Medical Treatment: Decisions and the Law

14. Treating Suicidal Patients

CONCLUSION

The application of the law surrounding suicide demonstrates the interplay of the most basic, fundamental ethical principles and how they may well conflict. In particular, neither autonomy nor the sanctity of life is an absolute: one may gain precedence over the other, depending on the particular circumstances of the case and other competing, legitimate interests. In Brady Kay J’s reference to institutional integrity was unusual, but important, in that case.

The law in this field is evolving. The courts must wrestle to reconcile with the conflicts that can arise between autonomy and the sanctity of life. While this may appear a minefield for the practising healthcare professional, it should not be forgotten that acts taken to preserve life, objectively in the patient’s interests, will often be justified under the doctrine of medical necessity and provide a defence to most actions.

The law in relation to assisted suicide continues to arouse much controversy. The State’s position has been that the interest in protecting life outweighs any individual’s interest in facilitating the suicide of another. Purdy and Nicklinson raised vital issues about an individual’s right to regulate not only his life but also his death. However, the courts have understandably left resolution of   the key ethical issues to Parliament. It remains to be seen whether the latest attempts to progress the matter in the 2016/17 Parliament will succeed.

Given the latest DPP guidance, a genuinely compassionate facilitator of someone’s suicide will still technically be acting unlawfully, but it would seem he is unlikely to face prosecution, on the ground that it is not in the public interest to pursue such a conviction.

Finally, it may seem odd to the reader to criminalise any person who assists another in a lawful act, but it is important to remember that most people who contemplate suicide do so because they feel weak and vulnerable. The DPP’s guidance on when it will not be in the public interest to prosecute cases of assisted suicide is a step towards marking out those situations when it is ethically right to assist someone else’s suicide.

Contents

  • A Introduction  14.1
  • B Basic definition 14.2
  • What is suicide?  14.2
    • An act  14.3
    • An intention to act  14.4
    • An understanding of the likely consequences 14.5
  • C Suicide Act 1961 14.6
  • European Convention on Human Rights  14.7
  • D Refining the definition of suicide: failure to treat or feed 14.16
  • E General principles: autonomy  14.19
  • F Patient autonomy versus liability for failing to act  14.24
  • H European Convention on Human Rights: duty to preserve life  14.31
  • I European Convention on Human Rights: the balance to be struck 14.38
  • J Practical Problems  14.40
  • K Compulsorily Detained Patients  14.44
  • L Guidance On Approach To Treatment 14.52
  • M Conclusion  14.53

updates and appendices will be provided for this chapter in due course

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