Dr Kevin Fitzpatrick is working on a detailed response to the Falconer Report and we will publish his thoughts in a short while. However I’ve reproduced below his initial concerns. We would welcome any views or comments you might have. Please feel free to post on our Forum page or send an email.
Initial Reaction to Lord Falconer’s Report on Assisted Suicide by Dr Kevin Fitzpatrick
The work of this group (never formally constituted as a ‘commission’ despite its name) was funded by wealthy supporter of euthanasia/assisted dying.
It was populated mostly with supporters of euthanasia/assisted dying.
Headline
The report states clearly (p19) that: ‘It is not the role of the Commission to promote a change in the law’ yet its headline is: the law as it stands, is inadequate and incoherent.
The report then immediately goes on to describe (what it views as) the ‘case for change’.
The whole endeavour and report of this group is to make a case for changing the law in order to allow euthanasia/assisted suicide.
But the work and the report is shot through with difficulties, many of them unresolved and even insurmountable, despite the tone and tenor of it.
Evidence?
Having spent so much time gathering ‘evidence’ from 1,200 responses, 6 public events, visits to Switzerland, Holland, Belgium and Oregon US, and commissioning ‘original research’, it is damning that the group was unable to fulfil its stated purposes.
In the first place, its wealthy patron Sir Terry Pratchett wished to have legal room to have an assisted suicide when his Alzheimer’s disease has progressed to ‘a certain point’. That point has not (cannot?) be determined in advance. In keeping with the problems associated with this and other mental capacity issues, the group found it would not sanction euthanasia/assisted suicide for anyone who has a difficulty with mental capacity.
In the second place, the task was to find a way to support people who could no longer physically take their own lives. In this case mental capacity is not the issue, but the physical capacity to e.g. inject oneself, was no longer present as a result of progressive illness. The group also recommended that euthanasia/assisted suicide should only be allowed for those who have physical capacity to do it themselves (whether pressing a button to activate a machine or to be able to take and swallow a poison). Thus the high-profile cases such as Tony Nicklinson, which generated so much ill-informed public sympathy, are not allowed by the terms of this report.
Thirdly, the arbiters of death are supposed to be doctors. This is a real problem since most doctors do not want to participate in euthanasia/assisted suicides. That means only the doctors who already believe in euthanasia/assisted suicide will come forward. But the point of euthanasia/assisted suicide is not that it is a medical decision – it is exactly the opposite, being a decision where medicine has reached its limits and it is decided that all further medical intervention is futile. Therefore end-of-life decisions are exactly not medical decisions – they cannot be. They are however moral decisions – but whilst the report recommends checking and re-checking the individual’s ‘settled’ intention and motivation for requesting euthanasia/assisted dying, it makes no effort to recognise that doctors are:
- a) No better placed to make such moral decision simply in virtue of being doctors
- b) Are just as open to human frailties and can make mistakes (the ruling about junior doctors not working extremely long hours is just because of this human frailty)
- c) Can be influenced in so many ways by other pressures, just as anyone might
- d) May be the worst placed to make such decisions having developed a clinical (inured) view of death over some years of practice
- e) May be open to secondary gain
This last e) is never considered but to take two examples of doctors openly involved in euthanasia/assisted suicide: Dr Philip Nitschke is an Australian doctor who killed (at least) 4 people by his own admission, when the law in Northern Territories allowed it for a period. We do not know how much he makes from his books and travels around the world giving seminars ‘informing’ people ‘how to die’. We do not know how much the Swiss clinic makes from providing the ‘euthanasia service’. But there are other gains: the photo released in the press of Peter Smedley’s death showed two women at his side. One was cradling his head tenderly on her breast and the other was sitting at the bedside touching his arm lightly; the former was the doctor who administered the poison on which he choked to death, the latter was his wife of forty years, witness and bystander. We do not know what sense of power over life and death this doctor has, but it is truly chilling to listen o either of them speaking about their roles.
This is also important because good clinical governance is about patient safety. How can anyone feel safe in the hands of an avowed euthanasia/assisted suicide supporting doctor or nurse? That has not been raised as a question in the report which speaks of confidence in professionals (medical and social workers) but then also contradicts itself and argues that special training should be developed for these professionals.
There is no training which can turn anyone into a moral expert, not doctors nor family.
No patient can feel safe in the hands of a doctor ready to, or who already has been party to euthanasia/assisted dying.
Clinical governance demands everything be done to alleviate any suffering and protecting patient safety – the doctor’s role embraces both not just the first.
Anyone faced with the end of life can be vulnerable to all sorts of feelings and deserves more protection, not less, and the report actually makes a much stronger case for pressing forward in providing the best palliative care possible than for introducing a law for a tiny number of people, most of whom are, in fact, excluded by its findings.