Health: Time to put euthanasia to the vote

THE thing about euthanasia debates is that the audience tends to be - how shall I put this? - mature.

Most of the bums on the 300 or so seats at the 6 April International Science Festival debate - "This House believes that voluntary euthanasia should be legalised" - had the mark of 60 years or more about them. But there was still a fair sprinkling of young butts about Edinburgh's Playfair Library.

Proposing with me was Jean Davies, currently president of the European division of the World Federation of Right-To-Die Societies and a campaigner for the individual right to opt for voluntary euthanasia (or not) since before I was at medical school.

She is not, as she was at pains to point out, pro-euthanasia but pro- choice. "I would defend your right to choose no as vehemently as I would defend mine to choose yes," she says.

Jean was the only woman and non-doctor in the debate, and a fine antidote to male medical stodge. She wasn't - as anti-euthanasia groups had lead me to believe - the Devil incarnate, but witty, wise and on the side of the angels. At least she would be if she wasn't an atheist.

Her beliefs are well encapsulated in her book, Choice in Dying (Ward Lock, 1997 ISBN 0-706-37510-6) which, she assured me, "has never been reviewed anywhere". Well, it's the best book I have ever read on the subject and I heartily recommend it.

Against was Michael Wilks, chairman of the British Medical Association's Ethics Committee, and Ian McColl, Professor of Surgery at UMDS (that's Guy's and Thomas's hospitals merged with a bit of King's thrown in. Or vice versa).

Lord McColl gave a passionate defence of the status quo. Most of the people he had served with at sea wanted to die at some time and changed their minds on dry land. And 96 per cent of the patients in the hospice he is associated with have complete pain relief, and he has only ever known one person request to die (but he still insisted on taking tablets to keep him alive).

Patients sent home from the hospice with diamorphine to control their pain did just that and never committed suicide, even though they easily could have. And although voluntary euthanasia might on paper be voluntary for both doctor and patient, Lord McColl - not a Catholic - remembered when the Abortion Act was passed in 1967. "The pressure from patients was so great that woe betide any doctor who didn't offer abortion on demand. To this day, you very rarely meet a Catholic consultant gynaecologist."

McColl was also full of praise for today's medical students. "Better trained, better communicators, more compassionate, all round nicer people." He felt that this was the best insurance that patients in the future would receive excellent palliative medicine.

There might still be a call for voluntary euthanasia from a few, but this autonomous right was less important than the need to protect the vulnerable who might be coerced or feel duty bound to ask for it. He ended with a quote from a Dutch doctor about the difficulties of actively terminating a patient's life: "The first time was very difficult, the second less so and the third was a piece of cake."

This threw Jean Davies into an apoplectic rage, and she apologised to all the Dutch doctors she knows who have been practising compassion-motivated voluntary euthanasia in a controlled, open and regulated way and would never refer to it in those terms.

Jean sees the issue as a matter of liberty. If you have a progressive, insufferable, incurable illness, you have a right to choose the time and means of your death. It was about dignity, rather than pain, and many independent people used to being in control of their lives would rather be helped to die in such circumstances than regress to a futile, undignified state of dependence. "I for one, do not want to be remembered like that," she said. Huge round of applause.

My views on the subject are very similar (see last week), although the pressure is off because I have the access and expertise to retire gracefully if life becomes intolerable. Being a doctor is currently the best guarantee of a dignified death (that is, if you survive the alcohol and depression).

Most of us know someone who's had a bad death or a futile prolonged life, even with the best palliative care. I think you deserve the choice not to and the audience agreed with 80 per cent in favour and none of the over-60s against. Let's have a referendum.

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