The case for assisted dying
Acting in the name of religion, a small and unrepresentative number of believers are inflicting needless suffering on others. Raymond Tallis, Chair of Healthcare Professionals for Assisted Dying, on why the law must be changed
The case for a law to legalise the choice of physician-assisted dying for mentally competent people with terminal illness, who have expressed a settled wish to die, is very easily stated. Unbearable suffering, prolonged by medical care, and inflicted on a dying patient against their will, is an unequivocal evil. What’s more, the right to have your choices supported by others, to determine your own best interest, when you are of sound mind, is sovereign. And this is accepted by a steady 80-plus per cent of the UK population in successive surveys.
Even so, after decades of campaigning, the law has yet to change. How can this be? The answer is simple: there has been a highly organised opposition by individuals and groups, largely with strong religious beliefs that forbid assistance to die. Such groups know that religious absolutism cuts little ice in a predominantly secular society, where many will point out that the doctrine of the sanctity of life has been historically negotiable, with clerics supporting “just” wars that kill the innocent, and in some cases the death sentence for murder, apostasy, blasphemy or being gay. (Some religions, it seems, are more at ease with killing healthy people who want to live than with helping terminally ill people to realise their wish to be released from suffering.) The role of religion is particularly evident in the case of the medical profession, where bodies such as Care Not Killing and the Christian Medical Fellowship are punching above their numerical weight.
The Catholic Church played a prominent role in the formation of Care Not Killing, via the Catholic Bishops’ Conference of England and Wales. In the document Faith in the Future 2006-08 they state:
“The work of the Church supporting and promoting pro-life issues has been given a real boost through Faith in the Future. The Care Not Killing Alliance was established in 2005 to work with other faith groups, palliative care organisations and disability rights groups, forming a broad coalition of parties concerned with the legalisation of euthanasia.”
Only four of the known 30 member organisations of Care Not Killing are non-religious. So much for “a broad coalition”. Dr Peter Saunders, CEO of the Christian Medical Fellowship and Campaign Director of Care Not Killing, made the strategy clear:
“As Christian doctors we oppose euthanasia and assisted suicide because we believe in the sanctity of human life made in the image of God … But to win the debate on assisted dying we need to be using arguments that will make sense to those who do not share our Christian beliefs … Christian doctors need to play a key role in this debate; and they will do so most effectively by learning to put what are essentially Christian arguments in secular language.”
In Parliament, opponents of change are even more effective in cloaking a principled objection in the clothes of pragmatic concern. Resistance to change, specifically in the House of Lords, is organised by the supporters of Living and Dying Well, co-chaired by Lord Carlile QC and Baroness Finlay. Launched in 2010, they describe themselves as “a public policy think tank” whose aim is to “promote reasoned discussion and to publish evidence-based information on the laws relating to what is euphemistically called ‘assisted dying’ – i.e. euthanasia and assisted suicide”. Madeleine Teahan, the former part-time Press Officer of Living and Dying Well and researcher to Baroness Finlay, who is now Associate Editor of The Catholic Herald, recently wrote about the need to separate pro-life campaigns:
“One key group would defend the rights of the unborn child and the other would focus on opposing the legalisation of assisted suicide and/or voluntary euthanasia.
Both groups would take a strictly evidence-based approach to influencing and resisting future legislation. Religious sentiments or distracting arguments about sexuality would be kept out of the equation.”
Most faith-based opponents of assisted dying, therefore, conceal their real reasons behind arguments intended to instil fear of the consequences of legalisation – mobilising factoids that do not withstand scrutiny as part of the “strictly evidence-based approach” referred to by Living and Dying Well.
Some claim that palliative care, combined with psychological and spiritual support, can address all the problems of all dying patients. This ignores a clinical reality, in which some patients, despite the best palliative care, still have bad deaths, with some resorting to dreadful journeys to Dignitas to end their suffering. International experience also confirms that palliative care and assisted dying are not either/or options. For the last ten years, assisted dying has been legal in Oregon under the Death with Dignity Act. Of the 50 states of the USA, Oregon has amongst the best palliative care and nearly 90 per cent of those seeking assisted dying do so from within those services.
The claims that assisted dying would inhibit the development of palliative care services, and would break down trust between doctors and patients, are unsupported by international evidence. So, too, are nightmare scenarios conjured by opponents in which decriminalisation of assisted dying places us on a slippery slope that would lead to the involuntary euthanasia of people who do not want to die. The Dutch experience, frequently misrepresented by those against assisted dying, has shown how liberalisation of the law has the reverse effect. Rates of non-voluntary euthanasia (i.e. doctors actively ending patients’ lives without having been asked by them to do so) have decreased. The present clinical, ethical and legal fudge in the UK, where some patients’ deaths are hastened with no regulatory framework, is more dangerous.
Even more absurd is the claim that to accede to someone’s request for assisted dying is to devalue human life. It is nothing of the kind. It does not devalue the life of the person who seeks assistance to die, but rather accepts their valuation of a few remaining days or weeks of engulfing sickness that they do not wish to endure. Nor does allowing terminally ill people to be helped to die devalue the lives of others – people with disability or chronic illness or who are simply old or deemed a burden. The public recognises this: in the UK the majority of people are against assisted suicide for older people who are dependent on others for all their needs.
Opponents also argue that a change in the law is unnecessary because of the Director of Public Prosecutions’ (DPP) policy of not prosecuting in cases of compassionate assistance to die. Unfortunately, the DPP’s guidelines make it very clear that doctors and nurses who help patients to die will be prosecuted. Assistance is therefore delegated to amateurs who have to assume a huge responsibility at a time when they are already greatly distressed and may well be incompetent to carry it out. This morally repugnant situation, imposing a final cruelty on those who have seen their loved ones suffer an appalling death, is unacceptable.
So a law is needed, it is morally right, and the anxieties that have been raised are not founded in experience. And yet we stumble on with a bad law because of the over-representation of the views of a vocal minority of largely religiously motivated opponents. Just how effective these groups are has been illustrated by their shaping the public stance of the medical profession. Polls consistently show that between 30 per cent and 40 per cent of doctors are in favour of assisted dying. Even more to the point, a poll conducted in October 2011 found that only 30 per cent of doctors would be opposed to having the option of assisted dying for themselves. Despite this, the most influential medical representative bodies – the British Medical Association (BMA) and the Royal Colleges of Physicians, of Surgeons and of General Practitioners – are opposed. Given the division of opinion in the medical profession, not to speak of the views of the patients, the correct stance should be one of neutrality, permitting individual doctors to express their views, not one of paternalistic opposition that rides roughshod over the opinions of the majority of the patients.
But this is where it gets interesting. Prompted by a poll in May this year, which found that 62 per cent of doctors were in favour of the BMA being neutral, the British Medical Journal (BMJ) published a leader from the editor Fiona Godlee which called for the BMA to adopt this stance at their upcoming Annual Meeting, where it was to be debated. The call was supported by a deeply moving account, written by her daughter Tess – mandatory reading for anyone who opposes assisted dying – of the dreadful, protracted death of Ann McPherson, a GP who founded Healthcare Professionals for Assisted Dying.
The BMJ invited its readers to respond to the editorial by voting for or against neutrality. Astonishingly, over 80 per cent of those who voted were against neutrality – the opposite of what had been found in the scientific poll. This surprising result prompted an analysis of voting patterns. In a two-day period, there was a huge surge in votes. During this time, there were many anomalies, the most striking being one individual, apparently located in Iceland, who voted against neutrality 168 times. One could not have clearer evidence of how the debate against assisted dying is being hijacked. This is a rerun of what happened in 2006 when Lord Joffe’s Bill for legalising assisted dying was being debated in the House of Lords. The Euthanasia Prevention Coalition – an international body based in Canada – flooded two polls of British public opinion, one run by Bath University and one by the Evening Standard, with “No” votes from Canada and USA.
The medical profession’s present powerful influence against a change in the law, unrepresentative of what doctors actually think, is not only an illegitimate use of authority but monstrously cruel. Just how cruel is illustrated by the death of Ann McPherson – a doctor and the wife and mother of doctors – who had the best possible care.
Diagnosed with pancreatic cancer in 2007, she bore with grace and courage all the trials and indignities associated with her illness – including handling her own chest drain. She wanted to continue her work and to spend time with her family and friends. By May 2011, the cancer had spread and she had had enough. She could no longer eat, her chest drain was pouring fluid and she had pressure sores. She expressed her longing to die. But she couldn’t. Morphine drips, one in each wasted leg, did not help. The end came at last, after three endless, unbearable weeks of unremitting suffering:
“Even as she died, her body seemed furious with its final fight, gasping to the end, and in a desperate haunting shudder I found myself sitting in pools of expelled fluid. That was not what she wanted. Mum had seen this happen before and wanted to avoid it, for future patients and their families.”
Thus the testimony (much abbreviated) of a loving daughter.
Because of the fancy footwork of those who have beliefs I do not share, this is a fate that could await me or those I love. A small but vocal group, prepared to bear other people’s suffering heroically for the sake of God, must not be allowed to impose their views on the rest of the medical profession, and through them on society as a whole. Opponents of change make a lot of noise – it’s time that the relatively silent majority made more.
Raymond Tallis is Emeritus Professor of Geriatric Medicine at the University of Manchester and Chair of Healthcare Professionals for Assisted Dying