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.