Professor Richard Huxtable:

Thank you. I am professor of medical ethics and law at the University of Bristol, where I direct the Centre for Ethics in Medicine, based in the Medical School. My research is funded by, among others, the Wellcome Trust and the National Institute for Health and Care Research, NIHR, and I serve on a range of committees and boards, including those of the UK Clinical Ethics Network, the European Association of Centres of Medical Ethics, the Bristol Clinical Ethics Advisory Group and the research committee of the Institute of Medical Ethics. I also recently served as an expert adviser to a citizens' jury in Jersey which ultimately recommended that assisted dying be legalised in that jurisdiction. However, the views I express in evidence are my own and not necessarily those of the groups with which and for which I work. I have been undertaking research into the legal and ethical aspects of assisted dying and end-of-life care since the mid-1990s. In legal terms, I am most familiar with the law governing assisted dying in England and Wales, and the current focus of my research in this area is primarily on the ethical issues.

My own ethical position on assisted dying distinctively occupies the middle ground, in recognition of the arguments on both sides, which I will briefly summarise. Arguments in favour tend to rest on one or more of the following three claims. First, choice matters. Life has a self-determined value so people who are capable of making the relevant choice should be at liberty to determine the timing and manner of their deaths. Second, suffering matters. Life has instrumental value insofar as it can enable people to achieve that which they do value, and where life has a poor quality or is marked by suffering, this may be a basis for allowing assistance in dying. Third, consistency matters. Some claim that many legal systems already permit practices which rest on identical or similar justifications, so it would be consistent to permit assisted dying as well. Examples include euthanasia of suffering animals, the refusal of life-supporting treatment and withdrawing or withholding life-supporting treatment from incapacitated minors and adults.

Arguments against assisted dying tend to rest on one or more of the following three claims. First, life matters. Life has an intrinsic value, captured by concepts like dignity and the sanctity of human life, so it should not intentionally be brought to an end, and the lives of potentially vulnerable people, including people with disabilities, should be protected. Second, medicine matters. Providing assistance in dying is incompatible with the values inherent to, or adopted in, medical practice. Third, consequences matter. The so-called slippery slope objection holds that if we permit assisted dying in some apparently appropriate situations, then, either as a matter of logic or as a matter of fact, we will come to find ourselves accommodating assisted dying in less appropriate or even wholly inappropriate situations.

I see some of the merits and some of the problems with the arguments on each side, which has led me to defend some possible compromise positions. These include a proposal for a specific, reduced offence that I call compassionate killing, which seeks to reflect the killing aspect that concerns opponents of assisted dying and the compassion side that motivates those in favour.

If a decision were to be made to legalise assisted dying in some form, then my research to date suggests that the following four areas warrant careful attention. The first is to ensure the eligibility and other criteria are clear. As I understand it, models vary internationally. Regarding who may receive assistance in dying, some jurisdictions restrict this to the imminently terminally ill, for example, the death of an adult expected within six months, in Oregon in the USA. However, others are much more expansive, for example the Netherlands and Belgium reportedly allow assisted dying in situations where the patient is neither an adult nor terminally ill. Some jurisdictions only permit assisted dying when the patient takes the final fatal step, sometimes referred to as assisted suicide, while others allow another party to do so, so-called voluntary euthanasia. In those countries that allow the practice in some form, doctors tend to be the people who are legally permitted to assist in dying. However, given opposition from some members of the medical profession, some have queried whether a new group of specialists should be created to provide the service.

The second is to retain and, if necessary, enhance access to palliative care. Although views differ globally, specialist providers of palliative care tend to be opposed to the legalisation of assisted dying, and some express concerns that its availability might in some way compromise the provision of palliative care. Even if assisted dying is to become available, good quality care for the dying will still be needed. If it is judged to be necessary, one option might be to enshrine in law the right to access such care.

The third is to include a right to conscientiously object to participation in assistance in dying. If, as is often stipulated, doctors are to provide assistance in dying, some will object to doing so. If so, they should not be required to provide such assistance and they should be protected if they object. Provision should be made for such objections while also respecting the right or other legal entitlement of the patient to receive assistance in dying.

The fourth is to ensure that there are safeguards, ongoing monitoring and that boundaries are enforced. As I understand it, monitoring mechanisms vary internationally. For example, the Netherlands has a review committee which may refer matters on to prosecutors and in Switzerland all assisted deaths are reported to local authorities and all are investigated by the police. There are, however, periodic reports of legal criteria and processes not being following, but apparently no further legal action being taken. I would suggest that if slippery slopes are to be avoided, safeguards will be needed, the practices should be monitored, and the boundaries should be policed, with suitable penalties available and applied to those who fail to comply.