By Tim Wyatt
Assisted suicide — doctors providing drugs for patients to use to deliberately end their lives — is now legal in a range of jurisdictions around the world and the subject of regular campaigning in Britain. While most religious groups have historically opposed its legalisation, there is a growing movement of people arguing for its introduction on the grounds of faith
What’s in a name?
Historically, a doctor providing lethal medication for a patient and helping them to take it to end their lives was broadly known as physician-assisted suicide. It was differentiated from euthanasia in that the patient themselves actually took the final act to administer the drugs, rather than the doctor.
However, in recent years the practice has also become widely referred to as assisted dying, especially by those advocating for its legalisation. This is said to be a more accurate description given that the laws proposed by assisted dying campaigners would include only those who are terminally ill and close to a natural death. Similar language has been used in some countries which have passed laws, such as Canada where it is officially called medical assistance in dying.
But this rebranding has been resisted by many on the other side of the debate, who argue the term assisted dying deliberately obfuscates the reality of what helping somebody kill themselves is and have mainly persisted with the term assisted suicide.
History of assisted suicide in Britain
While assisted suicide and any form of euthanasia has never been legal in the UK, the topic has been the subject of debate for well over a century. In 1870 a schoolteacher called Samuel Williams published a widely read essay that argued doctors should be allowed to give patients suffering from “hopeless and painful illness” overdoses of chloroform to render them first unconscious and then dead, if this was requested.
In the early decades of the 20th century the idea was sometimes proposed again, often in the context of a growing interest in eugenics, which was fashionable at the time. In 1935, the Voluntary Euthanasia Society was formed to advocate changing the law, although at first they found little public or institutional support.
The Suicide Act of 1961 abolished the crime of attempting suicide. But assisting someone else to kill themselves remained a serious offence. The passing of this law prompted renewed debate around euthanasia, although mostly in the context of children with severe disabilities rather than terminally ill adults.
The Voluntary Euthanasia Society, which had attempted sporadically with limited backing in parliament to change the law, published in 1978 a booklet called Guide to Self-Deliverance which offered tips on how to commit suicide.
In 1994, a House of Lords committee on medical ethics investigated the issue and concluded while in certain cases euthanasia might be the best option, legalising it on the basis of a few hard cases alone would be unwise.
Ever since the 1990s, campaigners in Britain have overtly rejected full euthanasia regimes as now available in the Netherlands and exclusively argued for a more limited assisted suicide regime for the terminally ill. The Voluntary Euthanasia Society renamed itself Dignity in Dying in 2005 and on its website now explicitly rejects Dutch-style euthanasia for those not terminally ill and without capacity to die by their own hand.
Since the late 1990s, bills have been introduced into both the Lords and the Commons (as well as devolved parliaments) by supporters of assisted suicide. Mostly these would only permit those who were terminally ill with less than six months to live and experiencing “unbearable suffering” to request their doctors provide lethal drugs.
On every occasion so far the bills have been defeated or run out of time. The most recent failed attempt came in 2015 when Labour MP Rob Marris proposed an Assisted Dying Bill. It was voted down 330 to 118. In 2021, Baroness Meacher introduced a similar bill into the Lords, which has prompted a renewed surge of campaigning on both sides.
What is the current legal status of assisted suicide?
Under the Suicide Act 1961 it is a criminal offence to encourage or assist the suicide (or attempted suicide) of another person, punishable by up to 14 years in prison.
However, there have been a series of high-profile legal cases in which severely ill individuals have sought the courts’ approval of the right of their family or friends to help them end their lives.
In 2002, a woman who had motor neurone disease called Diane Pretty launched a legal case seeking a binding commitment from the director of public prosecutions (DPP) that her husband would not be charged if he helped her die. She argued the Human Rights Act enshrined a de facto right to die in its right to life and right to a private life. This was rejected by British courts, so she appealed to the European Court of Human Rights, which was similarly unsuccessful.
In 2009, Debbie Purdy, who suffered from multiple sclerosis, won her case before the Law Lords which contended she had a right to know in advance if her husband would be prosecuted for helping her travel overseas to end her life.
This ruling led to the DPP to publish a formal policy that detailed when and why someone might be prosecuted for assisting a family member’s suicide. This did not change the actual law, but formalised guidance that states someone is less likely to be prosecuted if it is clear the person who died had a voluntary and informed wish to end their life and the assisting person was solely motivated by compassion.
It also stated prosecution was more likely if the person committing suicide was under 18, lacked mental capacity to make an informed decision and could have killed themselves without help. The policy also said the assisting person was more likely to be prosecuted if they were unknown to the person dying or were acting in their capacity as a healthcare professional such as a doctor or nurse.
This effectively has meant that if a close family member of someone who is severely ill and has a clearly expressed wish to die, but is unable to kill themselves, helps their loved one travel abroad to end their life, they will normally not face prosecution on their return. But it has not relaxed the law on doctors providing lethal medication for patients who wish to kill themselves in the UK.
Other famous cases
Another high-profile legal challenge to Britain’s prohibition came in 2014, when Tony Nicklinson, who was paralysed from the neck down after a stroke, asked the courts to declare it would be legal for his doctors to help him to die and if not, that the law was incompatible with his human rights.
This case eventually went to the Supreme Court, which ultimately declined to make a declaration on the compatibility of the right to a private life with the UK’s ban on assisted suicide. The judges ruled that changes to the law should be made by parliament, not the courts.
A similar case occurred three years later when Noel Conway sought a judicial review of the 1961 act, on the same basis of conflict with the European Convention on Human Rights. This was rejected by the High Court, which ruled parliament had already reviewed the law following the Nicklinson case when in 2015 it debated and voted down Rob Marris’s Assisted Dying Bill. In 2019, the High Court declined to take up another similar case, reiterating that the courts lacked “legitimacy and expertise on moral (as opposed to legal) questions” and that it would be wrong for judges to approve arguments which had failed to persuade parliament.
What is the situation around the world?
A growing number of countries have legalised assisted suicide. In 1997, the US state of Oregon became one of the first jurisdictions to introduce a law allowing terminally ill patients with less than six months to live to be prescribed lethal drugs to take themselves.
This example has inspired a number of other states, including California, Washington, New Jersey and Hawaii to pass similar legislation. In total, 10 states and Washington DC now have comparable laws on their statute books.
Quite a different regime has been legal in the Netherlands since 2001, although the law codified a procedure that had become common practice among Dutch doctors for several decades. It permits both assisted suicide but also the more common euthanasia, where the doctor administers a lethal injection to a patient. The criteria are that the patient must be in “unbearable suffering” with no prospect of improvement, at least 12 years old (although plans are afoot to open euthanasia up to children) and fully aware of their condition and options, and have made a voluntary request.
Patients suffering from dementia can also make advance written requests. There is significant public debate about extending euthanasia to those suffering psychiatric conditions — with numerous cases of doctors already carrying this out despite it being of dubious legality — and elderly people who are not suffering but simply “tired of life”.
A similar law has been in place in Belgium since 2002, which permits adults in unbearable suffering and with no hope of recovery to request euthanasia. Unlike in the Netherlands, the law specifically included mental as well as physical suffering. Since 2016, this right has also been extended to children of any age.
In Switzerland, assisted suicide has been legal since 1942, provided it was not performed by a doctor or anyone else with a vested interest in the person’s death (including spouses, children or other related parties). Most famously, this has led to the establishment of the Dignitas clinic in Zurich, which has helped 1,700 people to kill themselves, including many Britons and other foreigners who come expressly to be helped to die. There are no clear criteria to be terminally ill or even in significant suffering to qualify for Dignitas’s help. In the past decade, an average of 32 people a year have travelled from the UK to Zurich to end their lives.
What are religious views on assisted suicide?
Historically, most religious groups have been opposed to doctors or others helping patients, even those who are terminally ill or experiencing significant suffering, to kill themselves. However, in recent years there has been a growing movement of religious people arguing in favour of legalisation.
Dignity in Dying, the main pressure group which lobbies for changing the law, has gathered a coalition of faith leaders who argue their religious principles actively endorse assisted suicide rather than oppose it. This alliance is primarily spearheaded by the Reform Rabbi Jonathan Romain, the former Archbishop of Canterbury Lord Carey, and the iconic South African former Archbishop Desmond Tutu.
This group often points to polling from 2019 which suggested 82 per cent of Christians and 63 per cent of people from other faiths backed introducing assisted suicide (although religious affiliation in the survey was simply self-identification and so did not filter for those actively practising a faith).
Most Christian traditions have opposed suicide, arguing that human life is precious and sacred in God’s sight and therefore to deliberate end it is a grievous sin. In the past century, this perception has been mellowed with compassion for those who kill themselves, acknowledging it is often a result of mental ill health. Historic prohibitions on offering normal funeral or burial rites for those who die by suicide have mostly been abolished as a result.
However, most denominations continue to oppose legalising assisted suicide in Britain. The Church of England’s position is that the current laws and DPP guidelines strike a “fair, balanced and compassionate approach to a difficult issue which has defied consensus”.
Responding to the Dignity in Dying religious alliance, the Rev Dr Brendan McCarthy, the church’s national adviser on medical ethics, argued that any change in the law which undermined “our egalitarian commitment to the intrinsic value of every human life” was deeply flawed. Pointing to scandals and deaths in care homes and hospitals, he wrote that even with rigorous safeguards, an assisted suicide regime would inevitably lead to more abuse and exploitation of the elderly and vulnerable.
“The aspirations of a very small number of individuals seeking a change in the law, whose needs and concerns are nonetheless genuine, must not endanger the very large numbers of people who will be put at grave risk by any such change,” Dr McCarthy concluded.
The United Reformed Church also voted to oppose legalisation when it last debated the issue in 2007, while the Catholic Church remains implacably opposed. Last year, the Vatican reiterated that assisted suicide was equivalent to murder and that priests should withhold the last rites to anyone planning to end their own lives. The English and Welsh Catholic Bishops’ Conference has recently written an open letter calling on believers to lobby peers against the Meacham Bill and pray for its defeat in parliament. Pope Francis has written that assisted suicide is part of a “a throwaway culture that offers a false compassion and treats a human person as a problem”.
But there are also plenty of Christians who argue for assisted suicide. Lord Carey came out strongly in favour several years ago and contends that Christian teaching points him towards, not away, from helping suffering people to end their lives. “For too long we have turned a blind eye to the suffering inflicted on terminally ill people by the ban on assisted dying,” he said. “Compassion, a central tenet of the Christian faith, should not be a crime, and yet under the current law it is treated as such.”
Others have also been shifting in recent years. In 2015, the Methodist Conference debated two motions: one voiced the standard concerns around the risk to the vulnerable, but the other argued “a compassionate due judicial dispensation to allow assisted end of life could be appropriate”.
Others from more liberal Christian traditions, such as the Quakers and the Unitarians, have also suggested the argument from autonomy has Christian foundations. In 2013 the General Assembly of Unitarian and Free Christian Churches passed a motion backing assisted suicide on the grounds that all people should have the freedom to act as their conscience dictates.
Similarly to Christianity, Jewish tradition places a very high value on human life and teaches it is a sin for people to deliberately end it. Ancient Jewish teachings from the Talmud insist that even those who are dying continue to hold the same value and worth as anyone else: “One who is in a dying condition is regarded as a living person in all respects.”
The Chief Rabbi, Ephraim Mirvis, was one of many faith leaders to lobby against previous assisted dying bills in 2014. “In the light of Jewish tradition, this bill seems to me to be irresponsible and dangerous,” he said. “Life is a gift from God and it is not ours to cut short.” Orthodox Jews tend to go further than simply opposing active steps to end life and regard any effort to hasten a natural death, such as by increasing pain relief or removing artificial life-support or feeding, is also wrong.
However, other Jewish traditions are less unanimous in their rejection of assisted suicide. Both the Liberal and Reform Jewish denominations in Britain include rabbis and congregations who argue in favour of legalisation. In September 2021 the Assembly of Reform Rabbis agreed to be neutral regarding campaigns to change the law and permitted individual ministers to offer pastoral care to any individuals seeking an assisted death should it become lawful.
Rabbi Romain, a Reform rabbi who has long led Dignity in Dying’s interfaith alliance for assisted suicide, argues Jews should have be free to choose to die at a time and manner of their choosing. In an article for the British Medical Journal, he quoted from the Book of Ecclesiasticus, which is an extra-Biblical but esteemed part of the Jewish tradition: “Death is better than a miserable life, and eternal rest than chronic sickness.”
Although the sample sizes are very small, several polls have also suggested a majority of people who describe themselves as Jewish disagree with historic teaching and back assisted suicide., including 71 per cent in the same 2019 survey mentioned above. And the peer who led campaigns in the House of Lords for decades to introduce an assisted dying law, Lord Joffe, was a distinguished Jewish human rights lawyer.
In common with the other two Abrahamic faiths, Islam teaches that life is sacred and a gift from God and prohibits suicide and any form of euthanasia. As well as a tradition of the sanctity of life, a hadith (traditional sayings attributed to the Prophet Muhammad) directly addresses the question of deliberately killing oneself to hasten death and end suffering.
“The Prophet said, ‘Amongst the nations before you there was a man who got a wound, and growing impatient (with its pain), he took a knife and cut his hand with it and the blood did not stop till he died. Allah said, ‘My Slave hurried to bring death upon himself so I have forbidden him (to enter) Paradise.’’”
Some more devout Muslims share the Orthodox Jewish belief that even do not resuscitate orders or other removal of futile treatment amount to a form of soft assisted suicide and must be avoided. Other Islamic authorities on medical ethics, however, do not follow this line and instead suggest doctors can be allowed to abandon unnecessary procedures which would extend life at all costs and prevent an imminent natural death.
Unlike Christianity and Judaism, there has not yet been any significant shift in this longstanding opposition to assisted suicide which remains the default teaching of every Islamic denomination and tradition in Britain. However, it is likely that some ordinary British Muslims are probably less opposed to legalisation than their imams or mosques, as with those of other faiths. The Dignity in Dying religious alliance claims to include Muslim figures, and the 2019 survey of views suggested 37 per cent of those describing themselves as Muslims backed introducing assisted suicide (although this was again a very small sample size).
There is less clarity around Hindu medical ethics, as the faith does not have a single historic tradition to draw on compared with the Abrahamic religions. There are Hindu traditions that would seem to oppose assisted suicide, and also some streams of thought which suggest it could be acceptable in some circumstances.
Some Hindus argue any unnatural ending of a life is wrong because it would interfere with the cycle of reincarnation, separating the soul and body at an unnatural time. This would bring bad karma to both the doctor assisting the death and the patient who requested it. Suicide, even one delivered via medically assisted lethal drugs, could also be interpreted as breaching Hinduism’s prohibition on violence.
However, other streams of thought in Hinduism could lead some Hindus to support changing the law. Unlike in Abrahamic religion, the act of suicide is not universally condemned in Hinduism, and in some circumstances is seen as a virtuous act — for instance the tradition of prayopavesa or fasting to death when an individual judges their life is ready to end and they have no responsibilities remaining.
This is normally only undertaken by elderly ascetics, such as the Hawaii-based guru Sivaya Subramuniyaswami who was diagnosed with untreatable cancer in 2001 and chose to refuse food for 32 days until he died.
Other Hindus argue helping a person who is suffering to end their life peacefully is a good deed which fulfils one’s moral obligations to another.
Traditional Sikh teaching is squarely opposed to assisted suicide and euthanasia. Ending one’s life before God does so naturally is seen as a contradiction of Sikh beliefs around a high value on life as a gift from God. The Sikh holy book, the Guru Granth Sahib, states: “God sends us and we take birth. God calls us back when we die.”
Suffering in life is believed by Sikhs to be the result of bad karma from a previous life, and the response is to resolve this by enduring it to the end, rather than seeking to cut it short by any form of suicide, assisted or otherwise. However, most Sikhs make a distinction between passively removing artificial medical interventions to allow someone to die and actively supplying a patient with lethal drugs.
Although there is not much significant teaching on Buddhist medical ethics, most commentators agree the Buddhist tradition has long been opposed to the intentional destruction of life, even when done in acts of suicide. Some traditions record the Buddha himself chastising monks who told sick patients in their care that dying would be better for them than continuing to live.
Similar to Hinduism, many Buddhists would stress that assisting another’s suicide risked accruing bad karma which would affect their next life after reincarnation. On the whole, a strongly held tradition of the sanctity of life points most Buddhists away from endorsing assisted suicide.
Tim Wyatt is a freelance religion and social affairs journalist
Jonathan Ives, professor of clinical and research ethics at Bristol University
Brendan McCarthy, the Church of England’s national adviser on medical ethics, health and social care policy
Mark Pickering, head of the Christian Medical Fellowship
Hina Shahid, chairwoman of the Muslim Doctors’ Association
Jonathan Romain, rabbi of Maidenhead Synagogue and head of interfaith alliance for assisted dying
Liz Slade, chief executive of the Unitarians
Dignity in Dying, main lobby group for assisted suicide
Care Not Killing, main campaign group opposing assisted suicide