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Death with Dignity - An open letter to MPs and Peers

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Lord Joffe reintroduced his Assisted Dying for the Teminally Ill Bill on 9 November 2005 in a form that would legalise assisted suicide but not euthanasia – along the lines of the Oregon model. The bill will be debated, but not voted on, in the House of Lords early on 12 May 2006. This will be followed by the Committee stage (beginning two weeks or so later) where the House of Lords considers detailed amendments to the Bill – of which there are likely to be many put forward by opponents of the Bill. There is then a final report and third reading stage when the amended Bill can be further amended and finally voted on by the House. Even if the Bill were to pass all its stages in the House of Lords, it would still need to go through the House of Commons to become law.

As a general surgeon, I have sometimes seen patients fall victim to overzealous treatments at the end of life that have simply prolonged the dying process and ignored the ancient wisdom that speaks of 'a time to die'. I believe there is a time to recognise that enough is enough. It is good medical practice to stop, or not to start, invasive treatments in certain situations – especially when death is imminent and inevitable, and where the burden of a treatment outweighs its benefits.

And yet, having witnessed first-hand the deaths of patients, friends and relatives, I remain convinced that the law should not be changed to allow either physician-assisted suicide (PAS) or voluntary euthanasia.

I have only twice been asked to end the life of a patient, and on both occasions the request was withdrawn quickly as soon as the symptoms prompting it were relieved! Requests for euthanasia are in fact extremely rare when patients' physical, psychological and spiritual needs are properly met; in general most patients adjust their expectations during a terminal illness and become thankful for the quality of life that they have. We have an excellent tradition of palliative care in this country; and putting increased resources into research and making good palliative care more readily available must always be a key priority.

Requests for assisted dying are usually motivated by fear of 'loss of control', and yet paradoxically legalising voluntary euthanasia or PAS would actually undermine patients' freedom. Requests for euthanasia are rarely free and voluntary. As the last Lords' committee on euthanasia recognised in 1994, vulnerable people very often feel a burden on family, society and a struggling health service and feel pressure, whether real or imagined, to request early death. 35% of people requesting PAS in Oregon currently do so because they feel themselves to be a burden to others.

Hard cases make bad laws. A change in the law to allow euthanasia or PAS would give doctors power that could be too easily abused and would threaten the trust necessary for the doctor-patient relationship to function. The experience in the Netherlands (where over 1,000 patients are killed by doctors each year without their consent) demonstrates that progression to involuntary euthanasia would be a real danger should the law be changed here. Furthermore, one out of five attempts at PAS fails leaving the doctor to step in with a lethal injection. PAS and euthanasia cannot be separated and ethically they are equivalent as the doctor's intention is the same in each case. To protect the vulnerable majority it is right that a tiny minority of insistent patients forego a 'right' that the European Court of Human Rights, in considering the case of Diane Pretty (pictured above) in 2002, has said they don't have anyway.

Legalising PAS and euthanasia would split the medical profession. 75% of doctors in a major poll (Hospital Doctor, 15 May 2003) have already indicated that they would not participate in euthanasia if it is legalised, and a change in the law, as in the case of abortion, will lead to doctors who want to abide by the Hippocratic Oath (by not practising PAS or euthanasia) being excluded from specialities where euthanasia becomes part of the 'full range of services'. Euthanasia legislation would have a devastating effect throughout the National Health Service on already critical levels of staffing, where we are reliant especially on many overseas nurses from Muslim, Christian and other faith backgrounds who are strongly opposed to the practice. Furthermore it would put Britain out on a limb from the international community. The World Medical Association reaffirmed its strong opposition to both PAS and euthanasia in May this year.

The last Lords' Select Committee wisely and courageously rejected any change in the law in 1994. They concluded 'that it would be virtually impossible to ensure that all acts of euthanasia were truly voluntary and that any liberalisation of the law in the United Kingdom could not be abused'. I would urge this parliament to do the same. There is no need to change the law.

Euthanasia and PAS are unnecessary (because alternative treatments exist), dangerous (because they undermine autonomy) and morally wrong (being contrary to all historical codes of medical ethics and the Judeo-Christian ethic on which our laws are based). Nobody has a 'right' to be killed by a doctor, Britain does not need PAS or euthanasia and no society could ever control them. As professionals and society we need instead to get on with the task of working for that genuinely 'gentle and easy death' all patients deserve. Pope John Paul II showed us what real 'death with dignity' means: facing the end with courage, hope and serenity with balanced medical intervention and effective palliative care.

Peter Saunders is General Secretary of Christian Medical Fellowship, representing 4,500 doctors throughout the UK and Ireland

Published in both The Parliamentary Monitor and Dod's Parliamentary Companion in September 2005 prior to the House of Lords' debate on the Select Committee Report on Lord Joffe's Assisted Dying for the Terminally Ill Bill. An earlier version was published in pre-election versions of both The House Magazine and The Parliamentary Monitor

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