Why we should allow assisted dying: compassion, choice, and safety

Lord Falconer’s Private Members’ Bill to legalise assisted dying for mentally competent adults who have expressed a settled wish to control the time and manner of their death will today have its crucial Second Reading. The issue has attracted intense interest inside and outside parliament. An unprecedented 120 plus peers are tabled to speak and there has been extensive (and increasingly favourable) coverage in the media, prompted in part by declarations of support by prominent figures – notably Desmond Tutu and Sir Richard Thompson, President of the Royal College of Physicians - and by the fall-out between the Archbishop of Canterbury Justin Welby (against) and a predecessor George Carey (for).

The overwhelming case for Lord Falconer’s Bill can be summarised in three words: compassion; choice; and safety. The law at present lacks compassion for that significant number of dying people who have intolerable suffering which cannot be relieved by palliative care. It denies a terminally ill person the choice of assistance to escape this suffering. This is at odds with the fundamental principle of medicine – namely that the wishes of a patient with sound mind should be respected. What is more, the present situation is unsafe, encouraging decisions about end-of-life care to depend on a clinical, ethical and legal fudges such as the single-minded use of the double effect, whereby it is permissible to give a patient treatment that may shorten their life if the primary aim is to relieve their suffering. This is happening outside any clear framework of law.

The alternatives to assisted dying are appalling: lonely suicides or botched attempts, ghastly pilgrimages to Switzerland for those who can afford them and are still fit enough to travel, slow death by starvation and dehydration, and amateur assistance from loved ones who face the possibility of prosecution and the place where they said goodbye to their loved one turned into a crime scene.

So how has it taken so long to get to the point where a law supported by 80 per cent of the population at last has a fighting chance of surviving in the Lords to be debated in the Commons? The answer is deeply disturbing. The opponents, although they are small in number, have been highly organised and have been very effective in spreading confusion about Falconer’s bill and disseminating factoids and INSERT: inaccuracies about what happens in other jurisdictions that have liberalised the law on assisted dying.

Falconer’s Bill is routinely described by opponents as a “Right to Kill” Bill. Assisted dying for terminally ill people (where the last act is carried out by the patient) is conflated with assisted suicide for people who are not terminally ill, and euthanasia (where the final act is carried out by a third party). There is constant reference to slippery slopes where, so we are told, legalising assisted dying has resulted in pressure being placed on “burdensome’ elderly” - or simply unhappy - people to accept medical death.

The most pertinent evidence is from Oregon, which passed a Death with Dignity Act (DDA) 17 years ago. This is similar to the Falconer bill, though the latter has more safeguards. The proportion of deaths that are assisted has never risen above 0.25 per cent. There has been no extension to people who are not dying or who do not have mental capacity, and there is no public appetite to extend the law. What is more, for every person who is assisted to die, 10 or more people gain comfort from discussing this option with their medical team, and from knowing that it is available.

The reassuring Oregon experience has prompted the passing of similar laws in Vermont and Washington. Tellingly, the Oregon Hospice Association – which, like palliative care physicians in the UK – initially opposed DDA , withdrew its opposition after eight years of seeing the law in action, observing “no evidence that assisted dying has undermined Oregon’s end of life care or harmed the interests of vulnerable people”. Essentially, they have confirmed what supporters of the Falconer bill argue: that an assisted dying Bill will not mean that more people will die but that more people will have good deaths. Needless to say, opponents of assisted dying ignore the evidence from Oregon and focus on other jurisdictions, such as Holland that have an entirely different law from that proposed in the Falconer bill.

The population at large, however, does not buy this scare-mongering. What is more, there is a striking disconnection between the spokespeople for certain groups and those on whose behalf they claim to speak. In a recent survey, 79 per cent of people with disabilities supported assisted dying, though their leaders have repeatedly asserted that the Falconer bill would make them feel threatened, unwanted, and devalued. And a steady 70 per cent of Anglicans, Catholics, and Jews are at odds with the views of their bishops and rabbis.

Most disturbing of all (because potentially most influential) is the position of the bodies purporting to represent the medical profession. The British Medical Association (BMA), the Royal College of Physicians (RCP), and the Royal College of General Practitioners (RCGP) are opposed. However, only a third of doctors would be against having assisted dying for themselves! In successive polls, two thirds of doctors feel that their representative bodies should be neutral as they believe (correctly) that this is a matter for society as a whole decide. “Doctor knows best” is, or should be, a thing of the past.

Although the medical profession is deeply divided on assisted dying, the BMA refused to debate any of the 12 motions asking for a survey of members’ views on neutrality put forward at this year’s Annual Representatives Meeting. The RCGP has reaffirmed its opposition, having announced that 77 per cent of their members are against assisted dying, a figure based 234 individual respondents, or 0.48 per cent of the membership. The RCP is planning at last to poll its members, sensing perhaps that its current stance may not reflect the views of its members.

The present situation is cruel, dangerous, and at odds with the deepest values of the profession of medicine which I practised for nearly 40 years. Lord Falconer’s bill must not be blocked by an unrepresentative minority of opponents who may have their own reasons for denying the rest of us the right to die well. Let us hope that reason and humanity will prevail and that, if and when assisted dying is discussed in the Commons, politicians will have the courage to do the right thing and not be cowed by a very well organised minority exercising what they believe is their right to block attempts to alleviate the needless suffering of their fellow citizens.

Raymond Tallis is Emeritus Professor Geriatric Medicine University of Manchester and Chair of Healthcare Professionals for Assisted Dying