Physician Assisted Suicide
Over the last twenty years there have been many unsuccessful attempts to change the law on ‘physician assisted suicide’. The recent debate and vote on medically assisted suicide showed that there is much ignorance about the problem of death. I was a surgeon with particular interest in Surgical Oncology so often had to face issues of people who were facing death. The word ‘euthanasia’ literally meant ‘good death’ and this is something every caring physician wants for his patients who have a terminal disease. It is unfortunate that many now understand it to mean an accelerated death, a form of physician assisted suicide.
In the last fifty years there have been many changes under what may be called a ‘woke’ umbrella, where individuals can decide what they want to think about anything. Homosexual acts were once illegal, suicide was once illegal but now these attitudes are changing. It is as if right and wrong are defined by those in authority and in what the media want it to be. What is significant is how little time for public debate was allowed before this vote was taken. It is a concern that many of those MP’s who voted did so on emotional grounds and anecdotes and not on good evidence and argument. This new bill takes these ethical changes even further but it contains major concerns.
1. Less than six moths prognosis
It is extremely difficult to state with any degree of certainty how long a person is likely to survive. There are so many variables. Patients with malignancies find that with treatment tumour growth can be static for some time. Six months is an arbitrary figure. Will those doctors and judges who sign these forms confirming the prognosis is less than 6 moths be audited as this would be one way to prevent abuse? It is clear from television interviews that many who say they have advanced terminal cancer appear outwardly well and coping. It is an undefined fear of a terrifying end that is usually the drive to have this option but this should very rarely happen.
It is only in a person’s final days that a clinician can be fairly confident that imminent death is likely and even then we have all had surprises. Joy can have very beneficial effects on a patient’s symptoms.
2. Associated depression and anxiety
We are all made up of physical, psychological, and social components. All clinicians know that when a person is depressed or anxious they not only find their pain is increased but they dread the future. Suicide in people who are depressed is generally thought of as being wrong and not encouraged. The aspect of depression in sick people has not been focused on. Many people who are thinking of suicide when they have a terminal disease often demonstrate concomitant psychological problems which may be helped by specialist care.
There is good evidence that pain and physical suffering are seldom the drivers for assisted suicide but more common is the fear of being a burden to family and friends.
Psychological features are well recognised by palliative care doctors and nurses and are a major aspect of patients’ care. When these are well addressed then a patients last days can still be satisfying and be a help to others.
3. Financial concerns
The costs of implementing a physician assisted suicide programme with the involvement of specialists to ensure safe practice will be significant. ‘Dignitas’ charges approximately £8000 for those they help to die in Switzerland. Would the bankrupt health service be expected to pay for this or will it be just available privately? If the NHS will pay for this what will be sacrificed?
In the recent parliamentary debate there was much talk about the need for more hospice care facilities and palliative care specialists. Although not mentioned much this is expensive and undoubtedly some think, but rarely verbalise, that a cheaper solution is for terminally ill people to disappear. This is reminiscent of the argument used by a cigarette company to an Eastern European government that said that encouraging smoking would be financially beneficial as early deaths from heart diseaseand cancers would reduce the pension payouts! It would be cheaper for the state to encourage the death of any with terminal disease. This was a solution accepted by the third Reich and some doctors there accepted this. Current British law makes it illegal to assist anyone to take their own life.
4. Slippery-Slope arguments.
As has been seen in other countries who have instituted liberalising laws, it will be difficult to maintain this bill’s limited scope. Even before the present bill’s first reading, up to 54 MPs were calling for the bill’s provisions to include a wider group of patients facing intolerable suffering. There has been an expansion in the conditions permitted in many countries that have brought in similar legislation, including the offering of assisted suicide to people with anorexia, arthritis, hernias, diabetes and even tinnitus. Canada is now considering extending its law on assisted suicide to include those with mental illness.
Canada’s euthanasia program, known as Medical Assistance in Dying (MAiD), has faced significant criticism and challenges since it was legalised in 2016. MAiD has become increasingly common, accounting for over 4% of deaths in Canada by 2022, much surpassing initial predictions. In 2022, there were 13,241 MAID deaths in Canada, which was a 31.2% increase from 2021.
In Canada people can apply if they ‘experience unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable.’ They do not need to have a fatal or terminal condition to be eligible for medical assistance in dying.
This raises ethical questions about whether assisted dying in Canada is being offered as an easier alternative to inadequate medical and social care. Critics have highlighted cases where individuals with disabilities or chronic conditions feel pressured to choose suicide due to inadequate healthcare access. Reports show some patients have opted for ‘euthanasia’ after being denied essential services, such as accessible housing or treatment for chronic pain. The inclusion of ‘advanced directives’ and the removal of a final consent requirement in some cases have sparked fears about potential abuse. This could lead to situations where patients are killed despite a change in their wishes or condition, particularly for those with dementia or mental health issues. While wait times for many medical procedures and services in Canada remain lengthy, MAiD is often expedited, with some cases resolved in as few as 11 days. This has fuelled concerns that Canada prioritises “death care” over improving “life care” for its citizens. There is criticism about inadequate oversight mechanisms for MAiD, particularly in sensitive environments like prisons or among marginalised populations.
In Britain, when medical abortions were legalised in 1967, there were clear restrictions in the law to try and limit the practice. The Act made it lawful to have an abortion up to the 28th week if two registered medical practitioners believed in good faith that the continuance of the pregnancy would involve risk to the life of the pregnant woman, or harm her physical or mental health, or that of any of her family members. This seemingly restrictive wording was loose, including the words ‘harm her physical or mental health’ and as a consequence this act resulted in abortion on demand. With home abortions, using drugs, now readily available even these limited restrictions are becoming difficult to police. In 2020 62% of abortions in the UK were undertaken at home using drugs prescribed on the NHS by their doctor and so did not need hospital or clinic visits. The abortion law was also passed on emotional arguments based on hard cases but has been used in such a way that in the United Kingdom when contraception fails an abortion is readily available. These changes have had significant effects on family life and birth rates are lowering.
It is inevitable that even with restrictive beginnings there will be a growth in the rate of physician assisted suicides in years to come, much as has been seen in Canada. Suicide for other reasons will then become acceptable practice.
Social arguments
There are many, including the current Secretary of State for Health and other ministers, who are concerned that the current crisis in the NHS, the decreasing availability of access to palliative care and the crisis in social care, make this a terrible time to introduce such legislation.
A recent poll has demonstrated that legalising ‘euthanasia’ is very low on the public’s list of priorities for the new government yet the Prime Minister has promised government time to debate this bill.
Could these changes in law, that will permit the taking of life, be the result of self-centred attitudes that are prevalent in our society. Are there increasing numbers who are thinking, ‘My comfort and well-being have become the focus of my life’. If so, this is a serious problem, as selfishness is very dangerous for any society.
Moral arguments
The moral argument concerning who gives life and who has the right to remove it is still significant both in medically assisted abortions and in medically assisted suicide. It is significant that most churches have been opposed to these changes in the law.
Spiritual arguments
Offering an easy early death to people can obscure the big questions of life. What am I here for? What happens when I die? Will I face God’s judgment as Jesus tells us? If a person is thinking of committing suicide, whether or not this is physician aided it is most important that people have the opportunity to think about these questions before it is too late for a change of mind, which is repentance.
The last chapter of my book ‘Cure for Life’ tells of a patient with terminal cancer who asked me ‘to speed up her death’. The subsequent conversation resulted in her finding peace with God and this change of direction and outlook gave her peace and also resulted in her husband finding answers he had never previously considered.
Practical Answers
A good doctor or nurse is in their profession to care for patients. No-one wants our patients to suffer. If a person has a terminal condition good palliative care is essential and in most cases this needn’t be expensive. Much of this can be offered by the patients General Practitioner so long as they have the confidence and backing to use opiates adequately when needed. Unfortunately since the trial of Shipman, who expedited the deaths of many patients, some doctors have been reticent to give adequate drugs to ameliorate pain and other symptoms. No patient should be left to suffer and good care will ensure good pain relief.
Solomon in all his wisdom nearly 1000 years B.C. recognised the need for adequate relief of symptoms using drugs!
“Give strong drink to the one who is perishing, and wine to those in bitter distress; let them drink and forget their poverty and remember their misery no more.” Proverbs 31:6-7
Good pain relief is essential but psychological and social problems must also be addressed. Patients with terminal problems can be helped to see that even when under great pressure there is a purpose to life. Sir Kenneth Calman, a previous Chief Medical Officer consistently emphasised the need for a holistic approach to healthcare, that addresses not just physical needs but also mental, emotional, spiritual, and psychological well-being, particularly for those facing chronic or terminal illnesses. This philosophy has been particularly influential in improving palliative care services, ensuring patients receive compassionate and multidimensional care.
B.V.Palmer
November 2024
