Death with Dignity or a License to Kill?

By None, The Yorkshire Post, May 12, 2006

The House of Lords is set for a showdown today [May 12, 2006] over a Bill which would allow doctors to help patients in unbearable pain to die. Lord Joffe explains why he believes his Bill is needed, while GP Mark Houghton fears we are on the slippery slope to euthanasia.

Lord Joel Joffe (For)

When Dr Anne Turner, together with her three children, stepped on the plane to Zurich on her way to be assisted to die there, she said she was doing this sooner than she wanted to because if she waited any longer, she would not have had the strength to travel.

If my Assisted Dying for the Terminally Ill Bill had been in force, Dr Turner would not have been obliged to make that choice and would still be alive today, and her loving children, who were determined to be with their mother when she died, would not now be faced with possible prosecution.

Our law makes it a criminal offence punishable by up to life imprisonment to assist anyone to die, even if they are terminally-ill, suffering terribly and pleading for such assistance. The Bill aims to change the law so that terminally-ill patients can, after complying with an array of safeguards, ask their doctors to prescribe medication which they can take in order to end their lives and bring their suffering to an end.

In the US state of Oregon, in the Netherlands and Belgium, it is legal for doctors to assist terminally-ill patients to die, if that is what they want, but this help is restricted to residents of the countries concerned. In Switzerland, their ethical outlook is that if Swiss nationals can be assisted to die, then such compassion should not be denied to others. That is why Dr Turner was obliged to go to Switzerland to die peacefully on her own terms, after having said her goodbyes, and surrounded by her family. She became the 42nd British patient to end their life in a small unfamiliar flat in Zurich instead of in their own home. It is inevitable that many more British patients will follow them unless our law is changed.

It is not as if patients here are not presently being assisted to die at their request. According to research published last month by Prof Clive Seale of Brunel University, more than 900 patients are being so assisted. It is clear therefore that the choice is between making medically assisted dying lawful and regulated, or allowing it to continue "underground" without any safeguards, transparency or accountability.

My Bill is based on the law in Oregon but with even more safeguards. The Select Committee which was set up by the House of Lords, visited Oregon to learn from its experience. We received evidence from a range of organisations, including the Regulatory Authorities, the Hospices Association, the Nurse Association, the Medical Association and a number of researchers, all of whom felt that the law was working well and that there was no credible evidence of abuse. Indeed, the take-up of assisted dying in Oregon was small – only about 1 in 700 deaths. However, the beneficial effects of the legislation were significantly greater, as it was a comfort to the terminally-ill to know that they had the option of assisted dying, if their suffering became intolerable, even if, in the end, they did not exercise this option. If the experience of Oregon were repeated over here, the number of patients assisted to die would be in the order of 650 each year.

The opposition to the Bill is largely based on religious beliefs and on speculation that there will be a so-called slippery slope, that the disabled and elderly will be put at risk, and that palliative care will be undermined. The actual evidence received by the Select Committee in Oregon showed that these fears were unfounded and that, in practice, palliative care had flourished after the assisted dying legislation. This is particularly important because I and the supporters of the Bill are committed to palliative care, which we believe would be the preferred choice of the overwhelming majority of terminally-ill patients. However, the Select Committee specifically found that the demand for assistance to die is particularly strong among determined individuals accustomed to being in control of their lives, who are unlikely to be deflected from their wish to end their lives by more or better palliative care.

In order to make absolutely certain that patients and society are fully protected, the Bill includes an array of more than 20 essential safeguards which include examinations by two independent doctors, a psychiatric assessment where there are doubts about capacity, a consultation with a palliative care expert and two written requests for assistance to die, the final one of which must be signed in front of a solicitor or notary public.
Most of the opposition to the Bill comes from people driven by their religious beliefs, although many of them seem reluctant to admit this, and desperately look for other reasons to oppose. Naturally I respect the beliefs of the religious leaders and those who share their beliefs. However, they have no right to seek to impose their views on the 80 per cent of the population who do not share them, particularly as public opinion surveys show that 80 per cent of both Anglicans and Catholics support a change in the law.

The Bill is based upon the principle of personal autonomy and patient choice. It is all about valuing life through respecting the wishes of the dying. It will provide an additional end-of-life option to terminally-ill patients which they are free to exercise or ignore. It does not seek to impose any course of action on anybody, and health care professionals will be free to refuse to participate in any way if they so wish.

It was Diane Pretty's suffering which inspired me to seek to change the law. Paralysed from the neck downwards with virtually no decipherable speech, her intellect was unimpaired. She wished to be spared the suffering and loss of dignity which was all that was left of her life for her. She wanted to control how and when she died but the courts were unable to assist her because of the law, and she died the death she dreaded.
The Bill is about choice and who better to make a decision on their life than the terminally-ill patient whose life it is.

Lord Joel Joffe's Assisted Dying for the Terminally Ill Bill will be discussed in the House of Lords today [May 12, 2006].

Mark Houghton (Against)

My heart goes out in sympathy to those who want to die. I have spent the last 12 years battling chronic pain and I know how easily suicidal thoughts can tell you death is the best way out. So Lord Joffe's Bill for Assisted Dying is of intense interest. He thinks death by suicide with a doctor's help is everybody's right; so he proposes a law based on the one in Oregon. There the doctor must prescribe – but not actually give – the lethal draught. So what's the problem?

The Bill is based on some dangerously wrong assumptions.

Firstly, the Bill's supporters try to separate physician-assisted suicide (as in Oregon) from full-on euthanasia. Lord McColl pointed out the hypocrisy of this proposal when he said: "Placing the lethal pill on the table by the patient is good. Placing it on the tongue would be murder." Clearly there is little difference between the two.
Furthermore, Oregon deaths often go wrong. About 20 per cent vomit or wake up and have to be "finished off" by someone. That is euthanasia, not assisted suicide. In reality, physician-assisted suicide and euthanasia are inseparable.

Secondly the assisted suicide lobby say we need it. Naturally, most of us, if just asked to choose between unbearable suffering and assisted suicide will choose the latter. But the House of Lords has thrown out the opinion poll as biased. True euthanasia requests are in fact rare. I haven't known one in 30 years of work. I have known a man say to my boss, a consultant, "Doc just finish me off". But as the conversation developed, it became apparent that his real concern was paying his mortgage when unable to work. We need to find the real question behind the request and treat that problem.

So what about the tiny number who seriously see suicide as the right option? People like Anne Turner who went to Switzerland for assisted suicide, though she could have lived on for years with her disease. The true answer lies in palliative or terminal care.

British doctors have brilliantly pioneered compassionate care of the terminally-ill. This has literally changed the way the world dies. Pain relief expert Dr Robert Twycross says there is now no need for anyone to die in pain.
Contrary to what euthanasia activist Deborah Annetts says, powerful painkillers, rightly used, do not usually speed death and are not a covert form of euthanasia. They are what they are meant to be – pain relief.
It should also be recognised that assisted suicide has unintended consequences. In particular it reduces quality of palliative care. This is evident in Oregon where a study shows the quality of pain control has got worse since their assisted suicide law was introduced. Now 22 per cent of people are dying in pain, which should be controlled. An American study showed that the law has led to doctors being trained to kill, not just to care.
They begin, often with the best of motives, to assist death or euthanasia, without the patient's consent. The safeguards of the new law in Oregon began to be bent within months.

Lord Joffe and his lobby say their law will have more checks against abuse than anywhere else. But there is not a shred of evidence that this will work. The official figures from Holland (one of the handful of countries where euthanasia is legal) show 1,000 a year are dying without consent. Deborah Annetts asserted in Doctor magazine last year that these were due to the painkillers. As a lawyer and co-author of the Bill it is odd she seems not to have read the House of Lords select committee report disproving that idea. Sheffield's Professor of Palliative Care, Sam Ahnedzai, told me of a tidal wave of revulsion sweeping Holland at their undignified practices; especially the recent illegal killing of an infant.

Let's thank God that some of the very few British doctors who try it on face criminal prosecution. Some claim that, "It's happening all the time," but the recent Brunel University study of 834 British doctors found that not one had assisted suicide. Only 2.6 per cent thought that changing the law would help patients.

Assisted dying is unnecessary, uncontrollable and unkind. What is required is justice and compassion in society, especially towards the powerless. Lord Dalton, speaking for the House of Lords commission of inquiry on euthanasia in 1994 rejected it, saying it would put the elderly and vulnerable at risk. Put more money into palliative care, they said, which is what has happened, though much more needs to be done.

I feel that some doctors have helped to create this problem. Well-meaning attempts to artificially prolong life create their own indignities. Thankfully, most medics know when the natural end has come. It's the unnatural ends that should worry us. We should reject assisted suicide.

As I write this, my pain is touching the unendurable point, and I briefly interrupted writing to phone for help. I want a robust law to protect me, because just a notch more and my will to live will evaporate. I want protection from myself, and any well-meaning professional, who may forget that tomorrow, with skilled care, I can feel a new man. Deep down most of us know that the ethics of this are wrong. Parliament and people should spare no effort to throw out such a dangerous and inhumane Bill. Beware, Joffe himself has said: "Assisted dying is just the first step..."

Mark Houghton is a family doctor in Sheffield. For the past 12 years he has worked part-time, suffering from chronic pain.

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