The question before Parliament isn’t whether ‘assisted dying’ is desirable or undesirable, whether it’s moral or immoral, whether it’s compassionate or cruel. It can be any or all of those things depending on your point of view. The essential question is: can a law be made to license it in advance without putting the public at risk?
Many of us might break the law in extreme situations. We might drive well above the speed limit to get a desperately sick child to hospital, we might steal to feed a hungry family, we might injure or even kill an intruder in self-defence. But would we seriously consider making a law that licensed such actions in advance provided a check list of so-called safeguards had been complied with? I think not.
‘Assisted dying’ is no different. Most people recognise that an individual act of ‘assisted dying’ might be acceptable in exceptional situations. The problem is that, when you make a law to license something, you are taking the act out of the ‘exceptional’ category – simply because we do not make laws to cover exceptional situations. An ‘assisted dying’ law would, in effect, be creating a routine process.
Anyone who doubts this should look at what is happening in the US State of Oregon. If you take the latest death rate from legalised physician-assisted suicide in Oregon and apply that to the population of Britain, you end of with around 1200 assisted suicides a year here. Contrast this with the 10 to 20 cases of assisted suicide that occur every year in Britain now. Assisted suicide is a very rare occurrence here precisely because it is against the law. That makes those involved think very hard before going ahead and that is why assisted suicide is rarely prosecuted. Change the law, however, and you are into a completely different ball game – the process becomes routine.
The so-called safeguards that the campaigners boast of are not, in any real sense, safeguards at all. In Oregon, which is the model for their proposals, research into a sample of assisted suicide deaths showed that in one in six cases the mental capacity test had not been fully carried out – people had been given lethal drugs and died even though they were suffering from undiagnosed depression. And, again, in Oregon there is no means of knowing whether, when people come to take the lethal drugs given to them (which can be months or even years later), they are not being coerced or have become mentally incapable or are being otherwise subject to manipulation. The system simply isn’t safe by any normal standards of law-making.
Much is made of opinion polls which appear to indicate that a majority of the population want an ‘assisted dying’ law. This is a complex and emotive subject and the public are subjected to active opinion forming. Only a few weeks ago one of Dignity in Dying’s patrons stated on the radio that ‘we have to build a sense of public outrage’. Opinion polls favoured going to war in 1914 and appeasement in the 1930s. Today they regularly favour the restoration of capital punishment and other causes on which Parliament, wisely, declines to be stampeded.
Parliament has wisely rejected calls for ‘assisted dying’ legislation, not (as the campaigners like to claim) because of religious pressure – anyone who reads the record of the debates will see there is no truth whatever in this – but simply because it isn’t safe to unleash onto the public. The campaigners focus their attention on a tiny minority of people who are serious about this and it is around them that their proposals are drafted. But we have to remember that terminal illness is a highly stressful event and that most people who find themselves in this situation are not the cool-headed, resolute and self-confident people whom the campaigners envisage. The law is there to give protection to the majority, not to provide facilities for a minority. We need to think with our heads as well as feel with our hearts.
Covert Euthanasia (‘Doctors are already doing it…’)
The evidence that exists for this claim is based on anonymous surveys of doctors. It concludes that illegal action by doctors in Britain is (and I quote) ‘extremely rare’, and interestingly comparisons with other countries which have legalised ‘assisted dying’ (Holland, Belgium) show that the incidence of illegal action in those countries is higher than in Britain. While one understands why such surveys need to be anonymous, the fact remains that anonymous information cannot be subjected to scrutiny and cannot, therefore, relied on as substantial evidence. By contrast the official reports from the Oregon Health Department are clear and incontrovertible – the incidence of legalised assisted suicide has risen fourfold in the last 12 years.
The Director of Public Prosecutions has made clear the basis on which he will reach decisions on whether to prosecute the very small number of cases of assisted suicide that come before him each year. He has set out the factors that will incline him to prosecute or not to prosecute. There is nothing unusual about this. Other criminal laws are treated in the same way. The degree of criminality varies from case to case, and every case has to be judged on its merits. It is clear, however, that no one is being prosecuted who should not be.
One of the DPP’s ‘aggravating factors’ is where assistance has been given by a doctor or nurse. The campaigners, who want to build their schemes into the health care system, are alleging that this encourages what they call ‘amateur assistance’. This is not the case. What the DPP is saying is that, given the relationship of trust that must exist between a doctor and patient and the reliance that seriously people necessarily place on their doctors’ and nurses’ judgements, it would be an abuse of their positions for doctors or nurses to participate in this. But this is not to give the green light for ‘amateurs’ to assist: it is simply a warning that health care professionals are in a special position of trust.
We need to get the Dignitas phenomenon into proportion. Less than 1 in 50,000 deaths of Britons in the last 10 years has been at Mr Minelli’s suicide apartment. They make headlines precisely because they are so exceptional. Most deaths in this country are peaceful and go unreported for that reason – as does successful surgery or the safe landings of airliners.
What’s wrong with the ‘safeguards’?
Prognosis The first question most people ask when told they are terminally ill, is ‘How long have I got?’ As a parliamentary select committee was told a few years ago by expert witnesses, prognosis at a range of six months is highly unreliable. Look at the Libyan Abdelbasset al Megrahi. Released from prison on the basis of a 3-months prognosis, he is alive two years later. His case is not by any means exceptional. Some people in Oregon who are being given lethal drugs on the basis of a six months prognosis are living months or, in a few cases, years longer.
Mental Capacity A suicide wish is normally regarded as grounds for psychiatric referral. But the campaigners tell us that it’s different in the case of assisted suicide – there should only be a referral if a doctor has doubts. But this would offer a lesser standard of protection to some people than to others. Then there is the problem of cognitive impairment, which is widespread in neurological illnesses and not uncommon in others – not to mention the side-effects of medication.
And then, of course, there is clinical depression. I have already referred to the situation in Oregon, where depressed patients are not being referred for psychiatric examination and are being given lethal drugs with which to end their lives.
Voluntariness There is no suggestion in the campaigners’ proposals for any kind of in-depth investigation of whether a person seeking ‘assisted dying’ is seriously resolved or acting out of a sense of obligation to others – indeed, we hear some campaigners say from time to time that acting out of a wish to spare others shouldn’t be a bar to ‘assisted dying’!. Their proposals simply leave it for the doctor to form a view of the matter. But how many doctors these days know their patients that well – very few.
Oversight As I’ve already pointed out, there are no safeguards governing the proper use of lethal drugs once they have been handed out. They could be swallowed by a child or administered to a terminally ill patient by force or mixed in with food surreptitiously. No witnesses are required and no one would know. The system is wide open to abuse. We should not forget that, while most relatives are loving and caring, there are those who are not.
 Edward Turner, son of the late Dr Anne Turner – World This Weekend