Sunday, April 25, 2010

'Right to Die' or 'Right to Life'

One of the best articles to appear in the main stream media over the last number of years on the issue of end-of-life ethics:
Taken from the Sunday Times Dec 04 2008 by Dominic Lawson (brother of Nigella Lawson - Chef)

It is traditional, when mounting a coup, to seize control of the airwaves. Last week the supporters of euthanasia did their best. Monday’s Panorama was entirely given over to a “report” on this topic by the Lothians MSP, Margo MacDonald; but since Ms MacDonald has already launched a campaign to legalise “assisted suicide” north of the border, the BBC’s attempt to promote her as an impartial reporter was disingenuous, at best.

Two days later, Sky broadcast Right to Die, a 90-minute documentary that told the story of Craig Ewert, a 59-year-old Yorkshire-based American, who had travelled to the Dignitas clinic in Zurich to be humanely put down. As advertised, we were not spared the moment of Mr Ewert’s death.

The very phrase “right to die” is a fashionable piece of nonsense. How can we be said to require a “right” to something that is absolutely unavoidable, whether we want it or not? It is not the “right to die” that campaigners such as Margo MacDonald want, but the right to be killed – at a time of their own choosing. This is why some doctors, less sensitive to public queasiness, refer to the practice of “assisted dying” as “therapeutic killing”.

In the case of Craig Ewert, it seemed to be as much therapy for his mental condition, as the removal by annihilation of his physical ailment, motor neurone disease. While he was definitely becoming incapacitated after five months with the condition, the programme commentary at no time suggested that he might be suffering from clinical depression. Yet any sensitive viewer could see that he was, and indeed his wife seemed to suggest as much to a news reporter last week. Obviously for the thoroughgoing euthanasiast it is quite irrelevant if the applicant for immediate extinction is not in unbearable physical pain, or indeed in any pain at all. He should have his wishes respected: it is his life, to do away with when and how he wishes. Suicide, indeed, is not illegal, and has not been so in this country since 1961. The problem with getting yourself terminated by another, however, is that it requires that other to do the terminating – and the overwhelming majority of doctors in this country are opposed to any legislation introducing “assisted suicide”.

When three years ago the British Medical Journal printed a leading article advocating “physician-assisted suicide” it received a searing blow-back from its readers. One doctor wrote: “If I was prepared to kill my patients then with the 15% of them over 85 I would have lost all trust.” Another commented: “As one who spends every working day caring for the terminally ill, I am acutely aware of the damage such a change would cause to vulnerable patients.” It’s true that it would not be strictly necessary to have the therapeutic killing carried out by doctors. The nation’s veterinary service might have some spare capacity, and plenty of Nembutal to go round, although somehow I think the vets might find it difficult to put down Granny with the equanimity they display when dispatching animals.

Lord Joffe, who has unsuccessfully launched two bills to introduce a form of euthanasia, indicated last week that he would try for a third time. When the High Court recently refused to give any encouragement to Debbie Purdy, who wanted preemptive legal approval for a one-way trip to Dignitas (although none of the 100 or so British families to use Dignitas has been prosecuted), Joffe claimed that there was hypocrisy in the fact that “mercy killings” are already commonplace in the UK. This is essentially the same argument as was used by proponents of the Abortion Act 1967: it frequently happens anyway by stealth, and it would be better if it were done legally without fear of prosecution.

In the case of euthanasia, this is simply untrue, or at the least a grotesque exaggeration. The first UK-wide study of medical “end-of-life decisions” – conducted two years ago on a confidential basis – revealed only a tiny number of deaths that could be described as “euthanasia”. Almost a third of deaths were categorised as “alleviation of symptoms with possibly life-shortening effect”, while another 30% were described as caused by “nontreatment decisions”. The former category is often thought of as “mercy killing”, but this is a misunderstanding: to give someone a very powerful painkiller may reduce the body’s resistance to an infection, but the purpose is to reduce the pain, rather than increase the infection.

In one respect, however, there is an extraordinary hypocrisy at the heart of the current position: while voluntary euthanasia is illegal, involuntary euthanasia has long been sanctioned by the highest courts in the land. This stems from the House of Lords’ decision in 1993 to authorise the removal of a feeding tube from the stomach of Tony Bland, a young man who had been crushed in the stampede at Hillsborough football stadium and who was deemed to be in a “permanent vegetative state”. Bland was able to breathe unaided by a ventilator, however; so he would not expire immediately – instead he would slowly starve to death. This was not murder, it was argued, because the withdrawal of feeding was an “omission” rather than an “act”.

One of the judges justified the decision on the grounds that this was no longer a true human being: in a strange use of almost religious terminology, he declared that “Tony Bland’s spirit has already left his body”. This was not the view of the Catholic church. As it happens, I do not share the church’s view that human life is a “gift from God” – and Joffe’s persistent claim that all opposition to his proposals comes from people “largely under the influence of religious leaders” does his cause no good at all. I do not question Lord Joffe’s motives, which are based on a deep desire to minimise human tragedy. He is more likely to persuade the nonaligned in parliament if he stops attributing their doubts to mere religious indoctrination.

The supporters of “assisted dying” might argue that under their proposals a Tony Bland could be humanely dispatched rather than allowed to starve to death, but then – whoops! – voluntary euthanasia slips almost imperceptibly into the form that requires no consent, let alone a demand, from the patient.

This is why in the Netherlands, the supposedly enlightened pioneer of euthanasia, more than a quarter of “physician-assisted” deaths occur without any request from the patient-victim and people carry cards that read: “Please don’t kill me.” Some persist in calling this “dignity in dying”, but the Dutch health ministry recently admitted that a third of “physician-assisted deaths” had “complications”, such as delays in the poison taking effect, vomiting and even patients waking up afterwards. Dignified, it is not.

Perhaps the most compelling evidence given to the House of Lords came from Dr Bert Keizer, who worked as a geriatrician in Amsterdam for a quarter of a century and carried out many “physician-assisted suicides”– the basis of his book Dancing with Mr D. Dr Keizer told our legislators: “It is useless to worry about the slippery slope. Once a society has decided that euthanasia is allowed in certain cases, one is on it. Thus in Holland we have given up the condition that a patient must be in a terminal situation. Next, mental suffering was allowed [as a reason]. Then one’s futuredementia was suggested as a reason for a request for death . . . I believe, on the grounds of the more than 1,000 deathbeds I attended, that euthanasia is a blessing in certain exceptional situations, yet I would rather die in a country where euthanasia is forbidden but where doctors do know how to look after patients in a humane manner.”

One of our broadcasters should commission a documentary from Dr Keizer: it would do us no harm to look into the abyss.

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