The campaign group Dignity in Dying (formerly the Voluntary Euthanasia Society) prides itself on being more modest in the scope of its taste for medical killing that other more radical groups like SOARS, FATE, Exit International or Dignitas.
But careful listeners to Radio Four’s ‘Exit Strategy: Choosing a Time to Die’ at 8 o’clock on Monday 20 September will have been intrigued to learn that DID Chief Executive Sarah Wootton (pictured) has just extended her definition of ‘terminally ill’ by another six months. Yes, if you are within twelve months of death you now fall within DID’s widening net of people who will qualify for a ‘lethal drug-assisted’ death under their proposals.
DID tells us on their website that they ‘only advocate assisted dying - not assisted suicide, voluntary euthanasia or euthanasia’.
This supposedly makes them more modest in their aims that Belgium and the Netherlands (where voluntary euthanasia is legal) or Switzerland (where assisted suicide is legal). The law they want, we are told, is ‘similar to that in place in Oregon and Washington’.
DID support only ‘assisted dying’ – or more specifically ‘allowing ‘terminally ill, mentally competent adults’ after meeting ‘strict legal safeguards’ to ‘self administer’ lethal drugs.
The language is skilfully crafted to disguise its real meaning. But what does it actually mean?
Voluntary euthanasia is where a doctor ends a patient’s life by administering lethal drugs. Assisted suicide is where the patient is helped to administer the drugs herself. ‘Assisted dying’ is actually assisted suicide for the ‘terminally ill’, but calling it ‘assisted dying’ makes it sound like something altogether different. The aim, like that of any euphemism, is to make it more acceptable to the public.
But who is actually terminally ill? What an interesting question! I have on several occasions in debates and on media asked DID spokespeople to define what they actually mean by ‘terminally ill’ but until last Monday had never been able to elicit a specific answer.
However on Radio Four Ms Wootton actually defined it for us. She said, ‘What we do say is that they are dying, that they should be terminally ill and the GMC guidelines define terminally ill as someone who is likely to die in the next 12 months.’
Aha! So she’s going for the GMC guidelines definition of twelve months.
Lord Joffe’s Assisted Dying for the Terminally Ill Bill, which was defeated in the House of Lords by 148-100 in May 2006, specified six months. So also do the laws in both Oregon and Washington on which DID’s policy is supposedly based. But DID now wants twelve months as one of their so-called ‘robust safeguards’ aimed at limiting abuse.
How robust is this safeguard? Joffe’s Bill was rejected largely on the basis of the findings of a Parliamentary select committee report written after consultation with a wide range of experts. The references that follow, unless otherwise indicated, are to House of Lords Report HL 86 (Session 2004-05).
Medical experts were asked how accurate a prognosis of 'six months or less' was? Here is what they said:
'It is possible to make reasonably accurate prognoses of death within minutes, hours or a few days. When this stretches to months, then the scope for error can extend into years' (Royal College of General Practitioners, HL 86 Vol II, Page 80)
'Prognostication may be better when somebody is within the last two or three weeks of their life. I have to say that, when they are six or eight months away from it, it is actually pretty desperately hopeless' (Professor John Saunders, speaking for the Royal College of Physicians, HL 86 Vol I, Paragraph 118)
'A simple bit of practical evidence is one of the benefit forms that are filled in for patients assigned to a doctor thinking that the patient has six months to live. I would not like to count how many of these forms I have signed in my life for patients still living after a year, eighteen months or even longer' (Dr David Jeffery, speaking for the Association for Palliative Medicine, HL 86 Vol I, Paragraph 119)
The select committee suggested that any 'assisted dying' bill should define terminal illness 'in such a way as to reflect the realities of clinical practice'. This was ignored in the Lord Joffe's 2005 bill, and there is no indication that it has been taken on board by the pro-euthanasia lobby since Parliament's rejection of that bill in 2006.
In fact, after a period of failing to define terminally ill at all, DID is now daring to go twice as far as Joffe!