Richard Hough and Thorrun Govind consider the historical context of the assisted dying debate, the present position and what pharmacists and pharmacy technicians are actually allowed to say on the topic…

If adopted into law, the Terminally Ill Adults (End of Life) Bill would make it legal for over-18s, who are terminally ill, to be given medical assistance to end their own life.

Currently being debated in the UK Parliament, it proposes to legalise assisted dying for those with a life expectancy of six months or less. This contentious legislation would allow such individuals to end their lives with medical assistance, provided that strict safeguards are put in place.

If passed, it would mark a major change in UK law. This law would apply to England and Wales and a separate bill is already under discussion in the Scottish Parliament.

Historical Context

The UK has long wrestled with the ethical and legal implications of assisted dying. The Suicide Act 1961 decriminalised suicide but retained a prohibition on assisting another person, carrying a penalty of up to 14 years in prison.

However, over the years, key legal cases have brought the issue into the spotlight. Diane Pretty (2002) argued for the right to assisted suicide due to motor neurone disease but was denied by UK courts and the European Court of Human Rights.

Debbie Purdy (2009) succeeded in getting the Director of Public Prosecutions (DPP) to clarify when those aiding another person to commit suicide might face legal action.

That prompted Keir Starmer, who was at the time the DPP, to publish guidelines in February 2010 setting out the factors that would be taken into consideration when weighing up a prosecution.

Tony Nicklinson (2012) and Noel Conway (2018) respectively challenged the law on grounds of personal autonomy but were ultimately unsuccessful, with the courts deferring the matter to Parliament.

Key Provisions of the proposed Bill

The Bill introduces a number of safeguards with the aim of ensuring transparency and preventing abuse including:

• The individual must be resident of England and Wales and be registered with a GP for at least 12 months.
• The individual must have the mental capacity to make the choice and be deemed to have expressed a clear, settled and informed wish, free from coercion or pressure. They should also have been made aware of other care available to them, such as hospice care.
• The individual must be expected to die within six months.
• Two independent doctors must be satisfied that the person is eligible, confirming the terminal diagnosis and the patient’s mental capacity.

Under the Bill, a doctor could prepare the medical substance, but the individual themselves must take it. It should also be noted that the Bill (Section 23) does allow for conscientious objection.

No registered medical practitioner or other health professional is under any duty (whether arising from any contract, statute or otherwise) to participate in the provision of suicide assistance in accordance with the Act. Nor can an employer subject their employee to detriment for exercising such right.

Supporters consider that these measures strike a balance between respecting personal autonomy and protecting vulnerable individuals. Critics, however, warn of potential coercion and the risk of eroding societal values around the sanctity of life.

Implications for Healthcare Professionals

Healthcare professionals, including pharmacists, would have a vital role in implementing the law if passed. Pharmacists may be required to supply medicinal products which are prescribed for assisted dying, ensuring compliance with legal requirements.

The UK Chief Pharmaceutical Officers (UK CPO’s) have recently issued guidance, which recognises that there is a wide spectrum of considered views within the professions, as in society.

The proactive guidance recognises that some pharmacists and pharmacy technicians may be unsure whether they can take part publicly in the debate.

The guidance reassures pharmacists and pharmacy technicians that it is entirely reasonable for them to give their opinions, and that the public would expect that.

However, it specifically cautions against directly engaging patients in debate. It reiterates the importance of not identifying individuals you have cared for without their consent.

Finally, it reminds pharmacists and pharmacy technicians to be clear that they are expressing their personal views rather than speaking for the professions.

The UK CPOs believe the pharmacy professions will be unanimous that:

• they must not undermine the provision of good end-of-life care for all including the outstanding work done by palliative care clinicians; and
• individual pharmacists and pharmacy technicians, and other healthcare professionals, should be able to exercise freedom of conscience.

The Bill reflects decades of debate about autonomy, dignity, and protection at the end of life. Whether or not it becomes law, its implications will significantly shape the future of healthcare and ethical decision-making.

Richard Hough is a partner and head of healthcare at Brabners LLP and a former pharmacist. His co-author Thorrun Govind is a solicitor at Brabners, a pharmacist and TV health expert.