Ann Turner’s decision to end her life by assisted suicide, aged 67,
three years after the distressing death of her husband provoked me to add
a further contribution to the euthanasia debate. As a member of the
voluntary euthanasia society Anne Turner might have been keen to see Lord
Joffe’s bill on assisted dying for the terminally ill become law. I
consider the bill to be fatally flawed and deliberately misleading.
Why be so opposed to assisted dying or euthanasia? My knowledge of myself
and my colleagues suggests to me that we have insufficient wisdom and
inadequate safeguards, to introduce Lord Joffe’s bill.The provision of a
prescription for a fatal cocktail of drugs by medical practitioners, to
permit individuals to end their own life, results in a major shift in the
doctor patient relationship. After the Shipman case, patient trust in
their family doctors was visibly eroded. What degree of paranoia would be
induced in patients aware that their doctor will be advising how to heal
in one consultation and in a subsequent consultation advising how to
hasten death. Are we to anticipate the development of a medical specialty
in assisted dying? Surely this is an appalling prospect?
The degree of obligation felt by many elderly patients, not to be a
nuisance, should not be underestimated. Many older patients may feel
obliged to opt for assisted suicide to reduce the burden on their families
and the state. Individuals suffering from chronic ill health, bereavement
and depression may often see no future for many months and yet find a way
through suffering which enhances and enriches their lives.
Dame Cicely Saunders the founder of the modern hospice movement in the
United Kingdom highlighted “The often-surprising potential for personal
and family growth at this stage is one of the strongest objections most
hospice workers raise for the legalization of a deliberately hastened
death or for an automatic policy of ‘shielding’ a patient from the truth.”
Some doctors may well claim that they already assist patients to die.
Some might argue that death is a form of healing – whilst I believe death
to be an integral part of life, I don’t see death as a form of healing.
If terminally ill patients are deliberately overdosed with opiates with
the purpose of ending life rather than relieving pain on distress, then
this is against the current law. Lord Joffe’s bill also states its purpose
to make provision for a person suffering form such a condition to receive
pain relief medication . This is surely one of doctors’ existing prime
roles, to relieve pain and suffering and a right already available.
Symptom control provides many challenges for all doctors and palliative
care teams have a key educational role in this respect. The prescription
of anxiolytic sedative drugs in combination with opioids, in syringe
drivers, may shorten a patient’s life, by respiratory depression. These
drugs may be necessary to relieve pain, anxiety and distress, and only
after full consultation with the patient and family, including explanation
as to potential sedating effects should they be prescribed at a suitable
dose to control symptoms rather than hasten death. Lord Joffe bill links
assisted dying to the provision of proper palliative care. This is
misleading and engenders a public perception and fear that pain relief for
the dying is not already part of good medical practice.
There is then, a fine line between deliberate ending of life, and known
shortening of life as part of symptom control and palliative care. Whilst
subtle the line is identifiable and should be crossed at our profession’s
peril. The exercise of professional skills and discretion within the
existing law to alleviate pain and physical symptoms in so far as their
skill permits, is patient focussed care and not to be confused with
paternalism. Given adequate resources of clinician and nurse time and
access to palliative care specialty teams acceptable control of pain
should be achieved in the majority of cases. Some medical conditions such
as motor neurone disease will tax even the most skilled physicians and
carers, but surely should lead to a challenge to improve symptom control,
medical and nursing care and not to patient termination.
Lord Joffe argues that euthanasia is a matter of choice for the patient.
If Lord Joffe is successful the medical profession will be under pressure
to provide euthanasia as a service, thereby obliging and depriving doctors
of their choice to provide care that enriches life rather than ending it.
My suspicion is that once legalised, assisted dying will become
increasingly common as a convenience, rather than coping with the
demanding and expensive business of caring for an increasingly elderly
population. If as Benjamin Franklin wrote; nothing can be said to be
certain except death and taxes then Lord Joffe’s bill should be rejected
so we are not tempted to facilitate the former, to reduce the latter. I
wonder if the treasury has costed the financial benefits of the Lord Joffe
bill. I hope not.
Obituary Anne Turner BMJ 332;306
Assisted Dying for the Terminally Ill Bill Lord Joffe House of Lords
Marie Curie Memorial Foundation. Report on a National Survey
Concerning Patients Nursed at Home. London: Marie Curie Memorial
Foreward by Dame Cicey Saunders
Competing interests: No competing interests