Following the recent decisions of the Welsh Assembly, the First Minister of Scotland, Nicola Sturgeon, and the Scottish Parliament, to vote against assisted dying, David Cameron, the Prime Minister, has announced his opposition to the latest attempts to change the law in England.
House of Commons June 10th 2015
Fiona Bruce: Any move to legalise assisted suicide is viewed with the upmost concern by disability groups and others who fear that it could pressurise the vulnerable into making decisions that are not in their best interests. Would the Prime Minister inform the House of his view on this issue?
Prime Minister: On this issue I agree very much with my honourable friend, which is: I don’t support the assisted dying proposals that have come out of the other place, I don’t support euthanasia, I know there are imperfections and problems with the current law, but I think these can be dealt with sensitively and sensibly without having a new law that actually brings in euthanasia. And as she says, I think the problem is the pressure that is then put on frail elderly people to take a decision that actually they might not want to go ahead with.
Legislation that would give terminally ill patients the right to die is to be debated by the House of Commons on September 11th 2015.
The Labour MP Rob Marris (Wolverhampton South West), who topped the ballot for private members’ bills, is to adopt the Bill inroduveced previously in the House of Lords by Lord Falconer.
The Marris Bill would allow doctors to prescribe a lethal dose to terminally ill patients judged to have six months or less to live and who request it.
Agnes Fletcher, the director of the organisation Living and Dying Well, told the Guardian: “The existing Suicide Act is operating effectively and there’s no compelling evidence that it needs to change. There’s been no prosecution of anyone helping people going to Switzerland.”
Earlier posts about the Falconer Bill and Assisted Suicide:
See also –
The so-called consultation on the Falconer proposals is intended to provide a cloak of respectability for a Bill which will lead to doctors being required to take the lives of some patients.
It will be said that “this is what the people want”. The process will be as biased and distorted as the Falconer Commission – made up of people who want the removal of the protections for patient safety contained in the current law.
The draft Bill can be seen at http://www.appg-endoflifechoice.org.uk/pdf/appg-safeguarding-choice.pdf
There is a summary at:
Remarks made by David (Lord) Alton at the Lobby of Parliament on July 3rd 2012:
1.The lessons to be learnt from the Abortion Act and What’s Now At Stake
2.The Propaganda War that is Underway
3.What we can learn from Holland and Oregon.
4.Why we must resist the Falconer Bill
1.The lessons to be learnt from the Abortion Act and What’s Now At Stake
In using the framework and provisions of the 1967 Abortion Act as a template for euthanasia legislation the proponents of assisted dying are paving the way for the same outcomes. Instead of seven million unborn children, it will be legions of disabled, sick and elderly people whose lives will be ended. The proposals will be disguised with words like compassion and dignity but the reality will be doctors who will be required in future to kill patients; disabled people made to believe they would be better off dead; patient safety compromised; and politicians using the new law as a pretext to withdraw resources from the care of the sick. Far from providing dignity in dying these proposals will sound the death knell for Britain’s outstanding hospice movement and palliative care. To die with dignity we don’t need doctors to kill us. The so-called right to die will soon become a duty to die quickly!”
The Bill is to be based on the findings of Lord Falconer’s Commission on Assisted Dying.
Hopelessly biased and distorted, the Falconer Commission was stacked full of euthanasia sympathisers and was established by Dignity in Dying (formerly The Voluntary Euthanasia Society).
The funding for the Commission was provided by Bernard Lewis and Terry Pratchett, the latter a patron of Dignity in Dying. It is entirely wedded to introducing legalisation for assisted suicide for those who are terminally ill.
Over 50 organizations refused to give evidence to the Commission when they saw its composition. Instead, Dignity in Dying contacted its own members asking them to give evidence to the Commission. The British Medical Association (BMA) passed a 5 point resolution that undermined the Commission credibility by questioning its impartiality and independence.
When the Commission was established it was revealed that nine of the twelve commissioners were well-known names in the pro-legalisation lobby. The others were certainly not against euthanasia. The euthanasia lobby decided to take the ‘independent’ route because when two genuinely independent Parliamentary Select Committees carefully examined the issue they did not recommend a change of law. When votes were then taken in the House of Lords it resulted in large defeats for their proposals (148-100 and 194-141). The last attempt at legalization in Scotland also resulted in a heavy defeat (85-16) for Margo Macdonald’s Bill in 2010.
For the record, and to give some idea of the scale of the parliamentary Inquiry, the Select Committee covered some 246 Hansard columns and two volumes of 744 pages and 116 pages respectively, 15 oral sessions, 48 groups or individuals giving evidence, with 88 witnesses giving written evidence; 2,460 questions were asked and the committee receiving 14,000 letters. Compare the coverage given by the BBC and others to the parliamentary Inquiry with the media circus and feeding frenzy generated by the Falconer Commission.
An unbiased and impartial account of this debate might mention the opposition to a change in the law expressed in Parliament – predominantly on the grounds of public safety – and by the British Medical Association, the Royal Colleges, the hospices and Disability Rights Organisations – who eloquently set out all the negative outcomes which would result from a change in the law.
So much for The lessons to be learnt from the Abortion Act and What’s Now At Stake. Let me turn to my second point.
2. The Propaganda War that is Underway.
There is a systematic propaganda campaign being orchestrated by the media aimed at changing the law – hence the John Simpson programme last week . But for several years we have been treated to a barrage of propaganda . Even the BBC’s Radio Times joined the pack, claiming on its cover that watching a man die in Switzerland would be “5 minutes of television that will change our lives”.
The sub editor who chose that caption perhaps failed to appreciate its irony: that the 5 minutes it took to change our lives, irredeemably ended another’s life.
The BBC are in danger of being reduced to the role of mere cheerleaders, producing five programmes in the past three years in favour of a change, while signally failing to present the other side of the argument. But this isn’t just about bias.
The BBC’s recent programmes celebrating assisted suicide not only break their own Code about providing balance when discussing ethical issues but, even more seriously, they also breach the World Health Organisation’s (WHO) guidelines, published in 2000.
The WHO clearly set out the responsibilities and duties of the media. Consider some of these strictures in the context of the programme featuring Terry Pratchett and the euthanasia centre in Switzerland.
The WHO begin by reminding the media of the incredible impact which it can have in informing attitudes and behaviour:
“Media strongly influence community attitudes… media can also play an active role in the prevention of suicide.”
The WHO points to the way in which television can negatively influence suicidal behaviour. One study showed an increase in the number of suicides for up to 10 days after television news reports of cases of suicide.
They also warn against publicising suicide stories where celebrities are involved and warn against sensational coverage – which they argue should be assiduously avoided. The coverage should be minimized to the greatest possible extent possible. The WHO is right when it says:
“Suicide is perhaps the most tragic way of ending one’s life. The majority of people who consider suicide are ambivalent. They are not sure that they want to die. One of the many factors that may lead a vulnerable individual to suicide could be publicity about suicides in the media. How the media report on suicide cases can influence other suicides.”
In line with these WHO guidelines I would expect to see is a sober and balanced assessment of the issues, not cheap voyeuristic programmes which could easily form part of the genre known as “snuff” movies. A person’s death should not be a form of prime time entertainment, part of the battle for programme ratings – dressed up in the name of a hollow compassion.
In this country 550,000 people die each year. Very rarely do any make the newspapers or the media. Why does one lethal cocktail – but not 549,999 deaths – warrant wall to wall campaigning coverage?
Macmillan nurses, hospices and palliative care give the overwhelming majority in Britain a dignified death which does not involve commissioning doctors and nurses as patient killers. By all means agitate for improvement where the provision or practice isn’t good enough but let the BBC end this one sided and relentless campaign.
The Falconer Commission’s findings might be dismissed as propaganda but it would be foolish to underestimate the determination of little cliques and elites determined to manipulate public opinion and law.
And consider what is at stake.
Chillingly, Baroness Warnock, who shaped the laws which have led to the destruction of millions of human embryos, has said that the sick are “wasting people’s lives” because of the care they require: “If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service.” Suggesting that we have a “duty to die” she said “I think that’s the way the future will go, putting it rather brutally, you’d be licensing people to put others down.”
This turns the argument into a worth based on someone’s economic value rather than on their true human value and their human dignity.
So in addition to the lessons to be learnt from the Abortion Act and what’s now at stake; and having reflected on the propaganda war that is underway, let me turn to my third point
3. What we can learn from Holland and Oregon
In case you think “putting people down” just “couldn’t happen here” consider the situation in Holland.
Just before Christmas the Dutch announced that they are considering mobile units to kill people in their own homes. 1,000 of the 4,000 euthanasia deaths in Holland each year are now done without the patient’s consent. Not content with this, the Dutch say that 80% of people with dementia or mental illnesses are being ‘missed’ by the country’s euthanasia laws. They say that the death-on-wheels mobile units are necessary because some GPs have refused to administer lethal drugs to their patients.
This isn’t giving people “dignity in dying”. Sending out mobile units to administer lethal injections, to “put people down”, will strike fear into the hearts of the vulnerable. It diminishes the dignity and humanity of the sick and elderly and diminishes those of us who condone it.
Imagine what will happen in Britain if the Falconer Bill is implemented. You have a terminal incurable disease. You have the option of palliative care at £1,000 a week or a glass of barbiturates at £5. Would we honestly see relatives seeing granny living on and exhausting the inheritance? One in eight current cases of elder abuse currently involves financial abuse by relatives and it would inevitably increase if we change the law. Won’t health ministers, counting their pennies in a recession, be tempted to go for the cheaper option? A Bill allowing assisted suicide will carry the seeds of its own extension. If we allow it for some why deny it to others? So how long before the Dutch mobile killing units arrive in a street near you?
But never mind Holland and its 4,000 annual deaths by euthanasia. What about Oregon or Switzerland?
Take the case of Michael Freeland, whose life was taken by doctors in Oregon. Freeland had a long history of depression and suicide attempts. After Freeland’s death, Dr Gregory Hamilton, an Oregon psychiatrist, said that “this man was not in pain because his pain was not treatable; he was in pain because nobody bothered.” This was, commented Dr Hamilton,
“just one case among many”.
Professor Alexander Capron says that Oregon’s safeguards for patients are “largely illusory.”
Before relying too much on the Oregon experience our legislators would do well to pause and consider carefully the reflections of Professor Kenneth Stevens, a doctor specialising for 38 years in cancer treatment in Oregon. When Professor Stevens came to address us here in Westminster, he said: “The more I have learned, the more I realise the significant harm and danger of assisted suicide to the vulnerably ill and to society.”
Professor Stevens has studied the effects of the assisted-suicide since the passage of the State’s legislation in 1994. Among the consequences, he says, have been
A profound negative shift in attitude towards terminally ill patients in Oregon
The commitment to care has become a commitment to the option of killing
Pain has never been the issue (as, with proper palliative care, almost all pain can be alleviated). There has not been a single instance in Oregon of assisted suicide being used for actual untreatable pain.
Assisted suicide is being used for psychological and social concerns.
It’s not necessarily the patients but people controlling them who have pressed for assisted suicide
There have been problems with safeguards
There has been a veil of secrecy and a reluctance to be transparent about how the law works – and there has been no real monitoring.
Medical care has been distorted and the medical community has been divided.
The Oregon Medical Association is opposed to the law;
There are financial dangers and consequences for the wider society – and assisted suicide and euthanasia may often become the only choice for some patients.
Professor Stevens also says that he has always cared for his patients without regard for labels such as “terminal”. The effect of legalising assisted suicide has been that “even non-terminally ill patients are now considering assisted suicide.” Once a patient has received a prescription for lethal drugs – barbiturates – there is no incentive for doctors and others to care for the patient or to relieve their symptoms and Professor Stevens says this “results in a deterioration of caring for patients’ medical needs.”
When you legalise euthanasia or assisted suicide you are effectively telling patients they’d be better off dead. Instead of this counsel of despair, Professor Stevens says we should continue to support and develop our palliative care services and hospices.
To imitate Holland and Oregon is unnecessary, dangerous and unethical. As the distinguished lawyer, Lord Carlile QC, puts it we have “a hard law, with a kind face.” We should keep it that way.
When the physical, psychosocial and spiritual needs of the patient are met, requests for euthanasia are actually extremely rare. Less than 1,000 people persistently ask for it. 95% of Palliative Medicine Specialists are opposed to a change in the law. So, having seen the situation overseas, let me turn to my last point:
4. Why we must resist the Falconer Bill:
For thousands of years, Jews, Muslims and Christians have based their understanding of life and death issues on the age old injunction: “Thou Shalt Not Kill.”
Many others, who have no religious belief, like Lord (Alex) Carlile QC, hold the same view because of the danger to public safety of legalising euthanasia and a desire to uphold the non-religious principles of the Hippocratic Oath.
A House of Lords Select Committee that, in 1994, strongly rejected euthanasia because of the danger to society as a whole:
“Dying is not only a personal or individual affair. The death of a person affects the lives of others, often in ways and to an extent which cannot be foreseen. We believe that the issue of euthanasia is one in which the interest of the individual cannot be separated from the interest of society as a whole”.
Lord Carlile puts it this way: “The real concern was, and remains, public safety — the potential for collateral harm to the great majority of terminally ill people from giving a few individuals a “right” to prescription suicide pills. The so-called safeguards… were paper thin.”
Baroness (Ilora) Finlay – herself a professor of palliative care – remains implacably opposed to changing the law (as do all the Royal Colleges of Medicine and the British Medical Association). She says we don’t understand the difference between euthanasia and indefinitely continuing inappropriate treatment:
“Doctors regularly discontinue futile treatment. But they don’t do it in order to end a patient’s life: they are simply recognising that death cannot be prevented by treatment… end-of-life decisions, which are made every day by doctors, aren’t the same thing as ending-life decisions.”
Another argument that is endlessly trotted out is that the current law is unclear. This isn’t true either.
In reality, very few cases of ‘mercy killing’ are brought before British courts although, when they are, the pro-euthanasia lobby use them ad nauseam.
One reason for the small number of cases is that the law is perfectly clear and has a deterrent effect. Those “hard” cases that do come to court often require a compassionate response and although the law may appear to have a harsh face in practice it has a kind heart and carefully judged response. That’s what we need – not laws like those in Oregon or Holland that have led to any number of abuses.
The U.K law is clear. It says that aiding and abetting suicide is illegal and it imposes a maximum penalty, on conviction, of 14 years imprisonment. The police, the Crown Prosecution Service and the courts apply this law, like every other law, with discretion and flexibility, as not all offences are of equal gravity. That’s why some people are prosecuted and others are not, why some go to prison and others don’t.
And if the law is changed in Britain, where exactly will it end?
When he gave evidence to the Select Committee that considered his Bill to legalise “assisted dying” Lord Joffe, very honestly said that he saw his Bill as “the first stage.” And Baroness Warnock has given us a glimpse of where it will end. Let me repeat her words:
“If you’re demented, you’re wasting people’s lives—your family’s lives—and you’re wasting the resources of the NHS”.
Supporters of the Bill will seek to disguise the word “euthanasia” opting instead for the less graphic and more cuddly idea of “physician assisted suicide” But as one senior retired Law Lord said to me “that’s playing with words and splitting hairs, it amounts to exactly the same thing.”
The Falconer Bill will simply require two doctors to be “of the opinion in good faith” that someone is terminally ill – frighteningly reminiscent of the Abortion Act – whose two doctor requirement has led to seven million abortions.
It may sound reassuring to say that two doctors would have to assess an application for assisted suicide. But, when you think about what is actually involved, you soon realise that what is proposed would provide no safeguard for anyone.
The Falconer Commission set out no requirement that either of the two doctors should have any knowledge of the patient concerned at all. It isn’t required that they should have seen the patient’s case notes – or even examined the patient! The whole casual process could take place over the phone.
There is no requirement that either of these doctors should have any expertise in, or experience of, the medical condition in question. And yet this is an essential pre-requisite for determining the presence of a terminal illness and for giving a prognosis of its course.
There is no requirement that the two doctors should have any knowledge of how to establish that the patient has the capacity to make the required declaration and there are no arrangements for seeking an expert opinion in cases of doubt – what will happen, for instance, if a patient is suffering from cognitive impairment or their judgement is clouded by depression?
The Association of British Neurologists told the HOL Select Committee Select Committee that:
“there is a significant incidence of moderate to severe depression and anxiety at various stages throughout the course of many diseases. Measurement of these difficulties is problematic, particularly at the end of life, because many of the symptoms of depression are confounded by the symptoms of the disease”
To suggest that vulnerable people could be protected by two doctors being “of the opinion in good faith” is dangerously naïve at best, and deceptive at worst.
Such a casual system of assessment is totally out of proportion with the gravity of the decision that is being taken.
As the law stands at present it recognises the gravity of the decision being made. It wisely leaves open the option of shining a light on individual cases and prosecuting if the circumstances justify it.
Take that protection away and it will leave the way open for the unscrupulous, the strong willed, and those who may have something to gain from the death. This is especially so in a climate that the cost of care makes sick people believe they are an unreasonable burden on their family; The “better off dead” argument is often subtle but it is corrosive and it is coercive.
Lords Falconer insists that public opinion favours such a change. But public opinion probably would re-introduce capital punishment, too, and are we to suspend prudent judgement in that case too?
Rather than imitating the Dutch, we need to get behind groups like the admirable Care Not Killing Alliance, to defend and care for the sick and elderly and to put our energy into extending compassionate palliative care and hospice provision, and practical loving support – let’s demand “dignity in living” with the same fervour as those who want to license the routine killing of the most vulnerable in society
How much better it would be if we put the same emphasis on helping the living as we now do on arguments for assisted dying.
Please find attached the Falconer Bill and consultation document published today and CARE’s overview.
• The key issue is that the legislation sets out principles not details.
• The main criticism of the content of the Bill is that many of the details that might mean a safeguard would be robust etc have been left for Codes of Practice (clause 8). This is specifically acknowledged in the Summary of Safeguards but as individuals consider the proposals the exact process that would be employed is not “upfront and transparent” (page 8) and in practice it could operate very differently from the flowchart set out on page 37.
“Some safeguards are integral to be assisted dying process recommended by the Commission on Assisted Dying, which this Bill seeks to reflect, but are not required or appropriate to be included on the face of the Bill (for example they do not require specific law change but could be included in the Code of Practice)… The Code of Practice will provide more detailed information on how the safeguards would operate effectively.” (page 22)