Thursday, 5 January 2012

Assisted Suicide

The rather official sounding Commission on Assisted Dying was set up by a group of campaigners. Funded by Sir Terry Pratchett and chaired by Lord Falconer, a barrister and former Justice Minister, it has taken evidence from 1,300 sources during a year long enquiry. Its critics claim that it did not start from a neutral point, however, and was biased toward a change in the law. Unsurprisingly, its findings are that the law should be altered to allow assisted suicide under certain very strict conditions
  • the person must be terminally ill and judged to have less than a year to live
  • two indepenedent doctors must agree
  • the person must be over 18 and of sound mind
  • the person must be able to demonstrate that suicide is a voluntary decision on their part.
You can read more about the Commission's recommendations and reactions to them on

All very difficult yet fairly predictable, I think. The aspect of the argument that seems to have been overlooked in most of the reports I've listened to today is this: to allow assisted suicide is not something that affects only the individuals who are faced with a very, very difficult choice about whether to end their own lives. If we change the law to allow assisted suicide, people will be needed to organise the means of suicide and, probably, institutions will arise whose business it is to make suicide possible. Who will these people be? Will doctors, nurses and pharmacists take on the preparation of suicide drugs as part of their everyday work? Once the preparation of such drugs is allowed, it will only be a small step to the plea for someone to administer them in cases where the dying person cannot do this for themselves. This changes society's entire relationship with the medical and health care professions and is in danger of diminishing the trust we would feel able to put in any institution, such as a hospice or nursing home, which decided to adopt assisted suicide as an option for its patients. (You can image, 25 years down the line, protocols where staff have to ask the question, 'Would you like to discuss suicide?')

Much of the argument today has been based around the perceived and strongly articulated need of individuals either to be able to take their own lives or to have the law back up their own firmly held conviction that suicide is, or ought to be, an avoidable tragedy. I believe that people in both groups should be enabled to explore, honestly, their own position and that counselling and support should be available for those who want to think about suicide, without any penalty in law for the counsellor or supporter. However, to suggest the legalisation of the act of helping someone to die, even by their own express wish, is a step too far. It is being suggested by the Commission without a thorough survey of the effect this will undoubtedly have on our attitude to health care professionals, and to elderly and vulnerable people who often don't have much of a voice in these debates. How would we monitor and police counsellors and supporters, some of whom may turn out not to be as impartial as they appear? (And believe me, such cases would very quickly arise.) As part of the debate, I would like to see much more research done on the question of how we allow doctors not to strive officiously to prolong life and how this is discussed with patients.

This afternoon I am going to a meeting to prepare for a seminar on intervention in terminal care. How much is care allowed to intervene in the dying process - should it be allowed to and at what stages? How involved are patients in decisions? And what is the cost to the person of non-intervention or intervention? What are the boundaries of hospice care?

This is an agonizing dilemma for many caught up in progressive illnesses and for their carers and the professionals looking after them. But please let us approach the question from a wider base. It is true that sometimes the 'good' that individuals desire and the 'good' that we all, as a society, need to preserve the life and safety of the many (including the most vulnerable) can be contradictory. To place death under the gift of human agents and to welcome that as a 'good' for society is a radical departure from most ethical and religious philosophies, codes and teachings.  

There are some very good rapid response comments on the British Medical Journal website which show where many doctors' thinking is on this 

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