Friday, 16 January 2015

Round up on Euthanasia and Assisted Suicide – Review of 2014 from Care Not Killing Alliance

As 2015 dawns, pause with us to reflect on an extraordinary year. Despite the many challenges presented, 2014 was a year when, despite many pressures, those at the heart of this debate stood up and dared to say 'no'. It was the year when what proponents of assisted suicide have tried to sell as agreed wisdom was questioned, doubted and often dropped. We look forward to pressing on with you now (Care Not Killing Alliance)

Saying 'no'

2014, then, was the year when to sound concern and opposition once again became acceptable. The Prime Minister and Deputy Prime Minister; prominent figures in the arts and sport; major charities and disabled people's advocates - the list goes on. Lord Falconer's Bill to allow assisted suicide for terminally ill people was rejected both by MPs and - by a 2-1 margin - members of the Welsh Assembly, while the Supreme Court followed the High Court and Court of Appeal in refusing to agree that disabled people should be assisted to die.

Most importantly, those who have real life experience of the often brutal reality of end of life situations spoke ever more clearly of their gladness that assisted suicide is not legal. We heard this especially from the many, many people who massed outside Parliament on the hottest day of the year that far to speak out against Lord Falconer's Bill, and we continue to receive, and welcome, support for our petition concerning the bill before the Scottish Parliament.

Polling

We are all quite used to polls which appear to suggest high levels of public support for a change in the law with much effort going into suggesting that irreversible suffering at the end of life is the rule, not the exception. 2014 saw that perceived wisdom more widely doubted. First, we saw a drop in the level of support for a change in Scottish law, back in January. Then, on the day of the Falconer Bill's second reading, a ComRes poll commissioned by a CNK member organisation found that support for the Assisted Dying Bill plummeted when the reality of legal change and what it would mean for terminally ill and disabled people, and for the practice of medicine.

Perhaps the most dramatic expressions of changing public opinion were found in a further ComRes poll in November, forcing many to consider the context in which legalised assisted suicide would exist: more than four in 10 believe assisted suicide will be extended beyond the terminally ill if the current law is changed; a clear majority of the public says there is no safe system of assisted suicide; and fewer than three in 10 believe changing the law on assisted suicide will not lead to increase in abuse of vulnerable people.

Doctors

Flawed safeguards in the Falconer and MacDonald Bills caused legal experts to deem the draft legislation unsatisfactory even where they accepted principles to which the medical profession has remained overwhelmingly opposed. Key healthcare professionals' bodies were clear in their message to peers in July, and the Royal Colleges of General Practitioners and Physicians both conducted surveys of members, with the response being clearly in favour not only of continued opposition to a change in the law which would fundamentally alter the practice of medicine, but also in favour of continued collegiate opposition. Indeed, there has been a move against isolated but well-placed advocates of legal change who continue to demand that their views be accepted by the majority. This was particularly felt first at the BMA's ARM, and then later when the editorial team of the British Medical Journal sought to use the publication to advance the 'assisted dying' cause. Healthcare professionals are under no illusions: it is never 'just about the debate'.

All the while, those who dedicate their lives to end of life care continue to drive forward innovation, as we saw at the Palliative Care Congress in Harrogate in the Spring, and with positive media portrayals and constantly renewed thinking about palliative care's potential, we can be optimistic about what we are able to do for terminally ill people.

Saying goodbye

The reality of death and dying can never be far away in the debate on assisted suicide and end of life care, and 2014 saw the death of, among others, two people who were totally committed - to two very different points of view. Jim Dobbin MP, grandfather to two disabled grandchildren, was passionately opposed to the 'counsel of despair' inherent in all assisted suicide/euthanasia proposals, and his work in this area should continue to inspire parliamentarians. Independent MSP Margo MacDonald, meanwhile, the prime mover for assisted suicide in Scotland, died of natural causes in the Spring, with her bill being taken up by a Green colleague.

Remaining challenges

The combined threats in Westminster and Holyrood of the Falconer and MacDonald Bills continue to stalk end of life care, and will loom large in 2015.

  • Consideration of the Falconer Bill in committee will resume in January; have you read the guides circulated by CNK among members of the House of Lords?
  • Oral evidence will shortly be taken in relation to the Assisted Suicide (Scotland) Bill, and CNK will be among the contributors. Have you read our earlier, written submission?
  • The appallingly high (and growing) numbers of assisted suicide and euthanasia deaths abroad keep coming, with significant former supporters of euthanasia in the Netherlands joining the chorus of concern over the path the country is taking.
  • The effect of a recent change to prosecution guidelines in England and Wales, highlighted at the time by CNK, remains to be seen, but we will continue to monitor this closely.
  • As a nation, we remain, quite simply, bad at talking about death. This is a debate often framed as being about 'choice', but patients and families are already able to empower themselves, provided that they are offered the right support, educate themselves - and discuss openly their hopes and fears. We are at our strongest when we are honest with others and when we are prepared to accept support from others just as we have ourselves supporters others. Is end of life care the elephant in the room for you? Begin the conversation today.


Sunday, 30 November 2014

The Human Journey – Thinking biblically about health

Many people today hold to an atheist worldview – they believe that God doesn’t exist, that human beings are just clever monkeys, that morality is largely a matter of personal choice and that death is the end. 

Within this framework medical technology can become simply a tool to improve life’s length and quality without regard to any overall meaning and purpose. If we want it, and can do it, and it seems to improve our life and health then why not?

By contrast the Bible teaches that God does indeed exist, that he has clearly spoken and acted in history in a way that leaves us in no doubt about his character and intentions. He has created human beings to know him and love him.

Death is not the end at all but rather a gateway to two radically different futures – either to enjoy eternity with God in a new and perfect world, or to be excluded from his presence forever.

Under this scheme history is indeed ‘his story’ – a ‘divine drama’ worked out according to God’s will and purpose.

My new book, the Human Journey, aims to equip Christians to think biblically about health and healthcare. But it sets these issues in the greater context of God’s design for man, the universe and everything – his great plan of redemption to unite everything under Jesus Christ.

The book starts by sketching out the grand ‘metanarrative’ – the overarching great storyline of the Bible in which all our individual little stories make sense. This big story makes sense of all that follows.

But then I focus down on issues at the interface of Christianity and health under eight big themes – each accompanied by a key question:

·         Humanity - What does it mean to be human?
·         Start of Life - When does life begin?
·         Marriage and sexuality - What is marriage for?
·         Physical health - How should I live?
·         Mental health – Am I supposed to feel like this?
·         End of Life – How should life end?
·         New technologies – Are we playing God?
·         Global health – Who is my neighbour?

The overall aim is to establish a biblical framework to help Christians think about health, both to make better personal healthcare decisions and also to help their churches incorporate healthcare expertise more effectively into pastoral life and ministry.

While the book can be read alone, it is accompanied by a set of videos and a study guide for small groups, expanding on each chapter. It’s intended to be shared and discussed within the context of the Human Journey course. To help readers explore the issues I touch upon in more depth, there are also a host of articles and further resources on the Human Journey website.

My desire is to see people excited about the whole Bible, more amazed about Christ’s great work and all that it means and more confident about how to bring God’s word and healthcare together. So I have deliberately packed this book full of biblical references.

If you finish it more grateful for all God has done and is doing, more hungry to mine the depths of Scripture, more passionate about serving Jesus and more equipped to think, speak and serve for Jesus Christ then it will have achieved its purpose.


Friday, 14 November 2014

Lord Falconer’s phoney war continues

Lord Falconer’s Assisted Dying Bill reached Committee Stage in the House of Lords on Friday 7 November. It seeks to legalise assisted suicide (but not euthanasia) for mentally competent adults (aged over 18) with less than six months to live, subject to ‘safeguards’ under a two doctors’ signature model similar to the Abortion Act 1967.

Opponents to the Bill had tactical choices: either to try to kill the bill dead at second reading on 18 July – as they did with a similar bill from Lord Joffe in 2006 – or to strangle it slowly in committee by amending it, if necessary with ‘wrecking’ devices. They have opted for the latter, which means clear arguments against will form part of the official record of the debate. This will effectively stop Falconer complaining that ‘we have not yet had the debate’. Peers will instead literally do it to death.

And so the House of Lords are now debating the bill line by line and considering amendments. Thus far 175 amendments to the bill have been tabled and collated into over 40 groups. Only four of these groups were considered on the first day of committee (7 November) so there is still a long way to go (you can read last Friday’s full debate here). There have even been extra amendments laid for pure comedy value!

House of Lords protocol requires that each proposed amendment has to receive the offer of debating time so given that there are only three more possible committee days this year to consider it, and none of these days have yet been allocated to it by the government whips, the bill is fast running out of time.

It may not even reach the report and third reading stages necessary for it to clear the House of Lords. And even if it does those on both sides agree that there is no time for it to go through the House of Commons before the general election on 7 May 2015.

This means almost inevitably that the bill will fall and that Lord Falconer will have to start all over again next summer – which he no doubt will do.

The debate now however is still very important as it will form part of the parliamentary record and will influence future discussions. And so we are asking all those opposed to the bill to write to members of the House of Lords urging them to reject the bill at third reading, if it should come to a vote.

One development on 7 November was the ‘acceptance’ of an amendment that judges, not doctors, should take final decisions about whether someone should be given the go-ahead to take their own life. Or at least that is how it was spun by the media. In fact, Lord Pannick (a strong supporter of Falconer), who moved the amendment, was reminded by other peers of the convention not to vote on amendments before report stage, but he pushed it to a vote regardless at a time when his supporters (many of whom left soon afterwards) were present in good numbers.

Those opposed to him then simply sat on their hands and abstained meaning that a formal division was not called for. So in effect the ‘acceptance’ means very little.  No amendment stands anyway if the bill falls at third reading and more can be moved at report stage before that.

Lords Pannick’s amendment puts a fearsome onus on judges but also demonstrates one of the weaknesses of Falconer’s bill – the fact that someone on his own side felt moved to tighten his ‘safeguards’ further is further evidence that they are not safe. A fuller analysis of the bill and a paper giving warnings from Oregon where similar legislation was passed are both available on the Care Not Killing website.

These concerns about safety are further confirmed by a new Comres poll which showed that a clear majority of public says there is no safe system of assisted suicide and that more than four in ten believe assisted suicide will be extended beyond the terminally ill if the current law is changed.

Andrew Hawkins, Chairman of ComRes, has commented:

'The obvious conclusion is that while the public are broadly sympathetic to the rights-based argument in favour of ending lives at the time of a person's choice, there is widespread concern about the abuse to which any system is likely to be open. These concerns are apparent across three areas - by the medical profession... by unscrupulous relatives, and in terms of pressure to end lives prematurely and on diminishing palliative and other health care resources.'

This latest series of events has all the hallmarks of a phoney war. Regardless, Falconer and his allies will undoubtedly not let the matter rest. The first shots have indeed been fired but this battle will run and run. 

Monday, 3 November 2014

Lord Falconer has suffered enough - it's time to put him out of his misery

Lord Falconer’s ‘Assisted Dying Bill’ , which reaches its Committee Stage in the House of Lords on Friday 7 November, seeks to legalise assisted suicide (but not euthanasia) for mentally competent adults (>18) with less than six months to live subject to ‘safeguards’ under a two doctors’ signature model similar to the Abortion Act 1967.

The Bill had an unopposed second reading in the House of Lords on 18 July. This is not unusual for the House of Lords and simply means that the Lords were opting to debate it line by line rather than just rejecting it on principle.

A Supreme Court ruling earlier in the year put pressure on the Lords to give the bill a proper hearing and if they didn’t, doubtless Falconer would keep bringing it back, using up more precious parliamentary time and complaining that ‘we have not yet had the debate’.

For opponents to the bill – and there are many – the tactical options were either to kill the bill dead – as they did with a similar bill from Lord Joffe in 2006 – or to strangle it slowly in committee by amending it out of recognition before putting in the boot one last time.

They have opted for the latter, a kinder and more compassionate course of action for a piece of draft legislation which is already terminally ill. And a better plan for kicking it beyond the long grass to a place where no one dare retrieve it.

When the bill was debated in July thousands of people wrote to the Lords to complain about its loopholes and inadequacies and disabled people staged a mass protest outside Westminster Palace.

The depth of feeling against the bill across the political spectrum was underlined when the Guardian newspaper – that bastion of right wing conservative values - changed its editorial policy to oppose it because of real concerns about public safety.

Already a massive fight is brewing for this Friday with peers tabling a sack load of amendments aimed at exposing the bills weaknesses and inconsistencies. More are expected later this week and the government is already talking about extending the committee stage so that they can all be heard.

But in reality this is something of a phoney war.

It is conceivable that the bill may yet come to a final vote in the House of Lords, but both sides are agreed that the chances of it clearing the Commons in the run up to the election are virtually zilch.

The most Falconer’s supporters can hope for is some sort of a ‘moral’ - albeit Pyrrhic - victory by perhaps winning a vote over an amendment or two in a poorly attended committee debate.

The real battle will happen after next May’s general election and the chances of the bill progressing then will depend very much on who is in power. It’s very clear that the current House of Commons would not pass it.

Having said all that it is crucial that those opposed to the bill make their voices heard. Peers have been buried in letters from the pro-euthanasia lobby in the run up to committee as the former Voluntary Euthanasia Society – aka Dignity in Dying – launch their attack.

Now is the time for those opposed to the bill to strike back and urge peers to put down this deficient draft legislation. 

We don’t need this bill.

Any change in the law to allow assisted suicide will place pressure on vulnerable people to end their lives for fear of being a financial, emotional or care burden upon others. This will especially affect people who are disabled, elderly, sick or depressed. The right to die can so easily become the duty to die.

The law we have at present does not need changing. The stiff penalties it holds in reserve provide an effective bulwark against exploitation and abuse, but in so doing it still allows judges to act with mercy in hard cases. It also protects vulnerable relatives from being subtly coerced into assisting a suicide against their better judgement.

The pressure people will feel to end their lives if assisted suicide is legalised will be greatly accentuated at this time of economic recession with families and health budgets under pressure. Elder abuse and neglect by families, carers and institutions are real and dangerous and this is why strong laws are necessary. Where there is a will, there is an anxious relative.

Furthermore experience in other jurisdictions, such as Belgium, the Netherlands and the US American states of Oregon and Washington, shows that any change in the law will lead to ‘incremental extension’ and ‘mission creep’ as some doctors will actively extend the categories of those to be included (from mentally competent to incompetent, from terminal to chronic illness, from adults to children, from assisted suicide to euthanasia). This process will be almost impossible to police.

It’s time to put Falconer out of his misery. He has suffered enough. Let’s not draw things out too long. 

Come and stand with disabled people this Friday at 9am outside parliament.

And write some letters to peers. You’ll find all the briefing information you need on the Care Not Killing website along with the specifics of the Bill’s specific defects and the broader arguments against a change in the law.

Don’t delay.


Monday, 20 October 2014

RCP surveys its membership’s views on ‘assisted dying’

The Royal College of Physicians today launched a survey to assess its members’ views on assisted suicide.

The survey consists of four multi-choice questions with the option to write a more detailed response. It closes on 17 November.

The questions are:

1. Do you support a change in the law to permit assisted suicide by the terminally ill with the assistance of doctors? (Yes/No/Yes, but not by doctors)

2. We ask you to consider the following statement (this is a repeat of the question we asked when we last surveyed in 2006 and is included for comparative purposes):

'(We) believe that with improvements in palliative care, good clinical care can be provided within existing legislation, and that patients can die with dignity. A change in legislation is not needed.' (Yes/No)

3. What should the College’s position be on ‘assisted dying’ (as defined in the RCP’s consultation document)? (In favour/opposed/neutral or no stance)

4. Regardless of your support or opposition to change, in the event of legislation receiving royal assent, would you personally be prepared to participate actively in ‘assisted dying’? (In favour/opposed/neutral or no stance)

The accompanying consultation document explains that the College last surveyed its membership’s views on this issue in 2006 when the House of Lords was considering Lord Joffe’s Assisted Dying for the Terminally Ill.

At that time 73.2% of UK-based RCP fellows and collegiate members who responded did not believe a change in the law was needed, with 26% believing the law should change. The vote came out just before the Bill’s second reading in the House of Lords and helped to contribute to its defeat by 148 votes to 100.

This policy was later reaffirmed by the RCP’s Council in 2012.

This new survey has been prompted by Lord Falconer’s Assisted Dying Bill which seeks to legalise assisted suicide for mentally competent adults with less than six months to live. It has its committee stage (when amendments to the bill are considered and debated) on 7 November.

I have previously argued that the Falconer Bill is a recipe for the abuse of elderly and disabled people. Furthermore, public support for it falls from 73% to just 43% when the major arguments against it are heard.

There are also strong signals coming from the US state of Oregon, where very similar legislation was passed in 1997, that this is not the route to follow. The experience of other jurisdictions, like the Netherlands and Belgium, casts a dark shadow.

As the RCP consultation document notes, the BMA, the Royal College of Surgeons of England, the Royal College of General Practitioners and the Association for Palliative Medicine are also opposed to a change in the law on assisted dying.

Assisted suicide is unnecessary, dangerous and uncontrollable. The strong arguments against legalising assisted suicide, or any other form of euthanasia, need to be heard.

We can be sure that the vocal minority of doctors who support such legislation will do their best to skew this vote. This is why it is imperative that the majority speaks clearly.

If you have received an email from the RCP about this vote, please don’t ignore it. It takes only minutes to answer the four multi-choice questions above, and not much more to write something sensible in the comment box.

It is the very least we can do to protect our patients and keep the law safe. 

Elderly pro-euthanasia campaigner starves herself to death in high-profile attempt to advance her cause

A long-term pro-euthanasia campaigner has starved herself to death over five weeks because she could not have her life ended legally.

Jean Davies, 86, did not suffer from a terminal illness but said her life had become ‘intolerable’ after a series of fainting spells.

She died at home in Oxford on 1 October after giving an extensive interview to the Sunday Times.

Mrs Davies became involved in the right-to-die campaign as far back as the 1970s and was president of the World Federation of Right to Die Societies from 1990 to 1992 and was chair of the Voluntary Euthanasia Society UK (now Dignity in Dying).

In 1997, her book Choice in Dying argued for British law to allow doctors to end their patients’ lives.
According to her daughter she died peacefully and was ‘smiling at everyone’ the day before.

I was asked to comment on this story by the Sunday Times and my comments have been picked up in several follow up accounts in other papers (eg. Times, Express, Guardian, Daily Mail).

Essentially here, we have a long-time euthanasia campaigner attempting to use her own death to further the cause she has championed throughout her life.

Ironically her own daughter said in an interview that her case proves those who want to die already have power to take their own lives and that the law therefore does not need to be changed.

Her GP, a Christian who does not believe in assisted dying, told the Sunday Times he had treated her symptoms after consulting his defence union.

The full quote I gave the Sunday Times is below. They chose to major on the part about ‘emotional blackmail’ and not to include the reference to Helga Kuhse. But Kuhse’s comments deserve wider circulation:

‘It is not illegal to starve and dehydrate oneself to death but neither is it right. My fear is that this unusual and tragic case will be seized upon by the pro-euthanasia lobby to further their agenda of legalising assisted suicide and euthanasia.

It is the same technique used by Helga Kuhse, then President of the World Federation of Societies for the Right to Die at their 5th Biennial Congress on the Right to Die held in Nice, France, September 1984 when she said, ’If we can get people to accept the removal of all treatment and care – especially the removal of all food and fluids – they will see what a painful way this is to die and then, in the patient’s best interests, they will accept the lethal injection.’

We should recognise this ploy for what it is and reject it. However we might sympathise with this woman’s condition, by deliberating choosing to go public with it she is adopting a campaigning stance in the footsteps of Kuhse. It is, if you like, a subtle form of emotional blackmail aimed at softening opposition to a change in the law to allow assisted suicide or euthanasia.

There are good reasons for keeping the law as it is. Any change in the law to allow assisted suicide or euthanasia would place pressure on vulnerable people to end their lives for fear of being a financial, emotional or care burden upon others. This would especially affect people who are disabled, elderly, sick or depressed.

The present law making assisted suicide and euthanasia illegal is clear and right and does not need changing. The penalties it holds in reserve act as a strong deterrent to exploitation and abuse whilst giving discretion to prosecutors and judges in hard cases.

Persistent requests for euthanasia are extremely rare if people are properly cared for so our priority must be to ensure that good care addressing people's physical, psychological, social and spiritual needs is accessible to all.’

Thursday, 16 October 2014

The DPP needs to explain to Parliament why she has effectively decriminalised physician assisted suicide

In an astounding about face for the Crown Prosecution Service, the Director of Public Prosecutions, Alison Saunders (pictured), has today rewritten her prosecution policy so that doctors can now be involved in assisting suicide without fear of prosecution, provided they don't have a professional relationship with those they 'help' (See Daily Mail here and here,  Daily Telegraph, Yahoo, Premier, CT, ES).

The move has not surprisingly been welcomed by euthanasia campaigner Michael Irwin, and will also be music to the ears of Philip Nitschke.

Both Irwin and Nitschke are medical practitioners who have become media celebrities through their high profile campaigning for the legalisation of assisted suicide, and high profile assistance to those wanting to end their own lives.

Now it will be much easier for them to do so without a backward glance.

Michael Irwin was found guilty of serious professional misconduct by the General Medical Council in 2005 and was struck off the medical register after admitting supplying sleeping pills to help a friend kill himself. He now claims to have helped at least 25 people to die at the Dignitas facility in Switzerland. 

Irwin, nicknamed 'Dr Death' for his activities, said the change was a 'wonderful softening' that would 'make life easier' for people like him. 

Nitschke, who travels the world instructing people in how to end their lives using barbiturate drugs and nitrogen, is currently being investigated by police in every Australian state over his possible role in nearly 20 deaths in the past three years. 

Both men will now be able to sleep more easily in their beds and to continue their activities in Britain with considerably more peace of mind. And the DPP will no longer have to explain why she hasn't so far made moves to prosecute them.

Under the Suicide Act 1961, assisting or encouraging suicide remains a crime attracting a custodial sentence of up to 14 years.

But in order to be prosecuted any given case must pass two tests applied by the Crown Prosecution Service. The evidence test requires that there be enough evidence to bring a successful prosecution. The public interest test involves the application of 22 criteria, 16 making prosecution more likely and 6 making it less likely.

Up until now a suspect ‘acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer [whether for payment or not]’ was more likely to be prosecuted.

But the DPP has now amended this criterion so that it only applies if the victim was in his or her care.

In other words, it will not apply in the case of doctors like Irwin and Nitschke who are assisting the suicide of people who are not actually their own patients.

This is very concerning indeed. The Director of Public Prosecutions is effectively at a stroke of her pen decriminalising assisted suicide by doctors and other health care professionals as long as they don’t have an existing professional care relationship with the patient.

This weakens the protections for sick and vulnerable people and effectively gives a green signal to anyone in Europe wanting physician assisted suicide that Britain is open for business. It also opens the door to a Dignitas style death ‘clinic’ being set up in the UK.

Alison Saunders’ new guidance is an invitation to doctors who wish to push the boundaries and assist people to kill themselves to have free rein and go ahead.

The DPP’s job is actually to administer the law, not to usurp the democratic authority of Parliament, which ironically (or was it by design?) is due to discuss this issue in just a couple of weeks’ time.

The DPP has justified her position by reference to a highly contentious statement by one of the judges in last June’s Nicklinson/Lamb judgement in the Supreme Court.

But in so doing she has run roughshod over the original meaning of her own prosecution guidance.

The original prosecution guidance, developed in 2010, made it abundantly clear that any doctor or other health professional who assisted with a suicide was running the risk of prosecution.

Furthermore the General Medical Council (GMC) has warned that such doctors risk censure, including being struck off the medical register (see details of DPP and GMC guidelines here). 

Medical defence agencies have interpreted it in this same way in their advice to doctors and it has provided a strong deterrent to doctors abusing their powers.

But now the DPP has swept all of this aside with the mere stroke of a pen. In so doing she is acting way beyond her brief by effectively decriminalising physician assisted suicide by stealth.

When the guidelines were originally drafted by the former DPP, Keir Starmer, they were made subject to lengthy and rigorous public consultation. 

But Alison Saunders, rather than fulfilling her duty of upholding the law, has effectively chosen to rewrite it without apparently consulting anyone at all.

By doing this just weeks before Parliament is due to debate the matter she is raising two fingers to British democracy.   

In May 2012, the Solicitor General said in a parliamentary debate that if ‘a future DPP overturned the guidelines, (s)he would be judicially reviewed for behaving in a rather whimsical way'. 

I hope that such a judicial review will now indeed take place. 

But more than that I hope rather that the DPP will be forced to go in front of Parliament to explain why she has rewritten the current law, ignored the will of MPs and peers and put at risk the lives of many vulnerable people in our country.