Assisted suicide and the hospice alternative

Our position is not vitalist. We do not think that all life must always be preserved at any cost. We do, however, agree with the current legal prohibition on all intentional killing and specifically with the ban on assisted suicide contained in the 1961 Suicide Act. We believe that intentional killing is always wrong – though sometimes understandable – and that the consequences of legal assisted suicide would be disastrous. A much better option than assisted suicide, in our view, is the further expansion and improvement of hospices and care facilities for those with incurable conditions.

Palliative care

Britain is a world leader in palliative care and was among the first nations in the world to build up a systematic network of hospices where people coming to the end of their lives could be looked after with dignity and in comfort. More detailed information on the history of the hospice movement and its current workings can be found on the website of St Christopher’s Hospice, which was founded by Dame Cicely Saunders, one of the pioneers of palliative care in the UK .

Dame Cicely Saunders had the idea for a huge expansion of good-quality care for the dying in the years immediately following the Second World War, after her experiences nursing men injured in the conflict. At that time care for people who were dying, and were beyond any further medical help, was highly inadequate. Dame Cicely transformed that situation with the insight that the last weeks and months of life were just as important as the rest of a person’s life. Every individual was important; everyone’s dignity was to be respected; there was no such thing as a life worth living, and the traditional medical prohibition on intentional killing must not be infringed for the good of all society.

Looking at precedent

A serious problem with assisted suicide is that once we have admitted into law the principle that some patients can be intentionally killed, it is very difficult to control the wider application of that principle. This is because of way that the law works – we see this by looking at precedent. That is exactly what has happened, for instance, in the Netherlands. Assisted suicide has gone from being an option for a few people in very severe pain to being offered to teenagers with depression and people who have nothing physically wrong with them but are “tired of life”, and non-responsive patients who have not made any request to be killed. In the Netherlands, the movement towards widespread legal assisted suicide began with a small number of individual hard cases that came before the courts.

As Professor John Keown, one of the world’s leading experts on medical ethics, has written (in his 2006 work Considering Physician-Assisted Suicide):

“The Dutch experience has been one of widespread abuse perpetrated by doctors with virtual impunity…since 1984 the law requiring a request by the patient has been ignored in many thousands of cases….cases of euthanasia have been illegally covered up by doctors.”

If the courts granted requests for assisted suicide, it would not be long before another, similar case came before the courts, using a particular case as precedent. And that case would be followed by more and more cases, all arguing along the lines of “if he/she can do it, why can’t I?”

It is in that sense that any court victory allowing assisted suicide would “open the floodgates”; it establishes the principle in medical law that it can sometimes be in a patient’s best interests to be killed.

It is very difficult for this idea to co-exist with the ideals of palliative care for the dying, as we see from the relative inadequacy of end-of-life care in countries that have introduced some forms of legal euthanasia.

Endangering the vulnerable

When we talk about endangering the vulnerable, what we are talking about is a medical and legal culture where it becomes expected that the response to disability and suffering and difficulties of old age. It is worth noting that nearly all groups that promote and safeguard the rights of people with disabilities and are opposed to any legalisation of assisted suicide. Indeed, every major disabled organisation in the country is either opposed to assisted suicide or extremely concerned about its effects on people with disabilities, for example…

Disability Rights UK (a merger of RADAR, the Disability Alliance and the National Centre for Independent Living) ; SCOPE; the UK Disabled People’s Council; Not Dead Yet UK.

The organisation Age UK (a merger of Help The Aged and Age Concern) is opposed, as are almost all the major medical bodies, e.g. the British Medical Association, the Royal College of Physicians and the Royal College of General Practitioners.

Protecting doctors and patients

At the moment the presumption is always against intentional killing. This is a form of protection for both doctors and patients. Patients do not have to worry about their lives becoming seen as a burden, or being a waste of resources. This latter point is especially important, as there is going to be a great deal of financial pressure on the NHS for the foreseeable future. Ending someone’s life is cheap. Looking after a very sick person is not. If the law is changed so that killing becomes a treatment option, in the long run there must be a serious concern that financial considerations would come into play, in the form of (perhaps unconscious) psychological pressure on patients, families, doctors and hospital administrators.

As noted above, we do not think all human life should always be preserved at any cost in all circumstances. It is not ethically wrong to discontinue a medical treatment that has become over-burdensome or futile. The crucial distinction between, on the one hand, intentionally ending life, and on the other, withdrawing treatments that are no longer justified, is recognised in both ethics and law. There is, for example, a well-established right to refuse treatment for mentally competent patients, but this right has never been taken by the courts to mean that there is a right to be euthanised, just as the European Court of Human Rights has never found a right to die in European human rights law.

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