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by Trevor Stammers

Last week the United Kingdom’s House of Commons voted to pass, by a majority of 55, the Terminally Ill Adults (End of Life) Bill.

Kim Leadbeater, the Labour MP who put forward the Private Members Bill, promised it would have the “best safeguards in the world” and told those who spoke in terms of introducing a “state-sanctioned suicide service” to “mind their language”. I am doing so, for that is exactly what it will introduce into the NHS, and sadly, a minority of healthcare staff, including both hospital doctors and GPs, will be willing to dispense death as a legal option if the Bill does become law in England and Wales. (Interestingly, a majority of Scottish MPs voted against the Bill.)

The claim was repeatedly made by those promoting the Bill that palliative care would not be affected – but the vast majority of palliative physicians were opposed to the Bill.  Only a few days after the vote, it was announced that 300 beds in the UK hospice network were closed due to lack of funding.

Once assisted suicide (to distinguish it from the assistance in dying provided to patients for decades by hospices) is legal, there will be pressure for all hospices to offer it, as has happened in other jurisdictions. Palliative care is expensive, and however much money is set aside for the suicide service, it will be far less than the provision of palliative care in the final months or years of life – a prognosis of six months to live is notoriously inaccurate, as I know well from 30 years’ experience as an NHS doctor.

Extension of Those Qualifying

The Bill has many ambiguities. I shall mention just three of them here to illustrate that its figleaf “safeguards” are totally inadequate.

Part of the Bill’s definition of “terminal illness” (section 2 (1a)) is one of an “inevitably progressive illness, disease or medical condition which cannot be reversed by treatment”. Will potentially curative treatment be offered to the same extent as at present if the patient could opt for assisted suicide?

Disability and psychiatric illness are both currently excluded (section 2 (3)) as sole reasons for eligibility for assisted suicide, but these restrictions are untenable long-term in the light of the emerging concept of “terminal psychiatric illness” and the fact that many young patients with anorexia nervosa have already had their lives ended by assisted suicide in countries where the practice is legal.

Should the UK Bill become enacted, there will be legal challenges to the “discrimination” of restricting access to the “terminally ill” under any definition. The suffering of those with painful chronic but not life-threatening illnesses will successfully be claimed in the courts for their right also to state assistance to end their lives. Once the principle of individual autonomy taking precedence over the protection of the vulnerable has been conceded, as it has by this recent vote, its extension to other groups is inevitable.

Covert Euthanasia

My second concern is about what the Bill permits doctors to do and what essential details remain unspecified. The doctor may (section 18 (6)):

(b) prepare a medical device which will enable that person to self-administer the substance, and

(c) assist that person to ingest or otherwise self-administer the substance.

Assisting a person to swallow the fatal dose may entail just helping them to hold the glass or putting a straw in their mouth. But does it exclude the doctor holding the glass or, indeed, pouring it into the patient’s mouth? With regard to pressing the button to start “the device”, would the doctor putting their finger over the patient’s finger constitute assisting or euthanising?

I maintain that the Bill as it stands is already a Bill for covert euthanasia in some cases. But regrettably and importantly, the Bill gives no direction as to what the doctor should do if the “lethal” dose does not, in fact, kill the patient. This will certainly happen and it needs to be specified if the Bill is to become law.

There have been at least nine cases of the dose failing to kill in the past 25 years in Oregon, which has a population of 4 million. England and Wales have around 60 million, and based on Oregon’s figures, we will likely have 135 cases over a similar period – on average, five or so per year. Is the doctor allowed to inject a further dose of medication or not in such cases?

This surely needs to be specified before the Bill is passed.

Recruiting for the Service

Even among the minority of doctors supporting assisted suicide in principle, far fewer would be prepared to actually watch their patients die, let alone give active assistance to help them take the lethal dose.

The current Bill does not compel doctors to raise assisted suicide with their patients or to engage in a discussion about it when a patient raises it. However, it does compel them to refer their patients on to a doctor who is prepared to discuss it (section 4 (5)). This, for many GPs and hospital staff, will bring sufficient moral distress for them to retire early or leave the NHS if they are compelled to comply.

Those already working in palliative care will be under particular pressure to participate, as the vast majority of their patients will be terminally ill. Those who maintain that palliative care will simply continue as it is, should this Bill be passed, are mistaken.

If palliative care becomes part of a suicide service eventually there will be a crisis of recruitment of “willing doctors” just as there is currently in Canada where assisted suicide accounts for over 4 percent of all deaths.

Despite frequent assertions to the contrary, no jurisdiction which has legalised assisted suicide has been able to restrict its use to terminally ill adults; the UK will be no exception. As one commentator has stated about those who voted for it. “History will not look kindly on them”.

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Republished with thanks to Mercator. Image courtesy of Adobe.