On Friday 12th May, the House of Lord’s is scheduled to have its Second Reading of Lord Joffe's Assisted Dying for the Terminally Ill Bill. If the Bill eventually passes, patients throughout the UK will be able ‘to receive medical assistance to die.’ Having studied this Bill and having attended a committee meeting in the House of Lords about it, I have come to the conclusion that there are at least fifteen different reasons why this Bill should be firmly rejected.
Fifteen Reasons Why the Joffe Bill is Dangerous
First, the Joffe Bill could create conditions whereby vulnerable people would feel pressure, whether real or imaginary, to request early death. The elderly, lonely, sick or disabled may ‘choose death’ so as not to be a burden to others. No amount of precautions to ensure the death is voluntary can stop such pressures from effecting a person’s decision. In the state of Oregon, for example, the number of people who requested assisted suicide because they felt a burden to their families or carers raised from 12% in 1998 to 63% in 2000. (Data taken from ‘interview with neonatologist Carlo Bellieni, 6th May 2005.) Dutch parents who choose not to kill their disabled children have been known to hear comments like, ‘Such a thing should have been given a lethal injection.’ In August of 2005, the primary association of Dutch doctors asked the Health Ministry to create an independent board for considering euthanasia cases for terminally ill people ‘with no free will.’ Among those with ‘no free will’ were children, severely mentally retarded people and those in an irreversible coma. Prominent Dutch voices are now calling for an “end of life pill” to be handed to everyone who reaches 75. Do we really want to open England up to this same slippery slope? Lord Joffe has himself said, revealingly, ‘We are starting off, this is a first stage… I believe that this Bill initially should be limited, although I would prefer it to be of much wider application… But I can assure you that I would prefer that the law did apply to patients who were younger and who were not terminally ill but who were suffering unbearably, and if there is a move to insert this into the Bill I would support it.’
Thirdly, the Joffe Bill fails to take into account the full range of solutions available for those who are terminally ill. The European Association for Palliative Care reports that requests for assisted suicide are extremely rare when patients’ medical, social, psychological and emotional needs are being met.
Fourthly, the Joffe Bill is dangerous because it violates the Hippocratic oath a well as more recent codes of medical ethics, such as the Declaration of Geneva and International Code of Medical Ethics. As such, it would change the vocation of a doctor from one who seeks to bring healing, or to support a patient where no healing is possible, to an agent administering harm. It confuses the roles of physician with executioner. The fact that, under the Joffe Bill, the patient is the one who actually kills himself, does not make the doctor immune from responsibility. The doctor is the one who prepares the deadly cocktail for the patient to swallow. The difference between euthanasia (where the doctor actually kills the patient) and ‘assisted suicide’ is morally irrelevant, since in both cases the doctor means to bring about the death of the patient, a death that would not be possible but for the doctor’s actions. In cases where a patient vomits or is unable to complete the process, not to mention cases where an incapacitated patient requires help, the doctor will be required to finish the patient off with a lethal injunction. “Indeed, a Dutch study shows that in almost one in five cases where ‘assisted suicide’ is intended, the doctor ends up administering a lethal injection because of the complications that occur.” (Danny Kruger, ‘We don’t need doctors to speed us to our graves’, opinion piece for the Telegraph, 08/05/06). Not surprisingly, the majority of doctors in the UK remain oppose to assisted dying. (Click HERE for latest news on Doctors' position.) Significantly, opposition to euthanasia is strongest amongst doctors who work most closely with terminally ill patients.
Fifthly, the Joffe Bill would have us believe that assisted suicide is the ‘compassionate’ course for those whose suffering is unbearable. The emotional appeal of this argument is accentuated by the fact that the Euthanasia lobby routinely takes a handful of difficult, extreme cases, and then uses those to argue for a change in law. However, it is dangerous when appeal to compassion overrides more fundamental ethical principles. Eugenic selection can be masked by compassion just as easily as assisted suicide. This point was made by Arlov Bellieni, MD, in ‘Witholding and Withdrawing Neonatal Therapy: An Alternative Glance’ from Ethics & Medicine: An International Journal of Bioethics.)
Sixthly, currently, the UK is one of the world’s leading providers of hospices – special hospitals devoted to relieving the pain of dying patients. However, if the Joffe Bill passes, those who provide or finance palliative care may begin to resent the ones who choose to ‘stick it out.’ Professionals responsible for offering services to the terminally ill may cease to meet the emotional and psychological needs of those who suffer acutely yet reject assisted dying, on the grounds that ‘this person’s suffering isn’t necessary anyway, because they can always have a PAS (physician assisted suicide).’
Seventhly, the Joffe Bill endangers those who do not choose to have a PAS. In the Netherlands, the progression from assisted suicide to involuntary euthanasia is well documented. The Remmelink Report analysed that one in three of the deaths caused by euthanasia were ‘without explicit request.’ Even though doctors in Holland are legally required to gain consent, once they begin to think of death as a ‘treatment’ option, it is something they feel compelled to give. In 1990 Dutch doctors killed more than 1,000 patients without their request. (See Keown J, ‘Euthanasia Examined’, Cambridge University Press, 1995, p. 270.) Five years later, another study found that out of 4,500 euthanasia deaths, 1 in 5 occurred without the consent of the patient. (See Jochemsen H and Keown J, ‘Voluntary Euthanasia under control?’ See also Journal of Medical Ethics, 1999; 25: 16-21. See also van der Maas, J.; van Delden, J.J.M. and Pigenborg, L. Euthanasia and Other Medical Decisions Concerning the End of Life: An Investigation Performed Upon Request of the Commission of Inquiry into the Medical Practice Concerning Euthanasia, Elsevier Science Publishers, Amsterdam, 1992, pp 73, 75, 181 - 182.) These figures do not even include the thousands of cases of indirect euthanasia where treatment was withheld with the direct intention of shortening life without any explicit request from the patient. Many of these deaths were administered to people “who could have made a request but did not.” Despite the precautions that the Joffe Bill would put in place, it is impossible to guarantee that these precautions would be observed in England any more than the precautions that have always existed in Holland. That was the main reason why the 1994 House of Lords Select Committee unanimously rejected both euthanasia and PAS.
Eighth, the Joffe Bill allows assisted death when someone’s suffering becomes unbearable. But ‘unbearable’ is a subjective term that could easily be abused. This is not altered by the Bill’s definition of ‘unbearable suffering’ as ‘suffering whether by reason of pain or otherwise which the patient finds so severe as to be unacceptable and results from the patient’s terminal illness; and “suffering unbearably” shall be construed accordingly…’ Danny Kruger has pointed out that this “places enormous power in the hands of the doctor, who, in the wording of the Bill, has merely to ‘satisfy himself’ that the patient is dying and is competent to make the decision to die early. No recourse to outside experts – ethicists or psychologists – will be required. The doctor becomes God.”
Ninthly, pain abating drugs are now so highly developed that most types of pain can be relieved. When a patient thinks his/her suffering is unbearable, this is normally a reflection of depression, fear or other non-medical treatable issues. These other factors may make a person feel like cutting off their life in a sudden moment of despair, even when the level of physical suffering is manageable. ‘Palliative care specialists have noted that unbearable suffering prompting the request for assisted dying is often a reflection of unresolved psychological issues.’ (From
‘Written evidence to the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill’, collated by The Royal College of Physicians of London.) In all such cases, there may be solutions other than death that the patient has not considered or does not know about, such as support, discussion, counselling, reassurance, therapy, anti-depressant drugs, etc. It requires considerable skill to know when these other methods are viable solutions, and it is not to be expected that every doctor operating under the Joffe Bill will have this expertise.
Tenthly, the Joffe Bill is dangerous in so far as the prognosis in terminal illness is often extremely difficult to define. The evidence from Oregon and Holland, where assisted dying has been legal, shows that doctors’ self-reporting can be unreliable. To quote again from the Select Committee, ‘…autopsy studies have shown that in a small minority of cases people who are thought to have had terminal cancer turn out to have had a treatable non-cancerous cause of death.’ Even when diagnoses of a terminal illness is accurate, it is difficult to predict life expectancy and degree of pain. Yet, a patient’s decision to under go PAS may hinge on these expectations. “A patient who expects to die within the month may go on to live over a year, and in that period experience many happy times and put their affairs in order (including emotional and relational affairs).” (Information Pack on Physician Assisted Suicide and Euthanasia)
Eleventh, society is measured by how it treats the most vulnerable people. Vulnerable people are protected when we affirm that human life is intrinsically valuable, regardless of the mental state of the sufferer. The Joffe Bill undermines the inviolable sanctity of human life by suggesting that this value is derived from conditions of consciousness. It also undermines it by giving doctors the right to conclude that a patient would be better off dead and then to act upon that conclusion. When personal value or identity is dependent on the doctor’s belief or decision or on a patient’s condition of consciousness, vulnerable people are put at risk. This can be seen in the case of Tony Bland, who was in a permanent non-fatal coma. Philosophers such as John Harris from Manchester University and Peter Singer from Harvard, argued that Tony may have been human, but he was not a person. Tony Bland’s consultant neurologist, a follower of Harris, also took this view. When asked whether he saw Tony as a person, Howe replied, ‘No, his personhood had gone when his chest was crushed; he was not a person in the sense that I understand it, in an ethical sense. A person is someone who has the capacity to value their life: that’s the definition given by Professor Harris from Manchester, and I think it’s the best one I have seen. A person is that creature, that sentient creature, which has the capacity to value its own life, so by that definition chimpanzees and gorillas are persons; we should not kill them, any more than we should kill other human beings who don’t want to be killed.’ Tony was allowed to be slowly starved to death. (Cited by Andrew Dunnett in A Euthanasia: The Heart of the Matter, Hodder and Stoughton, 1999 , pp. 78-79.)
Twelfth , the Joffe Bill is dangerous because it will lead to a loss of trust between doctors and patients. Evidence from Holland suggests that some patients with terminal diseases or disabilities fear their doctors who may regularly offer euthanasia. (‘Euthanasia – the erosion of trust?’ Royal College of Physicians Journal, Vol 5: March/April: editorial.) For this reason, many Dutch patients are asking to be transferred to German hospitals. Further, patients who are opposed to PAS on moral grounds, may fear their own decisions once rationality has been worn down through pain or senility.
Thirteenth, the Joffe Bill places a dangerous amount of autonomy with those whose minds may be worn down through pain, depression or senility. People in such a position often gain enormous security from knowing they can trust their doctor to make decisions in their best interests. The Joffe Bill will directly undermine this sense of trust.
Fourteenth, the Joffe Bill would have us believe that assisted suicide brings ‘healing’ in a more general sense, since it releases the sufferer from pain. But once the distinction between healing and harm is blurred in this way, involuntary euthanasia can also be defended on grounds of ‘healing’ for those who suffer. To go one step further, it might be argued that it is ‘healing’ for our nation when certain segments of society are targeted for elimination. For example, in Germany in 1920, a document was published which suggested that killing mentally ill, retarded and deformed children was a ‘healing treatment.’ (From David Stolinsky's article, ‘Assisted Suicide of the Medical Profession’, 20 March, 2006) If the Joffe bill can treat the death of one individual as a ‘treatment option’, what is to stop government from treating the death of thousands – for example, minority groups – as a ‘treatment option’ for society? The genocide of the elderly might be view as a ‘healing treatment’ for our economy since a significant portion of our healthcare budget is spent on those in the last year of life. Only by maintaining the conventional distinction between healing and harm in the small areas, will we be protected from their confusion in the larger areas.
Fifteenth, the Joffe Bill is dangerous since it would almost inevitably erode people’s courage to suffer by encouraging them to run away from it. It is not ‘dying in dignity’ to end one’s life as soon as pain becomes too great.
Keep checking this site, because in a few days I will be publishing another post, dealing with the history of the theological and philosophical issues behind this question.
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