This is a sparkling address by English Peer, Lord David Alton. Particularly relevant for Tasmania at the moment...
Lord David Alton, October 2012:
Anyone who has followed the cases of Tony Nicklinson, Diane Pretty and Debbie Purdy – whose personal tragedies can leave no sane man or woman untouched – will inevitably ask the question is it possible to frame a better law? And there is a danger that those who defend British law and medical practice can be caricatured as uncaring or somehow in favour of suffering and pain.
Repeatedly, Parliamentarians have asked the question whether is it possible to allow euthanasia for a determined few without putting much larger numbers of others at risk – and they have concluded that it is not.
After extensive debates in Parliament and detailed examination of what has occurred in jurisdictions where the law has changed, Parliament, the British Medical Association, the Royal Colleges of Physicians, Surgeons , the General Practitioners the Royal College of Anaesthetists and the British Geriatrics Society remain strongly opposed to any legal change.
So do the Disability Rights Organisations, and the Hospice and Palliative Care movement, who have come out firmly against changing what has been described as “a hard law with a kind face;” a law which provides protection and safety for vulnerable people; a law which affirms dignity in living as well as dignity in dying. The 1994 select Committee on medical Ethics concluded that:
“Individual cases cannot reasonably establish the foundation of a policy which would have such serious and widespread repercussions… Dying is not only a personal or individual affair. The death of a person affects the lives of others, often in ways and to an extent which cannot be foreseen. We believe that the issue of euthanasia is one in which the interest of the individual cannot be separated from the interest of society as a whole”.
1 Parliament’s Response To Calls for Change
In 2004 Parliament established a second full parliamentary committee of inquiry.
That Select Committee, chaired by the former Lord Chancellor, covered some 246 Hansard columns and three volumes covering around 1,000 pages of evidence and commentary. It took expert evidence from over 140 witnesses in 45 sessions in the UK, the US State of Oregon, The Netherlands and Switzerland, And it considered around 14,000 letters and emails from members of the public. When an ‘assisted dying’ bill was introduced into Parliament a year later, it was defeated by 148 votes to 100. Three years later when Lord falconer tried to amend another parliamentary bill to legalise assisted suicide, his amendments was defeated by 194 votes to 141.. A similar campaign to change the law in Scotland was defeated in 2010 by 85 votes to 16.
Does this make parliamentarians heartless, insensitive bigots; does it make doctors or nurses unfeeling and uncaring automatons; does it mean disabled people organisations lack compassion or understanding of suffering or pain?
95% of Palliative Medicine Specialists – these are the people who care for dying patients day in and day out – are opposed to a change in the law. Are they all uncaring?
The Association of British Neurologists warn that severe depression will lead to cases of assisted dying and that a law which says two doctors can determine such cases will offer few safeguards. Do they have no understanding of either patients or law?
And what of disabled people? Jane Campbell, who has spinal muscular atrophy, who is a Commissioner of the Equality and Human Rights Commission, and now Baroness Campbell of Surbiton, says:
“I and many other severely disabled people will not perceive your support for euthanasia as an act of compassion but one founded in fear and prejudice.”
Do we have a better understanding of how disabled people view euthanasia than the organisations which represent them?
Having listened to voices like Jane Campbell’s Parliament declined to change laws which have served this nation well for two principal reasons:
Firstly, having weighed the evidence, it remained unconvinced that any change would provide sufficient safeguards for the elderly, disabled people and the terminally ill, and thus they rejected attempts to change our rigorous laws; and as one member of the most recent select committee, the distinguished lawyer and judge, Lord Carlile QC, said, in the end he resolutely came down against a change of law because of his fears for public safety. He said “The so-called safeguards… were paper thin.”
Secondly, Parliamentarians went to see the situation in Holland and Oregon to see how the law has been changed they concluded that the British approach to end of life issues is infinitely preferable and, even as Mr.Ottaway was asking the House of Commons to consider watering down Britain’s vitally important safeguards, the Council of Europe was urging parliamentarians not to do so. In January of this year, having seen the consequences of full scale euthanasia, the Council of Europe passed a new resolution that euthanasia and assisted suicide should be banned throughout Europe.
Parliament’s reluctance to sanction change has been greatly influenced by this overseas experience. Let me describe how the Law of Unintended Consequences has unravelled in Holland; my second point:
In the Netherlands a Euthanasia law was enacted in 2002 and euthanasia is defined as the administering of lethal drugs by a physician with the explicit intention to end a patient’s life on the patient’s explicit request. The law and the practice deserve proper analysis before wishing such laws on the UK.
Official Dutch statistics indicate that last year the number of euthanasia deaths increased by 18% to 3,695. This follows increases of 13% in 2009 and 19% in 2010. In due course, at this rate of increase, in the technical sense of the word, euthanasia will properly be able to be described as endemic. Why would it be any different here in the UK if the movers of this Motion achieved their goal. It may be the law of unintended consequences which will be at work but be clear what the consequences have been in Holland.
The Lancet has suggested that 23% of Dutch euthanasia deaths were not even reported in 2010 – and the 2011 annual report of the Regional Euthanasia Review Committee found that 13 psychiatric patients were killed by euthanasia in 2011, up from 2 in 2012. This, despite a notional legal requirement that the patient should be mentally competent.
It is also clear that, despite changing the law to legalise voluntary euthanasia, involuntary euthanasia persist in The Netherlands.
A recent report of the Central Bureau for Statistics said that of the almost 4,000 euthanasias and assisted suicides, 310 were ended without the patient’s explicit request. What price patient safety in such circumstances?
And, does a 77% reporting rate suggest a rigorously enforced and regulated law?
The 2005 select committee inquiry predicted, following detailed evidence-gathering in The Netherlands, that a Dutch-style law in Britain would lead to 13,000 euthanasia deaths annually: I repeat, 13,000 deaths every year. That number needs to be revised upwards in the light of the latest figures. In March of this year the Dutch introduced mobile units to deal with what they call the 80% of people with dementia or mental illness currently being “missed “ – their words – by the country’s euthanasia laws.
Do we want that here?
Let me turn to my third and final point. What do we mean by dying with dignity?
3. Dying With Dignity
The introduction of euthanasia will be cloaked in words like dignity, mercy, compassion and autonomy but the reality will be – doctors who will be required in future to kill patients; disabled people encouraged to believe they would be better off dead; patient safety compromised; and politicians using the new law as a pretext to withdraw resources from the care of the sick.
The so-called right to die will soon become a duty to die – and to die quickly.
Consider what is at stake.
Chillingly, the philosopher Baroness Warnock, has said that the sick are “wasting people’s lives” because of the care they require: “If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service.” Suggesting that we have a “duty to die” she said “I think that’s the way the future will go, putting it rather brutally, you’d be licensing people to put others down.”
This turns the argument into a worth based on someone’s economic value rather than on their true human value and their human dignity.
Imagine what will happen in Britain if the proposed laws are implemented. You have a terminal incurable disease. You have the option of palliative care at £1,000 a week or a glass of barbiturates at £5. What will happen if we accept Lady Warnock’s proposition that “you’re wasting the resources of the National Health Service.”
And consider, also, those with a vested interest who will be tempted to put an inheritance before a life. One in eight current cases of elder abuse currently involves financial abuse by relatives. It would inevitably increase if we change the law.
Remember Jane Campbell’s warning that support for euthanasia will be seen by disabled people as fear and prejudice. This summer all of us were deeply inspired by disabled athletes achieving extraordinary things. At the opening ceremony of the Paralympic Games Professor Stephen Hawking urged us to look up to the stars, not down at our feet. What a contrast with the constant negativity and mantra that that disabled people are a drain on resources and be ‘better off dead’. Quite the contrary they can teach the world valuable lessons of hope and courage.
And don’t be misled into believing that the current laws are uncertain or inadequate. The law in Britain is crystal clear. We leave the DPP to judge every single case on its merits – although there are rarely prosecution the law leaves open the route to prosecution where the DPP believes it to be desirable and forcing anyone contemplating the premature ending of a person’s life to weigh most seriously the possibility of prosecution: a tough law with a kind face. And that is precisely how it should be.
We are told that people are going to Switzerland to end their lives there. Yet over the last 10 years less than 1 in 50,000 of all deaths in this country has been at the Dignitas suicide apartment.Why does one lethal cocktail – but not 549,999 deaths – warrant wall to wall campaigning coverage?
Proponents of change insist that public opinion favours such a change. But public opinion probably would re-introduce capital punishment, too, and are we to suspend prudent judgement in that case too? And anyway, isn’t the question, which is usually asked “do you want to die in dignity?” And who wouldn’t answer yes to that?
But to die with dignity we don’t need doctors to kill us.
Macmillan nurses, hospices, and palliative care give the overwhelming majority in Britain a dignified death which does not involve commissioning doctors and nurses as patient killers. When the physical, psychosocial and spiritual needs of the patient are met, requests for euthanasia are actually extremely rare.
Rather than imitating the Dutch, we need to defend and care for the sick and elderly and put our energy into extending compassionate palliative care and hospice provision, and practical loving support – let’s demand “dignity in living” with the same fervour as those who want to license the routine killing of the most vulnerable in society. ‘Helping someone to die’ has come to mean helping to kill them, not asking them what help they need.
Let me end by recalling a warning given at a parliamentary hearing by Dr Robert Twycross, Emeritus Clinical Reader in Palliative Medicine, Oxford University. He insisted that ‘euthanasia must never become part of normal medical practice ‘and that ‘society must safeguard the right to life’. Dr Twycross said that ‘if we kill voluntarily we will eventually offer involuntary euthanasia’.
Euthanasia, then, represents a terrible defeat. Care and kill cannot be used as synonyms. To have a right to do a thing is not at all the same as to be right in doing it.
Euthanasia diminishes the dignity and humanity of the sick and elderly and diminishes those of us who condone it.
A change in the law would inevitably carry within it the seeds of its own extension.
If ever there was an occasion for heart and head to act together, this is it. It is a moment to support the BMA; to support the Royal Colleges; to support the hospice movement: and to support the disability rights organisations by rejecting this proposition.