When I first heard that Dame Esther Rantzen was campaigning in favour of assisted dying, I thought, “That’s it. Sooner or later, the bill will pass.” The presenter of the long-running consumer affairs programme entitled – perhaps rather inappropriately in this context – “That’s Life!”, is such a powerful persuader, in modern parlance an “influencer”, always with the keenest antennae for the public mood (finger on the pulse – another inapt phrase), that it is hard to imagine that the nations of the United Kingdom will not, in due course, follow in the footsteps of such countries as the Netherlands, Switzerland, Canada, and New Zealand. Esther Rantzen has stage 4 lung cancer. It is impossible not to have the deepest sympathy for her situation. She was interviewed this morning on BBC Radio 4’s Today programme. She has collected more than 200,000 signatures to a petition triggering an MP’s debate, to be held later today, in Westminster Hall.
The Today programme went on to interview a palliative care expert, Dr Amy Proffitt, past president of the Association for Palliative Medicine of Great Britain and Ireland, who deplored the lack of nuance in what has become a divisive binary dispute. She thought the debate at this stage had rather be in the public domain than in the Palace of Westminster. She compared the current level of discourse with that which surrounded Brexit eight years ago. People did not know what they were voting for. Interestingly, in the Today interview she did not express direct opposition to assisted dying; rather she wanted to remove the entire process, whatever it might be, from the domain of the NHS.
I’m very struck by the tacit assumption of the supporters of assisted dying, that the participation of doctors will be integral to any end of life procedure. There is a close parallel here with the formulation of David Steel’s 1967 Abortion Bill. I make this point without putting forward any judgment as to the moral-ethical rights or wrongs of either termination of pregnancy, or of assisted dying. Termination of pregnancy is actually illegal in this country, except in very specific circumstances. The relevant act of parliament dates back to 1861, and remains on the statute book. In order for a termination of pregnancy to be legal, two independent medical practitioners must make a judgment as to whether the person requesting the termination fits into one of several strict criteria. In most cases, the termination goes ahead because two doctors consider that a continuation of the pregnancy would harm the physical or mental health of the pregnant patient. Now it is true that, de facto, patients may undergo termination of early pregnancy, on request, because doctors who may not wish to sanction the process, on grounds of conscience, are nonetheless obliged not to frustrate the will of the patient, but rather to point her in the direction of clinicians who are prepared to carry out her wishes. But it would be wrong to assert that termination is a patient’s right. The decision to terminate resides solely with doctors, empowered by an Act of Parliament. It could all turn on a dime. Think of Roe v. Wade.
Now we find that assisted dying, should it become legal, will also depend upon the judgment of two doctors. When I was a medical student I remember asking a consultant obstetrician how he (of course he was male) went about making a judgment as to whether or not to proceed with termination. He told me quite frankly that he provided terminations solely and simply on request. Who am I, he said, to make judgments as to the level of my patient’s anguish? By the same token, I can well imagine something similar happening with assisted dying. When termination was debated in parliament in 1967, proponents of the bill reassured those who were dubious, particularly in the House of Lords, that termination would only occur in exceptional circumstances. Then look what happened. I could well imagine that, 60 years from now, assisted dying will be available on demand.
This notion is often referred to as “the slippery slope” argument. Mission creep. Not so, say the advocates of the bill. Safeguards, measures of protection, will be robust. Well, one way to ensure that the mission will creep is to hand the administration of it over to doctors. You see, we doctors understand that everybody is terminally ill, and that everybody is not quite of sound mind. And everybody, one way or another, is being coerced. And we are notoriously bad at prognosis. (When Mr al-Megrahi, allegedly responsible for Lockerbie, the worst act of terrorism on British soil, was released from prison, terminally ill, on August 20th, 2009, and returned to Libya, on compassionate grounds, he lived far longer than was anticipated. He died on May 20th, 2012.)
Sixty years hence, a sixteen year old girl will present herself to one of my colleagues and say, “Doctor, I’ve had enough. I’m suffering intolerably. I want you to end it for me.” And my colleague, reaching for the relevant forms, will say to himself, who am I to make a judgment about the extent of my patient’s suffering?
jamescalumcampbell 