Abortion reform’s lessons for assisted dyingBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4539 (Published 09 July 2012) Cite this as: BMJ 2012;345:e4539
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Winyard claims that there is ‘no evidence’ that assisted suicide happens in Oregon without patient consent. Winyard may not have noticed reference 4 of my letter (the paper by Hicks [i][i] ) where several cases of assisted dying without patient consent have been listed that have occurred in Oregon. Hicks describes:
Case 1, Oregon: An 85-year-old cancer patient with worsening dementia requests Physician Assisted Suicide (PAS). But her psychiatrist believes that she is being pressured by family. Nevertheless, she is then approved for PAS by a psychologist and receives assisted suicide .
Case 2, Oregon: Louise, who has a degenerative neurological disease, requests PAS. As her disease progresses, those in her network who support her suicide become increasingly anxious that she will become too mentally or physically incapacitated to act on her request. This includes her doctor, her mother, a friend who will be present at her suicide, and the Oregon Compassion in Dying PAS advocate who has arranged for a New York Times reporter to fly in and cover the suicide. Louise says she is almost ready but not quite. She wants a week to relax and be with her mother. On learning indirectly that her doctor thinks she will not be able to act if she waits, she appears startled. Her mother tells her, "It's OK to be afraid." She replies, "I'm not afraid. I just feel as if everyone is ganging up on me, pressuring me. I just want some time."  [These footnotes refer to the Hicks paper].
As Winyard seems to believe that everything regarding assisted suicide in Oregon is legal, and if one were to follow his logic, then one has to assume that even these cases of coercion would be entered into the official statistics as 'legal' cases of assisted suicide. Winyard seems furthermore to believe that - because something is illegal (like assisted suicide in Oregon without patient consent) - it does not happen. This is quite a naive assumption. Theft, speeding and euthanasia without patient consent in the Netherlands are all examples of activities that are illegal, but still happen. For example 3 surveys in the Netherlands over a 10 year period have shown that there are around 1000 cases of euthanasia without patient consent per annum in the Netherlands[ii].
In this context - as Winyard does not seem to challenge my assumption that euthanasia/assisted suicide occurs in the Netherlands without patient consent - does he by implication agree that there is 'euthanasia' without consent in the Netherlands which is no longer euthanasia but ought more properly to be classified as murder?
Then Winyard - without giving any supportive evidence - claims that 'in the UK approximately 2,500 deaths attended by a medical practitioner per year are as a result of voluntary or non-voluntary euthanasia.' It is wrong to suggest that I claimed that 'safeguards' for legal euthanasia could lead to an increase in cases of assisted suicide/euthanasia. I never suggested that. The point made was that UK legalisation could well lead to an increase in euthanasia cases without consent. There certainly seems to be a suggestion of increased cases of euthanasia in the Netherlands over a 20 year period after ‘legalisation’, perhaps partly due to cases of euthanasia masquerading as ‘terminal sedation’. [iii] And of course Winyard’s fanciful legal ‘crampons’ can be used to go down slippery slopes quite well-which is just what Lord Joffe said he wanted when he tried to bring in a limited euthanasia bill in the UK as a step down the slope to the full blown medical killing.
As euthanasia advocate Lord Falconer is quoted as saying, 'I don't think you can ever have a system that is completely watertight.' http://www.telegraph.co.uk/news/uknews/law-and-order/8994338/Church-of-E...
This is certainly the lesson learnt from abortion legalisation, where we see an 8 fold rise in abortion rates since abortion was legalised over four decades ago.[iv]
So the warning from Dr Habgood in 1974 was spot on about the risks of euthanasia when based on our experiences with legalising abortion. He wrote: ‘The safeguards and assurances given when the Bill [1967 Abortion Act] was passed have to a considerable extent been ignored.’ [v] And this was only a few years after abortion was legalised.
The same will happen should assisted suicide/euthanasia ever be legalised in the UK. Safeguards and assurances given at the time will be quickly forgotten.
That is the lesson that needs to be learnt from abortion legalisation.
[i] Hicks MH. Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors. BMC Fam Pract2006;7:39
[ii] Van der Maas PJ et al.: Euthanasia and other medical decisions concerning the end of life. Lancet 1991; 338: 669-74. And:
Van der Maas PJ et al.: Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. NEJM 1996; 335: 1699-705. And:
Onwuteaka-Philipsen BJ et al.: Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995, and 2001. The Lancet published online 17 June 2003.
[iii] Onwuteaka-Philipsen BD et al. Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. The Lancet, Published online July 11, 2012.
[iv] Abortion Statistics, England and Wales: 2010, Department of Health.
[v] Dr Habgood, quoted in: Keown J. Euthanasia, ethics and public policy. Cambridge University Press, 2002:71.
Competing interests: No competing interests
Response to Abortion reform’s lessons for assisted dying by Adrian M Houghton.
Adrian Houghton states that assisted dying takes place without patient consent in Oregon. There is no evidence to support this assertion, nor have any such cases been reported since assisted dying was legalised in 1997.
It is illegal for a doctor in Oregon to assist someone to die without their full consent and without ensuring that the strict eligibility criteria and safeguards are met.
Research tells us that in the UK approximately 2,500 deaths attended by a medical practitioner per year are as a result of voluntary or non-voluntary euthanasia. In this light, a safeguarded assisted dying law can be seen to apply crampons rather than skis to the so-called ‘slippery slope’. There is no logic in the argument that safeguards would increase the numbers of illegal cases. Furthermore, in Oregon assisted dying has been legal for 15 years without the dire consequences Dr Houghton predicts – there has been no relaxation or expansion of the safeguards, nor has there been an explosive increase in cases.
In the UK the call for the legalisation of assisted dying is for terminally ill adults with mental capacity only. The draft Bill recently published for consultation by proponents of change is similar to the Oregon system, where assisted dying counts for approximately 0.2% of all deaths per year.1 Based on this number, we can estimate that there would be approximately 1,000 (out of 500,000 total deaths) cases per year in England and Wales. Many thousands more would be given the opportunity to openly discuss the option, but would not go on to have an assisted death.
Competing interests: Steering group of Health Professionals for Assisted Dying