Should Euthanasia be legalized?

Euthanasia remains one of the most controversial topics in modern society where it has recently been subject to critical debate in the legal fraternity. As medical advancements have achieved the ability to artificially extend human life, it is often contended that a terminally ill individual should have the right to die with dignity, or relieve themselves of suffering by way of ending their life. A conflict, therefore, primarily subsists in the realm of euthanasia killings due to moral values meddling with the long-established position of common law offences for homicide. While some jurisdictions have embraced euthanasia through legislative frameworks, others strictly prohibit it, citing concerns over morality, medical ethics, and the potential for abuse. Thus, it is imperative to understand the difference between the various types of euthanasia killings to be able to discern and analyze legal viewpoints and developments on this increasingly complex and sensitive issue.

The National Health Service (NHS) in England defines Euthanasia as the ‘act of deliberately ending a person’s life to relieve suffering’. This could be by way of a doctor intentionally administering a drug, like a fatal dose of sedatives or muscle relaxants, to a terminally ill patient with the specific purpose of causing death, even if it is for compassionate reasons. However, this is different to cases where acceleration of death is a side-consequence of pain-relieving treatment, as held in R v Dr Bodkins Adams [1957] Crim LR 365 (the “double-affect” principle). Assisted suicide, on the other hand, is defined as the ‘act of deliberately assisting another person to kill themselves’. If a relative acquires potent sedatives, aware that a terminally ill person plans to use them for suicide, they could be seen as aiding in the act. As of now, both euthanasia and assisted suicide are illegal in the United Kingdom (UK) where assisted suicide is punishable by up to 14 years’ imprisonment under the Suicide Act (1961) and euthanasia is construed as either manslaughter or murder, punishable at maximum by life imprisonment. There are further two types of euthanasia: voluntary (where a person makes a conscious decision to die and seeks assistance in doing so) and involuntary (where seeking consent is not possible but they express a wish to end their life in such circumstances).

Involuntary euthanasia is, in essence, different to withdrawal of life-supporting treatment, which is permissible if approved by a body of recognized medical professionals. A recent decision where the court allowed this was seen in London NHS Trust v CD & Ors (Withdrawal of Life Sustaining Treatment) [2021] EWCOP 727 where, following an unsuccessful suicide attempt, an application to withdraw life sustaining treatment to the P who was in a vegetative state was allowed. On the other hand, in R (Nicklinson) v Ministry of Justice [2014] UKSC 38, the former position of voluntary euthanasia was discussed by the UK Supreme Court where it disapproved three individuals from committing assisted suicide, also declaring that the position under English laws was not incompatible with Article 8 of the ECHR. It further called for the Parliament to decriminalize assisted suicide in the UK.

There have now been developments in the UK where the Terminally Ill Adults (End of Life) Bill was introduced in November 2024, where the Parliament has voted to advance legislation governing and legalizing assisted dying, or suicide. The Bill is currently in the Committee Stage in the House of Commons where, under the Bill, it is proposed that doctors would be able to prepare the substance required to end the patient’s life but the person would be required to self-administer the substance, similar to drug cases. The Bill contains safeguards, allowing only mentally competent adults with a terminal illness and a life expectancy of six months or less to request assisted dying. They must make two separate declarations, witnessed and signed, about their wish to die and satisfy a High Court judge and two independent doctors that they are eligible with at least seven days between each assessment. More importantly, the Bill legalizes assisted dying but does not permit euthanasia without the patient’s express consent. This would effectively mean that persons wishing to end their lives could now do it without travelling to a foreign jurisdiction where it is legal to do so, contrary to the situation in R v Wallace [2018] EWCA Crim 690.

With progressions in the medical domain and widespread calls for legalization of euthanasia, the world is now increasingly moving forward to tolerate, at least, assisted dying. Leading examples of countries permitting assisted dying for terminally ill people include Australia, where every state allows assisted dying for terminally ill, mentally competent adults. A similar position is adopted by New Zealand’s End of Life Choice Act 2019 and 10 states and one federal district in America, which include commercial hubs like Washington DC and California. By the same token, assisted dying is legal for people experiencing unbearable suffering in Canada in 2016 with the Medical Aid in Dying (MAID) law, following a Supreme Court ruling. It is further legal in Colombia, Cuba and Ecuador in Central and South America and nine European nations, including Germany, Italy, Spain, Switzerland, and The Netherlands to mention a few. The position in Pakistan remains (and is likely to remain) that all forms of mercy killing, or euthanasia, are illegal as it is categorically prohibited by Islamic law which Pakistan is bound to constitutionally follow. The Lahore High Court, in 2023, dismissed a petition where the Applicant sought permission to publicly administer poison for the sake of an experiment. The judgment recognized euthanasia being legal in states such as India. However, it stated that Pakistan is an Islamic State under Article 2 of the Constitution and refused to delve further into whether euthanasia was legal. This hints at the possibility of the Pakistani courts adjudicating upon matters relating to euthanasia in the future, or even partially or fully legalising it. Nonetheless, for now it has blurred lines on the question of assisted dying in case of terminally ill patients. The judgment, nonetheless, discusses other grounds that imply that such a reform is unlikely to be introduced under currently existing legislations.

The legal debate surrounding euthanasia and assisted dying remains complex, balancing individual autonomy with ethical and societal concerns. It further comes along with a threat of producing counterproductive effects and unwanted consequences is misused. While some jurisdictions have introduced strict safeguards to allow assisted dying, others continue to prohibit it due to fears of misuse and moral objections. Accordingly, it seems that the once firmly established law of homicide, especially in the UK, might see further exceptions where we might see new statutory defenses of assisted dying or perhaps consent. Nevertheless, with the growing population, medical advancements and increased awareness of one’s rights, it may not be plausible to entirely ignore the question of decriminalizing euthanasia.  As medical and legal landscapes evolve, the discussion will likely continue, shaping future legislation and the rights of terminally ill patients.