Doctor Michael Irwin was arrested after he paid £1,500 for his friend Raymond Cutkelvin to have a lethal dose of sleeping Nembutal in Swiss clin Dignitas.

Here the retired Hove GP talks about how “terminal sedation” is common in the UK and asks are we so different from people in the states of Oregon and Washington and other European countries where the practice is legal.

In medical practice today, in the UK, there are basically four ways in which doctors may help someone to die - the first is legal, the second is frequently done, and the last two are still illegal.

The first, once called “passive euthanasia”, involves the withholding or withdrawing of medical treatment which is perhaps required to keep someone alive. This is completely legal because it is everybody’s right to refuse medical treatment: and, when death results, it is due to the underlying pre-existing disease.

If someone is conscious and is mentally competent, refusing treatment is straightforward. Today, it is important for all adults to complete a living will (also known as an advance decision) in which they can state the type of medical care they wish to receive if they should lose the mental capacity to be fully involved, with their doctors, in making such decisions about themselves. These documents are now called “pro-choice”

because they allow individuals either to refuse further treatment, which would prolong their lives, or to request being kept alive for as long as possible. Living wills can be obtained from Dignity in Dying, 181 Oxford Street, London W1D 2JT. These advance decisions are legally binding today, and are fully supported by the British Medical Association, the Royal College of Nursing and the Law Society. The second way in which a doctor can assist someone to die is through the procedure now called “terminal sedation”. When a patient is suffering from the symptoms of a terminal illness, a doctor can use sedatives and painkillers (like diamorphine) to “lessen the pain and distress”. Officially, palliative care doctors will give these drugs to keep the patient symptom-free.

But, today, doctors often give increasing dosages of painkillers and sedatives privately knowing that the intention is to shorten an individual’s life (hopefully, the patient has agreed).

Thirdly, a doctor can help a terminally-ill patient with an assisted suicide. The doctor can either provide a prescription for a lethal substance or perhaps may even give the actual drug. The patient can take this whenever he or she wishes to do so.

This possibility is illegal in the UK. But, it is legal in the American states of Oregon and Washington, and also in Belgium, Luxembourg, and The Netherlands, and it is decriminalized in Switzerland.

Finally, the fourth way for a doctor to end a patient’s life is euthanasia when a lethal drug is injected - this can be either non-voluntary or voluntary (in the latter situation, the patient has requested this to be done).

The best example of non-voluntary euthanasia in the UK is the death of King George V in 1936. The king was dying slowly, but was semi-conscious on his last day. Without his knowledge, his doctor, Lord Dawson, with the agreement of Queen Mary, injected morphine and cocaine into the royal jugular vein.

Later that year, in a debate in the House of Lords regarding a possible Bill to legalize euthanasia, Lord Dawson stated that there was “no need to change the law as all good doctors do it”.

Voluntary euthanasia today is legal in Belgium, Luxembourg and The Netherlands. As with doctor-assisted suicide, there are strict guidelines to be followed. The great majority of the population, and most doctors, in these countries support this procedure.

Importantly, there is no evidence of disabled people or the elderly being pressured into accepting euthanasia, in spite of what anti-choice groups in the UK state when opposing a change in the law here.

Until recently, no one knew how often “doctor-assisted dying” occurred in the UK. However, two recent surveys (the last in 2007) by Professor Clive Seale, of St. Bartholomew’s Hospital, in London, have shown that one in six of all the deaths in this country are due to terminal sedation. But, of even greater significance, was his conclusion that there are 1,000 deaths due to voluntary euthanasia, and another 2,000 deaths due to non-voluntary occurring annually here - totally illegally.

Attempts to change the law, in the UK, to legalize doctor-assisted suicide and voluntary euthanasia, date back to 1935, when Dignity in Dying (then, called the Voluntary Euthanasia Society) was formed. Its founders were mainly a group of clergymen (including Canon Dick Shepherd from St. Martins-in-the- Fields, in London) and several doctors (among them, the surgeon, Lord Moynihan). This is important to remember because, today, the main opposition to changing the law comes from religious organizations and several of the professional medical and nursing bodies (although, the BMA, in 2005 for one year, adopted a “neutral” position - which was reversed the following year - and the Royal College of Nursing, just two months ago, dropped its opposition).

Public support to legalize doctor-assisted suicide and voluntary euthanasia in the UK is great - various surveys in recent years, show a 75% support. In Parliament, the last serious attempt to change the law was in 2006 when Lord Joffe introduced a draft bill based on what is legally possible in Oregon - at the secord reading, in the House of Lords, he lost by 148 votes to 100.

In discussing a change in the law, I believe it is essential to personalize the subject. Many of us will have seen relatives and friends die slowly and perhaps in great discomfort. If we should develop a terminal illness, would we like the possibility of legalized doctor-assisted suicide or voluntary euthanasia for ourselves? If the answer is “yes”, then we should support a change in the law to make this possible. After all, are we so different from the Belgians, the Dutch, the Swiss, or those who live in Luxembourg or the American States of Oregon and Washington?

Michael Irwin (Retired GP) Former Chairman of Dignity in Dying (1996 to 1999, and also 2001 to 2003) Former Medical Director of the United Nations, in New York (1982 to 1990)