Saturday, 18 May 2013

Lord Falconer is seeking to overturn the Hippocratic Oath and change 2,400 years of history

'I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.'

So reads the Hippocratic Oath, which until recently used to be taken by all graduating doctors. 

Hippocrates of Cos (c. 460 BC – c. 370 BC) was an ancient Greek physician of the Age of Pericles (Classical Greece), and is considered one of the most outstanding figures in the history of medicine.

His oath at the time it was drafted was revolutionary.

Previously doctors had had the power to prescribe both remedies and poisons. But Hippocrates, recognising their great power and the potential for abuse, demanded that they should dedicate themselves solely to healing. 

Along with the Judeo-Christian ethic the Hippocratic Oath has formed the basis of every code of medical ethics since 400 BC; that is until now.

Lord Falconer, who has just introduced his ‘Assisted Dying Bill’ into parliament this week (see timetable here), is seeking to change 2,400 years of history.

His bill would make it legal for doctors to help mentally competent adults with less than six months to live to kill themselves. Two doctors would need to agree that a patient met the criteria and the option would not be open to minors, people without mental capacity or those who are not terminally ill.

The final step would involve a doctor (or nurse) hand-delivering lethal drugs to the patient at a time and place of their choosing and staying with them while they took the drugs and until they were dead.

Falconer has some supporters within the medical profession.

Twelve retired senior doctors have today send a letter to the Times (£) backing his bill. And in the last few years a new organisation, Health Professionals for Assisted Dying (HPAD), has set itself up under the auspices of the Dignity in Dying (formerly the Voluntary Euthanasia Society).

But as an article in the Times (£) accompanying the above letter notes, the British Medical Association and almost all Royal Colleges are opposed to a change in the law. In fact about two thirds of doctors are opposed.

Interestingly, the Times newspaper, is in agreement with them.

In its editorial (£) today it says it would be ‘wrong to legislate’ and that ‘the law that Lord Falconer now wants is a step too far’.

The current blanket prohibition on assisted suicide keeps the numbers low, as evidenced by the very low numbers of people travelling to Dignitas facility in Switzerland to kill themselves.

Furthermore the Director of Public Prosecutions (DPP) already has discretion not to prosecute in hard cases and the authority to temper justice with mercy. But he is particularly tough on doctors, because of the power they have, as recognised by Hippocrates.

‘There is a danger’, argues the Times, ‘that a codified law that attempted to replace such difficult and nuanced judgments with statute would produce two problems.’

‘The first is a large increase in assisted suicides as it becomes more legally straightforward. This is the reason why many lobbyists for the disabled oppose the Bill, concerned that people will be put under pressure to end their lives.’

‘The second danger is, oddly, an increase in prosecutions for assisting suicide, as the discretion of the old system is replaced by a more formulaic approach. This may be the reason why doctors are, in general, against a new law. And why they are right to be.’

It is significant that the Times, which backed a change in the law at the time of Falconer’s last attempt to alter it in 2009 has now changed its position.

But it has done so on the basis of good evidence.

Jurisdictions which have legalised either assisted suicide or euthanasia, have seen a steady increase in case over subsequent years and the widening of criteria to include categories of people for whom it was never intended.

This pattern of incremental extension is seen in the NetherlandsSwitzerland, Oregon and Belgium and extension beyond mentally competent adults has been clearly seen in both the Netherlands and Belgium.

Our current UK law is clear and right and does not need changing. The penalties it holds in reserve act as a powerful disincentive to exploitation and abuse, whilst giving both prosecutors and judges discretion to temper justice with mercy in had cases.

It may not be perfect, but we tamper with it at our peril.

And Hippocrates was right about doctors too. They are too powerful and too human to be given the power and authority to kill.


  1. The Hippocratic Oath is also breathtakingly misogynistic and out of step with most modern medicine we utilise today.

    Why should pets be treated better than humans? Why must Al Qaeda look compassionate in relation to hospice care today?

    1. The right to die can so easily become the duty to die and a good doctor can kill the pain without killing the patient.

    2. More dishonesty. You assume the slippery slope can only run in one direction. What if the right to refuse treatment is taken away by overly zealous anti-choicers?

      And why is a duty to suffer somehow better than a duty to die?

      And terminal sedation is not a fair alternative. If someone is unconscious for three weeks until they die, they are essentially dead for all essential purposes, since they will not experience anything for three weeks.

    3. Patients already have the right to refuse treatment and requests for euthanasia are extremely rare amongst dying patients who are being properly cared for. Our priority is good care.

      Terminal sedation is necessary only in extremely rare circumstances and there is a world of difference between relieving symptoms on the one hand and killing people on the other. The latter is unnecessary and wrong.

    4. Patients can commit assisted suicide by dehydrating themselves. How can you possibly claim a moral difference between that option and a lethal injection?

      Self-dehydration is only painless if patients are given continuous sedation, which puts the quality of their final days contingent on the diligence of the treating staff.

    5. There may be no moral difference if on both occasions suicidal ideation is involved but there is a huge legal and practical difference between a person killing themselves and having someone help them kill themselves.

      This is why under the Suicide Act 1961 suicide is legal but assisting suicide is not.

    6. Congrats, Peter. As I mentioned in another post, you make Al Qaeda look compassionate.

      Self-dehydration, with the state's approval and backing IS assisted suicide, because no one is allowed to interfere. The practical difference is larger than it is in Oregon, because the patient must be kept sedated for over a week until death occurs.

      Furthermore, doctors ALREADY have the power to kill patients simply by botching an operation and making it look like an accident. So that argument fails right out of the gate.

      Dr Ike - the Nazis never cared about patient choice. How dare you. Just so you know, even one of your fellow anti-choice allies (Daniel Callahn) is against the Nazi parallel:

      “First, the Nazi program did not slide from voluntary to involuntary. It was, from the beginning, involuntary. Second, the Nazi program was motivated by jingoism, racism, and a fascist political ideology. By contrast, the movement to decriminalize assisted suicide and voluntary euthanasia is motivated by a desire to alleviate suffering and respect for individual autonomy. Third, pre-Nazi Germany did not have as a part of its collective consciousness an awareness of the horrors of the Holocaust. The example of Nazi Germany could actually deter the very slippage it is taken to indicate is possible.”

    7. What if a patient is refusing food/water today, but perks up and takes in fluid tomorrow?

    8. That's up to the individual patient's choice. What's your point?

      As far as I know, self-dehydration requires no waiting period, making it more open to abuse than a regulated system that is present in the Netherlands.

    9. It's a bit problematic to use self-dehydration as an indication of the will-to-die because the patient might feel differently after a period of time.

      This is the problem with depression. The mind and the body and interconnected things. When the body is ill, the mind is often depressed. When the patient feels more positive, this often affects the health of the body and things like ability to eat and drink.

    10. But to prevent obscene quantities of suffering, the patient must be sedated to the point of unconsciousness once dehydration has begun.

      Are you trying to say that patients should not be permitted to dehydrate themselves to death?

    11. I'm not familiar enough with the process you're talking about. I would need somebody involved in hospice care to explain it to me.

      What concerns me is that doctors who actually care for the dying day-in day-out are against euthanasia. I'm not sure how constructive it is for the rest of us to sit here second guessing.

    12. Do you not think self-dehydration is monumentally excruciating (to put it mildly)? It takes around 10 days (unless one takes medication to accelerate dehydration).

      I highly suggest that you study up on terminal sedation before you reply. It would be torture to allow patients to dehydrate themselves to death without employing terminal sedation.

      Many doctors who are against assisted dying do it anyway. They sweep their deeds under the carpet and clearly do not wish to be held accountable. One of those hypocrites is Brendan Nelson, an Australian politician.

    13. I looked up terminal sedation. As far as I understand, the underlying disease must kill the patient, not the drug itself. This is what separates it from euthanasia. Like I said, I don't feel qualified to discuss this in detail. I'm not contradicting you, but I'd like to hear a doctor explain the role of these various treatments.

  2. So it is back to Nazi Germany. When will Europe learn? Indeed, do we ever learn from history?

    1. What we learn from history is that we don't learn from history

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