What’s wrong with assisted dying

The 20th Rapid Response on this subject published on 14.06.12 by Clive Seale balances the ‘for’s and against’s’ in this polarised debate, ending with a question rather than a firm opinion that concedes nothing to the other side.
I salute Iona Heath’s courageous stand in putting forward her arguments against the legalisation of assisted dying. To speak out against the growing tendency of some professionals, as demonstrated in this correspondence, to seek the legitimisation of euthanasia is indeed a brave thing to do. Although those who argue for the law to be changed do so on the grounds of enhancing patient autonomy, the driving force is often a wish to protect the doctors who carry out the procedure.
The paramount professional intention must be to relieve distress but any action that the physician takes is constrained by the law and may make achieving relief of suffering difficult. No one will argue that control of distress is what is required by doctor, patient and family. If the patient succumbs during well intentioned efforts to mitigate intractable symptoms, it will be a death that is incidental rather than the planned objective of treatment. Intention is everything. It is always a difficult and unsettling judgement to make in the face of the law as it presently exists because the doctor has to constantly question whether the action taken can be justified in a court of law. The law stands as an unseen guardian of the vulnerable patient in their last few days or hours of life. If the law is weakened, the power of the doctor to act according to his or her conscience is greater and the moral code of the doctor inevitably becomes the more decisive authority. Different doctors have different codes and although I would use neither Mengele nor Shipman as examples of doctors with any moral code such evil individuals or indeed regimes, will seek succour in the softening of current legislation.
Difficult decisions are by their very nature difficult and to make them easier may not necessarily make them better or right.

Comment to Iona Heath following her article
“What’s wrong with assisted dying”
in the BMJ June 2012
(cite 2012:344:e3755)
SANS EVERYTHING
By Nikki Kenward

In this month when Tony Nicklinson will resume his fight, this time in the High Court, to allow a doctor to assist him in committing suicide, the BMA will also hold its Annual Representative Meeting in Bournemouth. During this meeting members will be asked to vote in favour of allowing society and the law to take responsibility away from them for legalising assisted suicide, they want to remain neutral; although presumably not when they’ve got the syringe in hand, maybe they’ll just look away, after all isn’t that what they’ll be doing anyway. Since we won’t be invited to either event, I would like to call an imaginary meeting of the Distant Voices, or at least all those who won’t be heard, or the people no-one wants to hear, or those who for whatever reason can’t speak, or who are, esteemed members, living in all those places, in all those situations, you’d rather not go to. How do I know this?

Because if you and for that matter the general public really, really, thought about it they would have to consider their own inevitable fate and that means being very, very, careful what you wish for. I speak on two counts, one, as someone who constantly asks the general public what they think and want for their relatives and themselves and also as someone who has been ‘locked in’ and is now significantly disabled. In the first instance and I have to agree with Iona Heath’s statement of “campaigns being predicated on an excessively rosy view of society” people simply aren’t thinking this through. You see, we are a society that likes to make best and most use of everything that we pay for, especially in the NHS. Iona herself has commented publicly on breast screening and the apparently heretical view that a woman (this one anyway) could say, “No thanks.” To which their response was absolute horror that someone would decline the offer, ‘put her life at risk,’ and not be moved by all the money that had been spent on the equipment, which they in turn must make use of. Also as a woman labelled Elderly Primigravida who refused a scan, on the advice at the time of The World Health Organisation, I can tell you now saying, “No,” does not win you any popularity stakes. If we’ve got it we’re dam well going to use it. And the same will happen with assisted suicide, once we’ve got everything in place; and according to many experts we already have with the LCP, there will be no stopping us.

So, people on the street, for those of us who ask, think it’s going to be like Grand Designs whereby you say what you want and how it’s going to be, there’ll be some hassle and a bit of indecision but the doctors will see to it that it goes alright in the end – your end. People insist on saying it’s their right, to be autonomous, to choose. Professor Nigel Biggar says of legalization, that it will “jeopardise society’s commitment to the high value of individual human lives, and its support for those lives when they are ailing. It will make society more liberal at the expense of making it less humane.”

We won’t end up with the dream home but tears and rubble as lives are lost without thought and strewn carelessly around us. We can’t create the botox of death and hope that no-one ends up with a ‘trout pout’ and remember, only dead fish float the same way and that’s not an ocean any of us should rush to dive into - because we will, we will dive in. We’ll cogitate, mediate and of course procrastinate (although we can rely on Dignity in Dying to do most of that) in the end we’ll come up with some heinous logarithm only meant to be used in extremity or as a signifier of ‘inalienable’ rights, but finally, extreme situations will become orthodox. We’ll be left with, as Arch Bishop Runcie said of the church, “a lot of noise coming from the shallow end.” For these are shallow and ill thought out desires.

But what of me and the likes of me? You see sadly to most medics I’m a physicians nightmare, a reminder of failure, or as my doctor said when discussing me with my son “you wouldn’t want to end up like your mother would you.” And as for the 75 and counting, disabled people who have already died because their lives were “considered not worth living,” or so the medics thought. Are we really going to be safe in these hands? And how much are we and the elderly going to save the government if we pop off early? Lots. And who cares? Do we even know who cares anymore?

Have we asked enough about growing legions of the dead? 12 hundred in Stoke alone, over 200 at the hands of Mr. Shipman. Take the alarming death rates across the West midlands which, according to a statement by Brian Jarman, Emeritus Professor of Imperial College and world authority on mortality rates, “the only way you could get mortality rates like that would be if all three trusts suddenly became terminal care hospitals overnight........I’ve never seen anything like this.”

Hospitals offer facile apologies, relatives are left with guilt and a pain that won’t ever go away because it needs the truth to salve it.

And yet the public are placing their faith in these systems and yet, and yet, sadly they believe that in the end it’s for the best. Well it always turns out best for some there are always those out for a fast buck. Bring on the rewards for the euthanizors, the governments bent on saving money, or just bent. There always someone waiting in the shadows, what “rough beast” is this then.

And so to the Youth Worker who said she’d rather be dead than be like me, you may not have long to wait, perhaps not even until your next Botox session.

And to Mr Nicklinson I say, “Get a life,” go out more than once a year, some of us do. Whatever you do, even if you take your own life, or if you make it legal for someone to kill you, you’ve still got no right to take my life. For that is what will happen Tony unless these people let all of us speak, so I speak here at my imaginary meeting I speak for you Tony and for all those who are or who will be like you and I. “Sans everything.” Tony.

This response is sent on behalf of The DISTANT VOICES and ALERT, Defending Vulnerable People’s Right to Live.

Iona Heath is President of the Royal College of General Practitioners her comments come from the BMJ May 2012 Article: What’s wrong with assisted dying.

Nigel Biggar is Regius professor of Moral and Pastoral Theology at the University of Oxford, where he directs the McDonald centre for Theology, Ethics and Public Life. He is the author of Aiming to Kill: The Ethics of Suicide and Euthanasia (2004), he sits on the Royal College of Physicians’ Committee for Ethical issues in Medicine. From: The Case Against Intentional Medical Killing.

Brian Jarman is Emeritus Professor, Faculty of Medicine, Imperial College, London. Amongst his many positions he was President of the British Medical Association (2003-4) his recent work has involved calculating adjusted hospital death rates in England, Scotland, USA, Canada, the Netherlands and Sweden.

Philip Hartropp makes such a good point. There is still no obligation to inform people about the need to make their wishes known. Nor are advocates always identified even though their need has been acknowledged for a long time. It leaves individuals at risk of being subjected to others' personal opinions. That the UK has a very long way to go in dealing with these issues is illustrated by the eight Pilot End of Life Locality Registers (which did not even touch of the issue of Assisted Dying) published on the Ipsos Mori website.

It is disappointing that the RCGP President not only describes Voluntary Euthanasia and the Nazi war criminal Mengele in the same sentence but also seems unaware of the evidence regarding the safety of Assisted Dying around the world. One can only speculate as to the motivation for this. The opponents of Volunary Euthanasia(VE) around the world usually do this - muddy the waters with words and concepts that evoke really bad connotations. They are wiful misrepresentations of the facts regarding VE.
Numerous independent audits of existing Euthanasia Laws from several jurisdictions have shown them to be safe. The "slippery slope" does not exist. Vulnerable people are LESS likely to take advantage of assisted dying.

“Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.” M P Battin et al, “Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups”, J Med Ethics 2007; 33: 591-597

Courtney Campbell, Hundere Professor in Religion and Culture at Oregon State University, and not a supporter of assisted dying, nevertheless concluded in his review of the operation of the Oregon Death with Dignity Act “The procedures embedded in the statute for ensuring informed and voluntary decisions by terminally ill patients have been substantially effective. The pre-implementation concerns of critics about coerced or compromised choices do not seem borne out in practice.” (“Ten Years of “Death with Dignity””, The New Atlantis, Fall 2008).

“There is no evidence from the Netherlands supporting the concern that society’s vulnerable would be at increased risk of abuse if a more permissive regime were implemented (in Canada).” “What has emerged is evidence that the law is capable of managing the decriminalization of assisted dying” (Report by Royal Society of Canada Expert Panel, End-of-life Decision-making November

Facts are facts and it is misinformed and arrogant to state that no safe law can be drafted.
They already exist and are working just fine and safely in Oregon, The Netherlands, Belgium, Washington State, Switzerland, Montana, Luxembourg.
Change is inevitable.