SIR Terence English, who lives in Iffley, is a former president of the British Medical Association and the Royal College of Surgeons. He is leading a campaign for physician-assisted deaths:
Some people still suffer towards the end of a terminal illness despite good palliative care. This can be distressing not only for the individual but also for those loved ones looking after them.
Lord Falconer’s Assisted Dying Bill, which receives its second reading in the House of Lords in July, addresses this difficult problem.
The Bill seeks to legalise the option of an assisted death for terminally ill adults who, after meeting strict legal safeguards, would have the option of self-administering life-ending medication prescribed by a doctor.
This is not euthanasia, where the doctor intentionally ends the life of a person by the administration of drugs. Nor is it assisted suicide for those who are mentally incompetent or seriously disabled but not terminally ill.
Unfortunately, opponents try to confuse the debate by referring to euthanasia, which is legal in Belgium and the Netherlands, or assisted suicide which is practised at the Dignitas Clinic in Switzerland instead of addressing what is proposed.
As the B ill stands, in order to qualify for an assisted death, two doctors acting independently would need to agree that the patient was not expected to live for more than six months, that the request was initiated by the individual and no one else, and that he or she had the mental capacity to make such an informed and autonomous decision.
Furthermore, if there was doubt about serious depression affecting mental competence, a psychiatric consultation should be sought.
There is also a “conscience clause” for doctors, who on ethical or religious grounds were against helping a patient die in this way.
Many reasons are advanced by those who seek to prevent such legislation.
These include the uncertainty of medical prognosis – but a patient is unlikely to ask for life-ending medication unless or until the situation became intolerable towards the end of their illness.
Concern has also been expressed that legalising assisted dying would inhibit the development of palliative care, or undermine trust in doctors.
However, there is no evidence for this from those countries where euthanasia and assisted dying are legal.
DR Peter Saunders is a retired surgeon and campaign director of the Care Not Killing Alliance, representing 40 organisations opposed to the legalisation of assisted suicide and euthanasia:
Any change in the law to allow assisted suicide or euthanasia would inevitably place pressure on vulnerable people to end their lives for fear of being a financial, emotional or care burden upon others.
The “right to die” would so easily become the “duty to die”. This would especially affect people who are disabled, elderly, sick or depressed and would be greatly accentuated at this time of economic recession with families and health budgets under pressure.
Elder abuse and neglect by families, carers and institutions are already real and dangerous and would be made worse.
Any so-called “safeguards” against abuse, such as limiting it to certain categories of people, will not work.
This is because exactly the same arguments – autonomy and compassion – would apply to people outside the categories decided upon and so any law allowing it for some would immediately be challenged under equality legislation.
If for terminally ill people, why not for those who have chronic illnesses but are “suffering unbearably”?
If for adults why not for “Gillick competent” children? If for the mentally competent why not for people with dementia who “would have wanted it”?
The news coming from other jurisdictions which have gone down this route, particularly Belgium and the Netherlands, shows a pattern of incremental extension and pushing of the boundaries – an increase in cases year on year, a widening of categories of people to be included and people being killed without their consent.
Belgium has recently legalised euthanasia for children and in the Netherlands babies with spina bifida and people with dementia are already put to death.
This is why British parliaments have rightly rejected the legalisation of assisted suicide in Britain three times in the last seven years and why the vast majority of UK doctors, almost all medical groups including the British Medication Association (BMA), Royal College of Physicians (RCP) and Royal College of General Practitioners (RCGP), and all major disabled people’s advocacy groups are also opposed.
Persistent requests for euthanasia are extremely rare if people are properly cared for, so our real priority must be to ensure that good care addressing people’s physical, psychological, social and spiritual needs is accessible to all.
This issue is understandably an emotive one but hard cases make bad law and even in a free democratic society there are limits to human freedom. Our present law with its blanket prohibition on all medical killing does not need changing.
The penalties it holds in reserve act as a strong deterrent to exploitation and abuse whilst giving discretion to prosecutors and judges to temper justice with mercy.