“Eligibility criteria for physician-assisted suicide in the UK proposes: the patient must have capacity; the request be entirely voluntary; a terminal illness with a prognosis of fewer than 6 months to live; and two physicians certifying the criteria are met.
Leaving aside prognostic accuracy, considerations of justice trump all potential eligibility criteria. Why is an arbitrary six months proposed? Why not one, two or five years? If death is a therapeutic intervention, why restrict it to terminal illness alone and deny the proposed benefit to other sufferers? The incremental extension of eligibility criteria is alarming and inevitable, as seen in countries where physician-assisted suicide has been embraced.
Canada presents a stark case study. In under a decade, MAiD has progressed from illegality to the following: rolled out nationally from one province originally, the terminal illness criteria dropped, advanced directives for MAiD accepted, criteria expanded to include a sole diagnosis of a mental health disorder (‘temporary exclusion of eligibility’; initial March 17, 2023 implementation date delayed one year for logistical reasons), and Bill C-7 under review to consider lowering the legal age for accessing MAiD to 12-yr-olds deemed competent to make the decision to end their lives. Of note, the ‘right’ to euthanasia in the Netherlands extends to children from 12 years of age, and criteria in Belgium state no minimum age limit. Wiebe and Mullin19 have also defended homelessness alone as sufficient grounds to seek MAiD. In Belgium, euthanasia without explicit patient consent (as a best interest decision) has been practiced for some years.20
Societal normalisation is relevant and inevitable. Annual increases in assisted deaths have been seen across permissive legislatures, where safeguards become ‘barriers to access’. The same is true for reporting. In Belgium and The Netherlands, not all cases of euthanasia and physician-assisted suicide are reported, undermining regulation and accountability.3”
”Reports indicate that inadequate pain control is seen in less than 33% of patients requesting physician-assisted suicide; their issues relate to fears of burdensomeness, dependence, and loss of control.26 Suffering is a perception; advances in specialist palliative care can control the majority of pain and suffering effectively and change people's perceptions of themselves and what is happening to them. There are legitimate concerns from other jurisdictions that legalising physician-assisted suicide could result in devaluing and hindering palliative care development,6 rather than addressing how to harness the service more effectively for its users.27 Physician-assisted suicide conflates an individual's suffering with their very being, implying that their existence is the problem.”
“The proposition that ‘we end lives already’ is a fallacy. A treatment is only lawful if it is wanted, will work, and is a benefit.28 Stopping unhelpful or unwanted treatments is our duty, accepting the natural consequences of whatever underlying pathology is present. These include life-sustaining treatments and futile treatment escalations. The intent is not death, but avoidance of unnecessary harms. Rarely, continuous deep sedation at the end of life is used to palliate. In the UK, administering anaesthesia to those wishing to be unconscious in the final days of life has also been defended, though clearly distinguished from an intention to speed death.29 Evidence suggests that where medication is used judiciously, there is little risk of shortening life.30 Physician-assisted suicide is an independent causal act and therefore different.31”
https://www.bjanaesthesia.org.uk/article/S0007-0912(24)00003-5/fulltext