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Hold up! Before you read on, please read this...

This post was published more than 14 years ago

I keep old posts on the site because I often enjoy reading old content on other people's sites. It can be interesting to see how views have changed over time: for example, how my strident teenage views have, to put it mildly, mellowed.

I'm not a believer in brushing the past under the carpet. I've written some offensive rubbish on here in the past: deleting it and pretending it never happened doesn't change that. I hope that stumbling across something that's 14 years old won't offend anyone anew, because I hope that people can understand that what I thought and felt and wrote about then is probably very different to what I think and feel and wrote about now. It's a relic of an (albeit recent) bygone era.

So, given the age of this post, please bear in mind:

  • My views may well have changed in the last 14 years. I have written some very silly things over the years, many of which I find utterly cringeworthy today.
  • This post might use words or language in ways which I would now consider highly inappropriate, offensive, embarrassing, or all three.
  • Factual information might be outdated.
  • Links might be broken, and embedded material might not appear properly.

Okay. Consider yourself duly warned. Read on...

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.

This 602nd post was filed under: Headliner.

Some recently published posts

What I’ve been reading this month / August 2019, 7 minutes long

A flying visit to Copenhagen / July 2019, 9 minutes long

What I’ve been reading this month / June 2019, 6 minutes long

Reflecting on my first ten years as a doctor / June 2019, 8 minutes long

What I’ve been reading this month / June 2019, 6 minutes long

Some random old posts

David Foster Wallace: Infinite Jest / April 2005, 2 minutes long

Lib Dems in next week’s cabinet? / June 2007, 3 minutes long

Andrew Marr: My Trade / June 2005, 3 minutes long

The G8 and alleviating world debt / June 2005, 3 minutes long

Art of the Renaissance and anatomy / February 2015, 4 minutes long

Website (Part Two) / July 2003, 5 minutes long


Comments and responses

Comment from Snipcock the Lawyer


by Snipcock the Lawyer

Comment posted at 01:38 on 28th May 2005.

“What possible training does a solicitor have to recognise such attributes?”

So long as one is capable of paying the fees of the attorney at law, aforesaid attorney at law will most happily delcare one’s-self to be in a state of sound mind.

This surely is the best possible training any lawyer can have — determining the ability of the client to pay.


Comment from Harriet


by Harriet

Comment posted at 13:34 on 31st May 2005.

The links at the top of your comments are incredibly helpful. I think the Bill looks absolutely right: it must be aimed at patients who are competent but who will die shortly, and the help must be help they can take for themselves and which is medically overseen to avoid making a person’s suffering even worse. I strongly recommend that those interested in commenting should read what the report on Oregon says. This really opened my eyes about how euthanasia actually works in practice – it also has the benefit of being easy to read!


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