Professor David Albert Jones:

I thank the members for the invitation to address the Joint Committee on Assisted Dying. I am director of the Anscombe Bioethics Centre in Oxford and professor of bioethics at St Mary’s University, Twickenham.

The first thing I would like to flag up is the importance in this context of unambiguous terminology, or at least terminology which is as clear as we can get it. From this point of view, the phrase "assisted dying" though it is being used by this committee, is problematic and challenging because it is used by different people to mean different things. That can be seen internationally. If this phrase is going to be used, we need to agree on its meaning and what it is used for, and I suggest the most helpful and least problematic meaning is as an umbrella terms for different forms of euthanasia or physician-assisted suicide, which exists in different jurisdictions.

The topic for today, or at least that which I was given, is developing a legal framework for assisted dying. However, there is a legal framework for assisted dying in Ireland. The framework is that euthanasia is illegal under common law and the Criminal Justice Act 1964 and assisted suicide is illegal under the Criminal Law (Suicide) Act 1993 as upheld in Fleming vIreland in 2013. This puts Ireland among the 180 or so countries in the world where euthanasia and assisted suicide are prohibited, or are not practised, rather than among the dozen or so countries where they are available. There are differences between different legal frameworks which provide either euthanasia or assisted suicide or both and we can talk about these different frameworks. However, what they have in common is more significant than how they differ. Those dozen or so countries that have introduced some form of assisted dying have all abandoned a principle of healthcare ethics which is as old as Hippocrates and a legal principle which, in most countries of the world, prohibits the intentional taking of life.

This is a radical change and as a result has practical implications. If one crosses the Rubicon, as it were, it is very difficult to have lesser barriers which will be as effective. If we have abandoned this historically very well-established and very deeply rooted rule against euthanasia and assisted suicide, how long could we maintain a much more arbitrary rule such as it being available for people with six months to live but not for those with seven months to live? That is obviously not as fundamental a principle. How long could we maintain a rule that it should be permitted for those with this diagnosis but not for that diagnosis? If we look at what happens in these different jurisdictions, and this is something common to the different jurisdictions, numbers go up in every one, categories tend to expand and restrictions tend to drop away. Nor is it only the future extension of the law that should concern us, and therefore one might say restrictions or requirements within the law, it is also the impact of the law outside on wider society. We need to consider how this legal change affects the perception, both the self-perception and the perception by others, that someone might feel a burden to society? How does it impact the way other medical decisions are made?How does it impact the cultural acceptability of suicide, that is, unassisted suicide, for people who have severe physical or mental disabilities? We know that in the United States, unassisted suicide rates have increased significantly in those states which have legalised assisted dying in comparison with those that have not. The legal frameworks now in place in Ireland and in the United Kingdom, which in this area of law are very similar and which prohibit euthanasia and assisted suicide but allow other end-of-life decisions such as withdrawal of treatment and the giving of treatment which has risks or side effects, offer a clear bright line, which is much more robust and protective than any collection of ad hocrequirements after this bright line is taken away.

Once the dam has been breached, it is naïve to think a series of makeshift barriers downstream will have the same protective effect. That is what we are talking about.