Sunday, 8 June 2014

Carry On, Regardless

Dr Peter Saunders, the Chief Exec of the Christian Medical Fellowship** has written a pamphlet called Live and Let Live, opposing assisted dying.

Dr Saunders has chosen his moment because Lord Falconer’s Assisted Dying Bill will receive its Second Reading in the House of Lords on 18 July. Lord Falconer’s proposals would apply only to terminally ill, mentally competent patients with strict legal safeguards.

These are some of the arguments Dr Saunders uses against changing the law. He makes no distinction between euthanasia, assisted suicide and assisted dying - legally, medically or morally. There is no detail on what assisted dying would involve, just fear-mongering and moralising. This is a complex issue but for the CMF it’s just wrong, full stop, no debate.

Murder is against the ten commandments. Our lives belong to God not to ourselves so euthanasia, suicide and assisted suicide are wrong.

Patient autonomy, informed choice and doing what is in the patient’s best interest are tenets of medical ethics. The pamphlet should really be called Live and Force to Live. The sanctity of life argument is concerned only with quantity, not quality.

There are plenty of Biblical examples of killing that is not wrong. There are plenty of wars and massacres sanctioned by God, who even got hands-on and slaughtered the first born of the Egyptians himself. Many religious people support capital punishment, particularly in the US. But then, it’s easy to be selective with which bits of the Bible suit your argument.

Death is not the end. For non-believers, assisted suicide may be ‘propelling them towards a judgment for which they are unprepared. This may be the worst thing we could ever do for them’.

By ‘non-believers’ he means non-Christians, so not just atheists but people who sincerely believe in other religions. There’s always the chance of a deathbed conversion. We’re all lost little lambs who can’t be trusted to make our own decisions. This goes against ethical principles of patient autonomy and informed consent, which they’re happy to apply in other areas of medicine, as long as they have the CMF stamp of approval.

The CMF and Dr Saunders cannot claim to represent all believers. The 2010 British Social Attitude Survey found that 71% of religious people agreed that a doctor should probably or definitely be allowed to end the life of a patient with a painful incurable disease at the patient’s request.

Religious views, unlike the ten commandments, are not set in stone. They evolve constantly. In the past, the Church disapproved of inoculation, vaccination, quinine as an anti-malarial and the use of chloroform in childbirth. Just because a minority of believers currently oppose assisted dying does not mean that they always will. At some point, they will move on to some other area of medicine or scientific break-through and condemn that. They’re fickle like that.

The CMF is also well out of step with society as a whole (not that this has ever bothered them). The 2010 British Social Attitude Survey found that 82% of the general public believe that a doctor should probably or definitely be allowed to end the life of a patient with a painful incurable disease at the patient’s request.

A change in the law would put pressure on the vulnerable

This is the slippery slope argument; it is fear-based, not evidence-based. The way to stop something sliding down a slope is to build a wall across it. That’s what a new law would do. It would also make it easier to identify and prosecute suspicious deaths.

People may feel obliged to die to relieve their families of a burden, especially in tough financial times, they claim. The new law is very specific about who can apply for assisted death; it would not be a free-for-all for anyone who wants to die or feels they should and would involve only a very small number of people. A 2013 report from Oregon shows that only 0.2% of deaths in that state were by assisted dying and this figure has been stable for six years.

The evidence (as opposed to the fear-mongering) shows that an assisted dying law has worked in Oregon for over 16 years. There have been no cases of abuse and no calls to extend the law beyond terminally ill, mentally competent adults. In addition, in Holland in the 1990s, doctors rejected around two thirds of patients who requested death.

Members of the medical profession and disability advocates oppose it because it is dangerous

The CMF pamphlet doesn’t discuss the various and complex reasons why doctors and disability activists are opposed to assisted dying. They don’t want a debate, they want to lay down the law.

As with abortion, doctors would not be forced to do it, there would be conscience opt-outs. For those medical professionals who see assisted dying as the final part of patient care, a new law would give them clear guidance so that they could be compassionate and humane without risking prosecution.

The 2007 British Social Attitudes survey found that 75% of people with a disability believed that a person with a terminal and painful illness from which they will die should be allowed an assisted death. There are genuine concerns among disability activists that need to be addressed sensitively through debate and careful legislation but the CMF don’t say why it would be dangerous. They get out the pitchforks and flaming torches and whip the villagers into a frenzy of fear for their lives about a non-specific monster hiding in the barn. That’s their MO.

The principle of double effect

This is treatment that may shorten life, for example large doses of morphine for pain relief that are also fatal. This apparently is not considered assisted dying because the effect is foreseen but not intended. You may have trouble getting your head round the difference because it’s nonsense. But currently it’s nonsense that keeps doctors on the right side of the law. It’s not enough for patients and it’s not fair on doctors.

Hospice and palliative care are better alternatives
The 2013 Oregon report found that 90% of people who requested assisted dying were already in hospice care. It’s not an alternative to this care, it’s part of it. For some people, hospice care is enough but others should have the choice of the time and the way their lives end so that they can die with dignity – not just for themselves but for their families too so that they can make the most of the time that remains.

At the moment, there is the option of going to Switzerland but this is expensive and thus excludes many people. It also means that people may die sooner than they want to for fear of not being able to get there when they really need to.

The CMF’s position is not humane and it’s not compassionate. Nor is it well-informed. CMF members, like anyone else, are entitled to their beliefs but in trying to foist them onto the whole population, its members want their own moral purity enforced at the expense of the suffering of others. As usual.

For more information:
The Dignity in Dying web site.
Classic Cases in Medical Ethics by Gregory E Pence (I used the 4th edition, 2004)
Easeful Death by Mary Warnock & Elisabeth Macdonald (2008)
Medical Ethics by Tony Hope 2004
Lord Falconer’s Bill

**The CMF claims to represent over 4,000 UK doctors and around 800 UK medical students. I’ve written several pieces about them over the past few years. These are some of them:
CMF on gender reassignment surgery
CMF on mental illness
CMF on abortion