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Assisted Dying for the Terminally Ill Bill - A dangerous document that Christian doctors should oppose

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Briefing Paper on Lord Joffe's Private Member's Bill

A new Bill attempting to legalise Dutch-style euthanasia throughout Britain is now the subject of a Select Committee in the House of Lords. Lord Joffe's Assisted Dying for the Terminally Ill Bill[1] passed its second reading on 10 March 2004 without a vote, and is now being considered by a Select Committee, where it can be rejected or amended before returning to the House of Lords. The Committee is taking submissions up until 3 September 2004. If it traverses the House of Lords it then faces the much easier challenge of three readings in the Commons before becoming law.

The Bill seeks to legalise assisted suicide for competent adult patients who are 'terminally ill'[2] and 'suffering unbearably'.[3] Patients who are unable to participate in assisted suicide can receive euthanasia. All that is required are the signatures of two doctors and two witnesses to the decision.

If passed we believe it would open the floodgates to euthanasia in this country given the current climate of favourable public opinion, some willing doctors, and many patients already feeling a burden to relatives, carers and society at large.

Requests for voluntary euthanasia are rarely free and voluntary, and in fact extremely rare when patients' physical, psychological and spiritual needs are properly met. CMF has consistently opposed euthanasia on the grounds that it is unnecessary (because alternative treatments exist), dangerous (because of the slippery slope) and morally wrong (it is contrary to all historically accepted codes of medical ethics and the Judeo-Christian ethic).[4]

It is noteworthy that a House of Lords Select Committee on Medical Ethics in 1994 opposed any change in the law to allow euthanasia after an extensive enquiry and concluded that 'it was 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.' They 'were also concerned that vulnerable people - the elderly, lonely, sick or distressed - would feel pressure, whether real or imagined, to request early death.' We need to pray that this wisdom continues to prevail.

Christian doctors are encouraged to write to individual House of Lords members, encouraging them to oppose the Bill, at: House of Lords, London, SW1A 0PW.[5] A full list of members, along with instructions on how to address them is available on the internet.[6]

Arguments against euthanasia and assisted suicide follow along with a more detailed critique of the provisions of the Bill

See also CMF Files on Euthanasia[7] and Assisted Suicide[8] and Triple Helix Editorial[9]

Why voluntary euthanasia should not be legalised [10]

Voluntary euthanasia should not be legalised for the following reasons (See www.cmf.org.uk/ethics/twelve_reasons_euthanasia_1997.htm for full article)

  1. Voluntary euthanasia is unnecessary because alternative treatments exist
  2. Requests for voluntary euthanasia are rarely free and voluntary
  3. Voluntary euthanasia denies patients the final stage of growth
  4. Voluntary euthanasia undermines medical research
  5. Hard cases make bad laws
  6. Autonomy is important but never absolute
  7. Voluntary euthanasia leads to euthanasia tourism
  8. Voluntary euthanasia changes the public conscience
  9. Voluntary euthanasia violates historically accepted codes of medical ethics
  10. Voluntary euthanasia gives too much power to doctors
  11. Voluntary euthanasia leads inevitably to involuntary euthanasia
  12. In 1994 the British House of Lords recommended no change to the law on euthanasia after an extensive enquiry

Arguments against Physician Assisted Suicide

Medical technology and palliative care have now advanced to a level where most people in this country are able to die comfortably. However, on rare occasions, patients' fears about distressing symptoms and loss of dignity or control over death can prompt them to request help in committing suicide. These fears may be potentiated by depression or a false sense of worthlessness and are often heightened by anxiety about overzealous and inappropriate medical intervention.

As well as treating physical and psychosocial symptoms, doctors have a duty not to administer intrusive medical treatment when the burden of that treatment outweighs its therapeutic benefit. Neither should they give treatment forcibly to competent patients who refuse it, even if that treatment is life-saving.

However, while upholding respect for patient autonomy, doctors must never intentionally give their patients advice or the means to commit suicide, either directly or indirectly. Any law allowing physician assisted suicide would threaten the trust necessary for the doctor-patient relationship to function, place pressure on patients (whether real or imagined) to request early death, and introduce a slippery slope to voluntary and involuntary euthanasia. Such legislation would also be impossible to police, might well undermine the development of palliative care services and could lead to patients being pressured to request suicide for economic reasons by family, carers or society at large.

Medical Ethics are built on the foundation of the Judeo-Christian Ethic and the Hippocratic Oath. The Judeo-Christian ethic affirms that human beings are made in the image of God, and belong to God and that the taking of innocent human life (even if the life is 'one's own') is always wrong regardless of the wishes, circumstances or motivations of those involved. In the same spirit the Hippocratic Oath enjoins that doctors 'give no deadly medicine to anyone if asked, nor suggest such counsel'. Despite the many changes in medicine these time-honoured values must be reaffirmed by the profession.

Accordingly, whilst as doctors we have a responsibility to provide appropriate treatment, palliation and support to patients who are suffering from distressing symptoms (whether in the context of terminal illness or not) - we must continue to resist any change in the law to allow physician assisted suicide.

Critique of the Assisted Dying for the Terminally Ill Bill

We favour a complete rejection of the Bill because we believe that the arguments against legalising euthanasia are overwhelming. A bill legalising euthanasia would create the following precedents that would lead inevitably to more and more euthanasia:

  1. Euthanasia would be established as a 'therapeutic option' valid in some cases, and therefore would need to be considered as a therapeutic option in all cases. This would change the whole character of medicine, which is aimed at relieving symptoms, treating illness and preserving life. For a doctor to kill a patient violates all historical ethical codes. It also makes the doctor the most dangerous person in the state.
  2. If euthanasia or assisted suicide are established as a right for competent adult patients then when the Mental Capacity Bill comes into law there will be nothing to stop a patient enacting an advance directive for this 'right' should they become incompetent and develop 'unbearable suffering' according to their own definition
  3. As euthanasia and assisted suicide can be given for treatable symptoms and conditions, they become a treatment option for any symptom in a terminally ill patient (eg. thirst, hunger, pain, depression, anxiety, existential angst etc). To refuse euthanasia for patients who are not terminally ill but with the same symptoms could well be the subject of a successful challenge on the basis of discrimination under the Human Rights Act. Thus the law could be extended to allow euthanasia for a wide variety of patients, at their request.
  4. The bill effectively legalises euthanasia for all patients, whether they are capable of carrying out assisted suicide or not, simply because assisted suicide often fails requiring a doctor to step in to finish the process.
  5. The history of the Abortion Act has demonstrated that once killing is sanctioned for any reason, it is inevitably carried out for every reason – a slippery slope operates as the definition of unbearable suffering and terminal illness are both open to subjective interpretation by a doctor acting in 'good faith'.
  6. The setting up of specialised Euthanasia clinics will be inevitable in order to streamline the process and provide the means by which any doctor can refer a patient to such an institution for the two medical signatures and two witness signatures in a single visit, with a second visit two weeks later for euthanasia. Under the bill there is no need for any of these four people to have met the patient before – only to be satisfied of his/her identity. The euthanasia could then be carried out without any further person being involved.
  7. The 1994 Select Committee which rejected legalising voluntary euthanasia concluded that 'it was 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. We were also concerned that vulnerable people - the elderly, lonely, sick or distressed - would feel pressure, whether real or imagined, to request early death.' This still holds.

References

  1. www.publications.parliament.uk/pa/ld200304/ldbills/017/2004017.pdf
  2. 'terminal illness' means an illness which in the opinion of the consulting physician is inevitably progressive, the effects of which cannot be reversed by treatment (although treatment may be successful in relieving symptoms temporarily) and which will be likely to result in the patient's death within a few months at most
  3. 'unbearable suffering' means suffering whether by reason of pain or otherwise which the patient finds so severe as to be unacceptable and results from the patient's terminal illness
  4. www.cmf.org.uk/index/euthanasia.htm
  5. Select Committee on the Assisted Dying for the Terminally Ill Bill [HL], Committee Office, House of Lords, SW1A 0PW - or alternatively email to assisteddyingbill@parliament.uk
  6. www.publications.parliament.uk/pa/ld/ldinfo/a-z.htm
  7. www.cmf.org.uk/literature/content.asp?context=article&id=151
  8. www.cmf.org.uk/literature/content.asp?context=article&id=168
  9. www.cmf.org.uk/literature/content.asp?context=article&id=903
  10. www.cmf.org.uk/ethics/twelve_reasons_euthanasia_1997.htm

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