Campaigners for euthanasia will not go away. Earlier this month, a Department of Health spokesperson said Matt Hancock, the Health Secretary, had requested data from the Office for National Statistics on how many Britons had committed suicide “for medical reasons” so as to “inform Parliament’s debate on the issue.”
We are all familiar with the high profile court cases such as those brought by Dianne Pretty, Debbie Purdy, Tony Nicklinson and others plus countless attempts to get legislation through Parliament. They will not give up, but their arguments are based on seven false pillars.
The need to end suffering and be merciful
We must beware of the sedulous way the argument is presented. Pro-euthanasia campaigners use the term ‘physician-assisted dying’ as this gives the impression that it is no different from palliative care where a person in great pain is given a dose of morphia to ease pain and also hasten death. What is actually proposed is ‘physician-assisted suicide’ or, more accurately, ‘killing on request’.
This does matter and is not semantics. The use of the term ‘physician-assisted dying’ by the Canadian courts led to the Canadian Constitution being interpreted so as to legalise euthanasia in that country. Moreover, a US Gallup Poll in 2013 found that 70% of respondents agreed that doctors should be allowed to end a life by ‘some painless means’. This however, fell to 51% when the question was whether doctors should be allowed to help patients commit suicide.
The Right to Patient Autonomy
Autonomy is a misused word. It can be valuable in the context of medical ethics by emphasising the importance of the patient rather than any process, but it can also be a pretext for selfishness for none of us are completely autonomous : we depend on each other. Moreover an overemphasis on autonomy in the context of euthanasia places the doctor in the position of a servant to do the patient’s will, unable to exercise any independent professional judgement.
Any proposed safeguards would be adequate
The Oregon Death with Dignity Act 1997 (note the title) which legalised euthanasia is held up by pro-euthanasia campaigners as a success. Consider this though: a survey found that physicians who prescribe the lethal drugs for assisted suicide were present at only 21.7% of reported deaths and so could not deal with any complications arising from their use.
A House of Lords committee visited Oregon to find out how the law worked and were told that “there had been no complications (other than ‘regurgitation’) associated with more than 200 assisted-suicide deaths.” A member of that committee, Lord McColl of Dulwich, a surgeon, remarked: “if any surgeon or physician had told me that he did 200 procedures without any complications, I knew he possibly needed counselling and had no insight. There is something strange going on.”
In any event, who is going to police the safeguards?
The patient cannot if the suicide succeeds and doctors involved are hardly likely to report themselves. Auxiliary Bishop Jean Kockerols of Mechelen-Brussels pointed out in 2018 that in Belgium the Federal Euthanasia Control and Evaluation Commission ‘has failed to refer a single case of suspected abuse of the law for investigation’.
There is no evidence, as campaigners allege, that a significant proportion of suicides are by those suffering from terminal illnesses who might wish to end their lives with ‘dignity’. The Office for National Statistics Report for 2019 shows that since 2013 men aged 45 to 64 years have had the highest age-specific suicide rates. Possible factors were economic adversity, alcoholism, and isolation.
The National Confidential Inquiry into Suicide and Safety in Mental Health (2021) confirmed this and stated that “the reasons for this are complex and include a combination of longstanding and recent risks.”
Terminal illness does not feature as a major cause in either report.
Indeed of those who used the Oregon statute the three most frequent reasons were decreasing ability to participate in activities that made life enjoyable (94%), loss of autonomy (93%) and loss of dignity (72%).
Allowing euthanasia would not be the start of a slippery slope
It certainly would.
Take this example: Euthanasia has been lawful in Holland since 1973. In 2020 the Dutch government approved plans to allow euthanasia for terminally ill children aged between one and twelve years. They said that this “would prevent some children from ‘suffering hopelessly and unbearably’.”
Andrew Mitchell MP, a pro-euthanasia campaigner, says that under proposed UK legislation two doctors would have to agree that the person is within six months of the end of their lives, and a High Court judge would have to agree that it was their wish to die.
Remember though that withdrawal of food and fluid from patients in a long-term permanent vegetative state originally needed court approval.
In 2018, however, the UK Supreme Court decided that as long as the families and doctors agree, medical staff can now remove feeding tubes to allow such patients to die without applying to the court.
The same creeping relaxation of safeguards will happen here as euthanasia becomes common.
There is no danger of pressure from relatives
In Oregon 38.6% of patients committing suicide have expressed concern about being a ‘burden’ on others.
Can we say that they all came to this conclusion themselves and not through pressure, however expressed, from relatives? In the UK increasing litigation results from disputes over the estates of deceased persons.
Simply because the value of property has increased markedly. With euthanasia legalised will there be the temptation for relatives to pressure an elderly relative to commit suicide so that they can get their hands on their property. Suicide can in fact have a devastating effect on relatives, especially children, something which one of us, writing as a paediatrician, can speak of from personal professional knowledge.
Yet in all the arguments on the subject of assisted suicide, the effect on children is never mentioned.
The certainty of the prognosis
This is the worst argument: We all know of cases where a person has either lived much longer or much less than the prognosis indicated.
One of us was told by the surgeon who had just examined a close relative that she could die within three months and at most would have three years to live. In fact she lived for twenty more years.
Two of the most common causes given on death certificates are ‘Old Age’ or ‘Frailty of Old Age’ because the precise cause is impossible to make in the face of multiple morbidities.
The Oregon Death with Dignity Act applies to anyone “diagnosed with a terminal illness (incurable and irreversible) that will lead to death within six months.” This is simply bad law: no one can say that an illness will lead to death within a stated time.
The emotional tug of the argument for euthanasia may be superficially attractive but when clearly examined it falls apart. One final thought: if euthanasia is legalised and then extended, as it will be, we will lose one of the most fundamental of all human instincts: the instinct to care. There will be the insistent question: Shall we kill instead?
Dr. Anthony Cole is a retired consultant paediatrician and Chairman of the Medical Ethics Alliance. Dr. John Duddington is editor of Law and Justice, the Christian Law Review
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