This is a report I wrote for the Medical Journalist’s Association January 2011 newsletter. In the above picture taken at the debate I’m the devilishly good looking chap in the front row.
The MJA discussed this contentious issue on November 25 at the Medical Society of London. Four speakers, ‘widely respected for their integrity but divided by their beliefs’, in the words of John Illman, who organised and chaired the meeting, spoke for and against modification of the law on assisted dying. Stephen Ginn reports.
Support for a change in the law came first from GP and MJA member Dr Ann McPherson. She is behind a new group called Healthcare Professionals for Change, set up to challenge the medical establishment’s stance against assisted dying for terminally ill people, and to lobby for a change in the law. Ann’s support of assisted dying is not academic; she herself is suffering from a terminal illness, a situation that, she said, made her ‘really start thinking about death’, and led her to publish an article in the BMJ explaining her views.
Ann told us that, during her working life, she had cared for many terminally ill patients, seeing many die in a way she would not wish for herself. In her view, doctors were ultimately unable to provide humane help for the terminally ill because of their inability to offer assisted dying. She wanted to see assisted dying incorporated into the palliative process. She said that she was only calling for a change in the law for specific cases: for the terminally ill who had clearly stated their wishes when of sound mind.
Baroness Ilora Finlay, professor of palliative care at Cardiff University, opposed this proposal, based on her faith in palliative care and pragmatic concerns about how assisted death decisions would be reached. For her there was a paradox inherent in the debate: increased discussion of assisted dying came at a time when palliative care was improving. She had practical doubts as to the accuracy of a terminal prognosis, the degree of internal and external coercion put upon patients, and the reliability with which patients in distress were able to make clear end-of-life decisions.
She related the case history of a patient who, with what was thought to be only days to live, had requested an assisted death in 1991, but was still alive today. She spoke of ‘societal considerations’, concluding that licensing assisted dying was not only about personal autonomy: ‘To talk about it simply as a choice is to trivialise the enormous decision we take if we change the law.’
Baroness Mary Warnock, who spoke third, is a respected moral philosopher who has expressed strong, sometimes controversial, views in favour of assisted death. She said many people wish for a good death, and some stockpiled the necessary pills, but this was ineffective because most deaths took place in hospital where medication was controlled. She was critical of doctors’ resistance to change. ‘It is simply derogatory to suggest the medical profession has the right to override the longthought- out wishes of the dying,’ she said. In her judgement, if someone wished to die, this moral decision should be taken seriously and no one else should be able to gainsay it.
She thought that the possibility some people might seek assisted death because they wished to unburden their relatives was in fact an honourable motive, to be admired. ‘Why shouldn’t I shorten my life for the sake of my children?’ she asked. Nor did she accept that a change in the law would threaten disabled people, if they made their wishes clear. ‘No one is suggesting doctors make the decision to end a life,’ she said.
Professor Mayur Lakhani, chair of the National Council for Palliative Care, was the last to speak. In his estimation, ‘the case for a change in the law has not been made’. He reminded us that in the past 10 years little over 100 UK subjects had sought an assisted death at Dignitas, while during the same time period six million had died elsewhere. Although he felt it was important for doctors to facilitate end-of-life care, this did not imply assisting dying. In contrast to the two speakers who spoke in favour, Professor Lakhani thought it was ‘undignified to hasten death’.
The debate was opened to the floor and the audience posed questions and shared personal experiences. Someone asked about withholding medication, and Dr McPherson clarified the difference between giving medication to assist death (illegal) and withdrawing medical treatment (permitted) that resulted in death. There was general agreement that healthcare professionals found themselves as unprepared as lay people for the death of a loved one. Although there was no concluding vote, my impression was that most present were in favour of a change in the law. Debate continued over dinner, some saying that their opinion had been changed by the arguments they had heard.