All types of euthanasia and assisted suicide are illegal in England under the Suicide Act 1961. Public opinion, however, is divided on these issues and it is legal for doctors to decide to withdraw or withhold treatment if there is no realistic prospect of the treatment producing any benefit.

On the one hand, patients and their families expect life to be prolonged for as long as possible, even if this may mean prolonged suffering without hope of a cure. Many groups (including disability rights groups and religious groups) argue against any relaxation of restrictions on assisted dying, citing the risks of pressure on ill individuals and misrepresentation of the wishes of those powerless to speak.

Others argue that individuals have the right to a dignified death rather than protracted disability. These views are attracting public sympathy, as well as outrage in some cases. With advances in technology prolonging life, the economic and social cost of supporting older people beyond the natural life cycle may increasingly pose questions of morality.

Public and professional attitudes to assisted suicide and voluntary euthanasia continue to change. While a 2009 study revealed that 34 per cent of doctors supported the legalisation of euthanasia, there is a trend of euthanasia being deemed acceptable by a greater proportion of medical students.

The rising cost of healthcare, in absolute terms and also as a proportion of GDP spending, will drive a more financially sensitive healthcare system. There is a growing sense that the quality of extended life needs to play a greater role in ‘end-of-life decision making’. These considerations are already becoming increasingly commonplace, after the introduction of such concepts Quality Adjusted Life Years.

The terminally ill and those suffering from chronic conditions gain increased media attention and have a stronger voice.

Crucially, legislation is introduced to reflect changing opinion and for certain situations, euthanasia is legalised, and this may be correlated with a system refocus from cure towards prevention.

A significant number of frail and older people opt for assisted suicide and voluntary euthanasia. This leads to a reduction in costly treatments that do not significantly increase quality of life. Fewer people are kept alive at a high cost with little chance of improvement to their health. Efficiencies are therefore created and resources in ICUs are focussed on other demand sources.

Proposed workforce impact

• Changing the law will have an impact on the type and level of end-of-life care provided. It also has an effect on the capacity of acute care due to the efficiencies created.
• For all workforce groups, with increasing numbers of people choosing assisted dying rather than spending long periods of terminal decline, there may be far more ethical and legal conflicts and controversies. This may follow a similar situation around withdrawal and withholding of treatment where ethical dilemmas and legal conflicts have reduced the attractiveness of health and care careers.
• For public health officials, major shifts in public policy and law can make working in this profession difficult. For pharmacists, although euthanasia can be seen to directly contradict the role of pharmacy in healthcare, pharmacists have an ethical role to explain to patients what effect continuous drug taking will have on their quality of life.
• Applying best practice for euthanasia will involve significant changes to working practices, including introducing assessments for whether the individual has the capacity to take the decision, and many other activities carried out by a multidisciplinary team.

Sources or references

• NHS Choices – Euthanasia and assisted suicide http://www.nhs.uk/conditions/Euthanasiaandassistedsuicide/Pages/Introduction.aspx
• GMC – Treatment and care towards the end of life http://www.gmc-uk.org/static/documents/content/Treatment_and_care_towards_the_end_of_life_-_English_0914.pdf
• Assisted Dying Bill 2014-15 http://services.parliament.uk/bills/2014-15/assisteddying.html
• BMA – Withholding and withdrawing life-prolonging medical treatments http://onlinelibrary.wiley.com/doi/10.1002/9780470757994.fmatter/pdf
• Seale 2009 Majority of UK doctors opposed to legalisation of euthanasia http://www.qmul.ac.uk/media/news/items/smd/11578.html

Some of the information in this section is provided by stakeholders and expert groups, and does not necessarily represent the views of the CfWI.