I treat the very sick – and I urge politicians to vote against the very worrying assisted dying bill | Lucie Thomas
TThe thought of ending your life is a common response to human suffering. But with care and support they can usually be overcome. That’s why our usual response when someone wants to take their own life is to try to prevent suicide – and to show them that we value their life at a time when they themselves are struggling to do so. from Lord Falconer assisted dying billwhich will soon be debated in the House of Lords, represents a radical departure from this approach: it proposes circumstances in which we should helping someone end their life, rather than trying to prevent them from doing so. But what circumstances could justify this?
For Lord Falconer, the answer is simple: terminal illness. In his bill, as long as a person has mental capacity and is likely to live less than a randomly selected six months, they can receive assistance to end their life. There is no requirement that the causes of their suffering be investigated, let alone addressed, nor that they receive any form of care or support.
The only condition is that two doctors certify that the person is acting without undue influence or coercion and has been informed of the care available to him. One of these doctors, who in any other circumstance would try to help their patient through his suffering to avoid taking his own life, would instead help them do so.
Falconer’s bill is an example of a highly medicalized approach to assisted dying, which is almost completely unchallenged by both supporters and opponents. He does not justify why doctors should treat someone who says he wants to end his life in such a drastically different way just because he has a terminal illness. Instead, he implies that such patients are primarily motivated by uncontrollable pain or other persistent symptoms, and are fundamentally different from anyone else with suicidal ideation. This is not my experience. The terminally ill patients I have cared for who have considered ending their lives had the same complex set of problems as other suicidal patients and, importantly, responded equally well to care and support.
In the same way, official reports from the US state of Oregonon whose assisted dying law Falconer’s bill is based, it appears that one of the most common concerns of terminally ill patients receiving a medically assisted death is psychosocial problems common in people with suicidal thoughts, such as loss of autonomy and dignity. Many also worried about being a burden to others – rather than identifying the excruciating pain and other uncontrollable symptoms that campaigners encourage people to expect and fear at the end of life.
The implications of using terminal illness to determine eligibility for assisted dying extend far beyond those who actively want to end their lives. Once assisted dying is normalized as a care option for terminally ill people, everyone with a terminal illness should consider whether they should choose it too. Former Tory MP Matthew Parris is one of the few supporters of what he calls the “intellectual honesty” to openly acknowledge the consequences: that those who qualify would eventually feel pressure to choose this option, to “not be a burden” on others. For Parris, far from being a cause for concern, this is actually the main appeal of this approach. He actively welcomes the prospect that assisted dying will ultimately “considered socially responsible – and ultimately even incited to people.”
This is not a hypothetical vision, but one that is already starting to become a reality. When Canada introduced medically assisted dying for those whose “natural deaths were reasonably foreseeable,” economists calculated the outcome savings on the healthcare budget. Not even five years later, access was expanded to a much broader group of patients with chronic diseases and disabilities. There are more and more examples where it is actively offered to people who also have no desire to end their lives receive a terminal diagnosisor when you try have access to basic care and support for their disability. Even in the US, where medically assisted dying is only legal in less than a quarter of states and much less normalized, a significant proportion of assisted death patients worried about being a burden to others.
Why then is this medicalized approach supported by many who consider themselves compassionate and progressive? Few seem to realize that this is so nothing inevitable about basing access to assisted dying on medical conditions, and not requiring doctors to provide it – ending life is not a medical procedure, and providing a standard lethal dose of toxic chemicals does not require medical knowledge or skills. Yet this approach has gone unchallenged ever since first proposed in the 1930sin the heyday of the medical eugenics movement, by Dr. C Killick Millard – member of the Eugenics Society and founder of the organization now known as Dignity in dying.
An approach to helping die without this historical legacy would be very different to Falconer’s bill. If our motivation is compassion, and our goal is to alleviate intractable suffering, then surely eligibility should be based on the assessment that a person’s suffering is intractable—not whether or not he or she has a particular disease, disability, or life expectancy, nor any other external judgement. about what makes a life worth living. Helping someone die would then be a last resort, to be used only after all other options to support them and address their suffering have been tried.
It is not the doctors, but the courts that are best placed to assess whether such a situation has occurred, with medical professionals only being involved to provide relevant evidence. Specialist courts are familiar with balancing urgency and thorough consideration in life-and-death decision-making, and can thus make a timely decision when necessary for someone near the end of life.
When it comes to administration, a new, non-clinical professional role could be created to help the small number of people likely to need help in ending their lives access the deadly chemicals required to do so. This would ensure complete separation between assisted dying and healthcare, protecting patients, healthcare services and society at large from the harmful effects if they become intertwined.
Our politicians will vote with conscience on Falconer’s bill. Those determined to legalize assisted dying at all costs will vote in favor. Those who support the principle of assisted dying and are serious about learning the lessons of other countries should vote against it – and call for a radically different approach.