A moral claim to assisted dying

I will lay my cards on the table – I do not support legalising assisted dying (AD). I won’t run through the arguments here. In short, I am unconvinced that a system can be constructed to distinguish between voluntary and coerced requests. I was no more convinced after reading this book.

That is not necessarily a reflection on den Hartogh’s argument, which is logical and well-referenced. He principally rests his argument on ‘autonomy’, and the right of the individual to make decisions over their own life. From this, he extracts a moral claim to end one’s life, and locates a human right to suicide – which he presumably grounds in Article 8 of the European Convention on Human Rights – in Haas v Switzerland (2011).

His ethical analysis is excellent; his treatment of ‘palliative sedation’ – keeping a patient minimally conscious through sedation until death – is particularly thorough, as is his analysis of ‘hard cases’ of patients who are elderly, psychiatrically unwell, or have requested euthanasia via an advanced directive. He frequently takes a ‘devil’s advocate’ approach to the existing literature, which is surprisingly effective.

However, the part I found most interesting I also found most frustrating. The final chapter deals with developing a regulatory system for AD. He covers all the classic options for allowing those seeking AD to receive it while protecting the vulnerable – consultation, ex-ante third-party review, the doctor-patient relationship, mandatory palliative care advice, data collection – but covers them with such brevity it almost seems like the issue is not one about which to be concerned. This is plainly not so. Consider the fundamental failures of legal safeguards – including possible physician conflict of interest – identified in Mortier v Belgium (2021), and even a 2016 British Medical Association report which suggested it was impossible to tell when consent was freely given or coerced. However well-argued his ethical points may be, the approach to the final chapter undermines the work.

I remain unconvinced, but this work is timely given the current debate in parliament, and worth reading. It may not win converts, and for me one of the key parts of the debate is inadequately treated. Scholars in the field will want to read it and there is likely to be interest for the general reader.

James E Hurford is a solicitor at the Government Legal Department, London