On the day my sister died I asked the doctor to kill her. I didn't put it that way, naturally. I think the euphemistic cliché I used was that she should be "put out of her misery". The consultant replied that Thomasina was deeply unconscious, and that he had been giving her as much pain relief as was necessary. I think at the time I was concerned that despite suffering from terminal cancer my sister, being only 32, was strong enough to last for days in this distressing state. And that, of course, is the point. It was not Thomasina who was distressed, but her family around her. What I was asking for was not so much an end to her unbearable suffering, but to ours.
On the last occasion that the House of Lords debated Lord Joffe's Bill to legalise a form of euthanasia, Lord [David] Puttnam, with his film producer's sense of the dramatic, made an extraordinarily powerful appeal on behalf of the Bill, based on a description of the grim final weeks of his 93-year-old mother. The whole debate, indeed, was characterised by its quality, especially from a large number of peers who had been at the very top of the medical profession, and who therefore had vast experience of dealing with death. It might not have changed any minds, but it certainly made a compelling case against the fashionable notion of an elected second chamber. Can anyone imagine a debate of such wisdom and knowledge being conducted by second-tier party hacks not thought experienced enough for the intellectual struggles of the House of Commons?
Lord Joffe's Bill returns to the Lords for its second reading on Friday and I would urge anyone in London with time to spare that afternoon to try to attend the debate. But this is not just a debating society. If the Lords vote for Joffe's measure, then it has a chance of becoming law, providing that the Government makes time for it in the Commons. Originally Lord Joffe proposed a bill licensing euthanasia in the form it exists in Holland, where doctors kill patients directly with lethal injections. However it has for some time been clear that the Dutch experience is not entrancing. Even the Dutch Ministry of Health admits that about a quarter of those who are terminated receive their fatal injection without evidence of having requested it. Or perhaps, their families decided that it was "for the best". No wonder many thousands of Dutch people now carry cards in their wallets saying "Do not kill me". (Before we start to feel superior to the Dutch, let's not forget how in 1993, British Courts decided that doctors could, at the family's request, withdraw food and water from young Tony Bland, comatose after his lungs were crushed in the Hillsborough disaster. That was deemed not to be euthanasia on the grounds that feeding and hydration did not constitute medical treatment - a very convenient distinction).
The Lords Committee set up to examine Lord Joffe's proposals heard from a Dutch GP, Dr van der Muijsenbergh, who told them: "I see growing anxiety among patients, not just the terminally ill, that they think it is not decent not to ask for euthanasia sometimes, because they feel that they are such a burden to their families or their carers." Baroness Finlay, one of the peers from the medical profession, told of a 31-year-old Englishwoman with advanced cervical cancer living in Holland who "chose to return home to Newcastle because she was being offered euthanasia on every doctor's ward round, like a treatment option, and had felt pressured to accept the offer. In Newcastle they dealt with her problems of pain and incontinence and she was able to spend several weeks with her three-year-old son before dying peacefully from her illness." In this context it's worth noting that paragraph 24 of the Joffe Bill states: "nothing in the Bill ... prohibits a doctor or nurse suggesting assisted suicide or voluntary euthanasia to a patient."
Lord Joffe seems now to believe that his bill stands a better chance of being passed if it follows the more limited model practiced in the American state of Oregon since 1998 - although he has candidly admitted that this should be seen as just "the first stage" of the process towards full euthanasia. In Oregon doctors are not allowed to administer the fatal drugs directly. Instead they supply them to the patients, who must administer them themselves - this is called "physician-assisted suicide". You will not be surprised to learn that this has led to more than a few botched attempts. You might also not be surprised to learn that three years ago a report on end-of-life care in the US found that fewer than one in five of Oregon hospitals offered palliative care, and it awarded the state a Grade E for end-of-life care. I have no doubt, given the increasing financial pressures on the NHS and the approach of its managers, that we would follow a similar path, which will give least protection to those who need it most. As Dr Kenneth Stevens, the professor of radiation oncology at Oregon's only medical school now says: "The more I have learned, the more I realise the significant harm and danger of assisted suicide to the vulnerably ill and to society."
Fortunately the majority of doctors in this country do not require bitter experience to tell them that the abandonment of their Hippocratic oath - and by the way, Hippocrates predated Jesus Christ - would be a catastrophe for their profession. When last year the British Medical Journal published a leading article advocating physician-assisted suicide, the journal's rapid-response website almost went into meltdown: "If I was prepared to kill my patients then with 15 per cent of my patients above 85 I would have lost all trust", said one practitioner. "As one who spends every working day caring for the terminally ill I am acutely aware of the damage such a change would cause to vulnerable patients," said another. "Call me a coward, but I didn't go into medicine to kill people. Those advocating 'assisted suicide' expect us to include this in our professional duties - they can count me out."
It's clear that if Lord Joffe's Bill were to pass into law, the British medical profession would refuse to implement it. There is, however, a solution which should appeal to its advocates, who say they dislike what they claim is the hypocrisy of the law as it stands. A new profession will need to be created - let us call its practitioners "terminators". (Thanatologists would sound more impressive, but I don't think the medical profession would want to lose its monopoly on Ancient Greek derivatives). There will be a terminator at every hospital. He or she should wear a black gown so as to be distinguished from the doctors and nurses. Obviously we would wonder what sort of people would want this sort of job. But that's exactly the point - isn't it?Reuse content