today’s article?

• Assisted Dying and debate around it
• What is the current UK law on this issue?
• What is the procedure provided in the bill?
• How does it compare to the law in India?

Assisted Dying and debate around it

• Definition
  • Assisted dying generally refers to a person who is terminally ill receiving lethal drugs from a medical practitioner, which they administer themselves.
  • Assisted suicide is intentionally helping another person to end their life, including someone who is not terminally ill.
    • That could involve providing lethal medication or helping them travel to another jurisdiction to die.
  • Euthanasia is the act of deliberately ending a person's life to relieve suffering in which a lethal drug is administered by a physician/doctor.
    • Patients may not be terminally ill.
    • There are two types: voluntary euthanasia, where a patient consents; and non-voluntary, where they cannot because, for example, they are in a coma.
• Arguments in Favor of Assisted Dying
• Control and Dignity: Allows terminally ill patients to choose a humane way to end their suffering.
• Limitations of End-of-Life Care: Proponents argue that such care often fails to alleviate pain and symptoms effectively.
• Suicide Prevention: A legal framework could deter impulsive suicides and prevent family members from being involved in illegal assistance.
• Arguments Against Assisted Dying
  • Risk of Misuse: Potential for coercion, especially among vulnerable groups like the elderly and disabled.
  • Impact on Vulnerable Populations: Detractors fear it could lead to undue pressure on patients to opt for assisted dying.
  • Focus on Care Improvements: Critics advocate for enhancing end-of-life care instead of legalizing assisted dying.

What is the current UK law on this issue?

• Current UK Law
  • Both assisted dying and euthanasia are prohibited. Assisted suicide is a punishable offence with up to 14 years in prison.
• History of Assisted Dying Bills in the UK
  • Since 2013, at least three bills have been introduced to legalize assisted dying.
  • The debate remains polarised, reflecting deep ethical and social concerns.

What is the procedure provided in the bill?

• Eligibility Criteria for Assisted Dying
  • Age and Residency: Patient must be 18 or older, mentally capable, and residing in England or Wales for at least 12 months.
  • Terminal Illness Definition: The illness must be irreversible, worsening, and likely to cause death within six months.
  • Exclusions: Persons with disabilities or mental disorders are explicitly excluded.
• Initial Request and Assessment Process
  • First Declaration:
    • Patient signs in the presence of a coordinating doctor and a witness.
    • Coordinating doctor conducts a first assessment to confirm eligibility and voluntariness.
  • Independent Assessment:
    • Request is referred to an independent doctor for verification after a minimum seven-day reflection period.
    • Disagreements between doctors may lead to a referral to another independent doctor (only once).
• Judicial Review
• If both doctors approve, the request is sent to the High Court of Justice for verification of compliance.
• High Court may question the patient and doctors.
• Rejections can be challenged in the Court of Appeal.
• Final Confirmation and Administration
  • Second Period of Reflection:
    • A 14-day waiting period follows High Court or Court of Appeal approval.
    • Patient signs a second declaration, witnessed by the coordinating doctor, the independent doctor, and a third person.
  • Self-Administration:
    • Approved substance is provided to the patient by the coordinating doctor or designated practitioner.
    • Patient must self-administer the substance; the doctor is prohibited from administering it.

How does it compare to the law in India?

• Supreme Court of India’s Recognition of Passive Euthanasia
  • In Common Cause v. Union of India (2018), the Supreme Court ruled that the “right to die with dignity” is part of the fundamental right to life under Article 21 of the Indian Constitution.
  • Legality of passive euthanasia was established, allowing withdrawal of life support for terminally ill patients or those in a permanent vegetative state.
    • Passive euthanasia enables natural death without medical interventions, differing from assisted dying.
• Guidelines for Passive Euthanasia
  • Living Will or Advance Medical Directive
    • Patients can leave directives for withdrawal of life support.
    • Must be signed in the presence of two witnesses and a Judicial Magistrate.
  • Approval Process
    • Requires consent from the treating physician, a medical board, and an external medical board with local administration representation.
• Challenges and Modifications
• In 2019, the Indian Society of Critical Care Medicine sought changes, terming the guidelines cumbersome and impractical.
• In 2023, the Supreme Court modified the guidelines to introduce strict timelines and reduce the involvement of the Judicial Magistrate.
• Awareness and implementation of these guidelines remain limited across India.
• Draft Guidelines by Ministry of Health (2024)
  • In August 2024, the Ministry of Health and Family Welfare issued draft guidelines similar to the Supreme Court’s recommendations.