Why the authorities that matter still oppose assisted suicide

Lord Falconer’s Assisted Dying Bill begins its Committee Stage in the House of Lords today (7 November). The Bill seeks to “enable competent adults who are terminally ill to be provided at their request with specified assistance to end their own life”.

This is not the first time in recent years that peers have had to consider legislation aimed at changing the law in this area. In 2006 and 2009 the House of Lords voted on — and rejected — proposals to legalise assisted suicide. So Lord Falconer’s Bill makes this the third time in eight years that peers will have to vote on this issue. The numbers demonstrate the determination of the assisted suicide and euthanasia lobby.

It’s important to note that these votes of disapproval in the House of Lords are not an anomaly — all the relevant authorities on this matter are also strongly opposed to changing the law on assisted suicide. The World Medical Association re-asserted its opposition in 2013. A 2006 survey by the Royal College of Physicians found that over 70 per cent (and 95 per cent of those in palliative medicine) agreed no change in legislation is needed.

In addition, the British Medical Association, the Royal College of General Practitioners, the Association for Palliative Medicine, the British Geriatric Society and the vast majority of UK doctors (around 65 per cent in most surveys) are opposed to legalising euthanasia.

The Supreme Courts of the US and Canada, the European Court of Human Rights and the Irish Divisional Court also all agree that a blanket ban on assisted suicide is entirely justified.

So it is clear that legal, medical and legislative opinion are all united in opposition against changing the law. But why is there such consistent and resolute opposition? A brief look at the facts shows why the authorities that matter, across a range of jurisdictions, all oppose a change in law to allow assisted suicide and why the House of Lords, yet again, must vote against it.
 

Equal worth and dignity

Perhaps the most worrying aspect of Lord Falconer’s Bill is that it introduces a distinction between lives that are “worth living” and lives that are “not worth living”. This strikes at the heart of one of the key principles undergirding legal and medical practice: the equal worth and dignity of all people. In 1994, the House of Lords Select Committee on Medical Ethics put it this way: “That prohibition is the cornerstone of law and of social relationships. It protects each one of us impartially, embodying the belief that all are equal.”

Assisted suicide is grounded in the idea that some patients have lives which are no longer “worth living” and they would be “better off dead”. Once the law abandons its historic prohibition on intentionally ending the lives of patients, arbitrary and discriminatory judgments about what constitutes a life “worth living” are introduced.

This explains why disability groups are at the forefront of opposing this legislation. All the major disability groups in the UK are opposed, including Disability Rights UK, SCOPE, UKPDC and Not Dead Yet. They are united in their conviction that any change in the law will result in increased prejudice against them and increased pressure on them to end their lives. This latter point is particularly pertinent given the current cash-strapped situation of the NHS. With finances scarce, a £5 lethal prescription begins to look like the prudent option when compared to palliative care that could cost thousands of pounds.
 

Terminally ill?

It should also be remembered that for every “terminally ill” person who wants to end their life, there is another person who fights on and not only survives but goes on to lead a rich and fulfilling life. Take for instance the case of Heather Knies. At the age of 24 she was diagnosed with severe brain cancer and given six months to live. She went through two rounds of brain surgery, as well as chemotherapy and radiation treatment. Now, almost a decade later, she is cancer free, has a family and a full-time job and leads a normal life.

This inspiring story of survival did not receive nearly as much publicity as the recent case of Brittany Murphy. She too was diagnosed with severe brain cancer earlier this year but decided to take her own life just a few days ago (in the US state of Oregon, where assisted suicide has been legalised).

These two contrasting stories show just how difficult it can be to judge what is a terminal illness and what is not. Lord Falconer’s Bill requires two doctors to confirm “terminal illness” with a prognosis of less than six months to live. Heather Knies would have qualified according to this criterion and yet nearly 10 years on she is cancer free and enjoying life. This demonstrates just how weak the “safeguards” in Lord Falconer’s Bill are.

More weaknesses

And yet there are still more weaknesses in it. The Bill requires two doctors to confirm not just “terminal illness” but also “mental capacity”, “clear and settled intention” of the patient and an absence of “coercion or duress” from others. Yet there is no requirement for these doctors to have any particular expertise in any of the relevant areas i.e. assessing capacity, diagnosing or treating mental illness, diagnosing “terminal illness”, or in palliative medicine. This makes the requirements of the Bill clearly insufficient, especially in view of relevant psychiatric studies. 

“Deeply worried” by Lord Joffe’s 2006 Bill to introduce assisted suicide, the Royal College of Psychiatrists observed that studies of the terminally ill showed that depression is strongly associated with the desire for a hastened death and that once the depression is effectively treated, 98-99 per cent change their mind about wanting to die. Furthermore, it warned that many doctors do not recognise depression in terminally ill patients or know how to assess for its presence in the terminally ill.

The problem also remains of how doctors will be able to assess whether a patient’s decision to die is “voluntary” (another requirement of the Bill). How will doctors possibly know whether or not the patient has been pressured by others, or made to feel a burden? This will be especially difficult if the doctors in question have never met the patient before or do not know the specifics of their family situation.

The law as it stands

There are other problems which we could also consider in detail, such as the way assisted suicide opens the door for euthanasia because the arguments used to justify it could equally be used to justify euthanasia; or the lack of protection for those who do not want to die and those for whom there are alternatives (such as palliative care). But let us consider for a moment the law as it currently stands. 

The present law makes assisted suicide illegal. The penalties it holds in reserve act as a strong deterrent to exploitation and abuse while at the same time giving discretion to prosecutors and judges in hard cases. The saying that this law has a stern face and a kind heart is absolutely true. It preserves the principle of the equal worth and dignity of every human life, it protects the vulnerable, and it is clear and unambiguous. This is why the law should not be changed.

The House of Lords opposed similar attempts to change the law in 2006 and 2009 because they understood these reasons. If they consider the evidence — and not just the emotive appeals of the assisted dying lobby — they will do so again.