Last Resort: The hidden truth about how dying people end their own lives in the UK

In 2017, we published The True Cost: How the UK outsources death to Dignitas.

In 2019, we published The Inescapable Truth: How seventeen people a day will suffer as they die.

This final report - Last Resort - examines the third way in which the current law fails dying people.

It reveals the stories of those who feel they have no other option but to take matters into their own hands.

It explores their motivations and lays bare the repercussions for those who are left behind.

It looks at the ways in which the police struggle to enforce the law and examines how we might quantify how many dying people in the UK take their own lives each year.

Language around the assisted dying debate is contested.

In 2016, the term assisted dying was added to the Oxford English Dictionary.

However, most campaign groups opposed to assisted dying legislation instead favour the term ‘assisted suicide’, arguing that there is no difference between a dying person who chooses to control the manner and timing of an imminent death and someone who dies by suicide.

It is widely accepted that the term suicide carries social stigma and the idea that a person ‘commits’ suicide is an outdated reference to when – prior to the 1961 Suicide Act – suicide was a crime.

Even in the circumstances explored in this report, where people have ended their own lives, interviewees were keen to highlight the importance of distinguishing their loved ones’ actions from suicide.

Dignity in Dying rejects the term ‘assisted suicide’ and this report does not refer to dying people controlling the manner and timing of their deaths as having died from suicide.

The public agrees.

Research has uncovered cases of dying people in the UK who have ended their own lives from a range of highly distressing and violent means.

The uncertainty of various methods people used created significant anxiety, as did the knowledge for some people of what their dying loved one was planning.

The dark web consists of a hidden network of websites. It allows people to access and use the internet anonymously and while some people use it for legitimate means it has become renowned for illegal activity, including being a place where marketplaces for drugs are hosted.

Scams and fraud on the dark web have been uncovered, which no doubt creates anxiety for dying people who are trying to purchase substances for a specific use at a specific time in a clandestine manner in order to protect their families. This route also exacerbates inequalities given the resources and knowledge needed to navigate the process.

In our interviews we did not encounter any examples where somebody who attempted to end their life and survived did not try again. The experiences featured in this report all involve people who died at their first attempt or people who tried multiple times to end their own lives.

This contributes to an understanding of the differences between dying people ending their own lives and non-dying people who die by suicide.

The presence of a chronic illness is already considered a risk factor for repeated suicide attempts. In 2007, a report on the National Suicide Prevention Strategy for England acknowledged the presence of ‘painful illnesses’ as a factor that increased the likelihood of someone taking their own life.

Adam explained how his mum tried to end her own life by overdose on a number of occasions.

Adam’s mum did not end her own life. She died in a hospice. There was a haemorrhage in her throat and she choked on her own blood.

Throughout the UK the police are expected to attend all incidents of sudden or unexpected deaths that occur outside of a medical setting.

In 2012 the Association of Chief Police Officers, now the National Police Chiefs’ Council (NPCC), issued guidelines on dealing with cases of assisting or encouraging suicide. It is clear from our interviews that some police officers were uncomfortable investigating possible cases of assistance in line with the NPCC guidance, though many interviewees were sympathetic to the plight of the police in these circumstances.

For others the police appeared to have acted in a way that lacked sensitivity. There is dramatic inconsistency in the way these deaths are investigated.

There is much to differentiate the deaths of the people featured in this report from cases of suicide, yet one aspect where similarities remain is the immediate impact on those who are bereaved. This might be due to the fact that some interviewees discovered their loved one’s body, were denied an opportunity to have an open conversation with their loved one about their feelings and intentions or live with regret at the manner in which their loved one died.

These effects were compounded for some interviewees in this report because they also witnessed their loved ones suffering prior to their death and/or feared the potential legal implications following their loved one’s death, for them and for other people they knew, including the possibility of prosecution and imprisonment.

These negative outcomes contrast with what we know about bereavement in countries where some form of assistance to die is legal. A study of family caregivers of people who had accessed assisted dying in Canada found they overwhelmingly viewed the quality of their loved one’s death more favourably than the one they anticipated by ‘natural causes’, namely because of the prevention of unnecessary suffering.

Interviewees described many symptoms of complex grief, a term that is used to describe grief that is distinct from bereavement-related loss and is a predictor of long-term functional impairments.

While research on the impact of witnessing a stranger end their life is scarce, qualitative studies have found negative effects, including post-traumatic stress disorder, flashbacks and physical reactions such as sweating, nausea and trouble breathing when they are reminded of the event. Support resources for third party witnesses of suicide describe it as a life-changing event with shock, nightmares, difficulty sleeping, flashbacks, substance abuse, irritability, guilt and anxiety as common reactions.

Over 200 million people in the world have access to some form of assisted dying. Interviewees for this report told us why their loved ones would have had better, less traumatic death if this was an option in the UK.

The law must change to allow terminally ill, mentally competent adults the option of an assisted death, subject to robust, upfront safeguards

A change in the law would reduce anxiety, inequalities and unnecessary suffering amongst dying people in the UK. Crucially, it would make society safer, replacing the chaos of the status quo with a law that is open and transparent and has meaningful upfront protections, both for those who would want to explore the option of an assisted death and those who would not. This is in stark contrast t the current law, where investigations tend to take place after someone has died, if they happen at all. Law change would provide an opportunity for robust data collection and regulation, providing a much more accurate picture of the end-of-life choices dying people in the UK wish to exercise.

There must be recognition that assisted dying and suicide are distinct concepts

People who are terminally ill and approaching the end of their lives simply want to control the way they die. Presenting this as ‘suicide’ is misleading. It does not reflect the academic literature or the views of dying people and their families and leads to a lack of clarity in the assisted dying debate. In line with guidelines from the Samaritans, the phrase ‘commit suicide’ is inappropriate in any circumstance. As this report shows, many terminally ill people feel driven to end their lives in lonely and violent ways. An assisted dying law would protect these people from those kinds of deaths.

Society must know the true numbers of dying people who end their own lives in the UK

The Office for National Statistics (ONS) is currently researching the rates of deaths recorded as suicides amongst dying people. The ONS should routinely collect and present this data to Parliaments in the UK to  inform debates about assisted dying. Those with relevant expertise should work together to explore how further data could be collected. The Coroner’s Society of England and Wales should consider ways that it can contribute its expertise and knowledge to societal debates.

Dying people should be able to have open and honest conversations with others about their wish for an assisted death

Those who want to control the manner and timing of their deaths should not have to manage that wish alone out of fear of implicating their loved ones or healthcare professionals in a crime. Organisations that provide care and support to dying should assess their policies on assisted dying to ensure they are creating space for their members, staff and service users to have conversations about the subject. They should ensure they are pro-actively promoting a culture of openness and respect for diversity of views around choice at the end of life.

Police forces should review their procedures for responding to deaths where a dying person has ended their own life

Police officers should not be asked to instigate investigations into breaches of the 1961 Suicide Act without sufficient training and support. Grieving relatives should not be subjected to unnecessarily intrusive and insensitive police investigations immediately following the death of their loved one. Police forces should review their existing procedures and learn from previous investigations they have conducted. Organisations responsible for other first responders should also ensure that people have the support they need to respond to and deal with these cases.