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30/08/2014

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Should doctors be allowed to help people die?

As the Assisted Dying Bill makes its way through Parliament, we ask: Should doctors be allowed to help people die?  Ray Tallis and Alistair Thompson disagree.

The law on assisted suicide and euthanasia needs changing, says Ray Tallis

Healthcare Professionals for Assisted Dying (HPAD) and Dignity in Dying are two organisations working together to make the case for a change in the law to give dying people the right to take control of their own death. I am supporting Lord Falconer’s Assisted Dying Bill which will be debated in the House of Lords at the start of the next Parliamentary year.

Healthcare Professionals for Assisted Dying (HPAD) and Dignity in Dying are two organisations working together to make the case for a change in the law to give dying people the right to take control of their own death. I am supporting Lord Falconer’s Assisted Dying Bill which will be debated in the House of Lords at the start of the next Parliamentary year.

The Bill seeks to make it legal for someone who is terminally ill and mentally competent to be assisted to die if that is what they wish. The person must have a prognosis of six months or less to qualify to request life-ending medication, and their medical care and mental capacity must be evaluated by two independent doctors.

Public support

Assisted dying commands widespread support. 76 per cent of the public support the Bill’s proposals, and the most recent British Social Attitudes Survey found 71 per cent of people who identified with having a religious faith were supportive. At the end of 2013 the first survey in seven years specifically to ask disabled people about assisted dying found that 79 per cent supported a change in the law.

The Royal College of General Practitioners is currently reviewing its stance on the issue and a survey in conjunction with this process found that over two-thirds of GPs who responded were in favour of the college dropping its opposition to assisted dying. This is the background in the lead-up to the Bill: a demonstration of overwhelming support which cannot be ignored.

Terminal illness only

It is important to be clear about what is being proposed. Assisted dying is for mentally competent, terminally ill people only; the right – when dying – to die well. While some opponents try to deny this, it is quite clear to me that there is a fundamental difference between someone who is terminally ill seeking assistance to die and someone who is not.

The principle of autonomy respected in the Assisted Dying Bill must be balanced against potential harms, and I believe that an assisted suicide law that applied beyond terminal illness would be wrong. The Assisted Dying Bill draws the line at terminal illness. 

No slippery slope

Opponents, aware that they are losing their argument against the right of a dying person to choose the manner and timing of their death cite the ‘slippery slope’: the idea that wherever assisted dying is legalised this inevitably leads to assisted suicide for people who are not dying.

This is simply not true and the evidence demonstrates this. In Oregon, an assisted dying law has been safely working for over fifteen years and there have been no calls for extension. Since it was introduced, the proportions of deaths that are requested have never risen about 0.2 per cent and this would roughly translate to just over 1000 requests in Britain.

It is also important to note that other jurisdictions such as Belgium and the Netherlands (often cited by opponents) have from the beginning had much broader laws to allow assisted suicide or euthanasia.

When Lord Falconer’s Assisted Dying Bill is debated in Parliament I hope Peers listen to the evidence, to the public and, above all, to personal testimonies. My predecessor as chair of HPAD was Dr Ann McPherson who, despite being desperately ill with pancreatic cancer diagnosed in 2007, campaigned to have the option of assisted dying made available to her. Unfortunately this choice was denied her. She died in 2011 after weeks of appalling suffering, despite optimal medical care. It is clear from Ann’s story, as well as a thousand others every year,  that the law needs to change.

The law on assisted suicide and euthanasia does not need changing, argues Alistair Thompson

Later this year, the House of Lords will yet again be debating a Bill which seeks to legalise assisted suicide by amending the 1961 Suicide Act.

The commission behind the Bill has been criticised for being unnecessary, biased and lacking transparency by Parliamentarians, while doctors and disabled groups have pointed out that it is seriously flawed.

Later this year, the House of Lords will yet again be debating a Bill which seeks to legalise assisted suicide by amending the 1961 Suicide Act.

The commission behind the Bill has been criticised for being unnecessary, biased and lacking transparency by Parliamentarians, while doctors and disabled groups have pointed out that it is seriously flawed.

Death not drugs

Even setting this aside, the Bill proposes a less safe version of the highly controversial Oregon law, which has seen the terminally ill offered drugs to kill themselves, but not expensive life-saving and life-extending drugs.

And it's not just the terminally ill that this system would fail. Research has shown that one in six of those who have committed suicide in the last 10 years were suffering from treatable depression.

Thin safeguards

Consider, for example, the grandparent of a family in these economically austere times who is seriously ill and needs ever increasing care. This care isn’t easy to give when the breadwinners are struggling to keep their jobs, pay the mortgage and services from the local authority and NHS are being cut. It would be easy for the elderly relative to take the view that they would be better off out of the way, because they wouldn’t be imposing a care burden, or spending money which they had set aside as an inheritance.

Legalise assisted suicide and people like this could all too easily slip through the net and ask for what is euphemistically called ‘help to die’, against their better judgement, but to make life easier for their children.

The plain fact is the Bill and its ‘proposed safeguards’ are paper-thin, and ignores the pressure that the disabled, the terminally ill and those who have the responsibility for caring for them can be under. This goes someway to explain why they have already been rejected multiple times by the British and Scottish Parliaments and attempts to change the law via the Courts have also repeatedly failed.

Those campaigning for a change in the law have also failed to demonstrate why the law needs to changed. Only a handful of people go to Switzerland to commit suicide - less than one in every 30,000, and changing the law is opposed by every major disabilities rights organisation and doctors groups, including the Royal Colleges, BMA, hospice movement and APM.

Slippery slope

Finally, I am not a fan of the slippery slope argument, but in the case of assisted suicide and euthanasia, it applies. Just look at what has happened in Holland and Belgium. Laws that its supporters say were introduced with the best intentions have been extended. Mark and Eddy Verbessem, the 45-year-old deaf identical twins, were euthanasia by the Dutch state, after their eyesight began to fail. Nathan/Nancy Verhelst’s life was ended in front of TV cameras, after a series of botched sex-change operations. His mother said she hated girls, found her child ‘so ugly’ at birth and did not mourn his death.

Or the case of Ann G, an anorexia sufferer who opted to have her life ended after being sexually abused by the psychiatrist who was supposed to be treating her for the life threatening condition.

And the now these laws are being applied to children even when they are unable to express any view.

The current law exists to protect those who are sick, elderly, depressed, or disabled from feeling obliged to end their lives. It requires every case to be reviewed by the police and the DPP to determine whether a prosecution is appropriate. The present law protects those who have no voice against exploitation and coercion, acts as a powerful deterrent to would-be abusers and gives discretion to judges to temper justice with mercy in hard cases.

It does not need changing.

Professor Ray Tallis
Professor Ray Tallis is Chair of Healthcare Professionals for Assisted Dying (HPAD) and a Patron of Dignity in Dying.
Alistair Thompson
Alistair Thompson is an anti-euthanasia campaigner and members of the CNK (Care not Killing) Alliance
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