Thursday, 20 August 2015

Assisted Dying - or living at the end of life?

When I reach the time where the end of my life is foreseeable, I really do hope that none of those around me will speak or think in terms like "dying". I would much prefer them to think in terms of my living at the end of my life or, indeed, living the end of my life.  I also hope that, if I ever find myself accompanying someone else who is approaching the end of their life, we would speak and live using the same terms. It strikes me as being how the human person manifests and receives in an existential way, at this last stage of their life, the virtue of hope.

Even the term "assisted dying" articulates the denial of hope; and, if the patient is themselves at the origin of that denial, asks of their medical team to affirm them in that denial. (This seems particularly acute if it is a nurse who immediately provides the necessary drugs to the patient rather than the prescribing doctor.) If the medical team are the origin of that denial - which is a foreseeable consequence should proposed legislation before the Houses of Commons and Lords enter into law - the term expresses the projection from the medical team on to the patient of a denial of hope and inevitably provides a pressure in favour of it.

The Assisted Dying (no.2) Bill is due for Second Reading in the House of Commons on 11th September. In preparing my letter to my MP on this subject, I used the following sources:

Britain's law on assisted suicide is not 'broken' and does not need ‘fixing’

Eight Reasons not to legalize Physician Assisted Suicide

Since writing it, I have referred to:

Assisted Suicide and Euthanasia: A Guide to the Evidence

According to the first source, the Commons private members bill is "almost identical" to the Bill introduced in the House of Lords, though a full text has yet to be published. One has only to look at the experience of legalized abortion to be able to foresee that legislation that does not in any way establish a right for a patient to be provided with assistance to commit suicide will in the event be interpreted in that way. Over time, doctors will sign off a patient's request precisely "on request", though that is not envisaged by the legislation. In particular - and I didn't include this in my letter - the second "independent doctor" is required by the proposed legislation to satisfy themselves of a range of factors, including the freedom of the patient from coercion. But I cannot see how a doctor can do this in genuine good faith without having a close knowledge of the patient's care, a knowledge that can only be achieved by having a significant presence in the patient's care.... and in that case a serious compromise of independence. Page 8 of the last source above indicates an aspect of this from experience in Oregon, where a small proportion of doctors sign off a majority of cases of assisted suicide.

If you want a summary of the substance of my letter - text below - it is that the experience of the practice of legalized abortion indicates that, if the proposed legislation were to make its way into law, all the safeguards around assisted suicide contained in the legislation will turn out to be utterly illusory.
I do not believe that the provision for medical professionals to provide patients with the means to kill themselves is in accord with the proper duty of care due to those who suffer serious illness. It would be much more in accord with that duty for there to be sufficient provision for end of life care on the model of hospice care. It should be possible today in countries such as England and Wales, for example, to ensure that pain relief, symptom relief and appropriate spiritual care are available to fully support a patient as they come to the end of their lives without making provision for them to commit suicide.
Whilst the Commons Bill has yet to be published, the similar Assisted Dying Bill in the House of Lords gives a close indication of the provisions in the Commons Bill. It is my view that the protections contained in that Bill, and, as I understand it, which will also be present in the Commons Bill are largely illusory. If these provisions were to become law, one can readily foresee that, as a doctor communicates a terminal diagnosis to a patient they will be expected by regulation or code of practice to also communicate the option of assistance from a medical professional to help them kill themselves. As soon as this happens, all the safeguards in the proposed legislation are compromised, most particularly the voluntary nature of the patients request which has inevitably become the subject of external influence.
One can also foresee that, whilst the debate in favour of the proposed legislation might suggest a (single) narrative of a free choice by a terminally ill patient to avoid overbearing suffering, the reality of the practice of such legislation would involve a variety of narratives on the part of patients. The published experiences of women with regard to legalized abortion, including those from writers supportive of legalized abortion, show very clearly that there are a variety of narratives, only a proportion of which can be fully characterized as a free choice on the part of the woman. This experience is instructive, I think, for what would be the experience of implementing legislation allowing medical professionals to assist their patients in killing themselves.

An afterthought that has occurred to me since writing my letter is the possibility that regulations and codes of practice might even expect the clinical staff in hospice settings to offer the option of assisted suicide to their patients - something totally alien to the ethical and clinical principles of hospice care.


Jackie Parkes said...

This is an interesting post from a former teacher of my children


Joe said...

Thank you, Jackie, for a most valuable link.