1. The Pendulum of Physician Assisted Suicide:At a Crossroad
Background of PAS
PAS is defined as the act of helping someone to commit suicide by giving them the
means to do so. 1
Usually, this is done by prescribing or providing a lethal dose of a medication
that the patient independently ingests with the presence or absence of a physician at the time
the patient decides to die. 2
Background of Euthanasia
The definition of euthanasia is the act of killing to relieve pain. 3
PAS: At the International Platform
1. The United States
In the United States, PAS is illegal in most states and remains as a statutory offence.
For example, in Georgia, Kentucky and Rhode Island, knowingly assisting another person’s
death is deemed to be guilty of felony; in Hawaii, a person is guilty of manslaughter if the same
offence is committed.
However, exceptions to the above apply in Oregon, Washington, Montana and Vermont.
Oregon became the first state in the US to legalise PAS where the act does not require
any intervention from doctors or healthcare providers in PAS. On 24th March 1998, the first
person to die by way of PAS is a woman with terminal breast cancer under the state’s Death
With Dignity Act.
To utilise the law in order for PAS to be performed, the patient needs to fulfill a number
of criterias and among them are that the patient needs to be at least 18 years of age, is a
resident of Oregon, able to communicate and make healthcare decisions for himself and
diagnosed to have a terminal illness which survival period will not last for more than six months.
4
Lethal medication can be obtained from a licensed Oregon physician who is a Doctor of
Medicine or a Doctor of Osteopathy licensed to practice medicine by the Board of Medical
Examiners for the state of Oregon. Physicians are not obliged neither to prescribe the
medication nor participate at the time of the patient’s death because prescription of the lethal
1
Elizabeth A. Martin, Oxford dictionary of Law (Jonathan Law ed, 7th edn, OUP 2009) 46
2
Monika Ardelt, ‘Physician Assisted Death’ C.D. Bryant ed al (eds), Handbook of Death and Dying
(Thousand Oaks, Sage 2003) 424
3
n 1 at 212
4
Death with Dignity Act; See also House of Commons Library, Assisted Suicide (Standard Note No
SN/HA/4857, 2008) p 25

2. medication is done by a pharmacist who must be informed of the ultimate use of the medication.
5
If all the above requirements are met, the patient must undergo an outlined procedure to
obtain prescription of the drug. Firstly, the patient must make two oral requests to his physician,
separated by at least 15 days. At the end of the 15 days cooling-off period, the physician must
offer the patient an opportunity to revoke the request and the patient reserves the right to do in
manner at any time. Secondly, the patient must provide a written request witnessed by to
person to the physician. Thirdly, the diagnosis and prognosis is confirmed by both the consulting
physician and the prescribing physician. Forthly, the prescribing and consulting physician
decides if the patient is capable. After that, the patient is to be referred to a psychological test if
either physician believes that the patient’s judgment is impaired by a psychiatric or
psychological disorder. Then, the patient must be informed of the alternatives to assisted
suicide which includes comfort care, hospice care and pain control by the prescribing physician.
Last but not least, the prescribing physician must request, but may not require the patient to
inform his next-of-kin of the prescription request. 6
The Washington Death With Dignity Act 2008 was effective since March 2009 and
Vermont signed the Patient Choice and Control of End of Life Act (Act 39) in May 2013 to
allow residents with terminal illnesses in those states to hasten their death with the help of a
physician. Both of these states have adopted the PAS model in Oregon.
On the other hand, Montana has to clear legislation stating that PAS is legal but the
state Supreme Court but case law shows that the tribunal is not against it and held that the
physician bears no liability if it is carried out with the patient’s consent. 7
2. Switzerland
PAS may be unwelcomed in many parts of the world but it is an exception to the Swiss
society who thinks highly of it because they believe that this is such a vital human right,
especially towards the terminally ill. According to Swiss law, PAS is legal while euthanasia is
strictly prohibited. 8
The statute provides that any individual who instigate another to commit
suicide or assist in doing so with selfish motives will be imprisoned or confined by penitentiary
for not more than five years whether the suicide was attempted or successful. 9
Death by
injection however, is sanctioned.
5
House of Commons Library, Assisted Suicide (Standard Note No SN/HA/4857, 2008) p 25
6
House of Commons Library, Assisted Suicide (Standard Note No SN/HA/4857, 2008) p 25-26; Sandra
Norman Eady, ‘Assisted Suicide Laws in Oregon’ OLR Report 2002-R-0077
7
Baxter v Montana (2009 WL 5155363 [Mont. 2009])
8
Prof. Dr. Christian Schwarzenegger, Sarah J. Summers, ‘Criminal Law and Assisted Suicide in
Switzerland’ (2005)
<http://www.rwi.uzh.ch/lehroforschung/alphabeticsh/schwarzenegger/publikationen/assisted-suicide-
Switzerland.pdf> accessed on 24 October 2014
9
Penal Code of Switzerland, art 115

3. Unlike the regulations in the US, Swiss law does not have a yardstick to assess if a
patient qualifies to have access to PAS; who is a qualified physician or the standard procedures.
Very often, this is why the law is criticised to be vague and perceived as an ‘easy way out’. The
law does not deter foreigners from participating in the ‘suicide tourism’ at Exit Deutsche Schweiz
or DIGNITAS. These non-for-profit organisations provide counseling, lethal medication and
carrying out assisted suicide.
3. Belgium
In 2002, euthanasia and PAS is legalised. The former is regulated but not the latter.
10
Both requires the patient to make a voluntary request and the opinion of two doctors to
approve the documents. If either of them believes that the patient is psychologically unfit to
decide on such a matter, he must refer the patient to a psychological examination. 11
Recently, the Belgian government made a move to uncap the age limit, extending PAS
as an option to minors who are terminally ill, suffering intolerable pain, understood the nature
and gravity of PAS and has obtained their parents’ consent to do so. 12
4. Luxembourg
PAS is allowed in Luxembourg since 2008 provided that the patient meets the
requirements and the physician follows the procedures laid out by the legislation. 13
For a
patient to qualify for a PAS, he must: be a capable adult and conscious at the time of
application; must be thoughtful in making the request voluntarily without external pressure and
repeat this step if necessary; have medical reports showing that there is unbearable and
constant mental and physical suffering with no prospects of improvement affected by
pathological or accidental reasons; and document his request to use PAS. 14
5. The Netherlands
10
Loi relative a l’euthanasie (Law on Euthanasia); Herman Nys, ‘Euthanasia in the Low Countries’,
Ethical Perspectives, vol. 9, June-September 2002; See also Julia Nicols, Marlisa Tiedemann and
Dominique Valiquet, ‘Euthanasia and Assisted Suicide: International Experiences’ (Parliament of Canada,
8 April 2011, revised 25 Oct 2013) <http://www.parl.gc.ca/content/lop/researchpublications/2011 -67.e-
htm> accessed on 24 October
11
n 13
12
n 13
13
Loi du 16 Mars 2009 sur el’euthanasie at l’assistance au suicide (Law of 16 March 2009 on euthanasia
and assisted suicide), art 2; See also Julia Nicols, Marlisa Tiedemann and Dominique Valiquet,
‘Euthanasia and Assisted Suicide: International Experiences’ (Parliament of Canada, 8 April 2011,
revised 25 Oct 2013) <http://www.parl.gc.ca/content/lop/researchpublications/2011-67.e-htm> accessed
on 24 October
14
Loi du 16 Mars 2009 sur el’euthanasie at l’assistance au suicide, art 2

4. According to Dutch law, PAS is allowed as long as the physician complies with the
requirements of due care, comprising that the patient’s decision must be well-informed and
voluntary; that he is suffering from continuous and unbearable pain; the physician informed the
patient of his current condition and prognosis and, among other things. 15
The statute extends PAS to minors where the law provides that: a child of 16 to 18 years
of age of reasonable understanding of his interest can opt for PAS or termination of life without
their guardian or parents’ consent but they must allow their parents’ involvement in the decision-
making process; a child between 12 to 16 years of age who reasonably understands his
interests may be granted the said request if his guardian or parents agree to it; a six-year-old or
older child who is incapable of expressing his will but reasonably understands his interest before
reaching this condition and made a written request to terminally end his life may be approved. 16
The requirements of due care as well as the doctrine of mutatis mutandis applies to the second
and third category of minors. 17
6. Quebec
In June 2014, Quebec recognises assisted suicide be passing the Act Respecting End-
of-Life Care bill that is expected to be enforced by the end of 2015, aiming to allow quality and
appropriate end-of-life care more accessible to the public inclusive of prevention and relief of
suffering such as palliative sedation and medical aid in dying. The provisions also ensure there
is no discrimination by highlighting how these patients should be treated and emphasising the
necessity to create and maintain transparent communication between healthcare providers and
their patients. 18
However, obtaining medical aid in dying such as PAS is not as easy as merely having
the patient themselves to request for such services in a free and informed manner.
Qualifications examined by the physician must be met, among them stating that the patient must
be of age who is capable of consenting to care and insured by a person within the definition of
the Health Insurance Act (chapter A-29); suffer from an incurable serious illness, an advanced
state of irreversible decline in capability as well as constant and unbearable physical or
psychological pain which the patient deems intolerable and unrelievable in any manner. 19
15
Termination of Life on Request and Assisted Suicide (Review Procedures) Act, art 1, 2; See also
Government of the Netherlands <http://www.government.nl/issues/euthanasia/euthanasia-assisted-
suicide-and-non-resuscitation-on-request> accessed 21 October 2014
16
Termination of Life on Request and Assisted Suicide (Review Procedures) Act, art 2; See also CBC
News, ‘Assisted Suicide: Where Do Canada and Other Countries Stand?’ (CBC News Canada, 13
October 2014) <http://www.cbc.ca/news/canada/assisted-suicide-where-do-canada-and-other-countries-
stand-1.2795041> accessed on 23 October 2014
17
ibid
18
An Act Respecting End-of-Life Care, Bill 52, s 1- 3; See also CBC News, ‘Assisted Suicide: Where do
Canada and Other Countries Stand?’ (CBC News Canada, 13 October 2014)
<http://www.cbc.ca/newscanada/assisted-suicide-where-do-canada-and-other-countries-stand-
1.2795041> accessed on 23 October 2014
19
ibid s 26

5. On top of that, the patient himself or a third person on behalf of him must sign a dated
form prescribed by the Minister in the presence of a health or social services professional
(except the attending physician) who countersigns it. 20
It should be noted that a third person is
involved only under circumstances where the patient is incapable and the third person himself
must be a capable person of full age who is not a team member responsible providing caring for
the patient. 21
It is understood that medical aid in dying such as PAS is a permanent and unrectifiable
process once it is conducted. Therefore, the importance of ensuring the physician to be equally
fit cannot be ignored. Numerous requirements must be fulfilled before administering the lethal
drug. For example, the physician must be opined that the patient meets the criterias in section
26 of the act as mentioned above, making sure the patient to have a chance to contact and
discuss the request with whomever they wish to and acquire a second opinion from another
physician that the section 26 requirements are satisfied. 22
The patient must be informed of the
reasons if the physician thinks medical aid in dying should not be given and all documents and
communication pertaining to the medical aid in dying request must be recorded and kept in the
patient’s file whether or not the request is executed by the physician. 23
Also, the patient
reserves all rights at all time to withdraw the request even it is approved. 24
At this stage, the new bill seems to have a good prospect in safeguarding the rights of
terminally ill patients who make medical aid in dying as a personal choice while ensuring the law
is not abused by the service providers and members of the society as a device to promulgate
unnecessary deaths. However, the bill needs to stand the test of time to reveal its true colours
no matter how promising it looks in our theoretical discussion.
7. The United Kingdom
Both euthanasia and PAS are illegal in the UK as the statute explicitly stipulates that
assist in encouraging, committing or attempted to commit suicide is an offence, carrying a heavy
sanction of a maximum of 14 years imprisonment. 25
However, committing suicide or attempting
to commit suicide in itself is legal. 26
The ‘aid, abet, counsel and procure’ elements in the Suicide Act 27
is highly criticised for
being archaic and there is a need to amend or change the law in order to move with time.
Therefore, as at 1 February 2010, amendments by Section 59 and Schedule 12 of the
20
ibid (n 25)
21
ibid
22
n 24 at s 28
23
n 24 at s 29, 31
24
n 24 at s 27
25
Suicide Act 1961, s 2
26
ibid s 1
27
n 7

6. Coroners and Justice Act 2009 applies where the act of encouraging or assisting suicide on or
after the said date.
At the time being, there is no clear legislation expressing that PAS is illegal or
disallowed. Having said so, this does not mean that it is decriminalised. If such cases arise, the
Director of Public Prosecution (hereinafter known as ‘DPP’)’s consent must be obtained before
a suspect can be prosecuted. Liaising closely with the Association of Chief Police Officers in
investigation, the DPP must follow a set of guidelines set by the Crown Prosecution Service and
given is full discretion in determining if the suspect ought to be charged via the Full Code Test.
28
The test is divided into two parts, i.e. the evidential stage and the public interest stage. It must
be noted that the former must be proven regardless of its severity or sensitivity before
considering the latter and both elements must be satisfied to meet the test to prosecute the
suspect. 29
At the evidential stage, the prosecution must prove that the suspect’s conduct was
capable of either encouraging, assisting or attempting suicide of another person and it was
intentional. The statute also provides that the suspect can still be liable for this offence even
though the victim does not know or is unable to identify him regardless if a suicide or attempted
suicide takes place.30
Under circumstances where the victim commits suicide or attempts
suicide due to threats or pressure exerted by the suspect, this is captured by the statute as well.
Having said so, assisted suicide must be distinguished from that of murder or
manslaughter. The former requires the victim to take his or her own life whereas the latter
requires the suspect to take the victim’s life even if the suspect acts out of respecting and
carrying out the victim’s wishes. In scenarios where the victim ingest herself with a lethal dose
of drug but she becomes unconscious or remains conscious, the suspect who further supplies
more drugs for the victim to successfully take her own life will be liable for assisted suicide. The
charge will be murder or manslaughter if the same situation happens but it is the suspect who
supplies and administer the drugs to take the victim’s life. This is because the first scenario is
assisted suicide while the second constitutes euthanasia. Perhaps such an analysis explains
why Kay Gilderdale admitted to assisting her daughter’s death but denied the charge of
attempted murder. 31
Having the evidential stage satisfied, there is a need to consider the public interest stage
because the commission of an offence supported by strong evidence ought to be criminalised if
28
The Director of Public Prosecutions, ‘Policy for Prosecutors In Respect of Cases of Encouraging or
Assisting Suicide’ (The Crown Prosecution Service, February 2010, updated October 2014)
<http://www.cps.gov.uk/publications/prosecution/assisted_suicide_policy.html> accessed 23 October
2014
29
ibid
30
Suicide Act 1961, s 2A as amended by virtue of Coroners and Justice Act 2009, s 59(4)
31
Afua Hirsch, ‘Kay Gilderdale Case: A Clear Verdict on the Law’s Confusion on Assisted Suicide ’ (The
Guardian, 25 January 2010) <http://www.theguardian.com/uk/2010/jan/25/kay-gilderdale-case-expert-
view> accessed 19 November 2009

7. it is in the public’s interest. 32
This part of the Full Code test is assessed in a holistic manner on
a case-to-case basis and results in a successful prosecution only if the public interest factors in
favour of the prosecution outweighs the public interest factors against prosecution. In total, there
are 16 public interest factors in favour of prosecution such as the victim had not the capacity to
make an informed decision to commit suicide, the victim had not communicated clearly and
unequivocally to the suspect of his wishes to commit suicide and the suspect was not wholly
compassionate. The six public interest factors opposing prosecution includes the victim to have
reached a voluntary, clear, settled and informed decision to commit suicide and the suspect
sought to dissuade the victim from committing suicide or attempt to commit suicide. 33
In Scotland, a new bill paving its way to be passed to allow a person who assists another
in committing suicide bears no criminal or civil liability. 34
8. Malaysia
Restrained by the statute, PAS is not allowed in Malaysia due to strong religion beliefs
that shape the laws and norms of society. 35
Most religions embraced by Malaysians include
Islam, Christianity, Buddhism, Hinduism and Sikhism promote the sanctity of life and taking
away someone else’s life is a crime from a Christian or muslim’s perspective.
Ironically, when a terminally ill patient who is proven by doctors that the patient has no
opportunity or alternatives of regaining consciousness, no realistic prospects of recovering or
continuous treatment is perceived to be futile, then the patient’s family members are given the
discretion to consent to taking away the patient’s life by withholding or withdrawing treatments.
36
What makes this more interesting is that a 2011 study conducted on physicians and terminally
ill patients in Malaysia expressed that the majority strongly oppose PAS but agree in withholding
or withdrawing treatments to patients with no survival chances. 37
No doubt that this violates the
principle of sanctity of life, this is lawful. The law justifies this, reasoning that both medical
practitioners and the family members act in the patient’s best interest. 38
Guidelines provided
and agreed by the college of anaesthesiologist and their counterparts are practised but the line
is blurred in terms of liabilities and rights. 39
The law in this area demands for clarification in its
development and campaigns to promote awareness.
32
R (Purdy) v DPP (2009) UKHL 45 [44] (Hope LJ)
33
n 10
34
Assisted Suicide (Scotland) Bill (as introduced on 13 November 2013), s 1 and 2
35
Malaysian Penal Code (Amendment) Act 1989 [Act 727], s 299, 300; Dr Haniwarda Yaakob, ‘Islam and
Bioethics in Malaysia’ [2013] 6 MLJ 10
36
Puteri Nemie Jahn Kassim, Omipidan Bashiru Adeniyi, ‘Withdrawing and Withholding Medical
Treatment: A Comparative Study Between the Malaysian, English and Islamic Law’ (2010) 29 Med. & L.
443
37
Yousuf RM, Mohammed Fauzi AR, ‘Euthanasia and Physician Assisted Suicide - A Review from
Islamic Point of View’ (2012) 11 IMJM 63, 64
38
n 19
39
ibid (n 19)

8. Two sides of the coin in relation to PAS
It is healthy to see that there are constructive debates from different school of thought with
regards to the legalisation of assisted death. For those who supports it, it is mainly due to
practical, financial and compassionate reasons; on the other hand, anti-assisted dying
legislation based their opposition on matters such as the sanctity and value of human life,
tendency to be abused by malicious individuals and arbitrary discrimination on the part of
patients who are qualified to undergo PAS.
Patients whose deaths resulted from euthanasia or PAS in 1990 listed the following concerns
when asked about their decisions to end their lives: 57% feared a loss of dignity, 46%
mentioned unworthy dying, 46% mentioned pain, 3% didn’t want to be dependent on others,
and 23% were tired of life (van der Maas et al.1990) Contrary to popular belief, it appears to be
that psychological factors play a large role in end-of-life decisions as opposed to physical
factors.40
There are reasons as for the patient’s decision to opt for PAS. However, the main reason is, in
fact, psychological issues and social issues which have been their greatest consideration rather
than financial issues or fear of agony.41
1. Supporting views on PAS
For many patients with incurable and tormenting progressive illness, their wish to end their
suffering can be achieved by simply taking advantage of the availability of PAS. Here, the
patient views the dignity of living to supercede the dignity of dying since their quality of life has
plummeted whilst perceiving the need to spend an enormous amount of money to sustain their
lives as unnecessary.42
“My body and mind is broken. I am so desperate to end the neverending
care of silence of pain and suffering. I have nothing left and I’m spent”, this was what Lynn
Gilderdale, a young girl who suffered from chronic fatigue syndrome, or known as ME said to
her mum as she could not battle her agony as a result of this ill fated circumstance. Her mother,
Kay Gilderdale, assisted her daughter in ending her life by preparing morphine purchased from
a pharmacy for a lethal dose of injection as well as sedatives and sleeping pills for her to be
added in a drink. She was acquitted from the charge of attempted murder although she pleaded
guilty to assisted suicide earlier on. Although this does not directly relate to the main discussion
of PAS, but this indirectly show that possible prosecution could be avoided, despite the interim
guidelines prepared by the DPP in regards to assisting a person to commit suicide out of their
wish and out of love 43
40
Ardelt, ‘Physician Assisted Death’ (n2) 428-429
41
ibid 430
42
Smith and Boffey, ‘Desmond Tutu plea for ‘assisted dying’ before historic Lords debate’ (12 July 2014)
http://www.theguardian.com/society/2014/jul/12/desmond-tutu-assisted-dying-right-to-die-nelson-mandela
accessed 20 October 2014
43
BBC News, ‘Why I helped my daughter die’, 1 February 2010
<http://news.bbc.co.uk/2/hi/uk_news/magazine/8481751.stm> accessed 25 October 2014

9. In Desmond Tutu’s article for the Observer, the case of a 28-year-old South African, Craig
Schonegevel, who suffered from neurofibromatosis caught his attention. He felt forced to end
his life so he did it by swallowing 12 sleeping pills then tying two plastic bags around his head
with elastic bands because doctors could not help him. Tutu then further emphasised that, it is
more crucial to give respect to the patient’s end-of-life wish and their “right of autonomy and
consciousness”.44
Since the patient undergoes PAS, they knew that it was their choice to end
their lives based on an informed and voluntary manner to commit the suicide. Having said that,
when the patient decides to administer his or her own death, they can ‘die with dignity rather
than a shell of their of their former selves’.
The British Medical Journal had expressed their view, making their stand for the assisted dying
bill as it respects the patient’s right to autonomy which now, becomes more important than
abiding to the Hippocratic Oath as it becomes a “cardinal principle’ in medical ethics.
Furthermore, they argued that, the “respect for autonomy has emerged as the cardinal principle
in medical ethics and underpins developments in informed consent, patient confidentiality, and
advance directives. Recognition of an individual’s right to determine his or her best interests lies
at the heart of this journal’s strategy to advance the patient revolution in health care”.45
It is also
argued that the decision to end one’s life is intensely personal and private, harms no one else,
and ought not be prohibited by the government or the medical profession.
Since physically disabled patients would require constant care and comfort from caregivers,
they would have to incur a hefty amount of money to hire a caregiver or to pay medical fees
which involve life-prolonging treatments and procedures. Therefore, by using PAS, a significant
amount of health costs can be reduced. This would benefit those who are financially challenged
yet has to bear costs of palliative care and pain killers. Furthermore, the money saved on
palliative care and life-prolonging treatments can be channeled to finance newborns and those
who are at the full flow of their lives.46
Next, doctors and nurses can focus on providing other patients with better chance of living
rather than investing their entire time on caring for a terminally ill patient. This can be said as
there could be only a limited number of specialised doctors in palliative care who may not be
able to attend to every patient under the hospice’s care. However this should not be regarded
as the few main reason why patients undergo PAS, but this merely demonstrates the sideline
perks as a result of PAS.
In relation to patients who cannot bear the pain of the aftermath of their illness, embarking on
PAS will be a more ‘dignified’ yet less ‘horrific’ way to die. For some who cannot afford
extensive palliative care and life prolonging treatments, they may commit suicide in a way which
44
ibid
45
John Bingham, ‘Legalise assisted suicide because ‘choice’ the most important principle in medicine,
says BMJ’, 3 July 2014 <http://www.telegraph.co.uk/health/healthnews/10940767/Legalise-assisted-
suicide-because-choice-the-most-important-principle-in-medicine-says-BMJ.htm> accessed 25 October
2014
46
n 26

10. could be traumatic for their family. By informing their doctors and family about their plans to end
their lives through an advanced directive discussed ahead of their potentially difficult times to
cope with the repercussion of their illness, or if not, when the patient is incompetent to decide
whether to proceed with the procedure (herein refer to PAS), the pre-informed palliative care
doctor will discuss with their family members on the next possible step to take in the patient’s
best interest.
To further support such arguments, the Belgian case of an identical twin brothers who were
born deaf but learned that they are going to be blind soon sought euthanasia as a solution.The
brothers reasoned that they did not want to be dependent on another to continue living.
Although t neither did they suffered from agonising physical pain nor terminal illness, they were
euthanised under the Belgian law which permits them to do so by making their wish clear with
an unbearable pain, based on a doctor’s judgement.47
2. Opposing views on PAS
One of the main reasons why medical associations such as American College of Physicians and
American Society of Internal Medicine are against such liberalisation is because, by allowing
doctors to participate in PAS, it will break their Hippocratic Oath as a medical practitioner. In the
Hippocratic Oath, doctors will swear by the rule that they will play their main role as a healer,
rather than ‘intentionally bringing the death of the patient’. At the same time, for decades, the
Oath had pronounced against euthanasia and assisted suicide, which forms the backbone of
their practice.48
Hence, with the reason aforementioned, in event there is a legalisation of PAS, this gives rise to
a potential pressure on the vulnerable and disabled individuals to seek PAS as the last resort to
end their lives. Some argued that this will lead to a point where the patient feels that it is a ‘duty
to die’ to alleviate any troubles or pain incurred on themselves as well as their family, rather
than be awarded a ‘right to die’ as a respect to the individual’s right to autonomy. However it is
not absolute. As a disabled peer from the House of Lords, Baroness Campbell of Surbiton
strongly opposed the legalisation of Lord Falconer’s Assisted Dying Bill which intends to give
those who are terminally ill with less than 6 months of life expectancy to be given the green light
to administer their own death with the assistance of a doctor. Such bill, she said, “gives no
comfort to me. It frightens me because in periods of greatest difficulty, I know I might be
tempted to use it. It only adds to the burden and challenges life holds for me. Pain, suffering and
disempowerment are treatable. I have to believe that and it should always be treated”. She
47
James Rush and Damien Gayle, ‘Deaf twins who discovered they were going blind and would never
see each other again are euthanized in Belgian hospital’ 14 January 2013
<http://www.dailymail.co.uk/news/article-2261985/Belgian-twin-brothers-killed-doctors-choosing-
euthanasia-able-again.html> accessed 25 October 2014
48
Snyder & Sulmasy, ‘ Physician-Assisted Suicide’ Ann Intern Med 2001;135:209-216, 212
<https://www.acponline.org/running_practice/ethics/issues/policy/pa_suicide.pdf>

11. “urged the House to talk to disabled people who oppose the bill and suggested it is a regressive
step for those campaigning for disability rights”.49
With the legislation, it may create ‘"vultures" with an eye on the financial incentives to end the
lives of frail, ill and elderly people’, says Tebbit, a peer in the House of Lords. He spoke of his
wife, who was "crippled almost 30 years ago" in the IRA Brighton bombing, saying: "Those who
care for such people are all too familiar with the moments of black despair, which prompt those
words 'I would be better dead so that you could get on with your life.’"50
As PAS directly involves the loss of a human life, in which many religion regard the human life
as a gift from God and it is so sacred that no one should be given the authority to end anybody’s
life, even if one finds their life no longer worthy of living. On top of that, many Jews, Christians
and Muslims believe that ‘ the sanctity of life and sovereignty of God overrides any individual’s
desire of end his or her life prematurely’. (Alexander 2000; Hai and Hussain 2000; Kavesh 2000;
Rowell 2000) However, if one voluntarily forgoes a redundant treatment with regards to their
illness which imposes a heavy burden on their shoulders, it is considered permissible to end
their life in the eyes of religious beliefs.
The slippery slope argument in relation to this contention also argues that, as much as
legislation which Lord Falconer, ex Lord Chancellor of UK, have raised with proposals to benefit
those with terminal illnesses as well as 6 months or less life expectancy can take on assisted
suicide by injecting a permissible amount of lethal drugs, it may backfire others who are not
covered under the proposed legislation. Why so? Firstly, it is thought that this legislation would
encourage those who are chronically ill, disabled, and psychologically distressed to end their life
despite its lack of provision to include this group of individuals. Secondly, even if the legislation
is successfully implemented, it may not cover those who are unable to ingest lethal dosage of
medication in relation to existing legislation, for example, in Oregon and Switzerland
While some suffered from motor neurone diseases, various types of cancer and multiple
sclerosis, one of the many reasons that people who strongly discourage PAS is because it
involves those who are not terminally ill, especially in Switzerland. Statistical data shows that
even a minority with Crohn disease, inflammatory bowel disease, kidney disease, rheumatoid
disease and tetraplegics, all which are not terminal conditions, sought PAS.51
3. Alternatives to PAS
a. Hospice and palliative care
49
Rowena Mason, ‘House of Lords debate evenly splits over assisted dying legislation’ 18 July 2014
<http://www.theguardian.com/society/2014/jul/18/assisted-dying-legalisation-debate-house-lords>
accessed 25 October 2014
50
n 46
51
House of Commons Library, Assisted Suicide (Standard Note No SN/HA/4857, 2008) p 24-25

12. An alternative to PAS is hospice and palliative care. Firstly introduced in England in 1967,
hospice is generally available for patients with life expectancy of less than 6 months and wish to
forgo any life prolonging treatments hence resorting to palliative care. However it is recorded
that, despite the establishment of hospice and palliative care, the number of patients who opted
for physician assisted suicide remained high, thus questioning the effectiveness of hospice in
providing medical, spiritual and emotional comfort to patients.52
b. Voluntary refusal of food and water
Once the patient does not have any significant chances for recovery and yet does still feel the
excruciating pain of their illness, a legal alternative to PAS, i.e. voluntary refusal of food and
water can be done autonomously and requires no intervention from their family or their doctors,
hence, eliminating ethical or moral dilemmas (Quill and Byock 2000) . By doing so, they will
usher in a gradual death yet still has the buffer period to contemplate on their decision to end
their lives. (Miller and Mier 1998) Although patients still have time to contemplate on their
decision, along the line, they may suffer from side effects of the lack of nutrition such as mild
euphoria, or even worse, delirium or confusion. (Quill and Byock 2000)
c. Terminal sedation
Terminal sedation is also an alternative available for patients who seek to end their lives. Unlike
PAS, the intention of the physician will differ amongst these two methods. On one side, PAS
intends to end the patient’s life for good whilst terminal sedation merely reduces the pain by
putting the patient into deep sedation which does not lead to death. However, terminal sedation
is only recommended in event active euthanasia fails. (Quill et al. 1998) It is also crucial that the
patient has voluntarily consented to the method and if the patient is not mentally competent to
make a decision, their doctors should refer to the patient’s advance directives and discuss with
their family members on the next possible step to take before administering sedation. (Quill and
Byock 2000)
A patient who feels appreciated rather than a burden to the family and whose physical and
psychosocial needs are adequately addressed will rarely consider PAS or euthanasia. (Brogden
2001; Emanuel, Fairclough and Emanuel 2000) Long term hospice care should be provided,
and not limited to, those who are refusing any form of curative treatment. This also suggests
that the government should step in in providing financial, social and emotional assistance to
families with terminally ill and disabled loved ones.
Conclusion
52
ibid (n2) 431

13. “The reason to consider life and what its value is to make sure you’re not missing out. Seize the
day, what’s important to you, what do you care about it and what matters. Pursue that - forget
the rest.” 53
Many would agree that life is a sacred gift and it should not be ended by any means
prematurely. However, despite the view that PAS is unethical and legally challenging, yet we
should look into the reason why there are individuals who wish to end their lives despite
availability of palliative care or pain killers. If the legislation were to be implemented, lawmakers
should consider arguments from both sides of the spectrum to table and pass a legislation
which will highly safeguard interests of the society. Nevertheless, either respecting the patient’s
choice or preserving the sanctity of life, this procedure boils down to the perspective of the
respective nations on this issue. If not, more steps need to be taken in order to improve the
quality of health care provider in providing palliative care and government’s support in all
aspects, whether financially or emotionally.
53
n 52