DOMINIC LAWSON: Why we must fight this misguided drive to force through assisted suicide
Forget Brexit, just for a moment. Instead, consider the debate on something which is truly a matter of life and death. That debate is about assisted suicide: and it has just been re-entered by the professional body representing the nation’s doctors.
The Royal College of Physicians (RCP) is to poll its 35,000 members, on whether, in its words, ‘they would help a terminally ill patient to die and whether the law should be changed to allow assisted dying’.
The current official position of the RCP is one of opposition to a change in the law: in 2014 it polled its members, asking them ‘do you support a change in the law to permit assisted suicide by the terminally ill with the assistance of doctors?’ The response was that 57.5 per cent said ‘no’, 32.3 per cent said ‘yes’ and 10.2 per cent said ‘yes, but not by doctors’.
The Royal College of Physicians (RCP) is to poll its 35,000 members, on whether, in its words, ‘they would help a terminally ill patient to die and whether the law should be changed to allow assisted dying’ (file picture)
That seemed clear enough. Yet not only is the RCP now re-opening the issue: it has declared that unless 60 per cent of its members say they are opposed, it will switch its official position from ‘against’ to ‘neutral’. It is not unusual for a supermajority to be required for a fundamental change in a constitution: it is unprecedented for one to be required to keep things as they are.
I became aware of this having received a letter from Dr David Randall, a registrar in renal medicine at the Royal London Hospital. He expressed his concern forcibly: ‘The membership seems to be being offered a fait accompli by members of Dignity in Dying, who have achieved positions of influence on the RCP council, and it has been designed (using a totally unjustified supermajority requirement) to ensure that the College drops its long-standing opposition to assisted suicide ahead of future parliamentary attempts at legislation.’
Dr Randall urged me — as a newspaper columnist — to ‘shed daylight on an apparent manipulation of procedure by pro-euthanasia activists’.
Happy to oblige. The first point to note is the deceptive change of language. The 2014 survey referred to ‘assisted suicide’. The new one refers to ‘assisted dying’. That is in itself a concession to the PR efforts of the people Dr Randall refers to as ‘pro-euthanasia activists’.
Assisted dying already exists in this country: it is called palliative care and takes place in hospices across the land. Medically assisted suicide is the more accurate name for what is being proposed, but it is less appealing, as it translates as ‘self-killing’.
The issue here is whether doctors should be required to perform this if any of their patients request it. That is what the campaigners want, and one of the most longstanding and persuasive is the former presenter of Crimewatch, Nick Ross. He is on the Council of the RCP — which is presumably what Dr Randall meant in his letter to me.
Assisted dying already exists in this country: it is called palliative care and takes place in hospices across the land. Medically assisted suicide is the more accurate name for what is being proposed, but it is less appealing, as it translates as ‘self-killing’ (file picture)
But doctors, for good reasons, are deeply uneasy at being co-opted, and not just because it would be in clear breach of their Hippocratic Oath. Such a doctor wrote to me some years ago: ‘As one who spends every working day caring for the terminally ill, I am acutely aware of the damage such a change would cause to vulnerable patients.’
The point is that these patients can come under subtle (or not so subtle) pressures from relatives who stand to benefit from such ‘assisted suicide’.
That might seem a bleak view, but I adhere to Immanuel Kant’s immortal observation that ‘out of the crooked timber of humanity no straight thing was ever made’.
So when considering a fundamental change in the law, it is essential to be realistic about how it might be exploited by those whose character is not blameless — that is, all of us.
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Doctors have also had time to see what has happened in the Netherlands and Belgium, where so-called assisted dying was legalised. A Dutch GP called Dr Van der Muijsenberg warned a House of Lords committee examining proposals to change the law in this country: ‘I see a growing anxiety among patients, not just the terminally ill, that they think it is not decent not to ask for voluntary euthanasia sometimes, because they feel such a burden.’
And Theo Boer, who was between 2005 and 2014 a member of one of the five Dutch regional boards set up to review every act of euthanasia (and to report any suspicious cases to prosecutors) told the writer Christopher de Bellaigue: ‘We have put in motion something that we now have discovered has more consequences than we ever imagined.’
De Bellaigue also visited Belgium, and spoke to a GP he calls ‘Marie-Louise’ who had an experience which speaks exactly to that warning I received from a British doctor about the possible consequences for ‘vulnerable patients’.
One of Marie-Louise’s patients was a man in late middle-age who had been diagnosed with dementia and had signed a directive asking for euthanasia when his conditioned worsened.
So when considering a fundamental change in the law, it is essential to be realistic about how it might be exploited by those whose character is not blameless — that is, all of us (file picture)
But, De Bellaigue went on to record the doctor’s account: ‘As his mind faltered, so did his resolve — which did not please his wife, who became an evangelist for her husband’s death. “He must have changed his mind 20 times,” Marie-Louise said. “I saw the pressure she was applying.” In order to illustrate one of the woman’s outbursts, Marie-Louise rose from her desk, walked over to the filing cabinet and, adopting the persona of the infuriated wife, slammed down her fist, exclaiming: “If only he had the courage! Coward!” ’
The GP refused to agree to the euthanasia. Then she went on her summer holiday — and returned to find that a colleague, perhaps with fewer scruples, or simply less observant, had ‘euthanised her patient’. She is now planning to leave the practice: ‘How can I stay here? I am a doctor and yet I can’t guarantee the safety of my most vulnerable patients.’
The most vulnerable patients include those with disabilities. I think of my younger daughter, who has Down’s syndrome. After we are gone, would she, so naïve and eternally anxious to please, be able to resist suggestions that there is a wonderful permanent solution to pain or allegedly terminal illness?
Some years ago I attended a focus group held by the charity Scope, to examine the views of those with cerebral palsy on the legalisation of euthanasia.
One of them, whom I will call ‘Bill’ — and who worked for the NHS — said: ‘Five years ago I was very pro the legalisation of assisted suicide, but I’ve changed my mind, even though I know what it’s like to be in pain every day . . . I struggle to see in practice a system of assisted suicide that will guarantee vulnerable people don’t end up being assisted quite aggressively.
Former Archbishop of Canterbury George Carey, pictured, wrote a remarkable piece for the Mail a few years ago, explaining why he was now in favour of a change in the law
‘In other words, I’m not sure that so-called informed consent will work the way advocates of assisted suicide claim.’
I don’t question the good intentions of those advocates — such as the former Archbishop of Canterbury George Carey, with whom I have discussed this at length. Carey wrote a remarkable piece for the Mail a few years ago, explaining why he was now in favour of a change in the law.
The main reason he gave was that ‘sophisticated medical science offers people the chance to be kept alive far beyond anything that would have been possible only a few years ago. Yet our laws have not kept up with science.’
But this is a complete misunderstanding of medical practice. It has always been and remains the case that patients can refuse any and all procedures.
For example, when in the Eighties my mother was diagnosed with liver cancer, she decided she wanted no treatment, beyond pain relief.
She came under no pressure from doctors to allow surgery or chemotherapy, even though she was only in her 40s. They recognised that her condition was terminal — as it would be today.
Our time-honoured system of medical care should not be radically changed at the behest of activists for euthanasia, no matter if they are ex-Archbishops or TV stars motivated by compassion.
As Christopher de Bellaigue warned, after his investigations in the Netherlands and Belgium: ‘Euthanasia won’t be an occasion for empathy, ethics or compassion, but a bludgeon swinging through people’s lives, whose handiwork can’t be undone.’
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