Warning: This post was published more than 11 years ago.
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A couple of days ago, the Head of Communications at the Voluntary Euthanasia Society sent me the following email, which essentially asked me to reconsider my position on voluntary euthanasia in the light of three recently published documents: Lord Joffe’s Bill on Assisted Dying, a select committee report, and the most recent report into the way in which Oregon’s system works.
I’m surprised as I glance through the archives of this site that I’ve never gone into my position on euthanasia any more than in my brief comments here. But those comments do represent the general basis of my position: I’m in favour of voluntary euthanasia in theory, but have yet to see a workable model in practice.
I’ve read the bill, I’ve glanced at the Oregon report (but admittedly not studied it), and, most clearly, looked at the handy Flow Chart provided by the VES. And I still have my concerns about it, and still wouldn’t be able to support this particular bill. Here, I will explain some, but not all, of my reasons behind this decision.
My first, and possibly greatest, concern is that doctors will be asked to play an active role in killing someone, be this through supplying them with the medication to do so or actually administering them when the patient is unable to do so. This, whilst perhaps not in a legal sense, certainly in a moral sense changes the nature of the doctor. I see the role of a doctor in the traditional ‘first do no harm’ sense, and to ask doctors to actively kill patients changes that perception irrepairably, even if this is what the patient themselves wants.
The situation reminds me somewhat of the often-quoted medical case of the man who wants his left-leg amputated because he believes that this is important for his religious beliefs, as he has sinned and must pay for these sins. Despite the man’s clear request, and despite him having reasons which appear valid – even crucial – to him, it is still unethical to amputate the man’s leg, as it would do him harm with no particular medical benefit.
Clearly, there is something of a gulf between amputating the leg of a healthy man and helping a terminally ill patient to die with dignity, but the underlying ethical principle is, perhaps, not that much different. I recognise, as the Hippocratic Oath states, ‘that prolongation of life is not the only aim of healthcare’, but I equally agree, as it also states, ‘not [to] provide treatments that are … harmful’. We can then get into a philosophical argument as to whether the ending of someone’s suffering is actually harmful or helpful, but I think the meaning of the Oath is quite clear.
Another reason not to trust doctors with this power is that they’re notoriously bad at discussing death. Many patients who should have discussions about whether or not they want to be resussitated don’t have them, because we all find it difficult to sit down with a patient and say, ‘Well, it looks like you’re going to die. Shall we discuss it?’. And there is, as far as I can see, no provision in the bill for further education for doctors to overcome this difficulty, nor any procedure by which this topic will automatically be discussed with patients who are in this category. If the doctor doesn’t bring this up, and there is no system of making patients more aware, then you effectively disenfranchise those patients of lower socioeconomic backgrounds, who may not be up-to-date on DoH policies on such things.
And it’s also worrying that, as part of the declaration process, a solicitor of all people is asked to judge whether a patient is ‘of sound mind’. What possible training does a solicitor have to recognise such attributes? The bill also states that the patient should ‘understand’ what the declaration means. What exactly is meant by the word ‘understand’? Are they to be given an explanation of simply the outcome – that they die – or the process? And if the process is to be explained, to what level is the explanation to be given, and how is the understanding to be tested? In most cases, doctors make a judgement here, but when it is quite literally a matter of life and death, I wouldn’t want to be the person responsible for giving the explanation, or indeed checking that the patient understands. The language is far too woolly.
Whilst I have these practical objections, I think it is a terrible scar on the conscience of our society that we force people in terrible pain to extend their suffering. The patient’s right to death is as important as their right to life. My problem is simply that I can’t see an effective way of putting this system into practice, as I’m not comfortable with the treatment being administered by doctors, yet cannot see who else would be a natural choice for performing the procedure. And I don’t think it’s right, on an issue as important as this, to go with a bill that’s simply ‘as good as we are going to get’. This bill needs to be looked at in much more detail, examined as with a microscope until even scintilla of doubt can be removed from the whole process. There’s no room for ‘no reasonable doubt’ in a bill to do with certifying people to death – there must instead be an abscence of all doubt. And until such a time as I feel that this has been effected, I simply cannot support this bill.