The right to die is not the same as the right to be killed
ProbityFebruary 19 2018, 12:01am,
In 2015 parliament overwhelmingly rejected proposals to license doctors to supply lethal drugs to terminally ill patients — euphemistically called “assisted dying”. The medical profession doesn’t want it either. The BMA and the medical royal colleges are all opposed. The BMA conducted an in-depth study in 2015, consulting doctors and the public. It showed that doctors want to care for those facing the end of life and have no appetite to become agents of death.
Claims that legalised assisted dying is without problems overseas ignore the evidence. Oregon’s ostensibly watertight law has been found to have loopholes. It transpires that its criterion of terminal illness could include anyone with a chronic but managed illness that would prove terminal if the patient stopped taking medication. The quality of doctors’ assessments of requests for assisted suicide is not monitored. Coercion cannot be detected. And, with most doctors unwilling to provide assisted suicide, those seeking it are left in the hands of doctors who have no first-hand knowledge of them as patients.
There is much talk of choice at the end of life. If we are seriously ill and want to call it a day, we can ask our doctors to stop treatment. If doctors do that, they continue to have a duty of care for our comfort in dying. With modern specialist palliative care, in which Britain leads the world, that can be achieved for the vast majority of people. If we are worried we might not be able to halt treatment (for example, if we become unconscious), we can set out our wishes in a legally binding advance decision to refuse treatment, or in an advance care plan. There is already a right to die. That is different from a right to be killed.
In her book With the End in Mind, Kathryn Mannix writes about what dying really looks like and what can and should be done. She describes how attentive listening, exploring fears, modern analgesia and symptom control can make our dying comfortable and dignified. There is a world of difference between that and asking a doctor to supply or administer a massive lethal overdose.
Campaigners for assisted dying are resorting to scare tactics. Last December a campaigner wrote that terminally ill people in Britain have a stark choice between going to Switzerland or having an agonising death here. Such scaremongering may make for sensational political campaigning, but it distorts the truth and preys on the vulnerable.
How we manage death in an age of increasing longevity and loneliness is a complex question. It calls for careful and sensitive thinking rather than quick-fix solutions. We don’t resolve the question by disposing of the patient.
Baroness Finlay is professor of palliative medicine and a crossbench peer
LETTERS TO THE EDITOR in The Times
Sir, Dr Forest’s portrayal of legalised assisted suicide in the US (letter, Feb 17) omits to mention that palliative care in Oregon is not the same as in the UK. Only recently did it become a specialist branch of medicine there: it has been a speciality here for 30 years. A British parliamentary committee was told on a visit to Oregon that the state’s assisted suicide law had been in some respects a vote of no confidence in end-of-life care there.
Most Oregon doctors refuse to engage in assisted suicide, leaving a minority to provide lethal drugs to patients they hardly know. In 2017 one doctor wrote 29 prescriptions for lethal drugs. And the death toll is rising: in 2017 it was the equivalent of 2,000 assisted suicide deaths here.
Palliative care specialists here do not, as Mr Scheffer asserts (letter, Feb 17), claim to work miracles. But we should not forget that Britain has been ranked first in international surveys for quality of end-of-life care. Doctors can and do have open and honest conversations about dying with seriously ill patients. There is, however, an important difference between end-of-life and ending-life discussions.
Pain relief is a sophisticated science. Morphine dosages need to be titrated carefully to control an individual’s pain. That does not shorten life.
Professor Rob George
Medical director, St Christopher’s Hospice, London SE26
Sir, Nowhere in the assisted dying argument have I seen the chief drawbacks addressed.
How do we know the prognosis of a disease is correct? How do we know the patient who wishes to end his or her life is not suffering from reversible depression? How can a change in the law offer protection to a patient who may feel obliged to request assisted dying to avoid burdening relatives, friends or society?
It is not the opinion of others, even the General Medical Council, which trumps our duty of care but the law, passed by our legislators who, two and a half years ago, voted by a majority of nearly three to one to keep the present law.
Professor Peter DO Davies
Sir, The argument about rights is removing focus and therefore funding away from the needs of those who die in unnecessary pain each year. According to The Lancet Commission’s October 2017 report “Alleviating the access abyss in palliative care and pain relief — an imperative of universal health coverage”, more than 25.5 million people (45 per cent of recorded deaths worldwide) died in unnecessary pain in 2015 due to a lack of available palliative care, 80 per cent of whom lived in low- and middle-income countries. Surely they also had a right to be heard.
Sir, Bullying is not a term usually associated with end-of-life care. But when I was a district nurse, two of the 200 terminally ill patients I nursed made a serious request for a quicker assisted death, which was denied them. One gentleman did not want the prolonged death nor the sedation which he was forced to endure. In both cases I felt more like a bully than a nurse and I apologised to these patients during my care of them.
I look forward to the time when a kinder, safeguarded doctor-assisted dying law similar to the one described by Dr Forest is in place here, and when my personal treatment of such terminally ill people will be considered to have been assault.
Deaths, Assisted Killing, Statistics, and a BBC Charter That Supposedly Requires Balance When Reporting Ethical Issues…
In a newspaper article on February 10th the NHS Psychiatrist and newspaper columnist, Dr.Max Pemberton, cogently set out the arguments for and against assisted suicide(“No one should have to die in agony. But assisted suicide fills me with horror”). He came to the conclusion that while there are no easy answers, and that all of us understand and are aware of heart-rending individual cases, “with my head I know there are serious risks to assisted dying; that it will be misused.”
Patient safety is the reason why the British Medical Association, and most doctors, have opposed a change in the law – and they also loathe the idea that they will be forced to give lethal injections to their patients. For the doctor, assisted dying means assisted killing.
A very few people choose to go to the euthanasia centre in Switzerland to have their lives ended. Each time this happens campaigners turn the event into a media event.
One organisation trying to force a change in the law has published figures that in a recent year there were 47 such deaths in Switzerland. That figure represents just 0.008 per cent of deaths of Britons in 2016:47 out of a total of 597,211 UK deaths in 2016. Again: 0.008%
In reply to a recent Parliamentary Question that I tabled I asked about the number of deaths in the UK in each of the past ten years. In 2015 it was 602,782; 2014 570,341; 2013, 576,458; 2012, 569,024 – and about the same number in every previous year. Of these 5 million deaths, how many made the headlines? How many required a Court Case or a John Humphrey’s interview on the BBC’s Today Programme (that seems to campaign relentlessly for assisted killing). Yes, palliative care can always be improved; yes, our wonderful hospices could do with more resources; but, no, you don’t need a doctor to kill you to die with dignity.
So why does the BBC constantly distort the arguments and pour oxygen into a highly orchestrated and well funded campaign to introduce assisted killing into the UK?
If they were observing the balance which the BBC Charter requires them to show on ethical issues they would remind their viewers and listeners of the Royal Colleges that represent medics, the British Medical Association, the disability rights movement and the hospices, along with both Houses of Parliament, that have all said no to changing a law that protects the most vulnerable and doesn’t force doctors to kill their patients.
Why have they all come to the same conclusion as Dr.Pemberton?
They all agree that the key issue is public protection and in jurisdictions where the law has been changed the so-called “right to die” rapidly becomes a duty to die and public protection is eclipsed as thousands of depressed or disabled people are callously disposed of.
When you ask the question “should people have dignity when they are dying?” of course people say yes – so do I – but giving patients lethal injections is neither ethical or dignified.
Instead of listening to media cheer leaders for euthanasia we should ask why half a million deaths in the UK each year are unremarked and unreported. Hard cases always make bad laws.
The campaigners who are trying to subvert the medical organisations, and the will of Parliament, should put their considerable resources into supporting palliative care and hospices who do such wonderful work in caring for the hundreds of thousands that die annually, without recourse to euthanasia or the courts, and who need love and care as they enter the final days of their lives, not a lethal injection.