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尊厳死（旧称：自主的安楽死合法化協会）は、英国全土で活動するキャンペーン団体です。一般市民からの寄付によって運営されており、2010年12月時点で2万5000人の会員がいるとされています。同団体は、いかなる政治的、宗教的、その他の団体とも提携していないと明言しており、人生の終末期における苦痛を軽減するために、個人がより多くの選択肢と自己決定権を持てるようキャンペーン活動を行うことを主な目的としています。
「尊厳ある死」は、終末期における医療および緩和ケアサービスの選択肢の拡大、自己決定権の確保、そしてアクセス向上を目指して活動しており、厳格な法的保護の下で、末期患者の成人に苦痛のない安楽死の選択肢を提供することも提唱している。同団体は、終末期医療に対するより思いやりのあるアプローチの普及を目指していると表明している。
尊厳死は、2010年の英国社会意識調査で、一般市民の82%が、苦痛を伴う不治の病に苦しむ患者の要望に応じて、医師が患者の命を終わらせることをおそらく、あるいは確実に許可されるべきだと考えていることを指摘している。[ 1 ]さらに分析したところ、宗教を信仰する人の71%、無宗教の人の92%がこの意見を支持していることがわかった。[ 2 ]
尊厳死は、そのキャンペーン活動に加えて、パートナー慈善団体であるコンパッション・イン・ダイイング[ 3 ]を通じて、終末期問題に関する情報源であり、事前決定の提供者でもある。
1931年、1901年から1935年までレスターの保健医官を務めたチャールズ・キリック・ミラード博士は、保健医官協会の年次総会で会長演説を行った。演説の中で、彼は「自発的安楽死の合法化」を提唱し、イギリスでは医師、聖職者、そして一般市民の間で大きな議論を巻き起こした。ミラードの提案は、末期疾患の場合、法律を改正して「ゆっくりと苦痛を伴う死を、迅速かつ苦痛のない死に置き換える」というものだった。[ 4 ]
The organisation was set up in December 1935 under the name of The Voluntary Euthanasia Legalisation Society (VELS).[5] The initial meeting that set the society up was held at the headquarters of the British Medical Association free of charge, despite the BMA not supporting the aims of the society. During the debate, the meeting was disrupted by 40 members of a Catholic youth association.[6]
The foundation of the society followed an offer of £10,000 from Mr. O. W. Greene, a terminally-ill man in London. The initial offer was retracted and no posthumous endowment was left to the Society after Greene learned that the prospective Society would only be supporting legalisation of euthanasia for those with incurable conditions.[4] The first chairman was C. J. Bond, a consulting surgeon at the Leicester Royal Infirmary; Millard was made the first honorary secretary.[7] Other members of the executive committee were drawn from Bond and Millard's social milieu in Leicester, including Astley V. Clarke from the Leicester Royal Infirmary; Rev Dr R. F. Rattray, a Unitarian minister and principal of University College, Leicester; Canon F. R. C. Payne of Leicester Cathedral; Rev A. S. Hurn; Frederick Attenborough, also a former principal of University College, Leicester; and H. T. Cooper, the Honorary Solicitor of the Committee.[4]
The society did not attempt to build a popular movement at first but attempted to build, according to Kemp, "a network of distinguished sympathisers able to influence policy at high levels".[4] The society had a Consultative Medical Council and a Literary Group, and were endorsed by a variety of authors, progressive reformers, feminists and supporters of the Fabian Society. Early supporters included Henry Havelock Ellis, Vera Brittain, Cicely Hamilton, Laurence Housman, H. G. Wells, Harold Laski, George Bernard Shaw, Eleanor Rathbone MP, G. M. Trevelyan, W. Arbuthnot Lane, and a variety of peers including Lord Woolton of Liverpool (Conservative) and Lord Moynihan who had been the president of the Royal College of Surgeons.
英国で安楽死を合法化する法案を可決しようとする最初の試みは、アーサー・ポンソンビーが貴族院に提出した1936年の自主的安楽死（合法化）法案であった。[ 8 ]この議論は政党の政治的立場によって分裂することはなく、政府はこれを「政府の介入の適切な範囲外であり、貴族院議員個々の良心に委ねられるべきものである」と考えた。ハンテリアン協会は1936年11月16日に「自主的安楽死の実施は正当化できないか」を議論する討論会を開催し、英国医師会はこの法案に反対した。[ 4 ]
1950年11月28日、同協会の副会長であるケンダルのチョーリー卿が次の試みを行い、貴族院に安楽死賛成の動議を提出した。この動議は広く非難され、採決も行われずに撤回された。NDAケンプによれば、この試みは「不名誉な失敗」であり、中絶、同性愛、離婚に関するより自由な法律を制定しようとする同様の試みも同様であった。[ 4 ]
名誉秘書のキリック・ミラードの死去と協会の会長であるデンマン卿の辞任、そして協会の著名な支援者であるEWバーンズとNIスプリッグス博士の死去を受けて、RSWポラードが新たな名誉秘書に就任し、協会の拠点をレスターからロンドンに移した。協会はまた、戦術を変更し、医療や法律のエリート層に媚びることから、草の根の圧力をかけるための大衆運動を構築しようとし、ロータリークラブなどの市民社会団体や地元の新聞の社説などでこの話題を取り上げる努力をした。[ 4 ]
From 1955 onwards,[4] the 'Legalization' was dropped from the name along with the 'Voluntary' to make it the Euthanasia Society (although some sources place it at 1960).[9] The Euthanasia Society placed adverts on the London Underground and on mainline railway services in the south of England, with the wording "The Euthanasia Society Believes that incurable sufferers should have the right to choose a Merciful Death". In 1960, the chairman, C. K. MacDonald died and was replaced by Leonard Colebrook. He was replaced temporarily by Maurice Millard. In 1962, he was replaced by the Unitarian minister Rev A. B. Downing, and in 1964, C. R. Sweetingham was made secretary.[4] Prominent people who supported the society during the 1960s included the legal academic and president of the Law Reform AssociationGlanville Williams. Williams gave a paper entitled 'Voluntary euthanasia – the next step' at the Annual General Meeting of the society in 1955. Williams' ethical justification of euthanasia argued against the principle of double effect and for a utilitarian approach to the questions in medical ethics including both voluntary euthanasia and abortion. His proposal would have allowed a physician to put as a defence to a homicide, assault or bodily harm charge that the person was incurably and fatally ill if the doctor was acting in good faith. These proposals mirror those of James Rachels discussed below.
According to Kemp, the public association of euthanasia with eugenics and Nazi atrocities marred attempts in the 1950s to promote voluntary euthanasia, but such setbacks were short-lived.[4] The next legislative attempt was started in 1967 with a bill drafted by Mary Rose Barrington, a member of the executive committee of the Euthanasia Society and barrister. Attempts were made to find an MP willing to introduce it to the Commons but eventually it was introduced to the Lords in 1969 by Lord Raglan, a member of the National Secular Society.[4]
The word 'Voluntary' was reinstated to the name in 1969 to become the Voluntary Euthanasia Society.[9] It was also known as Exit (not to be confused with Exit International) from 1979 but this was reverted in 1982.[9] During the period it was known as 'Exit', the secretary of the society, Nicholas Reed, was convicted of conspiracy to variously aid and abet or counsel a number of suicides. He was jailed for two and a half years, although this was reduced to 18 months on appeal. Reed had supported Mark Lyons, a seventy-year-old man who provided pills and alcohol to several sick people. Lyons was given a two-year suspended sentence.[10][11] The society had voted in 1979 to publish a "Guide to Self-Deliverance", a booklet which described suicide methods. This was challenged by the Attorney General in 1982 under s2 of the Suicide Act 1961, and after a brief attempt to fight back against this, the distribution of the booklet was suspended in 1983.[4]
After the name was changed back following the conviction of Reed and Lyons, Lord Jenkins of Putney introduced an amendment to the Suicide Act to introduce a defence for those who acted "on behalf of the person who committed suicide and in so acting behaved reasonably and with compassion and in good faith" but this was defeated 48 votes to 15.[4]
In 1988, the Voluntary Euthanasia Society, as it was then, attempted to place a full-page newspaper advertisement in the Evening Standard showing twenty-four young men with advanced emphysema with the words "A day in the life of an emphysema sufferer" and accompanied by "We believe that he should have the right to choose a peaceful and dignified death." The British Medical Association contacted the Advertising Standards Authority to block publication of the ad, and a representative of the British Lung Foundation condemned the advert, saying that "fears of patients with lung disease should not be exploited in this way."[12]
In 1990, the group campaigned for the early release of Anthony Cocker, who was convicted of murder after killing his wife Esther after she begged him to end her suffering from multiple sclerosis.[13]
In 1992, the society supported Dr Nigel Cox, who was prosecuted and convicted for murder for shortening the life of a patient at the Royal Hampshire County Hospital.[14]
Dignity in Dying was the new name endorsed by members at the annual general meeting in 2005. Its current chair of the governing board is Sir Graeme Catto and its chief executive is Sarah Wootton.[15] The name change was done to "get away from the suggestion that you can only achieve dignity in dying with euthanasia".[16]
Dignity in Dying has a range of patrons, including people who have been associated with high-profile cases connected with Dignity in Dying's campaigns, such as Lesley Close (sister of John Close), Brian Pretty (husband of Diane Pretty) and Heather Pratten. Other patrons include prominent individuals from the worlds of business, politics, the arts and religion, such as Terry Pratchett, Jonathan Miller, Patricia Hewitt, Zoë Wanamaker, Simon Weston, Anthony Grayling and Matthew Wright.
In 2005, legislative attempts were made by Lord Joffe who joined the society in the 1970s.[17] The first bill was introduced in the 2003 session,[18][19] and the Bill has been reintroduced repeatedly since. The Joffe Bill led to the formation of the anti-euthanasia group Care Not Killing.[20] Dignity in Dying has a non-campaigning partner charity, Compassion in Dying, which carries out research to do with end-of-life matters, provides the general public with access to advance decisions and also works to provide information about a person's rights at the end-of-life. They are also associated with Healthcare Professionals for Assisted Dying,[21] a group formed by Dignity in Dying supporter and general practitioner Ann McPherson.[22]
In May 2011, Dignity in Dying noted the result of a referendum in Zurich, Switzerland, which showed overwhelming support for assisted dying and voted to reject the restriction of assisted dying services in Zurich to the residents of the city. The organisation called the result a "brave decision" on the part of the Swiss people.[23]
In 2014 Lord Falconer of Thoroton tabled an Assisted Dying Bill in the House of Lords which passed through Second Reading and ran out of time during Committee stage before the General Election. During its passage peers voted down two amendments which were proposed by opponents of the Bill. In 2015 Labour MP Rob Marris introduced an Assisted Dying Bill, based on the Falconer proposals, into the House of Commons. The Bill was praised by Philip Collins, chief leader writer for The Times as "a sophisticated and humane attempt" to clarify the law before the courts do so and which unlike religion "will actually ease suffering." Archbishop Welby's subsequent objections were described as "histrionic" and lacking any religious reason.[24] The bill was rejected by 330 to 118.[25] In June 2016, the Bill was re-introduced to the House of Lords by former Dignity in Dying treasurer Lord Hayward.[26] Falconer reintroduced the bill into the House of Lords again in July 2024.[27] In October 2024, Kim Leadbeater introduced Terminally Ill Adults (End of Life) Bill on assisted suicide.[28]
Dignity in Dying campaigns for patient choice at the end-of-life and supports palliative care and increased funding and provision of hospice care. It also campaigns for new legislation to permit assisted dying within strict safeguards, and promotes the concept and use of advance decisions in England and Wales. The group has repeatedly published opinion polls showing considerable public support for a change to the law on assisted dying,[29][30] as well as showing support from doctors[31][32] and disabled people.
Dignity in Dying's stated view is that everyone has the right to a dignified death. They interpret this to mean:
Dignity in Dying also outline how they go about their campaign:
One of Dignity in Dying's main arguments is that their proposals for a comprehensive strategy around the issue of assisted dying would provide safeguards and protection for an individual from, for example, the coercive pressures to die that some people believe can be exerted by families of the frail or relatively disadvantaged on occasions. Dignity in Dying argue that at the moment not only can unscrupulous people do this in a relatively unchecked way, but that the legal authorities can generally carry out investigations only after a person's death, whereas under their plans there would be safeguards and checks upfront to ensure a person was fully informed and counselled as to their rights and options and additionally protected from possible malign influences.
Dignity in Dying also state that their proposals would alleviate a great deal of the stress and worry that approaching death can bring to a person, particularly one suffering significant pain from a terminal illness. The use of Advance Decisions can help significantly but they also believe that if a right to an Assisted Death is available then the very knowledge of this fact can alleviate many of the worries an individual might have. Dignity in Dying supporters argue that the recent trends towards the use of the Dignitas clinic in Switzerland and press stories regarding botched suicides and do-it-yourself advice would be stopped because individuals would know that when and if they wished to finally request an assisted death in the UK, it would be available as arranged. Indeed, studies from parts of the world that have legalised assisted suicide report that many plans put in place for an early death are not taken up as people end up dying naturally, with the peace of mind brought about by knowing that an assisted death was available if pain and suffering had got too much. For example, in the U.S. state of Oregon in 2007, it was reported that of the 30,000 deaths in the state that year, 10,000 people considered an assisted death, around 1,000 spoke to their doctor about it, 85 actually got a prescription and just 49 went on to have an assisted death.[33]
Dignity in Dying are often opposed by groups such as Care Not Killing, a group that includes the Christian Medical Fellowship, the Church of England and the Church of Scotland. Some people of a religious persuasion take the view that all life is sacred and that only natural processes and divine intervention should determine a person's death. Dignity in Dying argue that if a person does not wish to take advantage of a change in the law which would allow for an assisted death then that is down to personal choice. However it strongly opposes opponents who would try to deny an individual a right to a personal choice in the matter by blocking enabling legislation. Meanwhile, opponents argue that the introduction of the sort of legislation supported by Dignity in Dying can be a "slippery slope" towards more draconian measures. Dignity in Dying refutes this by pointing out that the will of Parliament would be paramount, and any change in the law would be subject to ongoing review once established. They also point out that in those jurisdictions where aid in dying has been made legal (such as the US state of Oregon), the eligibility criteria have not been widened from their initial point.
Additionally, some disability rights campaigners are concerned that an assisted dying law would lead to extra pressure on some disabled persons to seek a premature death, as they might consider their lives to be devalued. A poll in 2015 found that 86% of people with a disability believed that a person with a terminal and painful illness from which they were certain to die should be allowed an assisted death;[34] however, polling by Scope (charity) reports that the majority of disabled people have concerns about a change in the law concerning assisted dying.[35]
Dignity in Dying point to other parts of the world that have some form of assisted dying or similar legislation, which is generally popular and supported by the majority. These include the Netherlands and Belgium in Europe, and Oregon, Washington state and Vermont in the United States. Dignity in Dying support the legislation of assisted dying (as legal in Oregon under the Oregon Death with Dignity Act), whereby a doctor prescribes a life-ending dose of medication to a mentally competent, terminally ill adult at the patient's request, and which the patient administers. This is different to assisted suicide, whereby somebody provides assistance to die to a person who is not terminally ill, and euthanasia, which involves a third party administering the life-ending medication to a patient.
Another argument used by Dignity in Dying regards the use of the Dignitas organization in Switzerland, saying that the availability of assisted dying in Switzerland is simply "outsourcing" the problem.[36]
尊厳死法制の支持者の中には、尊厳死の提案は不十分だと考える者もいる。My Death My DecisionやHumanists UKなどの団体は、尊厳死法制は余命6か月未満の人に限定されるべきではなく、余命に関係なく、耐え難い苦痛と不治の病に苦しむ精神的に健全な成人すべてに適用されるべきだと主張している。[ 37 ] [ 38 ]こうした考えは、2013年のR（ニックリンソン）対法務省の判決で最高裁判事のニューバーガー卿が「末期患者であっても余命を評価することの悪名高い困難さはさておき、余命が数か月しかない人よりも、価値がなく、惨めで、しばしば苦痛を伴う人生を何年も生きる見込みのある人の方が、死を幇助する正当性がはるかに高いように思われる」と述べた際にも反映されているようだ。[ 39 ]