Introduction
This chapter samples positions for and against physician assisted suicide. It includes statements in the United Kingdom and the United States of America (California) and makes special note of Christian groups opposed to suicide and assisted suicide. By noting the proposed regulations for assisted suicide, we can see what an immense project this becomes once one allows the possibility of institutional support for suicide.
Privatised and National Health Systems
We should consider the differences between countries without government funding of health care and countries with such funding and oversight:
US-style privatised medicine has
a perverse incentive to keep the patient alive with increasingly extreme and
expensive (but ultimately futile) interventions…. UK-style socialised medicine has an equal and
opposite perverse incentive to reduce the number of patients, especially in
times of crisis.[1]
Cajetan Skowronski adds that giving oversight of suicide to the National Health System (NHS) in the UK is a frightening possibility. An impersonal, institutional system that takes away decisions from doctors involved with patients is the problem.
Consider two proposals for assisted suicide, one from the United Kingdom and another from California. The 2025 UK bill before the House of Lords, the Terminally Ill Adults (End of Life) Bill, having passed the House of Commons, is 56 pages of regulations.[2] Regulations cover the following topics:
The Terminally Ill Adults (End of Life) Bill:
· a commissioner for this, procedures,
· safeguards, and protections to put in place,
· information in medical records,
· the provision of assistance to end life (such as authorising another doctor),
· protections for health professionals and others,
· offences (dishonesty, coercion, pressure; falsification or destruction of documentation),
· regulatory regime for approved substances,
· investigation of deaths,
· codes and guidance,
· provision of and about voluntary assisted dying services,
The previously
proposed bill in 2015 was not passed.[3] One shudders to
imagine the regulation, oversight, and implementation of a department of dying
and of what burden this would place on medical providers. Diagnoses of how long someone has to live are
conjectures and sometimes prove to be very wrong. This bill for England and Wales to legalise
assisted suicide has received over 1,000 amendments. It has reached the stage of being read in the
House of Lords, but it is meeting opposition.
Scotland’s bill, tabled in 2024, proposes assisted suicide for adults
(over 16 years of age) with terminally ill diseases and who have six months to
live.
The Disability Rights California (DRC) Proposals:
In the United States of America, the federal government does not pay
for suicides, but states may. The states
where assisted suicide is legal are: California, Oregon, Washington, Montana,
Colorado, Mew Mexico, Illinois, Delaware, New Jersey, Vermont, Maine, and
Hawaii. Washington and New Jersey are
considering amendments. It is also legal
in Washington D.C. States considering
the legalization of assisted suicide are: Minnesota, Missouri, Indiana, New
York, Pennsylvania, New Hampshire, Massachusetts, Rhode Island, Virginia, North Carolina, and
Tennessee.[4]
Consider the principles proposed by Disability Rights California (DRC) for California in 2015, which
are much briefer than the bill before the UK Parliament:[5]
Any legislation
or initiative about physician-assisted suicide must:
- Ensure and
document the patient is safe from coercion or influence at all times, including
during the written and oral request and after the initial request for the drug.
- Ensure if the
patient changes their mind, the drug is no longer available.
- Ensure and
document that the patient requested assisted suicide; forbid health providers
or insurers from offering or suggesting it.
- Ensure and
document how the physicians and witnesses determine whether the patient is
clear in their wishes, is not under duress or experiencing coercion or undue
influence. If the decision conflicts with a previous statement, such as one
requesting continuing treatment or extraordinary life-sustaining treatment, the
reason must be documented.
- Ensure and
document that each patient who requests a lethal drug is provided information
about and guaranteed provision of alternatives, such as palliative care,
hospice care, personal assistance services, further medical treatment and peer
support and counseling. Providing a list of services does not satisfy this
requirement. The patient has the right to refuse the alternatives and the
refusal must be in writing.
- Ensure that
people with disabilities are not discriminated against. Ensure people with
disabilities, including seniors, are offered medical treatment on a
non-discriminatory basis. Require the treating physician to sign a statement
stating no treatment was denied because of the nature or extent of a person’s
disability. The patient has the right to refuse any medical treatment and the
refusal must be in writing.
- Ensure managed
care entities and health insurance companies have not overruled the physician’s
treatment decisions because of the cost of care. Require the treating physician
to sign a statement that the physician’s recommended treatment was not denied
by the managed care entity or health insurance company.
- Prior to
prescribing a lethal drug, require and document a review of the individual’s
Advance Directive and Physician’s Order for Life Sustaining Treatment. Ensure
the person’s instructions about withdrawal of treatment and palliative care
have been honored. For people without an Advance Directive or Physician’s Order
for Life Sustaining Treatment, provide information and independent help to
complete an advance directive prior to authorizing a lethal drug.
- Allow the
patient to decide whether the official cause of death is the lethal drug or the
underlying diagnosis.
- Require
stakeholder involvement, including California’s protection and advocacy agency
and other representatives of people with disabilities, to design regulations,
oversight, specific safeguards, reporting requirements, and the collection and
publishing of data on a variety of measures. The data must include information
about the 2 race, ethnicity and income of people requesting the lethal
prescription. Data must be provided about whether predictions of date of death
by doctors who prescribe the lethal dose are accurate. The data must include
patterns of prescription, which might be related to “doctor-shopping.”
- Prohibit broad
protections for physicians or others who act “in good faith” even if the
physician misdiagnoses, declines to provide medical treatment for the
underlying condition, declines to approve palliative care, encourages assisted
suicide as preferable to other alternatives, or knows about and does not report
coercion or influence.
- Prohibit anyone
with a financial stake in the death, including heirs and facility staff (e.g.,
nursing home staff) from being a witness to the written declaration requesting
assisted suicide. - Prohibit any witness without significant knowledge of the
patient from assessing whether the patient is under duress, fraud or undue
influence.
- Prohibit
physicians who are new to the patient (e.g., nursing home attending and
consulting physician) to make and confirm a diagnosis and approve the lethal
drug.
The care put into such proposals seems
unaware of the consequences of implementation.
The amount of regulation and the affect this would have on the practice
of medicine is immense. Yet the
underlying question to all this is whether assisting people to kill themselves
is right.
Opposition to Suicide and Assisted Suicide
In October, 2019, the World Medical Association approved the ‘WMA Declaration on
Euthanasia and Physician-Assisted Suicide’ declaration at the 70th WMA General
Assembly in Tbilisi, Georgia:[6]
The WMA reiterates its strong commitment to the principles of
medical ethics and that utmost respect has to be maintained for human life.
Therefore, the WMA is firmly opposed to euthanasia and physician-assisted
suicide....
No physician should be forced to participate in euthanasia or
assisted suicide, nor should any physician be obliged to make referral
decisions to this end.
Separately, the physician who respects the basic right of the
patient to decline medical treatment does not act unethically in forgoing or
withholding unwanted care, even if respecting such a wish results in the death
of the patient.
One Christian group in the UK opposed to the legislative push
to legalise assisted suicide is CARE,
which stands for Christian Action, Research, and Education. CARE states:[7]
All life has intrinsic value and dignity—regardless of its condition. We recognise how immensely difficult it is to
suffer or to see a loved one enduring pain, but, as Christians, we are called
to protect those who are vulnerable and assist people to live—not to commit
suicide. And we want to advocate for a
better way: excellent palliative care, so that those approaching life’s natural
end can have confidence that death can be dignified and pain can be managed.
Another significant Christian group opposed
to assisted suicide in the UK is Christian
Concern, which states:[8]
Legalising
euthanasia or assisted suicide is unnecessary, dangerous, and wrong.
It is
unnecessary because alternative treatments are available. Good palliative care
should be available for all. Killing is not care – it is not kinder to take a
life instead of caring for it.
It is dangerous
because when people are ill, they are vulnerable and can easily be pressured to
make decisions that they may later regret. Society should protect the weak and
vulnerable rather than allowing them to be killed.
It is wrong
because it devalues human life which is sacred. All historical codes of ethics
have agreed that euthanasia is wrong. Disability organisations consistently
oppose assisted suicide and euthanasia.
Christian Concern has resources on euthanasia and assisted suicide,
including a booklet by this title, a number of articles, videos, testimonies,
and several key legal cases.[9] The 38-page booklet has the following
sections: ‘What is Euthanasia and Assisted Suicide (EAS)?’, ‘What does the
Bible say?’, ‘What does the law say?’, ‘Reasons not to legalise EAS’, ‘Isn’t
the public in favour of EAS?’, ‘What about countries where EAS is legal?’, and
a conclusion.
In the United
States of America, the Christian Medical
and Dental Associations have two relevant statements, one on suicide and one
on physician-assisted suicide, with additional explanation. Regarding suicide, it stated in 1992:[10]
We, as Christian physicians and dentists, believe that human life is
a gift from God and is sacred because it bears God's image. One of the
ramifications of societal acceptance of suicide is further devaluation of the
biblical view of human life.
The role of the physician is to affirm life, to relieve suffering
and pain, and to give compassionate, competent care as long as the patient
lives. The physician as well as the patient will be held accountable by God,
the giver and taker of life.
Suicide is an intentional act with the express purpose of ending
one's own life, often occurring in the context of isolation, pain, or mental
illness that may alter the victim's perceptions, thinking, and judgment. We
believe it is only for God to judge the ultimate moral culpability of those who
take their own lives.
Suicide is in opposition to the sovereignty of a loving God, the
Creator of all life, and it is an inappropriate exercise of the control that
God has given us over our own lives as created beings.
Release from suffering is thought by some to justify suicide.
However, suffering is a part of the current state of God's redemptive plan.
Relief of family or societal burden is thought by some to justify suicide. However,
the biblical view of family and community includes an obligation to attempt to
meet the needs of the individual.
For those family members who feel stigmatized by a sense of shock
and shame when a relative commits suicide, our task is to be agents of grace
and healing in the midst of their loneliness, their isolation, their grief, and
anger.
We do not oppose withdrawal or withholding of artificial means of
life support in patients who are clearly and irreversibly deteriorating, in
whom death appears imminent, and who are beyond reasonable hope of recovery.
The Christian Medical & Dental Associations advocate appropriate
use of treatment for clinical depression and physical pain as well as support
for depressed or suffering individuals by family, church, and community.
Regarding
physician-assisted suicide, the Christian Medical and Dental Associations
stated in 1992:[11]
We, as Christian physicians and dentists, believe that human life is
a gift from God and is sacred because it bears God's image. Human life has
worth because Christ died to redeem it, and it has meaning because God has an
eternal purpose for it. We oppose active intervention with the intent to
produce death for the relief of pain, suffering, or economic considerations, or
for the convenience of patient, family, or society. Proponents of
physician-assisted suicide argue from the perspective of compassion and radical
individual autonomy. There are persuasive counter arguments based on the
traditional norms of the medical professions and the adverse consequences of
such a public policy. Even more important than these secular arguments is the
biblical view that the sovereignty of God places a limit on human autonomy. In
order to affirm the dignity of human life, we advocate the development and use
of alternatives to relieve pain and suffering, provide human companionship, and
give opportunity for spiritual support and counseling. The Christian Medical
& Dental Associations oppose physician-assisted suicide in any form.
Conclusion
Governmental or organizational decisions to allow assisted suicide find themselves in a considerable effort to define, legislate, regulate, oversee, adjudicate, protect, and so forth. They not only provide death as a means of care but also introduce a social change at several levels. A regulatory office for suicide, judges, requirements and guidance for medical practitioners, and a general view of end of life matters in society at large are all introduced. Not only physicians and other medical providers but also psychiatrists will play a growing part in assisted suicide.[12] The introduction of euthanasia under strict restrictions easily expands to cover other reasons for suicide. As we have seen before regarding suicide, even in antiquity, and in regard to other matters more recently (e.g., an increasing number youth claiming to be transgender or bisexual), social trends are introduced when legislation brings such practices to citizens’ attention and legalises them.
Having noted
Christian objections to suicide and assisted suicide, one major concern is how
governments intend to handle such objections.
Will Christian doctors be forced to provide suicide or pass their
patients on to suicide-performing doctors?
How will such legislation affect pharmacists who object to providing
poisons for suicide prescriptions? How
will a Christian nurse relate to a doctor’s order for assisted suicide? Will Christian counsellors be forbidden to provide
counselling against suicide when the client desires to do it—as they have been in the
matter of homosexual identity in the UK? Will a Christian praying that a patient not proceed
with suicide be arrested, as Christians praying near abortion clinics have been
in the UK? Will teachers claiming to act
in kindness and aware of an adult student’s (16 years in Scotland) desire to commit suicide be able to
withhold this information from Christian parents? Perhaps we might expand these sorts of scenarios,
but the basic questions, once assisted suicide is introduced, are how will this reshape society itself and how will a society engage groups diametrically opposed
to governments allowing and regulating assisted suicide?
[1] Cajetan Skowronski, ‘The real scrutiny of assisted dying is only
just beginning,’ The Critic (21
January, 2026); The
real scrutiny of assisted dying is only just beginning | Dr Cajetan Skowronski
| The Critic Magazine (accessed 21 January, 2026).
[2] ‘Terminally
Ill Adults (End of Life) Bill’; (accessed 21 January, 2026).
[3] For updates on this
legislation and for Northern Ireland, the Isle of Mann, and Jersey, one might
go to the website of CARE: Assisted
Suicide around the UK | CARE (accessed 20 January, 2025).
[4] Information from: Death
with Dignity U.S. Legislative Status State Map (accessed 20 January, 2026).
[5] Available online: PrinciplesPhysician-AssistedSuicide.pdf
(accessed 20 January, 2026).
[6] Available online: WMA
Declaration on Euthanasia and Physician-Assisted Suicide – WMA – The World
Medical Association (accessed 4 January, 2025).
[7] CARE for
Assisted Suicide | CARE (accessed 21 January, 2026).
[8] Cf. End
of life - Christian Concern (accessed 20 January, 2025).
[9] Ibid.
[10] Available online: Suicide
(PDF).pdf (accessed 4 January, 2025).
[11] Available online: Physician
Assisted Suicide (PDF).pdf (accessed 4 January, 2025).
[12] Abilash A. Gopal, 'Physician-Assisted Suicide: Considering the Evidence, Existential Distress, and an Emerging Role for Psychiatry,' Journal of American Academy of Psychiatry and Law 43 (2015), pp. 183-190.
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