The de-medicalisation of assisted dying: is a less medicalised model the way forward?

Although assisted dying has been most commonly presented within a medicalised framework, the notion of de-medicalisation is employed in this paper to suggest that there are emerging models of assisted dying in which some medical aspects assumed to be an integral part of the phenomenon are both challenged and diminished. The paper considers cases where relatives have facilitated a loved one's assisted suicide abroad, cases of assisted death in which the assistor in the actual suicide act is a non-medic, and the growing debate surrounding non-medical grounds for desiring death. In evaluating the potential impact of partial de-medicalisation on the assisted dying debate, the argument presented is that whilst a de-medicalised model could well contribute to a richer understanding of assisted dying and a better death for the person who is assisted, there are cogent reasons to retain some aspects of the medicalised model and that a completely de-medicalised model of assisted dying is unrealistic.     

The Dutch Euthanasia Act and related issues

In 2002 the Dutch Euthanasia Act came into force. This Act is the result of a lengthy developmental process. It codifies the requirements that have evolved in case law and medical ethics since 1973. Empirical data indicate that the Dutch euthanasia practice is stabilising. Euthanasia and assisted suicide occur in 2.7% of all deaths. Now that the Act has been passed, the focus is on improving the quality of medical decision-making. From an international perspective, the Dutch legislation is exceptional. However, it appears that other countries and international organisations are considering euthanasia legislation as well. It remains to be seen how influential the Dutch model will prove to be.     

In the laboratory of the states: the progress of Glucksberg's invitation to states to address end-of-life choice

It has now been ten years since the Supreme Court handed down Glucksberg and Quill, rulings on laws that forbid "assisted suicide." In that time, normative and legal developments in the fields of law, medicine, and psychology have changed the landscape of the discourse on the choice of a mentally competent, terminally ill individual to choose to self-administer medications to bring about a peaceful death. Although the Court rejected petitioners' claims that state laws denying them the ability to end their terminal illnesses through self-administered medication violated the Constitution, it left states with the opportunity to experiment with legislation that would allow terminally ill individuals the choices they had previously sought through litigation. Oregon's experience with its Death with Dignity Act, which grants terminally ill, mentally competent individuals the choice to end their lives through self-administered medication, has proven that such laws provide comfort not only to those who, faced with the prospect of a horrible death from a terminal illness, choose to end their lives in a peaceful and dignified manner, but also to those to ultimately choose not to. Additionally, Oregon's experience shows that the fears that originally attended the "assisted suicide" debate are unfounded so long as proper procedures are in place. Because Oregon's Death with Dignity Act has proven both useful and harmless, this Article concludes that it is time for other states to follow Oregon's lead and enact their own legislation to allow their citizens an alternative to what otherwise could be a prolonged and painful death from terminal illness.     

Assisted suicide and the inalienable right to life

This article focuses on a topic largely overlooked by both the supporters and opponents of assisted suicide. The legalization of suicide assistance damages the interests of persons who value the law's full and equal protection of their lives by designating them as eligible for help in killing themselves. Measures such as Oregon's Death with Dignity Act regard every person diagnosed as having a terminal condition as a candidate for suicide assistance, as if the protection of life was an alienable interest for this class. Thus all members of the eligible class, including those opposed to assisted suicide, lose the status of being regarded by law as having an inalienable right to the protection of life. This status-based injury should inform the standing and substantive constitutional questions raised by a state's adoption of such a policy.     

Oregon's guidelines for physician-assisted suicide: a legal and ethical analysis

Oregon's Death with Dignity Act was first passed by a ballot initiative in 1994, but numerous judicial challenges delayed implementation of the Act. In November of 1997, following the United States Supreme Court decisions in Vacco v. Quill and Washington v. Glucksberg, which left the states' power to regulate physician-assisted suicide undisturbed, the Oregon voters upheld their law. Oregon remains the only state in the nation to authorize physician-assisted suicide. The Task Force to Improve the Care of Terminally Ill Oregonians published a Guidebook for health care providers on the Oregon Act, and the New England Journal of Medicine recently issued a special report on the first year's experience under the Act. This paper analyzes the legal context of the Oregon Death with Dignity Act, discusses the efficacy of the tenets in the Guidebook, and explores ethical issues underlying the guidelines, particularly those pertaining to the meaning of a patient's request for assisted suicide and processes supporting informed consent.     

The Human Transplantation (Wales) Act 2013: an Act of Encouragement,not Enforcement

The Human Transplantation (Wales) Act became law in Wales in September 2013. The Act aims to increase deceased donor organ and tissue donation in Wales by introducing a ‘soft opt‐out’ system to replace the previous requirement of express ‘appropriate’ consent under the Human Tissue Act 2004. Adults dying in Wales (with certain exceptions) will be ‘deemed’ to consent to donation, unless evidence of their objection is produced, and a duty is imposed on Ministers to promote transplantation and inform the public through awareness campaigns about how to choose the deemed status or opt out. Although a welcome development, these campaigns may obscure the effects of deemed consent, especially in the context of generally rising UK donation rates. There may also be problems of legal interpretation and of integration with the ‘opt‐in’ laws in the rest of the UK. In the absence of any statutory duty to retrieve all lawfully donated organs, the apparently restricted influence of donor relatives is likely to remain effectively dominant.     

自杀的认定及其相关行为的刑法评价

刑法中认定自杀有主客观两方面要求。在主观方面,被害人不仅应当认识到并且意欲死亡结果发生,而且必须自愿地、也即自主决定地选择了死亡。对于自愿性的判断应当以有效承诺的主观要件为标准。重大的动机错误同样导致不能成立自杀。此外,被害人还必须客观上事实性地支配着直接导致死亡的行为,在将不可逆转地造成死亡结果的最后关键时刻自己控制着事态的发展。自杀本身并非刑事不法行为,教唆或帮助自杀、对自杀者不予救助或者过失导致他人自杀等自杀相关行为也不应受到刑事处罚。     

Developments in medical law in the United Kingdom in 2005 and 2006

This article highlights and summarises the key developments in medical law in the jurisdictions of the United Kingdom in 2005 and to April 2006. Topics are mental health and mental capacity, data protection, freedom of information and the impact on health data, the Human Tissue Act, genetic research databanks, Human Fertilisation and Embryology Act--Review of the legislation, consultations and related case law, developments in embryo and embryonic stem cell research, clinical trials and human subject research, medical futility, and physician assisted dying.     

Assisted suicide under the European Convention on Human Rights: a critique

In a high profile case, a terminally ill woman, Diane Pretty, challenged the United Kingdom prohibition on assisted suicide as incompatible with certain fundamental rights which are guaranteed under the European Convention on Human Rights. Mrs Pretty's battle was ultimately unsuccessful, with a total of three courts and 15 judges ruling against her. Such unanimity of opinion might well be thought to represent the coup de grace for arguments about the right to assistance in death under European human rights law. However, in this article it is suggested that, in limited circumstances, such assistance might yet still be possible under the Constitution.     

Re-Evaluating ‘Best Interests’ in the Wake of Raqeeb v Barts NHS Foundation Trust & Anors

In Raqeeb v Barts NHS Foundation Trust, the latest of a number of cases concerning whether a child can travel abroad for treatment that doctors in the UK do not consider to be in their best interests, the High Court held that the hospital had acted unlawfully by failing to consider the child's rights under EU law when refusing to allow her to travel. Although this derogation could be justified on public policy grounds, as such treatment was, on the facts, in her best interests, no further interference with her rights was justified. In making this finding, the court recognised the ‘stress’ that such a case placed on the best interests test, lending weight to the argument for moving instead to a risk of significant harm threshold for judicial intervention in parental decisions, which better accounts for legitimate differences of value and strikes a better balance under Article 8 ECHR.     

Bouncing boundaries and breaking boundaries

New bio-technologies are currently forcing medicine to cross boundaries that might have seemed insuperable sometime ago. Specifically, they now help to prolong human life beyond its natural process and to maintain it almost indefinitely. Consequently, death takes on new meanings. For some it simply appears like an eventuality that can be postponed while, for others, death become synonymous to extended suffering, to dehumanization and to anguish. This apprehension gives rise to a wave of compassion for the dying person which is being translated into a new discourse around the notions of “quality of life” and “dying with dignity”. In this movement, the question of assisted suicide resurfaces. Through an extensive study of the Sue Rodriguez case in the Supreme Court of Canada (1993), the author shows that this particular case forced the Canadian society to rethink some of its long-standing socio-legal boundaries. First, the current social debate on assisted suicide poses new demands on Criminal Law, particularly on the judicial tradition since the courts are presently ill-equipped to respond to cases which demand to give content to new “human rights” that do not yet have a legal substance. Second, the Rodriguez case revealed the emergence, on the judicial and political scenes, of certain community groups that restructures the traditional power relations linked to the social regulation of assisted suicide. Finally, the study shows a change in the boundaries surrounding the accepted use of Criminal Law toward an administrative (risk management) rather than punitive use. This revised version was published online in August 2006 with corrections to the Cover Date.     

Standing and the Northern Ireland Human Rights Commission

On 7 June 2018, the UK Supreme Court held that the Northern Ireland Human Rights Commission (NIHRC) did not have standing under the Northern Ireland Act 1998 (NIA) and Human Rights Act 1998 (HRA) to challenge the legality of abortion law in Northern Ireland. This case note argues that while a literal reading of the NIA exposes its inconsistencies, a purposive reading of both the NIA and HRA indicates that the NIHRC should have had standing. The note seeks to highlight the unique democratic function of the NIHRC in a consociational setting in protecting rights that are not represented along ethno‐national lines. It also considers the negative ramifications that the judgment will have on women who have been victims of the legislative regime and seek to challenge the compatibility of Northern Irish abortion law with the HRA in the future.     

Constitutional Principle,the Rule of Law and Political Reality: The European Union (Withdrawal) Act 2018

The European Union (Withdrawal) Act 2018 is the cornerstone of UK legislation designed to accomplish the legal dimension of Brexit. It brings the entire acquis of EU law into UK law in order to avoid regulatory black holes that would otherwise occur. The Act embodies a twofold legislative strategy: EU law brought into UK law thereby is to be made fit for purpose by exit day, with necessary changes being made by statutory instrument; Parliament can then decide at greater leisure thereafter whether it wishes to retain, amend or repeal this legislation. The burden placed on Parliament is unprecedented, all the more so given the exigencies of time in which the changes are to be made. This article explicates the principal provisions of the 2018 Act, and the concerns as to constitutional principle and the rule of law raised by the legislation. The tensions in the drafting process are made apparent, and uncertainties in the resulting text are revealed.     

Thinking Sexual Difference Through the Law of Rape

2013 marks 10 years since the Sexual Offences Act 2003 was passed. That Act made significant changes to the law of rape which appear now to have made very little difference to reporting, prosecution or conviction rates. This article argues that the Act has failed against its own measures because it remains enmeshed within a conceptual framework of sexual indifference in which woman continues to be constructed as man’s (defective) other. This construction both constricts the frame in which women’s sexuality can be thought and distorts the harm of rape for women. It also continues woman’s historic alienation from her own nature and denies her entitlement to a becoming in line with her own sexuate identity. Using Luce Irigaray’s critical and constructive frameworks, the article seeks to imagine how law might ‘cognise’ sexual difference and thus take the preliminary steps to a juridical environment in which women can more adequately understand and articulate the harm of rape.     

Justins v The Queen: assisted suicide, juries and the discretion to prosecute

Juries are often a crucial protection for citizens against unjust or highly controversial laws. The decision whether to proceed with a prosecution rests on the discretionary powers of prosecutors. In cases where the community is deeply divided over right and wrong, it appears that there is, at times, a transference from the public of thwarted law reform aspirations which can create difficult tensions and expectations. This case commentary considers an appeal by Shirley Justins following her conviction for manslaughter by gross criminal negligence as a result of her involvement in the mercy killing of her partner, Mr Graeme Wylie. The morally unsettled nature of the charges brought against her, her own initial plea, the directions given to the jury by the trial judge and even the basis of her appeal resulted in a convoluted and complicated legal case. Spigelman CJ and Johnson J ordered a new trial, Spigelman CJ stating that it was open for a new jury to consider (a) if Mr Wylie lacked capacity; and (b) whether there was criminal involvement by one person in another's death. Simpson J found that further prosecution on the count of manslaughter would amount to an abuse of process and that an acquittal should be entered. This case highlights how fundamentally unsettled are the publicly much debated and persistently contentious issues of euthanasia, assisted suicide, the right of a person to die a dignified death and the way their capacity in that respect should be assessed. It perhaps asks us to reconsider the role of juries and the exercise of discretion by Directors of Public Prosecutions in areas of law where the community and law-makers are deeply and intractably divided.     

Oregon: does physician-assisted suicide work?

Since November 1997, Oregon, a State in the United States of approximately 3.3 million people, has allowed physician-assisted suicide, although not euthanasia, by virtue of the Death with Dignity Act. Before the Act, physician-assisted suicide, as in Australia and other common law jurisdictions, was illegal. Under the Act, the Oregon Department of Human Services is required to collect information and provide an annual report. The Sixth Annual Report on Oregon's Death with Dignity Act was released on 10 March 2004.     

Physician-assisted suicide: legal and ethical considerations

As medicine's technical limits have become increasingly clear, Americans seem more willing to address end-of-life decisionmaking. A major development during the 1990s was physician assistance in dying: physician-assisted suicide in Michigan, Oregon's Death with Dignity Act, and developments in Europe, most notably The Netherlands. This evolution toward recognizing the appropriateness of assistance in dying raises legal and ethical issues for physicians and healthcare institutions such as nursing facilities and acute care hospitals. These issues include the effects on providers' values systems, the trust between patient and provider, and the "slippery slope" that voluntary, active assistance in dying will become involuntary, active assistance. This Article addresses the policy issues that institutions must confront in a changing environment.     

Medical data breaches: Notification delayed is notification denied

The EU and the United States have implemented data breach notification rules that cover the health sectors. Nevertheless, data breach incidents involving medical data continue to rise, especially in the US and the UK. The HITECH Act, Pub. L. 111-5 Title XIII is the first federal health breach notification law in the US to be characterized by less government intrusions, while the revised EU Privacy Directive, 2009/136/EC calls for tougher privacy protection for data held by electronic communication providers. While the EU law sets a global de facto standard, the law remains toothless without strong enforcement mechanisms.     

Frozen Corpses and Feuding Parents: Re JS (Disposal of Body)

In October 2016, a dying teenager won the legal right to have her remains cryogenically frozen and stored indefinitely in an American clinic. The cryonics aspect was novel, posing questions around the legality of this particular method of corpse ‘disposal’ in the UK and the processes involved. More significantly, the case raises other substantive legal issues around the fate of the dead, including the status of funeral instructions under English law, and how courts adjudicate parental disputes over the funeral arrangements for a dead child.     

Changing the support system for asylum seekers

The issues of asylum and the treatment of asylum seekers have once again hit the headlines in the UK. The recent problems in Kosovo in the former Yugoslavian territory have made the problem of dealing with asylum claims more acute. The past arrangements for asylum seekers have been inadequate and piecemeal and have developed as a result of changes made in 1996 and the subsequent intervention by the judiciary. The cost to the British taxpayer of the pre-1999 Act asylum arrangements has been over 500 million per year, 80 per cent of which has been spent on accommodating and supporting asylum seekers. There is also a huge backlog of cases and current figures are indicative of a system that is unable to cope. It is in the light of these problems that the Government has passed the 1999 Immigration and Asylum Act. This Article examines the changes that will be made to UK asylum law by the 1999 Act and assesses the problems that may be caused by those changes in the areas of housing and other forms of assistance and the effect that these may have on families and children seeking asylum in the UK.