I think we have to go beyond the issue of whether they have the capacity to consent. When our panel was doing our various consultations around the world, I remember when we were in the Benelux countries we met with physicians, some of whom were engaged in this practice. Those who were practising it in a way that I thought was perhaps the most careful and responsible were saying that their duty is not only to determine whether or not they meet eligibility criteria but also to find out the antecedents of a wish to die. What is underpinning a person's request to end their life?
When you look at people's reasons for seeking a hastened death, medical circumstances alone are in the minority. Much of the research I have done over the last 15 years actually began with the fact that in Holland loss of dignity was the most highly cited reason for people seeking an assisted death. If you go to Oregon, on the other hand, it's not about physical pain. It is, in most instances, about loss of autonomy. There are existential issues. There are things that cause people to feel as though they are a burden on others.
The reason I suggested earlier that there needs to be some form of larger oversight, and I suggested judicial oversight, was that the sources of distress that underpin a wish to die aren't just within the area of expertise of physicians who can evaluate whether or not somebody is in pain or who can evaluate some of the physical sources of distress; there are also going to be social issues and financial issues and environmental issues. All of those things need to be evaluated if we're going to do a good job of determining whether or not we understand why somebody is seeking out a hastened death.