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. 

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.

Public support for Falconer’s ‘Assisted Dying’ Bill drops dramatically to just 43% when arguments against are heard

There is ample poll data showing that the majority of the British public support legalising assisted suicide (AS) in principle.

The former Voluntary Euthanasia Society (now rebranded Dignity in Dying) claims a figure of 80% although I have previously argued that such levels of support are uncommitted, uninformed and unconvincing.

However, there has been very little poll data gauging public attitudes in light of the various empirical and rational arguments against AS.  That is, until now.

An extraordinary new poll has demonstrated that public attitudes change dramatically once some of the key practical implications of AS are considered.

In a new Comres/CARE poll published today and reported by the Daily Telegraph respondents were presented with the following scenario:

‘A new Bill is due to be debated in the House of Lords which is designed to enable mentally competent adults in the UK who are terminally ill, and who have declared a clear and settled intention to end their own life, to be provided with assistance to commit suicide by self-administering lethal drugs. Two doctors would need to countersign their declaration and be satisfied that the person has a condition which cannot be reversed by treatment and is reasonably expected to die within 6 months.  In principle would you agree or disagree with this proposal?^’

73% agreed (38% strongly), 12% disagreed and 14% were in the ‘don’t know’ category.

So far there’s nothing that surprising. It would be odd for people not to be moved by some of the tragic stories of the ‘hard cases’ and to say they support a means of alleviating such suffering.

But then those who supported AS in principle were asked which of the following arguments would make them change their minds.  Each statement below was randomised throughout the survey in order to assess which argument moved opinion the most. 

The answers were truly astounding.

Overall 42% of those who originally supported the bill changed their mind on the basis of at least one of the arguments.

When these were added back into the original sample, aggregating all who opposed as a result of the arguments put to them, and incorporating all who still supported AS having heard each argument, they found the following:

43% support AS, 43% oppose it and 14% don’t know.

So hearing the arguments against AS causes support for AS to collapse from 73% to 43% - that is, to less than half!

Here are the arguments with the percentage change each cause on those who initially backed Falconer’s proposals.

1. The risk of people feeling pressurised into ending their life early so as not to be a financial or care burden on loved ones, as has happened in the US where more than six in ten of those requesting a lethal prescription in Washington State (where the law is similar to that proposed in the House of Lords debate) say that one of their reasons for doing so was not to be a burden on friends, family or caregivers

On hearing this 47% of those who originally backed Falconer’s proposals would still do so, but 28% would oppose him and 25% did not know.

2. Changes in the law to allow assisted suicide and/or euthanasia in other countries like Belgium, the Netherlands and Switzerland have led to a steady annual increase in the number of cases and spread of the practice to involve people with chronic but not fatal diseases, disabled people, children and those with mental illnesses and dementia

58% would still support, 21% would oppose and 215 didn’t know.

3. Concerns that end-of-life care would be likely to worsen under financial pressures because it costs on average £3000 to £4000 a week to provide in-patient hospice care, but just a one-off cost of £5 to pay for the drugs which would help them commit suicide

59% would still support, 15% would oppose and 27% didn’t know.

4. All major disability rights advocacy groups in Britain oppose a change in the law to permit assisted suicide including Disability Rights UK, SCOPE, UK Disabled Person’s Council and Not Dead Yet UK

63% would still support, 12% would oppose and 25% didn’t know.

5. Surveys consistently show the majority of doctors oppose a change in the law to permit assisted suicide, as does the British Medical Association, the Royal College of Physicians, the Royal College of General Practitioners, the British Geriatric Society and the Association for Palliative Medicine

65% would still support, 10% would oppose and 25% didn’t know.

Conclusion

Polls consistently show between 70% and 80% in support of AS.  However, the issue is clearly far more complex than a simple ‘support’/’oppose’ question can do justice to.  This polling strongly suggests that when offered evidence about the nature or source of opposition to AS, and some of the key arguments against it, this high level of support rapidly dwindles. 

The most powerful argument in swaying the public was that changing the law would place pressure on vulnerable people to end their lives for fear of being a burden on friends, family or caregivers, as has been the experience in the US state of Washington and Oregon.

In short, support for AS looks to be extremely soft and generally uninformed.

METHODOLOGY: ComRes interviewed 2,055 British adults online between 11th and 13th July 2014. Data were weighted to be representative of all GB adults aged 18+. ComRes is a member of the British Polling Council and abides by its rules.

Falconer bill is a recipe for the abuse of elderly and disabled people, says Care Not Killing

On the eve of the House of Lords’ debate on Lord Falconer's Assisted Dying Bill, Care Not Killing, an alliance of 40 organisations, has called on peers to reject the proposed legislation on grounds of public safety.

Campaign Director Dr Peter Saunders said, ‘This bill is a recipe for the abuse of elderly and disabled people. The pressure vulnerable 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. It will quite simply steer them toward suicide.’

‘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.'

‘In Washington, where assisted suicide is legal under a law very similar to that proposed by Falconer, 61% of people opting for assisted suicide give the fear of being a burden to family, relatives and caregivers as a key reason.’

The 85 assisted suicide deaths in 2012 in Oregon would equate with a similar law to 1,232 in England and Wales (14 times that of Oregon) and the Oregon experience raises many other causes for concern:

·       There has been a steady increase in annual numbers of people undergoing assisted suicide in Oregon
·       The Oregon health department is funding assisted suicide but not treatment for some cancer patients
·       Patients are living for many years after having been prescribed lethal drugs for ‘terminal illness’ showing that the eligibility criteria are being stretched
·       The vast majority of those choosing to kill themselves are doing so for existential reasons rather than on the basis of real medical symptoms 
·       Fewer than three per cent of patients are being referred for formal psychiatric or psychological evaluation
·       More than ten per cent of patients dying under the Act do not have terminal illnesses
·       Some doctors know the patient for less than a week before prescribing the lethal drugs
·       The fact that almost a third of patients dying under the Act report inadequate pain control or concerns about pain shows that palliative care provision in Oregon is unsatisfactory
·       The presence of no independent witnesses in over 80% of cases is a recipe for elder abuse
·       According to research 25% of cases of assisted suicide in Oregon involve people who are clinically depressed 

Elder abuse and neglect by families, carers and institutions are real and dangerous and this is why strong laws are necessary. Action on Elder Abuse, for example, states that more than 500,000 elderly people are abused every year in the United Kingdom. Sadly, the majority of such abuse and neglect is perpetrated by friends and relatives, very often with financial gain as the main motive. It would be very naive to think that many of the elderly people who are abused and neglected each year, as well as many severely disabled individuals, would not be put under pressure to end their lives if assisted suicide were permitted by law.

Parliament has rightly rejected the legalisation of assisted suicide and euthanasia in Britain three times since 2006 out of concern for public safety - in the House of Lords (2006 and 2009) and in Scotland (2010) - and repeated extensive enquiries have concluded that a change in the law is not necessary.

All major disability rights groups in Britain (including Disability Rights UK, SCOPE, UKDPC and Not Dead Yet UK) oppose any change in the law believing it will lead to increased prejudice towards them and increased pressure on them to end their lives.

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.

The current law is clear and right and does not need fixing or further weakening. On the one hand the penalties it holds in reserve act as a powerful deterrent to exploitation and abuse by those who might have an interest, financial or otherwise, in the deaths of vulnerable people. On the other hand the law gives judges some discretion to temper justice with mercy when sentencing in hard cases. We should not be meddling with it.

The mark of a civilised society and the first function of government is not to give liberties to the desperate and determined but to protect the weak and vulnerable. 

Even in a free democratic society there are limits to choice. Every law limits choice and stops some people doing what they might desperately wish to do but this is necessary in order to maintain protection for others.

Care Minister promotes assisted suicide as treatment option for disabled and elderly people

There is really something quite chilling about seeing the Care Minister backing assisted suicide as a treatment option for disabled and elderly people.

But that is exactly what Liberal Democrat Minister Norman Lamb, the cabinet member responsible for providing care for people with dementia and other serious disabilities, has done today.

It is bitterly ironic that he has spoken out on the very day that the CEOs of four major charities representing elderly and disabled people have written to members of the House of Lords warning about the dangers of passing Lord Falconer’s Assisted Dying Bill and one day before disabled people’s representatives take to the streets of Westminster and the airwaves of the nation to protest.

Falconer's bill is no less than a recipe for the abuse of elderly and disabled people.

In Washington, where assisted suicide is legal under a law very similar to that proposed by Falconer, 61% of people opting for assisted suicide give the fear of being a burden to family, relatives and caregivers as a key reason.

The pressure people will feel to end their lives if assisted suicide or euthanasia is legalised will be greatly accentuated at this time of economic recession with families and health budgets under pressure. It will quite simply steer them toward suicide.

Elder abuse and neglect by families, carers and institutions are real and dangerous and this is why strong laws are necessary.

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.

Parliament has rightly rejected the legalisation of assisted suicide and euthanasia in Britain three times since 2006 out of concern for public safety - in the House of Lords (2006 and 2009) and in Scotland (2010) - and repeated extensive enquiries have concluded that a change in the law is not necessary.

All major disability rights groups in Britain (including Disability Rights UK, SCOPE, UKDPC and Not Dead Yet UK) oppose any change in the law believing it will lead to increased prejudice towards them and increased pressure on them to end their lives.

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.

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.

Hard cases make bad law. Even in a free democratic society there are limits to human freedom and the law must not be changed to accommodate the wishes of a small number of desperate and determined people.

Norman Lamb risks taking Britain down the Dutch and Belgian route where assisted suicide is seen as a cheap treatment option for people with dementia.

The mark of a civilised society and the first function of government is not to give liberties to the desperate and determined but to protect the weak and vulnerable. 

'WE URGE YOU TO OPPOSE THE ASSISTED DYING BILL': Charities unite to condemn new legislation in letter to House of Lords

The CEOs of four major charities representing elderly and disabled people have written to all members of the House of Lords to oppose Lord Falconer’s Assisted Dying Bill which is due to have its second reading on Friday.

The letter comes from Gary Fitzgerald (Action on Elder Abuse), Janine Tregelles (Mencap), Richard Hawkes (Scope ) and Tony Hayes (Veterans Association UK)  and is published in the Daily Mail.

Especially in the current climate of austerity and economic pressure it is elderly and disabled people who will disproportionately take the brunt of it and be subtly steered toward suicide as the cheapest way of 'dealing' with their problems.

In Washington, where assisted suicide is legal under a law very similar to that proposed by Falconer, 61% of people opting for assisted suicide give the fear of being a burden to family, relatives and caregivers as a key reason.

Falconer's bill is no less than a recipe for the abuse of elderly and disabled people.

Dear member of the House of Lords

Lord Falconer’s Assisted Dying Bill

We write as organisations representing large and diverse groups of people: those who are elderly, those of any age who are disabled, including those with mental health conditions, learning disabilities, autistic spectrum conditions and serious long-term and/or life-limiting conditions.

We wish to express our profound concerns about Lord Falconer’s Assisted Dying Bill, due to have its Second Reading this Friday 18 July.

An assisted suicide law would for the first time in this country introduce the idea that there are some people whose deaths can actively be brought about; whose suicide, unlike other people’s, society would make no significant effort to prevent and indeed would actually assist.

Our organisations work every day with people in vulnerable situations who, whatever their medical condition, could lead a better life with access to the right health, palliative, social or mental health care.

The crisis in care services and cases of neglect mean that comfort and dignity do not characterise the lives of a significant number of elderly and disabled people.

For many, whether they have financial or practical support determines whether they live in an institution or in their own home; whether and at what time they get up and go to bed, eat a meal, wash, get dressed, see family and friends or go to work. Without support, many elderly and disabled people face isolation and poverty.

The absence of such support creates avoidable dependency, undermines their dignity and limits their autonomy and choices.

It is these wider social factors that could so easily create the context for people to feel they should ‘choose’ to end a life in which they are suffering, not just the symptoms of a particular condition, but isolation, avoidable discomfort and distress and the sense of being a burden to those who love them.

In Washington State, where physician-assisted suicide is legal for those who are terminally ill, 61 per cent of all those given lethal drugs to end their lives listed feeling a burden on family, friends or care-givers as one of the reasons for wanting to die.

We also have serious concerns about the Bill’s lack of safeguards, in particular its failure to properly address the issues of coercion and mental capacity.

Mental capacity can be affected by many factors, including depression (whether in its own right or, as is often the case, co-existing with another condition), learning disability, autistic spectrum conditions and the effects of medication taken to relieve symptoms.

Depression in particular can be difficult to diagnose or can be easily missed among those who also have debilitating physical symptoms. It is likely, diagnosed or otherwise, to relate as much to someone’s personal circumstances – where they live, who they see, what support they have, whether they face stigma or discrimination – as to their medical diagnosis.

The Bill expects GPs to be able to confidently assess mental capacity in applicants for assisted suicide without referral for specialist assessment. With many pressing demands on them, doctors can fail to detect underlying problems such as lack of adequate social care or mental health support, family conflicts, money worries or depression. We see the impact of these problems every day.

It is such experiences that characterise the majority experience among those who might request assisted dying, rather than the small minority who might have every comfort and support but who still find life intolerable.

We also fear that the requirement to have a diagnosis of ‘an inevitably progressive condition which cannot be reversed by treatment’ could, despite reassurances that the Bill is designed to apply to a small minority of people, cover many long-term conditions such as dementia, multiple sclerosis, cancer and HIV.

In some cases, available treatment does not reverse but slows progress of an illness and alleviates its symptoms – for example, artificial ventilation to help someone to breathe. Without it, many people would be ‘reasonably expected to die within six months’. In addition, prognosis at this range is notoriously unreliable.

Where assisted suicide or euthanasia have been legalised, there has been significant expansion of the groups who qualify - whether through broadening of the definition by statute or through evolution of the way the law is interpreted - to include people with psychiatric conditions such as long-term depression and (in the case of Belgium) children.

We strongly believe that the Bill would seriously undermine our efforts and lead unnecessarily to the deaths of many people whom as a society we should be helping to feel valued and to lead a fulfilled life.

Because of these concerns, we urge you to oppose the Assisted Dying Bill.

Yours sincerely,

Gary Fitzgerald, CEO, Action on Elder Abuse
Janine Tregelles, CEO, Mencap
Richard Hawkes, CEO, Scope
Tony Hayes, CEO, Veterans Association UK

Euthanasia Lobby assembles tiny group of doctors to create false impression of medical support for assisted suicide bill

The Cardinal Archbishop of Westminster, the Archbishop of Canterbury, the Chief Rabbi of the United Hebrew Congregations of the Commonwealth and the Secretary General of the Muslim Council of Britain are amongst the 24 faith leaders who have today voiced their shared concerns about Lord Falconer's Assisted Dying Bill.

You can read their statement in full and see all 24 names along with descriptions listed on a number of websites and also reproduced in the Telegraph. These faith leaders are fully transparent about what they think and who they are.

Contrast this with the ‘twenty-seven leading (medical) figures’ who, according to the Guardian, have written to peers asking them to back Falconer’s Bill.

The Guardian gives only a few isolated quotes from their letter and names only five of the signatories.

Of these five, three (Michael Rawlins, Graham Winyard and Terence English) are well-known members of Health Professionals for Assisted Dying (HPAD), the medical wing of the Voluntary Euthanasia Society, now rebranded Dignity in Dying.

They are listed on its supporters’ page amongst HPAD’s 602 health professional members. Even if we assumed that all of these 600 or so were registered medical practitioners (and many are actually either retired doctors or non-medics)  they would still make up only a tiny minority of the UK’s 260,000 registered GPs and specialists – to be precise less than a quarter of one per cent.

I expect that we would find most of the unnamed signatories on the HPAD list as well – which may well be why the Guardian has opted not to tell us who they actually are.

The two named signatories who don’t appear on the HPAD list are John Ashton, a well-known backer of assisted suicide, and Sir Richard Thompson, the president of the Royal College of Physicians.

However, as the Guardian acknowledges, this means very little as The Royal College of Physicians (RCP) and Royal College of GPs (RCGP) are both opposed to assisted dying. In their most recent surveys of their members' views, 73.2% of hospital doctors and 77% of family doctors said they were against legalising it.

The Guardian does not tell us that included amongst other official UK doctors’ bodies opposing any change in the law are the British Medical Association (BMA), the Association for Palliative Medicine (APM) and the British Geriatric Society (BGS).  

As Mark Porter , chairman of the BMA council, said earlier this year, ‘The BMA remains firmly opposed to legalising assisted dying. This issue has been regularly debated at the BMA's policy forming annual conference and recent calls for a change in the law have persistently been rejected.’

The British Geriatric Society in 2010 issued a strong statement on assisted suicide which outlined its concerns about how a change to the law would remove protection from vulnerable elderly people. The full statement is most worthy of study by all who take an interest in this debate. 

The World Medical Association (WMA) has also recently reiterated its strong opposition to euthanasia. The WMA similarly opposes assisted suicide.

A 2011 study showed that doctors in the UK have opposed both euthanasia and assisted consistently over the past two decades. Researchers from Limerick, Ireland, used 16 key studies into doctors' attitudes between 1990 and 2010. The findings appeared in the journal Palliative Medicine and further confirmed the fact that those doctors who favour a change in the law, constitute a small vocal minority.

The 27 ‘leading doctors’ quoted by the Guardian are merely part of that small vocal minority. They are entitled to their opinions but they do not speak for the medical profession.

It is astounding that the Guardian has managed to manufacture a headline out of this tiny group, whilst apparently lacking the balls even to publish the text of their letter or reveal most of their names. We've asked them for more information but so far there has been no reply.

The vast majority of doctors do not want Falconer’s Bill and it is disingenuous of the Guardian to try to suggest that it has serious or substantial medical support. 

Faith leaders unite against Assisted Dying Bill

The Archbishop of Canterbury has added his signature to a letter by faith leaders (see also here) calling for the Assisted Dying Bill not to pass through the House of Lords.

The statement has been released in response to proposed legislation by Lord Falconer which will be debated on Friday 18 July. It says:

‘As leaders of faith communities, we wish to state our joint response to Lord Falconer’s Assisted Dying Bill.

We do so out of deep human concern that if enacted, this bill would have a serious detrimental effect on the wellbeing of individuals and on the nature and shape of our society.

Every human life is of intrinsic value and ought to be affirmed and cherished.

This is central to our laws and our social relationships; to undermine this in any way would be a grave error.

The Assisted Dying Bill would allow individuals to participate actively in ending others’ lives, in effect colluding in the judgment that they are of no further value. This is not the way forward for a compassionate and caring society.’

The letter comes just days after former Archbishop of Canterbury George Carey announced he’s changed his mind on the issue and was supporting a change in the law (see my critique of Carey here).

Along with the Most Revd Justin Welby, the statement has been signed by Chief Rabbi Ephraim Mirvis, Dr Shuja Shafi of the Muslim Council of Britain and Lord Indarjit Singh of the Network of Sikh Organisations.

This latest stand comes in the footsteps of the unprecedented move by nine faith leaders representing the six major world faiths who wrote a similar letter to peers at the time of the Joffe Bill in 2005.

The full, text of that letter can be read here. 

Those helped to kill themselves under Lord Falconer’s Assisted Dying Bill may have years to live

Anyone listening to Lord Falconer talking about his ‘Assisted Dying Bill’ on Channel Four last Saturday night would have been led to believe (by Falconer itself) that it applied only to patients with hours or days to live. They were being misled.

The bill actually licenses doctors to dispense lethal drugs to mentally competent adults who have less than six months to live and a ‘settled wish’ to die.

But according to Margaret Dore (pictured), a Lawyer in Seattle Washington, who has experience of a similar law, says that even six months may be a gross underestimate.  

She argues that ‘eligible’ patients may have years, even decades, to live. 

Here’s her account – the references are on her website.

Lord Falconer’s Bill, which is based on the Oregon and Washington assisted suicide laws, would legalize assisted suicide for persons with a ‘terminal illness’, defined in terms of a prediction of less than six months to live. [1] The Oregon and Washington laws have a similar six months to live criteria. [2]

Under all three laws, ‘eligible’ patients may have years, even decades, to live. This is true for the following the following reasons:

1. Predictions of life expectancy can be wrong 

Patients may have years or even decades to live because predicting life expectancy is not an exact science. Consider John Norton who was diagnosed with ALS. He was told that he would get progressively worse (be paralyzed) and die in three to five years. Instead, the disease progression stopped on its own. In a 2012 affidavit, at age 74, he states:

‘If assisted suicide or euthanasia had been available to me in the 1950's, I would have missed the bulk of my life and my life yet to come.’ (Link) [3]

2. The six months to live is determined without treatment 

Consider Oregon resident, Jeanette Hall, who was diagnosed with cancer and decided to ‘do’ Oregon's law. Her doctor, Kenneth Stevens, didn't believe in assisted suicide and encouraged her to be treated instead. It is now 14 years later and she is ‘thrilled’ to be alive. This is Dr Steven's affidavit filed by the Canadian government in Leblanc v. Canada, now dismissed, discussing Jeanette. This is Jeanette's affidavit, also filed by the Canadian government in the same case.

3. In Oregon, the six months to live criteria is now being interpreted to include chronic conditions such as diabetes. 

Oregon doctor, William Toffler, explains: 

‘Our law applies to “terminal” patients who are predicted to have less than six months to live. In practice, this idea of terminal has recently become stretched to include people with chronic conditions such as chronic lower respiratory disease and diabetes. Persons with these conditions are considered terminal if they are dependent on their medications, such as insulin, to live. They are unlikely to die in less than six months unless they don’t receive their medications. Such persons, with treatment, could otherwise have years or even decades to live. ‘[4]

Margaret Dore is a lawyer in Seattle Washington the President of Choice is an Illusion.

Desmond Tutu’s arguments for assisted dying will fuel existing prejudice against the elderly, dying and disabled

It is perhaps in the nature of celebrities to champion causes they perceive to be popular. Celebrity bishops are no exception and Desmond Tutu’s support for Lord Falconer’s Assisted Dying Bill is not surprising but deeply disappointing.

Dignity in Dying, the former Voluntary Euthanasia Society, has assembled over 50 actors, sportsmen, entertainers, authors and other celebrities to add weight to their campaign - similar  people to those advertisers draft in to provide endorsement for consumer products.

The implication is that we should follow these celebrities and embrace their preferences.

And there is no doubt that so-called ‘assisted dying’ resonates strongly with the spirit of the age and its commitment to the beliefs that personal autonomy should trump all other considerations, that it is better to be dead than to suffer and that there are no moral absolutes.

These celebrities also fit the description of those who make most use of the law in the US state of Oregon – white, healthy, wealthy, college educated people who are used to being in control in life and want similarly to be in control in death.

Desmond Tutu has always been popular amongst the metropolitan liberal elite who disproportionately occupy the corridors of influence and power in Britain – parliament, the institutions, universities and the worlds of the arts, entertainment and media, and particularly the BBC.

His endorsement of the assisted dying cause will further strengthen their personal conviction that they are right.

However there are elements of Tutu’s argument that I find deeply disturbing, which I believe are deeply damaging to social attitudes towards the vulnerable and which greatly endanger our future cultural trajectory.

I would recommend that people read beyond the headlines of ‘Tutu embraces assisted dying’ and read his argument in full.

It’s clear first of all that Tutu has been profoundly influenced by the death of Nelson Mandela and the way his life was artificially prolonged nearing the end.

There are few people who would not sympathise with Tutu here. Life has a natural end. All of us are mortal. There is, as the good book says, a time to die. Intrusive ‘treatments’ at the end of life where the burden imposed on a dying person clearly outweigh any benefit should be avoided. Sometimes the treatment can be worse than the disease. We should not be ‘vitalists’, artificially prolonging life indefinitely just because we have the technology to do so. 

There comes a time when we must recognise that death is imminent, inevitable and that we are powerless to stop it, and that our priority must be to make the dying process as comfortable and bearable as possible. Part of that process will involve the withholding or withdrawal of inappropriately meddlesome therapeutic interventions. That is all part of good palliative care; it is in short good medicine.

But Tutu is arguing for far more than easing natural death. He wants to make it legal for doctors to kill people by prescribing legal drugs – and that goes against both the Hippocratic Oath which has for 2,500 governed the practice of medicine, and also thousands of years of the Judeo-Christian ethic as embodied in the sixth commandment  ‘Thou shalt not kill’.

What disturbs me most about Tutu’s argument are two key arguments that he uses to support his case.

First, Tutu argues that there is a duty for older people to die in order to make way for the young.

‘Dying is part of life. We have to die. The Earth cannot sustain us and the millions of people that came before us. We have to make way for those who are yet to be born…. But why is a life that is ending being prolonged? Why is money being spent in this way? It could be better spent on a mother giving birth to a baby, or an organ transplant needed by a young person. Money should be spent on those that are at the beginning or in full flow of their life.’

Such comments play into the hands of the likes of population controllers like Jonathon Porritt, chairman of the UK Government’s Sustainable Development Commission, who in the tradition of Malthus and Ehrlich, warn of ecological and environmental disaster ahead unless we do something rapidly to curb population growth. 

Up until now they have mainly argued that the best way of curbing population growth: contraception and abortion must be at the heart of efforts to combat global warming and couples who have more than two children are irresponsible. 

But it is a subtle extension of this same argument to say that the dependent elderly should make way for the younger generation by bringing forward their deaths. The right to die can so easily become the duty to die and the generation that has killed its children through abortion could very easily become that which is killed by its children through euthanasia and assisted suicide. Add in economic crisis, debt, cuts in health and welfare and the argument gains force by playing on popular prejudice against those perceived to be a drain on families and the state.

In the US state of Washington, where has enacted a law like Falconer’s, over six in ten of those making use of it do so because they believe they are a ‘burden’ on family, friends and caregivers. The law has removed the protection that vulnerable people currently have against the subtle coercion of relatives shouldering the care burden and anxiously eyeing a dwindling inheritance.

But the reality is that the overwhelming majority of elderly people want quite reasonably to live for as long as they can in the best state of health that they can. And the mark of a civilised society is that it makes sacrifices for the weak, rather than sacrificing the weak. ‘Bearing one another’s burdens’ is what St Paul said is at the very heart of the teaching of Jesus Christ; it is what true love really is (Galatians 6:2).

Second, Tutu argues that lives which depend on heavy medical intervention or technological support are not worth living.

‘I think when you need machines to help you breathe, then you have to ask questions about the quality of life being experienced and about the way money is being spent. This may be hard for some people to consider.’

I have two close friends who suffer from sleep apnoea so severe that they require CPAP (continuous positive airway pressure) machines to help them breathe at night. They each have a serious disability, and yet with the help of this medical technology are able to maintain ministries as international conference speakers.

I think of my many friends from the disabled community for whom technology – motorised wheelchairs, hoists, ventilators, dialysis machines, catheters and a bewildering array of drugs – make the difference between a life of utter dependency and one where they are enabled to function at an unbelievably high level. This is made possible by ongoing research and development, considerable financial investment and a willing supply of helpers and assistants.

There is a myth dangerously gaining traction today that medicine and technology have made our lives worse – that people are being kept alive by machines and that this is resulting in prolonged misery. The reality is the opposite. Because of medical and technological advances people are living longer than ever before and enjoying a better quality of life than ever before. And the overwhelming majority of people with terminal and chronic illnesses or disabilities do not want assisted dying but assisted living – help and support to live as long and as well as they can.

People who are dying and disabled value their lives in a very different way than those who are able bodied and have a remarkable ability to adapt.

This is why disabled people will be rallying in force outside parliament next Friday when Falconer’s bill is debated. They don’t want people like Tutu and others making judgements about whether or not their lives are worth living and suggesting that they are using up valuable resources that should instead be consumed by the young, vigorous and fit. We need to listen to them.

At the heart of the Christian story is Jesus Christ, the creator of the universe, who took the form of a servant to seek and save the lost. He brought compassion and healing to the elderly, dying and disabled and gave himself for us walking in the shadow of the cross and bringing the hope of life beyond death.

This is where Christians should be today – not campaigning like Tutu for lethal draughts of barbiturate to be made available for vulnerable people whose lives are judged not worth living in order to ease the burden of others who might have to care for them – but getting mobilised to provide time, money and manpower to make the lives of those who are dying and disabled as good as they possibly be until natural death intervenes in good time.

Desmond Tutu’s arguments in support of assisted dying will simply fuel existing prejudice against those who are elderly, dying and disabled. They should be seen for what they are and given the short shrift they deserve.

Might Miliband be brokering a manifesto deal with Falconer over assisted suicide?

Lord Falconer’s ‘Assisted Dying Bill’ will receive its second reading in the Lords on 18 July. The former Lord Chancellor wants to license doctors to dispense lethal drugs to mentally competent adults who have less than six months to live and a ‘settled wish’ to die.

According to the Sunday Times he is claiming that a majority of peers in the House of Lords now support a change in the law.

That seems rather unlikely given that there are over 760 peers – and that most of them have not yet declared a view - but I suspect Falconer fancies his chances of obtaining a majority at a poorly attended Friday evening sitting in late summer.

There are already 92 peers who have put their names down to speak in the debate which means we might be in for a late night finish.

We have also seen from other recent debates that there has been a significant change in the composition of the House of Lords since the last election in 2010. Large numbers of both new labour and conservative peers of a liberal social disposition have come in and things may not be as one sided as they were when Falconer last tried to change the law on this issue with an amendment to the Coroners and Justice Bill in 2009. Then he lost by 194 votes to 141.

The 200 or so new peers may outwardly look like establishment figures but we need to remember than many of them were in their teens and twenties during the 1960s and imbibed fully that generation’s values (!). They are rich and powerful and also strongly politically correct. And assisted suicide is seen as a popular liberal cause.

Even if Falconer manages to win a second reading for his bill it needs to go through committee and third reading stage in the Lords and through three readings in the Commons before going for royal assent and finally becoming law. And this is a private member's bill, not a government bill, so no one is going to be in a great hurry to get it onto the statute books.

And with a general election looming in May 2015 there is not going to be much time for it either. Nor will there be much appetite for anything so controversial with election campaigns in full swing.  

Or will there? David Cameron is on the record as being strongly opposed to changing the law to allow any form of euthanasia on public safety grounds. There is therefore little possibility, even given a conscience vote, of assisted suicide ever getting the nod under a Tory-led House of Commons. But a Labour or Lab-Lib government after the next election may be another prospect altogether.

Ed Miliband, however, has not yet revealed his hand on the matter. Labour sources apparently say the party regards the issue as one on which MPs and frontbenchers should be given a vote. But insiders, according to the Sunday Times, say that Miliband sympathises with Falconer’s efforts and that the party is considering a guarantee of government time to discuss it if it wins the next election.

Falconer was Tony Blair’s former flatmate and it’s no secret how he was elevated to the peerage: Tony Blair appointed him. Again from the Sunday Times:

'He built up a successful career as a barrister but failed to be adopted as a prospective Labour MP because he refused to take his children out of private schools. But Blair made him a peer in 1997 and a minister soon after that. Falconer rose quickly through the ranks — solicitor-general, minister for the Millennium Dome, housing, Home Office and then, in 2003, lord chancellor and later justice secretary.'

He is now in a powerful position to further his personal agenda of legalising assisted suicide.

Again according to the Sunday Times:

‘Falconer is just about the only member of the Blair inner circle to be close to Ed Miliband. He has been appointed “head of the transition”, a rather grand piece of American jargon for Ed’s hoped-for move into Downing Street. This means Falconer will have a central role in any coalition negotiations and in the appointment of ministers…. He is a skilled lawyer, a proven political operator…’

It is then not beyond the realms of possibility that Falconer could be using his power to seal a deal with Miliband for some parliamentary time for his bill after the 2015 election, should Miliband have the good fortune to win. Perhaps he might seek even to get it into the Labour manifesto?

It will be a difficult call for Miliband. On the one hand he will be concerned about gaining the support of the growing super wealthy liberal elite – the coterie of celebrities, politicians, sportsmen, actors and entertainers who are gagging for this legal change. See Dignity in Dying's patrons' page for a taster.

Based on the evidence from other jurisdictions where assisted suicide is legal such as the US states of Oregon and Washington, it is precisely this group, those who are most used to being ‘in control’ in life, who are also the most likely to seek 'control' over the one thing they most fear… dying and death. The main reasons given for seeking assistance to take ones own life in the US North-West are not pain and suffering but rather loss of autonomy, loss of dignity and loss of enjoyment of life. 

But on the other hand the poor, weak and vulnerable – those who are sick, elderly or disabled – are the very ones who will be most at risk from exploitation and abuse should assisted suicide be legalised.

In a Britain where there is a widening gap between rich and poor, many are still struggling financially and, given increasing pressure on the NHS, are also those who are most likely to be subtly steered towards suicide either for fear of being a financial or emotional burden on their families, or because a glass of barbiturate is much cheaper than the costs of a care home, palliative treatment or a cycle of chemotherapy. In other words they will 'choose' assisted suicide because they can't afford any other of the 'choices' on offer and don't have the range of healthcare choices the rich and famous have. 

The fundamental problem with offering assisted suicide as a ‘therapeutic option’, which Falconer is attempting to do, is that killing oneself ‘with assistance’ will be by far the cheapest ‘choice’ available. 

And this alone will make it hugely tempting to greedy relatives worried about an inheritance being spent on care or to health ministers looking for budgetary cuts whilst faced with the burgeoning healthcare needs of a growing elderly population. And the so called 'right' to die could then very easily become the duty to die - doing the decent thing.

So which route will Miliband go? Will he accede to the wishes of the wealthy liberal elite, the politically correct? Or will he make protection of the poor and vulnerable his key priority?

At present he seems, perhaps deliberately, to have chosen to keep all options open.

Doctors strike back at BMJ editors over assisted suicide stance

BMJ editors Fiona Godlee (pictured) and Tony Delamothe are long-time supporters of decriminalising assisted suicide and have frequently used their editorial position in Britain’s most widely read medical journal to advance their cause.

This week they have written an editorial in support of Lord Falconer’s Assisted Dying bill which has understandably received a lot of media coverage (see here, here and here) and has got the blogosphere buzzing (see here, here, here and here).

They argue that assisted dying should be legalised because respecting ‘choice’ (autonomy) is now a more important priority than preserving life.

The BMJ is editorially independent from the British Medical Association (BMA) but is paid for by the subscriptions of BMA members, most of whom do not support changing the law.

So it is not surprising that their editorial has generated a lot of correspondence, almost all of it opposing Godlee and Delamothe.

Dr Mark Porter, chairman of the BMA council has said:

‘There are strongly held views within the medical profession on both sides of this complex and emotive issue.

The BMA remains firmly opposed to legalising assisted dying. This issue has been regularly debated at the BMA's policy forming annual conference and recent calls for a change in the law have persistently been rejected.

The BMJ is a wholly owned subsidiary of the BMA, and quite rightly has editorial independence. Its position on assisted dying is an editorial decision and does not reflect the views of the BMA or the medical profession. Our focus must be on making sure every patient can access the very best of palliative care, which empowers patients to make decisions over their care.’

A letter in the same print edition (so received before the editorial was published) from RCGP Council Chair Maureen Baker makes clear that the recent RCGP consultation on ‘assisted dying’ was comprehensive and conclusively in favour of no change to the law.

‘Our recent consultation on assisted dying was one of the most comprehensive ever undertaken, with 1700 members responding from all four nations of the UK.

The result was conclusive—77% of members who submitted responses directly to the college indicated that the RCGP should maintain its opposition to a change in the law.

Of the 28 RCGP bodies and groups who responded, 20 reported a majority view in favour of maintaining the college’s opposition to a change in the law and three reported a majority view in favour of a “neutral” stance. None reported a majority view in favour of active support for a change in the law.’

There is also an excellent contribution, again the same print edition, from Rob George, professor of palliative care, Cicely Saunders Institute, King’s College London. 

In an article titled ‘We must not deprive dying people of the most important protection’ he argues that the safety of vulnerable people must take priority over the determined wishes of individuals. Hard cases are already dealt with mercifully under the law which does not need changing.

‘Elizabeth Butler-Sloss, former president of the High Court, said, “Laws, like nation states, are more secure when their boundaries rest on natural frontiers. The law that we have rests on just such a frontier . . . The law is there to protect us all. We tinker with it at our peril.”

For me the real question is this: “Which is worse: not to kill people who want to die or to kill people who might want still to live?” In my experience it is impossible to separate those who might want to die from those who believe they ought to die and whose view is pretty well never “settled.” No one can be sure that some people not now at risk will find themselves so were the law to change.

A full blooded expression of autonomy includes the responsibility at times to restrain oneself on behalf of another: when it comes to having our lives ended, let’s keep it that way. Once this line is crossed there is no going back.’

I was briefly quoted in the Telegraph making much the same point about the limits of autonomy:

‘While autonomy is important it has to be balanced against other principles including public safety.

None of us believes autonomy is absolute, if we did we would have to say that there was no place for law because every single law restricts personal autonomy.’

Godlee and Delamothe appear not to understand that autonomy has limits. They are also well out of step with medical opinion and do not speak for the medical profession.

About two thirds of doctors in most surveys are opposed to any change in the law along with all the major medical institutions including the BMA, RCGP, RCP, British Geriatric Society and the Association for Palliative Medicine.

In a free society choice is important, but it has its limits. The duty to protect life trumps the so-called ‘right to die’.