‘Selective reduction’ – a euphemism for deliberately killing one or more babies in an IVF pregnancy

Last week’s Life Site News ran a story titled ‘Five best and worst biotechnology developments of 2011 from a pro-life perspective’ which is well worth a read in its own right.

The third worst development it mentions is that of ‘selective reduction’:

'This year we were introduced to the ugly practice of selective reduction, a euphemistic term that describes the killing of one fetus in a multiple pregnancy. Selective reduction is becoming more commonplace because fertility treatments like IVF are creating more and more multiples and doctors are advising patients to “reduce” their quadruplets, triplets and even twins down to two or even one baby. In 2011 the world discovered the truth that abortion is the "safety net" for IVF.'

Selective reduction has actually been common practice for some time but it was brought to international attention in 2011 by an article in the New York Times titled ‘The Two-Minus-One Pregnancy’ which catalogued the rise of the procedure in the US.

An Australian story later in 2011, highlighted on this blog, described a situation where doctors had ‘mistakenly’ killed a ‘normal’ twin instead of the disabled one they had intended to eliminate. The ‘unwanted’ disabled twin was also later aborted.

The Telegraph ran a front page story over New Year about the increasing use of ‘selective reduction’ in the UK on which I was asked to comment. This was later picked up by the Daily Mail and Press Association but not, interestingly, by the BBC. PA summarized it as follows:

Dozens of unborn babies were aborted in 2010 by British women expecting multiple births but who wanted fewer children. Department of Health statistics found that more than 100 babies were terminated by women expecting twins, triplets or quintuplets.

The statistics, released under the freedom of information law, revealed that in 2010, 85 women aborted at least one foetus while going on to give birth to another baby. This compares to 59 women in 2006. Of the 85 women undergoing selective reductions last year, 51 were reducing a pregnancy from twins to a single baby, up from 30 four years before.

The data showed that there were 20 abortions to reduce triplets to twins and nine procedures to take a pregnancy from triplets to a single child. Three mothers reduced four foetuses to two, and two mothers reduced five babies to two.

The Department of Health said 78% of the selective reductions performed in 2010 were because there was ‘a substantial risk that if a child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped’ (ie. ground E abortions) but Professor Richard Fleming, the scientific director of the Glasgow Centre for Reproductive Medicine, is reported as saying: ‘I would be surprised if multiple pregnancy through fertility treatment was not a significant component to the increase in selective reductions. One of the components within that is the health of the mother and health of the offspring as well - both are compromised by multiple pregnancy. The more complicated multiple pregnancies lie almost exclusively in the IVF domain.’

According to the HFEA website (see here and here):

‘On average, one in five IVF pregnancies are a multiple pregnancy compared to one in 80 for women who conceive naturally. With approximately 11,000 IVF babies being born each year this contributes significantly and disproportionately to the national multiple birth rate and presents a significant public health concern…. In 2004 the HFEA policy was revised so that now a maximum of two embryos can be transferred to women under the age of 40, with no exceptions, and a maximum of three can be transferred in women aged 40 and over. Since 2004 only 4 in every 100 treatment cycles (4%) performed involved three embryos being transferred.’

Transfer rates in IVF are higher in some other countries:

I was quoted in the Telegraph article as follows:

‘There is no doubt that the rising use of IVF has contributed to a rise in multiple pregnancies. If prospective parents are not willing to have twins then they should not be implanting more than one embryo at a time. Parental preference should never take precedence over the right to life of the unborn child.’

But the full quote I gave them was a little longer and also brought in other medical and psychological issues that the Telegraph decided not to include. here are some of the words they left out:

'...there is very little evidence to suggest that parents choosing IVF will be any more successful in having a successful pregnancy implanting two embryos at once rather than one at a time... Furthermore some families who electively abort one of their children go on to experience a lot of grief. At every milestone for the child they decided to keep, there is this ghost in the room, this feeling that there should have been two or more of them. There is an urgent need to educate couples about these matters’.

I was interested to see further support for the idea of transplanting only one embryo at a time in a BBC article this week on the survival of frozen embryos titled ‘IVF: Frozen embryo babies heavier and healthier’

'Infertility Network UK chief executive Clare Lewis-Jones said the new study supported the move to transferring only one embryo at a time. This cuts down the multiple pregnancy rate - which is higher in IVF than natural conception - with health benefits for mother and baby. She said: "These initial findings, if proved accurate following further research, will give the medical profession more evidence to encourage patients to accept single embryo transfer, which reduces the risks of multiple births to both mother and babies. Single embryo transfer gives the best possible outcome - a healthy singleton baby - with the chance of further frozen embryo transfers in the future."'

I am not advocating IVF, multiple embryo collection, or freezing embryos. But if more than one embryo is being collected in an IVF cycle then, for more reasons than one, it seems best to follow a policy of one embryo being transferred at a time.

This will be mean better survival prospects for the baby and, more importantly, no selective reduction.

Five Quick Videos on the Falconer Commission on ‘Assisted Dying’ – What is it all about?

5 January 2012 marked the launch of the findings of the Commission on Assisted Dying, proposed by Dignity in Dying, funded by Sir Terry Pratchett and chaired by Lord Falconer (pictured).

The Commission has called for a change in the law in England and Wales, to allow assisted suicide for adults who are terminally ill and mentally competent but CMF, as part of the Care Not Killing alliance, believes that the current law does not need changing.

I have blogged a lot about this enquiry over the last year or so and especially in the last few days.

Over the last two days I have done 25 broadcast interviews on it including BBC, Sky and international TV networks.

The issues are complex and I know it can be difficult for people to get the big picture so in the five short You Tube videos below I have tried to summarise the main issues in the form of five key questions.

I hope they provide a helpful overview for anyone with an interest in the issue but without too much time to spare.

1. Was the Falconer Commission sufficiently balanced? (1m54s)

2. Do the Falconer recommendations contain sufficient safeguards? (2m10s)

3. Why has Parliament refused to change the law so far? (1m02s)

4. What happens now that the Falconer Commission has reported? (1m41s)

5. Why should Christian doctors be concerned about this issue? (2m52s)

Falconer report on euthanasia 'biased and flawed', says Care Not Killing

Here is the press release from the Care Not Killing Alliance (representing over 40 organisations) on the Falconer Commission Report.

Falconer report on euthanasia 'biased and flawed', says Care Not Killing

This investigation was unnecessary, biased and lacking in transparency and its report is seriously flawed. It is being spun as a comprehensive, objective and independent review into this complicated issue. It is anything but.

This private commission was sponsored by Dignity in Dying, formerly the Voluntary Euthanasia Society, and financed by one of their patrons, with panel members being handpicked by Lord Falconer, a leading advocate of changing the law.

Nine of its eleven members were known backers of assisted suicide with a strong ideological vested interest in this as the outcome. Those with a differing view including representatives from the major disability rights organisations and doctors groups were not invited to join the Commission. The overt bias in the structure of the commission is why over 40 organisations including the British Medical Association and many individuals boycotted the inquiry.

Its terms of reference were drafted to ensure that the final report backed a change in the law and ruled out maintaining the status quo. In the commission’s own words they were to, ‘investigate the circumstances under which it should be possible for people to be assisted to die; recommend what system, if any, should exist to allow people to be, assisted to die; identify who should be entitled to be assisted to die and recommend what changes in the law, if any, should be introduced’.

What the commission is proposing is a less safe version of the highly controversial Oregon law, which sees the terminally ill offered drugs to kill themselves, but not expensive life saving and life extending drugs. It’s so-called ‘proposed safeguards’ are paper-thin and have already been rejected three times in the last six years by British Parliaments. These recommendations if implemented will place vulnerable people under increased pressure to end their lives so as not to be a burden on others. This pressure can be especially intense at a time of economic recession when families and the health service are already feeling the pinch. The so-called right to die can so easily become the duty to die..

The current law exists to protect those who are sick, elderly, depressed, or disabled from feeling obliged to end their lives. It requires every case to be reviewed by the police and the DPP to determine whether a prosecution is appropriate. The present law protects those who have no voice against exploitation and coercion, acts as a powerful deterrent to would-be abusers and gives discretion to judges to temper justice with mercy in hard cases.

The current law does not need changing.

Lord Falconer’s commission – help in reading what lies between the lines in their press release

Lord Falconer’s Commission on Assisted Dying is reporting today.

I have reproduced below their press release which needs to be taken with a large helping of salt.

I have added my own comments marked in italics in order to help people read ‘between the lines’

Expert panel proposes framework to underpin any future change in law on assisted dying for terminally ill people

The Commission on Assisted Dying will today (Thursday) publish a 400 page report into the safeguards that would need to be in place for a safe assisted dying law to operate in England and Wales. The expert panel Chaired by Lord Falconer QC includes members of the House of Lords and House of Commons, a former president of the General Medical Council, a former Police Commissioner, a leading consultant in disability equality, an Anglican priest and medical, mental health, palliative care and social care specialists.
>> The Falconer commission was sponsored by Dignity in Dying, formerly the Voluntary Euthanasia Society, and financed by Terry Pratchett one of their patrons, with panel members being handpicked by Lord Falconer, a leading advocate of changing the law. Nine of its eleven members were known backers of assisted suicide with a strong ideological vested interest in this as the outcome. Asking this group for guidance on assisted suicide laws is like asking Philip Morris and British American Tobacco to advise on smoking legislation!

Over the last twelve months the Commission has held extensive public evidence hearings and consultations, conducted international research visits and commissioned expert briefing papers to produce the most comprehensive study to date of how a change in the law on assisted dying might affect English and Welsh citizens.
>> 46 high profile individuals and 40 organisations invited by Falconer to give evidence to his commission opted not to do so on the grounds that it was unnecessary, biased and lacking in transparency. With so many people pulling out Falconer was able only to hold six monthly oral evidence sessions and ran out of witnesses half way through the year. He then asked Dignity in Dying to email all their supporters to provide ‘evidence’ by filling out simple questionnaires. These responses made up the bulk of the 1,200 responses the commission claims to have received. Falconer also fails to tell us that in 2005 a balanced House of Lords Select Committee carried out an official parliamentary Inquiry into assisted suicide. This covered some 246 Hansard columns and two volumes of 744 pages and 116 pages respectively, 15 oral sessions, 48 groups or individuals giving evidence, with 88 witnesses giving written evidence; 2,460 questions were asked and the committee received 14,000 letters. Falconer’s enquiry, in comparison, was not only unbalanced but miniscule.

The Commission finds that the choice of assisted dying could safely be offered to people who are suffering at the end of life and likely to die within twelve months, provided that they satisfy the eligibility criteria. People who might not have the mental capacity to make such a choice, who might be clinically depressed or experiencing pressure from friends or relatives, would be protected by a comprehensive set of safeguards.
>> Well no surprises here. These are the conclusions that Dignity in Dying has paid for and campaigned for. Cash for conclusions!

The Commission also finds that the provision of high quality end of life care must be a priority for Government, independent of the issue of assisted dying. It recommends that in parallel with any change in the law, the Government should also take action to tackle inequalities in end of life care and ensure that good quality end of life care is available to every person approaching the end of their life.
>> Well would hope so. We all want this. Wouldn’t it have been wonderful if some of the time and money wasted on this commission might have been spent on achieving such ends.

Under the proposed framework, a dying person who met the legal criteria would be able to ask their doctor to prescribe them a dose of medication that would end their life. The person would need to be able to take the medication themselves, as a clear expression of the voluntariness of their choice. Appropriate practical support to take the medication should be provided if it is required by a terminally ill person with physical impairments but this could not take the form of another person administering the medication on their behalf (euthanasia). The Commission does not propose that any form of euthanasia might be allowed if the law were to be changed.
>> OK so they are recommending the law be changed to decriminalise assisted suicide (where people are helped to kill themselves) but not euthanasia (where people have their lives ended by someone else). But they use the word ‘medication’ when what they really mean is ‘lethal drugs’. And to say that ‘no form of euthanasia is proposed’ is splitting hairs because assisted suicide is a form of euthanasia. It is euthanasia one step back. The intention and result are the same. In fact the difference can be as little as one centimetre – if you put the lethal drugs in the patients hand that is assisted suicide; on the tongue and that’s euthanasia. And in about one in six cases assisted suicide doesn’t work (see original NEJM paper by Groenewoud)leaving the euthanasiast to wade in with a lethal injection.

The Commission recommends that if Parliament were to decide to adopt assisted dying legislation in the future, this should include the following eligibility criteria:
1.The person concerned is aged 18 or over and has a diagnosis of terminal illness
>> There is a huge difference between being terminally ill and having a terminal illness. Many live for years with terminal illnesses.

2.The person is making a voluntary choice that is an expression of his or her own wishes and is not unduly influenced by others
>> So what does unduly mean? And how is a doctor who does not know the patient or the relatives supposed to be able to make this assessment?

3.The person has the mental capacity to make a voluntary and informed choice, and the person’s decision-making is not significantly impaired as a result of mental health problems such as depression
>> What do we mean by significantly impaired and how is this to be assessed?

The Commission recommends that any future legislation should also include the following safeguards to ensure that potentially vulnerable people were protected:
1. A decision-making model involving the assessment, advice, support and independent judgements of two independent doctors, with support from other health and social care professionals where necessary.
2.A safeguard to ensure the person has been fully informed of all other treatment and end of life care options that are available and still wishes to proceed;
3.Safeguards to ensure that the eligibility criteria are met
4.Safeguards to ensure that the person has a settled intention to die
5.Safeguards to ensure the safe storage and transportation of lethal medication
6.Safeguards to ensure the person has a reliable and supported assisted death
7.Safeguards to ensure that assisted deaths are reported correctly
8.Monitoring and regulatory oversight by a national monitoring commission with powers to investigate suspected non-compliance.
>> This is a system very similar to the abortion act 1967 which was initially intended to apply only in extreme cases but has resulted in over seven million cases of abortion (prenatal involuntary euthanasia) since it was instituted – now about 200,000 per year. It is not difficult to find a small number of doctors who will willingly tick boxes and even perjure themselves in the process. After the event the key witness is dead and cannot give evidence about whether or not procedures were followed or just alleged to have been followed. Otherwise these safeguards were all (with the possible exception of no 5) included in the Joffe Bill which was rejected by 148-100 in 2006 by the House of Lords on the grounds of public safety. Peers considered its so-called safeguards were paper thin. The commission is proposing a less safe version of the highly controversial Oregon law, which sees the terminally ill offered drugs to kill themselves, but not expensive life saving and life extending drugs. Except that the Oregon Law uses a six month life expectancy for terminal illness, not twelve months like Falconer. In practice both limits are equally problematic as it is very difficult for any doctor to predict life expectancy accurately apart from in the last hours or days of life. These recommendations if implemented will place vulnerable people under increased pressure to end their lives so as not to be a burden on others. This pressure can be especially intensely felt at a time of economic recession when families and the health service are already feeling the pinch.

The Commission stresses that the issue of assisted dying cannot be viewed in isolation from the need for adequate health and social care, and emphasises the urgent need to improve discussions with patients about the care they wish to receive at the end of life. The Commission recommends that if assisted dying were to be legalised in the future, we would need to make improvements in end of life care in parallel, to ensure that all people dying in the UK could expect to receive an adequate level of care, regardless of where they lived. The Commission puts forward a series of core principles that frame and run throughout their recommendations on assisted dying. These are:
• Open discussion about death and dying
>> Well we have that already – we have been talking about it continually for the last five years as we are subjected to wave after wave of campaigning form the pro-euthanasia lobby.

• Each person should be entitled to core rights in end of life care
>> Well of course unless we mean the right to be killed or to have someone help you kill yourself which is not a right recognised by any religion or historic ethical or legal code or declaration.

• Good quality end of life care should be available in all settings
>> Well that goes without saying but what is Falconer doing to achieve it?

• An end to all forms of discrimination in end of life care, whether these are based on geographical location, physical condition, ethnicity or wealth
>> Great although not yet achieved since the foundation of the world in any country and legalising assisted suicide will provide a cheap alternative - £1,000 a week for care or £5 for a glass of barbiturates?

• More choice in how people die and clear and accessible information
>> Well we all know what that means…

• Effective support and protection for more vulnerable people
>> So why are we changing the law to remove legal protection from vulnerable people?

Notes to editors:

…Evidence brought before the Commission on Assisted Dying has led the Commission to conclude that the current policy outlined by the Director of Public Prosecutions in February 2010 is unsustainable for the following reasons:
• The current law concentration of too much power in the hands of the DPP
>> Agreed. He does seem to lack the courage to prosecute people. We need to be encouraging him to do his job more effectively!

• The absence of a robust scheme of safeguards
>> We would not need safeguards with a blanket prohibition on assisted suicide as at present. The number of cases is very small – 20-25 per year – but we would have 1200 a year with an Oregon law and 13,000 with a Dutch law according to the 2005 House of Lords report

• The absence of a factor based on suffering or a medical condition
>> The problem is that many people without terminal medical conditions claim to be suffering (at least mentally). If we legalise it only for those who are terminally ill we will very soon see claims of discrimination by others and Equality Law will be brought into play to extend the boundaries

• The lack of clarity for health and social care professionals
>> The law and the DPP guidelines are actually very clear. If you are a doctor don’t assist with suicide or you may well be prosecuted

• The reliance of amateur assistance
>> OK so let’s have professional assistance? Why not just enforce the existing law.

• The discrimination against people who not have the capacity to end their own life
>> A strange sort of discrimination indeed!

• The impact of friends and family being treated as ‘suspects’.
>> How else are the police supposed to find out if the law has been broken other than by investigating each case?

The Commission on Assisted Dying is made up of (I have added other relevant facts which are linked elsewhere on this blog)

Lord Charles Falconer (Chair) Barrister and Senior Counsel based in Gibson, Dunn & Crutcher’s London office. Former Lord Chancellor and Secretary of State for Justice in the Blair government.
>> Long time supporter of assisted suicide who tried to legalise it via an amendment to the Coroners and Justice Bill in 2009. Defeated by 194-151!

Professor Sam Ahmedzai Professor of Palliative Medicine and head of the Academic Unit of Supportive Care at the School of Medicine and Biomedical Sciences, University of Sheffield.
>> Unlike 95% of palliative medicine physicians a supporter of assisted suicide explaining his presence on the committee

Lord Ian Blair of Boughton Cross Bench Peer and former Commissioner of the Metropolitan Police.
>> Strong supporter of the legalisation of assisted suicide

Sir Graeme Catto President of the College of Medicine and former President of the General Medical Council.
>> And supporter of Healthcare Professionals for Assisted Dying – set up under the auspices of DID

Dr Carole Dacombe Medical Director, St Peter’s Hospice.
>> Unlike 95% of palliative medicine physicians a supporter of assisted suicide explaining her presence on the committee

Dr Stephen Duckworth Founder and former Chief Executive of Disability Matters Limited and board member of the Olympic Delivery Authority.
>> Another black sheep. Unlike the five major disability rights groups in the UK (NCIL, SCOPE, UKDPC, RADAR, NDY) he actually supports assisted suicide legislation and was chosen for this purpose. His organisation Disability Matters Limited stopped trading last year

Penny Mordaunt MP Conservative Member of Parliament for Portsmouth North.
>> Chair of the All Party Parliamentary Group on Choice at the end of life – the political wing of Dignity in Dying, which provides its secretariat.

Baroness Elaine Murphy of Aldgate Crossbench life peer, Secretary to the All Party Parliamentary Group on Mental Health and a vice-president of the Alzheimer’s Society.
>> Long-time supporter of assisted suicide who has voted to decriminalise it in the past

Dame Denise Platt DBE Member of the Committee on Standards in Public Life.
>> Prior views not known but has clearly ‘come around’

The Reverend Canon Dr James Woodward Anglican priest and Canon of St George’s Chapel, Windsor.
>> The 'token vicar' who is grought on to legitimise the enquiry but who does not actually support the Commission’s conclusions

Baroness Barbara Young of Old Scone Life Peer in the House of Lords and Chancellor of Cranfield University.
>> Long-time supporter of assisted suicide who has voted to decriminalise it in the past

Individuals and Organisations who refused to give evidence to Falconer Commission

The Falconer Commission on 'Assisted Dying', which publishes its report today, has been accused (quite rightly) of being unnecessary, biased and lacking transparency.

It was sponsored by Dignity in Dying, formerly the Voluntary Euthanasia Society, and financed by Terry Pratchett one of their patrons, with panel members being handpicked by Lord Falconer (pictured), a leading advocate of changing the law.

Nine of its eleven members were known backers of assisted suicide with a strong ideological vested interest in this as the outcome.

Asking this group for guidance on assisted suicide laws is like asking Philip Morris and British American Tobacco to advise on smoking legislation!

Here is the (long) list of 46 individuals and 40 organisations who were invited to give evidence to the commission but refused to do so.

Individuals

Dr Idris Baker, Consultant and Lead Clinician in Palliative Medicine,
Abertawe Bro Morgannwg University Local Health Board

Dr Christopher Baxter, Medical Director, North London Hospice

Professor Nigel Biggar, Regius Professor of Moral and Pastoral Theology,
University of Oxford

Dr Krishnakant Buch, GP, Lower Broughton Health Centre, Salford

Baroness Jane Campbell, crossbench life peer and Chair, All Party
Parliamentary Disability Group

Rt Revd and Rt Hon Richard Chartres, Bishop of London

Dr Mark Clayton, GP, Bideford Medical Centre, Devon

Lord Nigel Crisp, crossbench life peer, House of Lords

Dr Andrew Davies, Consultant in Palliative Medicine, Royal Surrey County
Hospital

Alison Davis, National Coordinator, No Less Human

Dr Jennifer Dixon, Director, Nuffield Trust

Professor Phil Fennell, Professor of Law in Cardiff Law School, University of Wales

Dr David Feuer, Consultant in Palliative Medicine, St Bartholomew’s
Hospital, London

Frank Field MP

Baroness Ilora Finlay, Professor of Palliative Medicine, Cardiff University
School of Medicine

Dr Rob George, Consultant in Palliative Care, Guy’s and Thomas’ Foundation Trust

Baroness Brenda Hale, Justice of the Supreme Court

Chris Ham, Chief Executive, The King’s Fund

Lord Khalid Hameed, crossbench life peer

Professor Rt Rev Lord Harries, crossbench life peer and Gresham Professor of
Divinity

Diane Haywood, Macmillan Lead Nurse, Specialist Palliative Care, Barts and
the London NHS Trust

Professor Irene Higginson, Professor of Palliative Care and Policy, King’s
College London

Dr Andrew Hoy, Consultant in Palliative Medicine, Princess Alice Hospice,
Surrey

Tessa Ing, Head of End of Life Care, Department of Health

Dr Jeremy Johnson, Medical Director, Severn Hospice, Shrewsbury

Professor Allan Kellehear, Director for the Centre for Death & Society

Professor Sir Ian Kennedy, Emeritus Professor of Health Law, Ethics and
Policy, University College London

Professor John Keown, Professor in Christian Ethics, Georgetown University

Lord James Mackay of Clashfern, Chairman of the Select Committee on the
Assisted Dying for the Terminally Ill Bill

Dr Wendy Makin, Christie Hospice, Manchester

Barbara Monroe, Chief Executive, St Christopher’s Hospice

Rt Revd James Newcome, Bishop of Carlisle

Dr Gareth Owen, Honorary Consultant, South London and Maudsley NHS
Foundation Trust

Rt Rev George Pitcher, Curate, St Bride’s Church, Fleet Street

Rt Rev Dr Lee Rayfield, Bishop of Swindon

Lord Jonathan Sacks, Chief Rabbi of the United Hebrew Congregations of
the Commonwealth

Dr Peter Saunders, CEO, Christian Medical Fellowship

Professor Julian Savulescu, Uehiro Chair in Practical Ethics, University of
Oxford

Peter Southern, Affiliated Social Worker, Barts Cancer Centre Palliative Care
Team, Barts and The London NHS Trust

Dr Patrick Stone, Macmillan Reader in Palliative Medicine, St Georges,
University of London

Judge Philip Sycamore, Department of Law, Lancaster University

Aswini Weererante, Barrister, Doughty Street Chambers

Michael Wenham, author of My Donkey Body

Dr Paul Whelan, Consultant in Psychiatry of Old Age, North Westminster
Community Mental Health Team

Dr Andrew Wilcock, Clinical Reader, Faculty of Medicine & Health Sciences,
University of Nottingham

The Most Revd and Rt Hon Rowan Williams, Archbishop of Canterbury

Organizations

Academy of Medical Royal Colleges
Age UK
Alert
Alzheimer’s UK
Association for Palliative Medicine
Association of British Neurologists
Association of Directors of Adult Social Services
Association of Hospice and Palliative Care Chaplains
BMA Ethics Committee
British Institute of Human Rights
British Medical Association
British Psychological Society
Care Not Killing Alliance (representing over 40 organisations)
Carers UK
Disability Alliance
Disability Awareness in Action
Dying Matters Coalition
Equalities and Human Rights Commission
Huntingdon Disease Association
Living and Dying Well
Macmillan Cancer Support
Marie Curie Palliative Care Institute
Marie Curie Cancer Care
Mind
Motor Neurone Disease Association
Multiple Sclerosis Trust
Muslim Council of Great Britain
National Council for Palliative Care
National Pensioner’s Convention
Parkinson’s Disease Society
Patients Association
Progressive Supranuclear Palsy Association
Royal College of Anaesthetists
Royal College of Nursing
Royal College of Physicians
Royal College of Psychiatrists
Royal Society of Medicine
Sue Ryder Care
The Stroke Association

What Falconer does not say about assisted suicide is even more worrying than what he does say

On New Year’s day, Lord Falconer (pictured) wrote an opinion piece for the Daily Telegraph with the specious title ‘A duty of care to our last days on Earth’. It was subtitled ‘Do Britain’s laws on assisted dying work, and if not, what should replace them?’

The piece was an advertorial for the much trumpeted (by the cheerleading BBC) publication of his ‘Commission on Assisted Dying’ final report this Thursday which he tells us will provide a ‘possible way forward, which addresses the need for safeguards’ for the legalisation of assisted suicide in Britain.

I have summarised his main points here along with my comments (but this is a long post so if you are short of time skip to the summary):

1. Our task was to assess whether the current law and policy towards assisting terminally ill or seriously disabled people to commit suicide works. And, if we think it does not, to consider if there is a workable alternative. We hope the report will both stimulate debate and guide policy-makers when making future decisions.

Falconer makes it sound as though someone in government was officially commissioning him to carry out this report. In fact he is a well-known advocate of assisted suicide and attempted unsuccessfully to legalise it in 2009 in an amendment to the Coroners and Justice Bill. His commission is actually a campaign strategy – suggested by Dignity in Dying (formerly the Voluntary Euthanasia Society) and part-financed by one of their patrons, celebrity novelist Terry Pratchett. Furthermore, nine of his twelve hand-picked commission members had previously expressed support for the legalisation of assisted suicide.

2. We heard ‘evidence from more than 40 witnesses and (considered) submissions from 1,200 individuals and institutions’.

What Falconer doesn’t tell is that over 40 organisations, including the British Medical Association,refused to give evidence to his enquiry on the basis that it was unnecessary, biased and lacking in transparency. He also fails to tell us that in 2005 a balanced House of Lords Select Committee carried out an official parliamentary Inquiry into assisted suicide. This covered some 246 Hansard columns and two volumes of 744 pages and 116 pages respectively, 15 oral sessions, 48 groups or individuals giving evidence, with 88 witnesses giving written evidence; 2,460 questions were asked and the committee received 14,000 letters. Falconer’s enquiry, in comparison, was not only unbalanced but miniscule.

3. We heard from disabled people who felt that the law on assisted suicide discriminated against them. While a non-disabled person might end their life without assistance (suicide has been legal since 1961), a person whose impairment makes this impossible is forced to choose between obeying the law (and therefore being denied an autonomous decision to end their life) or putting a friend, loved one or employee at risk of prosecution for assisting them. Tony Nicklinson, who was paralysed from the neck down by a stroke, expressed this sentiment when he described his life with locked-in syndrome.

What Falconer doesn’t tell us is that the same Tony Nicklinson is currently bringing a court case that has been described by his lawyers as a full frontal assault on the Murder Act 1965 (and not the Suicide Act 1961). Falconer, in answer to (my) repeated questions at the commission’s launch in 2010, eventually said that ‘assisted dying’ included only ‘assisted suicide’ and not euthanasia. But for Nicklinson to end his life it would require the legalisation of euthanasia (where someone actively ends his life) rather than assisted suicide (where someone helps him to kill himself) precisely because he could not kill himself even with assistance. This suggests that Falconer aims go beyond the legalisation of assisted suicide to include euthanasia as well.

4. No matter how much end-of-life care may improve, there is always likely to be a small cohort who will want to end their own lives rather than face a period of reduced function and independence in their final illness.

There have always been a very small number of desperate determined people who, whether they receive palliative care or not, wish to end their lives. Most of them are not even disabled or terminally ill. What Falconer does not tell us is that hard cases make bad law and that part of living in a democratic society involves accepting that there are certain ‘freedoms’ we cannot exercise because of the detrimental adverse effects a change in the law might have on others. The law, with its blanket prohibition on assisted suicide, is as it is to protect vulnerable people from exploitation and abuse by those who might have an interest, financial or otherwise, in their deaths.

5. As it stands, the system outlaws an action (assisted suicide) and yet frequently allows it to take place unpunished without employing any safeguards to protect and support people at a vulnerable stage in their lives. Between 2008 and 2010, 76 Britons ended their lives at the Dignitas clinic in Switzerland, in alien surroundings and often far away from their loved ones.

Falconer has highlighted the fact that a very small number (20-25) of British people go to Switzerland each year to end their lives at the Dignitas facility and that very few if any are prosecuted. What he neglects to tell us is that the House of Lords Committee reported that a Dutch-type law (allowing both euthanasia and assisted suicide) or an Oregon-type law (allowing assisted suicide only) in Britain would lead to 13,000 or 800 British deaths annually, a massive increase in these numbers. There may be abuses of the law, as there are for any law, but the current law which carries a blanket prohibition against assisted suicide acts as a very strong deterrent.

6. Commissioners visited the (Swiss) clinic and spoke to the people who ran it. They did not like much of what they saw. (So) should the UK adopt the model used in Holland, which allows a doctor to judge whether someone is ‘suffering unbearably’? People with psychiatric illness, the disabled and the terminally ill all might be considered eligible for an assisted death in that country. It also allows for young people aged 12-17 to request an assisted death, as long as the parents give their consent. Would that be acceptable to us in Britain? We doubt it. And would we want a system that required the ingestion of around 90 capsules of medication in a short period of time, often without the supervision or support of a doctor, as is the case in Oregon? We doubt that Britain would be happy to introduce such an approach.

Falconer cleverly rejects the Swiss, Dutch and Oregon models, despite the fact that Dignity in Dying have been campaigning for an Oregon-type law in Britain for several years. This makes him look cautious and is an attempt to disguise his full agenda. He does not however tell us what kind of law he would find acceptable apart from hinting at unnamed ‘safeguards’. But it is precisely the concern that safeguards will not work in restraining abuse that has led British Parliaments three times in the last five years to reject any legalisation of assisted suicide.

7. We also heard from Debbie Purdy, who has multiple sclerosis, who told us of her fear of ‘not taking the right quantity or quality of drugs and ending up in a worse situation than I would be in anyway’.

This is a similar argument to that used to legalise abortion (The CEO of DID Sarah Wootton comes with a wealth of campaigning previously for the liberalistion of Britain's abortion laws). If we do not legalise assisted suicide so that people can do it ‘safely’ they will do it ‘unsafely’. Debbie Purdy is a well-known pro-euthanasia campaigner with a chronic progressive disability whose life expectancy probably runs to decades. She has also said that she has no current intention of ending her life. It is interesting that Falconer should single her out as a case justifying a change in the law. It suggests that he wishes to extend assisted suicide and/or euthanasia to those who are not terminally ill. This would again take him beyond Dignity in Dying’s stated agenda. There is more than a hint here of incremental extension.

Summary

Falconer’s commission was ‘suggested’ by Dignity in Dying (the former Voluntary Euthanasia Society) and financed by one of their patrons. DID backs the legalisation of assisted suicide for mentally competent adults who are terminally ill and ‘suffering unbearably’. However their main arguments ('autonomy' and 'compassion') are equally used by those, like Nitschke and Irwin, with ostensibly more far-reaching agendas to justify the legalisation of both euthanasia and assisted suicide for those who are neither terminally ill, nor adults, nor mentally competent. This raises questions about their real agenda.

DID also backs an Oregon-type law, one which legalises assisted suicide but not euthanasia. Falconer, in contrast, tells us that his committee has concluded that the laws of Switzerland, Netherlands or Oregon would not be acceptable in Britain, yet judging by the examples he is using to argue his case his agenda seems more far-reaching than that of DID – extending to those who are chronically disabled (like Debbie Purdy) and those who would need euthanasia as opposed to assisted suicide (like Tony Nicklinson).

There are profound logical inconsistencies in what Falconer has said. Whether he will be clear and specific on Thursday about what he is actually advocating remains to be seen. But it would seem that he cannot have it both ways. He cannot have a law with more safeguards than that of the profoundly flawed law in Oregon and include people like Purdy and Nicklinson within its remit. And he cannot have a law with fewer safeguards than Oregon’s without putting the lives of thousands of vulnerable people at risk.

Falconer cannot hide behind hard cases, emotional arguments and imprecise terminology. He has to be specific about what ‘safeguards’ he is proposing and if his proposals are to have any traction at all they must be much better than those which have been repeatedly rejected by British Parliaments.

He also needs to define terms like 'assisted dying' and 'terminally ill' precisely so that we can understand what he is actually talking about.

His current bluster, vagueness and lack of precision make him look like a man with something to hide - a case of 'argument weak, shout louder'.

Judging by his record to date Falconer has set himself a very difficult task indeed.

Charles Falconer’s bent jury – why we should not be surprised by their ‘conclusions’

Charles Falconer’s ‘Commission on Assisted Dying’ is due to report on Thursday 5 January 2012, over a year after it first launched in November 2010, but its recommendations have already being leaked (ie. pre-announced) this week and we can expect more drip-drip as the week goes on.

The commission was originally ‘suggested’ by the pressure group Dignity in Dying (formerly the Voluntary Euthanasia Society) and has been part-funded by Terry Pratchett, one of their patrons.

Nine of the twelve members, handpicked by Falconer, are already known to favour a change in the law, including all four parliamentarians and all four doctors.

The commission is expected to make conclusions in line with Dignity in Dying’s campaign objectives – that is, that there is place for ‘a bill making provision for mentally competent, terminally ill adults who are suffering unbearably, to have "assisted dying" (this term will be I predict left conveniently undefined) with robust up-front safeguards’.

A Royal Society committee in Canada, similarly constituted, has recently made similar recommendations for the legalization of assisted suicide and euthanasia.

So who is on this ‘grand jury’ and what do we know about them? Who are ‘the twelve’?

All four Parliamentarians on the commission have either made their pro-assisted dying views public or voted for legalisation in the Houses of Parliament.

Lord Falconer himself, who chaired the commission, has campaigned long and hard on this issue and attempted to legalise assisted suicide via an amendment to the Coroners and Justice Bill in 2009.

Baroness Elaine Murphy of Aldgate and Baroness Young of Old Scone share Falconer’s views – Young supporting Falconer’s amendment on 7 July 2009 and Murphy voting for Lord Joffe’s Assisted Dying Bill on 12 May 2006.

Penny Mordaunt MP has not had an opportunity to vote on the issue but has made her own support for legalisation very clear and has, since joining the commission, taken on the chairmanship of the All-Party Parliamentary Group on Choice at the End of Life, effectively the political wing of Dignity in Dying, which acts as its secretariat.

While all the major disability rights organisations in the UK (RADAR, UKDPC, NCIL, SCOPE, Not Dead Yet) oppose a change in the law Stephen Duckworth, Chief Executive of ‘Disability Matters Limited’, is one of those rare disabled people actually to back legalisation. 'Disability Matters' sounds grandiose but it is in reality just a private business which according to Companies House ceased trading in 2010! Judging by the current inaccessibility of its website, it may not be doing all that much at present other than attempting to lend credibility to the commission. Duckworth happens to be disabled (hence his usefulness to Falconer) but he seems not to represent anyone but himself. Hardly surprising then that he is included on this panel.

Whilst 95% of Palliative Medicine Specialists are opposed to a change in the law Lord Falconer has managed again to find two who buck that trend in Professor Sam Ahmedzai, Professor of Palliative Medicine in Sheffield, and Dr Carole Dacombe, Medical Director, St Peter’s Hospice.

In 2010 I was involved in a two hour dialogue in Oxford (over dinner) with Lord Ian Blair of Boughton, former Commissioner of the Metropolitan Police, and I can assure you that he too firmly supports a change in the law and has confirmed this only this week.

Sir Graeme Catto, former President of the General Medical Council, has spoken in support of a new organisation seeking to promote the legalisation of ‘assisted dying’, Health Professionals for Change (now rebranded ‘Health Professionals for Assisted Dying’)

So who does that leave? Just three whose views we do not already know: Dame Denise Platt, Member of the Committee on Standards in Public Life; Celia Grandison-Markey (according to the website she has now been removed), Management Consultant for Health and Social Care in the public sector; and the Revd Canon Dr James Woodward, Anglican Priest and Canon of St George’s Chapel, Windsor.

So is this an independent committee? I think not! No wonder that the British Medical Association has refused to give evidence to it along with over forty other organizations.

Lord Falconer, of course, is perfectly free to set up an ad hoc committee to take evidence and make recommendations to Parliament. It is a free country and he has every right to try and influence public policy.

But it is a trifle disingenuous of him to pretend that a group with such clearly settled prior convictions, might bring any impartiality or objectivity to bear on these important issues.