Lord Alton's Speech in Euthanasia Debate - 25/11/10 - Liverpool Medical Institution

8/8/2019 Lord Alton's Speech in Euthanasia Debate - 25/11/10 - Liverpool Medical Institution

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presented to us as being either about compassion orabout morality. But this is to miss the point.Compassion and morality are common currencyamong both supporters and opponents ofassisteddying, though they may approach them from differentstandpoints. The real debate is about public safety about whether it is possible to license assisted dyingfor a determined few without putting larger numbersof others at risk.

It would be disingenuous and insulting for me tosuggest that Dr.Tallis has no regard for questions of

ethics and equally disingenuous and insulting toimply that those of us who uphold the law have noregard for suffering or pain.

Campaigners for changing the law recognise thatquestions of public safety are the reasons why onthree occasions, after hours of debate and a Select

Committee Report occupying 246 Hansard columnsand two volumes of 850 pages of evidence andwitness statements, Parliament has weighed theevidence and rejected the proposition before youtonight.

Campaigners for change tell us not to worry becauseany assisted dyinglaw would come with

safeguardsto protect the vulnerable. However, thesafeguards that are being proposed were criticisedfive years ago by a parliamentary Select Committee asbeing inadequate, yet nothing has been done sincethen to strengthen them. The campaigners also pointto the very few jurisdictions in the world whereassisted dying in one form or another has beenlegalised and they tell us that it is working well in

those places. But it isnt! There are some serious


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problems with the way assisted dyingis working inthese places.

Lets begin by looking at the so-called safeguards.

These are supposed to ensure that assisted dyingwould be available only to certain, strictly-definedcategories of people broadly speaking, theterminally ill and the mentally competent. Five yearsago a Select Committee of the House of Lordsconducted an exhaustive inquiry Lord JoffesAssisted Dying for the Terminally Ill Bill, which

contained the sort of safeguards we are hearingadvocated today.

The Committee did a very thorough job. It tookevidence from over 140 expert witnesses, including (Ishould say) Professor Tallis, in four countries theUK, the US State of Oregon, Holland and Switzerland.It did not reach a consensus on whether Lord Joffes

Bill could be commended to Parliament, but its reportmakes very interesting reading. I would commend itto anyone as a good place to start in any study of thesubject ofassisted dying.

Lord Joffe proposed and the campaigners are stillproposing that assisted dyingshould be offered topeople who are terminally ill and that terminal illness

should be defined as an incurable illness with apredicted life expectancy of six months or less. Thisplaces a premium on accurate prognosis. Someonewho is asking forassisted dyingon the strength of asix-month-or-less prognosis may well think again ifthere is a prospect of living longer. So this raises thequestion: just how accurate is prognosis of terminalillness?


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Not verywas the answer the Select Committeereceived.

Professor Tallis himself told the Committee thatmedicine is a probabilistic art. Another seniordoctor put it this way:

Prognosticating may be better when somebody iswithin the last two or three weeks of their life. I haveto say that, when they are six or eight months awayfrom it, it is actually pretty desperately hopeless as anaccurate factor.

Yet another physician, a specialist in palliativemedicine, told the committee about his ownexperience of signing benefit claim forms forterminally ill patients believed to have six months orless to live.

I would not like to count, he said, how many of

those forms I have signed for patients still living aftera year, eighteen months or even longer.

And he added: The reality in clinical practice is thatwe can be wrong.

The Royal College of General Practitioners wrote tothe Committee that (and, again, I quote):

It is possible to make reasonably accurateprognoses of death within minutes, hours or a fewdays. When this stretches to months, the scope forerror can extend into years

These statements are corroborated by the officialreports of what is happening in Oregon, where the six-

month criterion is used as a basis for prescribing


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lethal drugs to terminally ill patients under that StatesDeath with Dignity Act.

The annual reports from the Oregon Public HealthDepartment show that some of those who are giventhese drugs on the basis that they have six months orless to live are keeping them for up to three yearsbefore using them to end their lives. How long theymight have lived if they had not taken the drugs isanyones guess.

The trouble is that the general public tends to regard

medicine, not as the probabilistic artthat ProfessorTallis has rightly called it, but as an exact science,which it isnt. They are used to hearing colloquialphrases like three months to live, which are all toooften taken at their face value. The Select Committeerecognised this problem, and it recommended that(and I quote from its report):

If a future bill should include terminal illness as aqualifying condition, this should be defined in such away as to reflect the realities of clinical practice asregards accurate prognosis

So what have the campaigners done in response?Absolutely nothing! We see the same old definition ofterminal illness trundled out over and over again. Five

years on from the select committees recommendationMargo MacDonalds euphemistically-named End ofLife Assistance Bill, which is now in the ScottishParliament, is still seeking to legalise physician-assisted suicide and physician-assisted euthanasiafor people who have received a prognosis of sixmonths or less. Yet the weight of medical opiniongiven to the Select Committee was that, if we had to


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have legislation of this nature, it should be framed interms of weeks, not months.

Now lets take a look at the other principal safeguard that a person receiving assisted dyingmust bementally competent. Here again, we have a popularnotion that mental competence or mental capacity is something that can be determined, if not by adoctor, then by a consultation with a psychiatrist. Butin real life its rather more complex than that.

It is perfectly possible to be mentally competent in

the sense of being compos mentis and having onesnormal thinking processes working -and yet to beclinically depressed. The campaigners recognise this.They propose that, if a doctor who is assessing apatient forassisted dyingshould have any doubtsabout that patients mental capacity, then the patientmust be referred for psychiatric examination. Insaying this they are following exactly the model of the

Oregon law.

So the question arises: does this filter work inpractice in Oregon?

Research published in the British Medical Journaltwoyears ago suggests not.

The researchers examined a sample of 18 patientswho had received lethal drugs from their doctors afterbeing cleared for physician-assisted suicide. Theyfound clear indications that three of these patients in other words, 1 in 6 of them had been sufferingfrom clinical depression at the time they wereassessed but had not been referred by the doctorsconcerned for psychiatric examination. Their report

concluded that (and I quote) in some cases


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depression is missed or overlookedand that thecurrent practice of the Death with Dignity Act inOregon may not adequately protect all mentally ill

patients.

Yet this is the model that is being commended to ustonight and for legislation here in Britain.

Of course, the researchers looked only at a sample ofcases, and it is possible that that sample may havebeen untypical. But, while another sample mightshow fewer or no cases of missed depression, it

might equally show more. What is clear is that clinicaldepression is being missed in Oregon under just sucha law as the campaigners are urging us to enact here.

Take the case of Michael Freeland as an example.

He had a long history of depression and suicideattempts and his life was ultimately ended under the

Oregon laws.

Dr Gregory Hamilton, an Oregon psychiatrist, said thatthis man was not in pain because his pain was nottreatable; he was in pain because nobody bothered.

Dr.Hamilton added that this was just one case

among many:

Dignity in Dying, the re-branded Voluntary EuthanasiaSociety, accepts that there is evidence of some peoplewith depression being given lethal drugs to end therelives, but it states on its website that all had mentalcapacity and were able to make rational decisions.That may be so, but is it seriously being suggested

that it doesnt matter if people who are clinically


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depressed are helped to commit suicide so long asthey have mental capacity?

Listen carefully to Professor Timothy Maugham,Consultant Clinical Oncologist at Cardiff, who saysthat in the last four years three patients had askedme for a way to end it all quickly.

All three of these have been in the throes ofdepression at a the time and with goodcommunication, treatment of depression andongoing support, have changed their opinion and

gone on to face their future in greater peace.

Professor Maugham says a change to the law isa dreadful prospect.

There is yet another aspect of mental capacity to beconsidered.

In Oregon the official statistics show that around 1 in8 of those who received lethal drugs for physician-assisted suicide were suffering from Motor NeuroneDisease (MND). Establishing mental capacity amongpatients with neurological disorders is fraught withparticular difficulty. The Select Committee was toldby experts in this field that (and I quote the words of

Professor Christopher Kennard of the Association ofBritish Neurologists):

on the face of it, most of our patients with motorneurone disease are intellectually intact, very muchon the ball and able to make decisions. However, weknow from research that about 30% of those patientsactually have significant cognitive impairment.


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In other words, it is not just a question of establishingthat someone who asks forassisted dyinghasmental capacity and is not clinically depressed. Thereis also, among some of those who might pursue thiscourse, the additional problem of cognitiveimpairment, which can be very difficult indeed to spot.

But, even if we could predict the course of terminalillness with accuracy, and even if we could establishmental capacity or competence with certainty, thereremains a further danger how could we be sure thatsomeone who appears to be in earnest about wanting

to have his or her life ended is not acting either undercoercion from others or out of a sense of obligation toothers?

The only so-called safeguard that has been proposedin this vital area is that the assessing doctor shouldhave no reason to believe that this is the case and thata witness should confirm that (and I quote from Lord

Joffes last assisted dying bill) it appears to himthat the patient is of sound mind and has made thedeclaration voluntarily.

These are no more than paper safeguards. It is simplyunrealistic to expect a doctor to detect internal orexternal coercion in a patient seeking assisteddying, especially if he or she is not the patients

regular practitioner. And this brings us to a regularfeature of the physician-assisted suicides that areoccurring in Oregon.

The official reports of the Oregon Public HealthDivision tell us that (and I quote) a substantial

proportion of Oregon physicians are not willing toparticipate in legalized physician-assisted suicide

and that many applicants go from doctor to doctor to


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find one who will assess them and supply lethaldrugs. In other words, there is doctor shopping.

What this means in practice is that some applicantsfor assisted suicide are being assessed by a minorityof doctors who know little of them beyond their casenotes and who are themselves inclined to lookfavourably on the notion ofassisted dying. Added tothis is the phenomenon of pro-assisted dyingpressure groups seeing themselves, in the words ofOregons Compassion and Choices organisation, asstewards of the lawand offering to find compliant

physicians for people whose own doctors haverefused to participate in physician-assisted suicide.

Oregons doctor shoppingis almost certainly at theroot of another phenomenon. For the first year or twoafter that States physician-assisted suicide law cameinto force, about one in three of those who applied forlethal drugs were referred for psychiatric evaluation.

12 years later, though the number of deaths from thissource has risen fourfold, the number of referrals forpsychiatric examination has fallen to zero.

Why is this?

Two explanations have been offered. According toDignity in Dyings website, it is because of (and I

quote) improved techniques for screening outineligible patients prior to any psychologicalevaluation. However, no corroboration is offered forthis statement other than what is referred to aspersonal correspondencebetween Dignity in Dyingand its sister organization in Oregon, Compassionand Choices. In other words, the evidenceconsistsof a personal and therefore undisclosed letter from

one pro-assisted dying pressure group to another!


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This is what Professor Baroness (Ilora) Finlay,Professor of Palliative Care and Past President, RoyalSociety for Medicine, a Member of the House of LordsSelect Committee, who went to Oregon to see thesituation first hand, concluded:

In Oregon, there is a culture of doctor-shopping. Thepro-assisted-suicide organisations link patients to acompliant doctor. The Oregon health department'sreport showed that a tiny number of doctors provideall the lethal prescriptions. Such doctors from pro-

assisted-suicide organisations are hardly going to beunbiased in their "in good faith" assessments.

Let us not be fooled into thinking that a second,independent doctor is a rigorous check. Dr.Shipmanscremation forms were all signed by doctorsindependent of him. That safeguard failed in severalhundred cases. More than 90 per cent of doctors in

palliative medicine in this country want nothing to dowith this, as we work day in and day out with thosewith end-of-life diseases, on their management andcare.

I was also struck by the findings of a research paperpublished last month by the think-tank Living andDying Well. Could it be, the researchers ask, that the

sharp fall in referrals for psychiatric evaluation inOregon is just another consequence ofdoctorshopping. Could it be, they ask, (and here I quote)that a physician who is prepared to process anapplication for physician-assisted suicide might

perhaps be less inclined than others to regard such arequest as a pointer to possible psychologicaldisorder or depression?


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That sounds to me the more plausible explanation.

Professor Tallis centres his argument for changingour law on the experience from Oregon. The sameevidence has led others to opposite conclusions andis far from uncontested.

A distinguished American jurist, His Honour JudgeNeil Gorsuch, in A Reply to Raymond Tallispublished in The Journal of Legal Medicinetrenchantly repudiates the assertion that Oregons lawis good law and it begs the question that if it is such

good law, why arent other American States queuingup to enact similar provisions. Judge Gorsuch says:

While Dr.Tallis repeatedly touts Oregons assistedsuicide law as a model worthy of emulationelsewhere, that very law makes no mention ofsuffering: terminally ill individuals can kill themselvesfreely whether they suffer great pain, little pain, or

none at all

Although Dr.Tallis calls on us to believe that theslippery slope can be avoided, he offers us no reasonto ignore the empirical evidence, logical extensions,and stated intentions of others within the euthanasiamovement.

I have talked so far about the safeguardsthat wehave seen in recent assisted dyingbills and I haveset out for you the reasons why I believe these fallwell short of the mark. Now I want to deal with asafeguard that doesnt appear in any of these bills.


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I feel sure it is common ground between ProfessorTallis and me that, ifassisted dyingwere ever to belegalised in this country, it should be restricted to avery small minority of highly resolute and strong-minded individuals and that it should be structured insuch a way as to avoid giving encouragement toothers to pursue it. Yet it is here that we have one ofthe most serious weaknesses in the assisted dyingbills we have seen to date namely, that they areproposing, not assisted suicide or euthanasia, somuch as physician-assisted suicide and physician-administered euthanasia.

In other words, they are placing assisted dyingwithin the comfort zone of the health care system.This embedding of the practice within health care, inthe face (it has to be said) of opposition from themajority of British doctors, is probably intended tomake the practice easier to commend to Parliamentand the public, but it carries with it a serious hazard.

We rightly trust our doctors to give us the advice andthe treatment that they believe to be in our bestinterests. From the point of view of most patients,what a doctor recommends or is prepared to do isliable to be seen as the right course of action for thatpatient. This is not paternalism, it is simply arecognition of the asymmetry that exists in the

relationship between doctor and patient.

Very few of us have the knowledge and experience tochallenge our doctors view of what is the best clinicalcourse of action to follow in our own circumstances.

For this reason physician-assisted suicide andphysician-administered euthanasia carry with them a

suggestion of clinical endorsement of the act, a


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sharing of responsibility with a trusted professional.Here we have, in the proposals of the campaigners,not simply an inadequate safeguard but a condition the involvement of the medical profession whichmakes assisted dyingparticularly unsafe.

This fatally corrupts the precious doctor-patientrelationship. This is why the British MedicalAssociation, the Royal College of Physicians, theRoyal College of Anaesthetists, the Royal College ofSurgeons of Edinburgh, and the British GeriatricAssociation all oppose any change to the law. 95% of

the membership of the Association for PalliativeMedicine of Great Britain & Ireland, which representsover 800 UK specialists in palliative care, is opposedto any change in the law.

Listen to these statments:

Royal College of Anaesthetists :

a significant number of anaesthetists would have aconscientious objection to involvement with physicianassisted suicide. - Professor David Hatch RCA

The Royal College of Physicians:

key terms in the Bill are worryingly vagueit could beextended to apply to a very large number of patients beyondthose whom the sponsors had in mind when they proposedit.


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The British Medical Association:

the risks of significant harm to a large number of people aretoo great to accommodate the needs of very few.

And the General Medical Council unambiguously androbustly asserts that:

A change in the law to allow physician-assisteddying would have profound implications for the role

and responsibilities of doctors and their relationshipswith patients. Acting with the primary intention tohasten a patients death would be difficult to reconcilewith the medical ethical principles of beneficence andnon-maleficence

So much for the medical profession but what of thepatients?

It is sometimes argued that a patient who is sufferingand wants help to end his or her life should not beabandoned by the doctor on the final journey. But,while arguments like this may sound compassionate,they do not really stand up to rigorous thinking. If weare talking, as I hope we are, about limiting assisteddyingto a very small number of highly-determined

people, such people are unlikely to be deflected fromtheir project by the fact that the procedures they arerequired to follow are outside the health care system.

On the other hand, embedding assisted dyingwithinhealth care risks sending the message to the lessresolute that it is just another avenue of medicaltreatment and that, if a doctor is prepared to provide

it, it must be the right course for them in their clinical


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condition. Ifassisted dyingwere ever to be legalisedhere, it must be as a highly exceptional event, not aroutine procedure. Placing it inside health care ismost certainly not the way to achieve that.

Many who give this issue the serious reflection andconsideration which it deserves are also wary of anargument which can become driven by resourcesrather than clinical decisions or ethics:

On October 10th, 2008, Baroness (Mary) Warnockchillingly pointed us towards a future requirement not

to be a burden on our loved ones or society; that theright to die will become an obligation to die:

If youre demented, youre wasting peoples lives -your familys lives - and youre wasting the resourcesof the NHS.

Death becomes a form of therapy.

Lady Warnock has also said: Pensioners inmental decline are wasting peoples lives because ofthe care they require and should be allowed to opt foreuthanasia even if they are not in pain.

What does this say about the mental competence ofthose who will apparently make free decisions? More

strikingly, what does it tell us about the values of asociety where becoming an economic burden willdetermine your right to treatment, compassion orcare?

An open letter in the BMJ on October 16th, on How toreally save money in the NHS, addressed to AndrewLansley, suggests that physician assisted suicide and

euthanasia would allow health expenditure to be


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substantially contained.We have come a long wayfrom Hippocrates.

There have been signs of a belated recognition on thepart of the assisted dying lobby of the economicpressure which can be brought to bear onadministrators and doctors in an NHS starved orresources, and the subtle pressure which can beplaced on patients.

To address some of these concerns Sir TerryPratchett has talked about tribunalsfor assessing

applications forassisted dying, and Lord Joffe hasspoken of the possibility that the job might be done bythe courts.

Neither of these ideas has been fleshed out, and it isnot clear to what extent they would result in removingdoctors from the process. For example, how wouldany tribunalsecure medical advice? And who

would write prescriptions for lethal drugs?Nonetheless, they are a step in the right direction.

What is clear enough is that, if any system ofassisted dyingis to be at all safe, it must operateunder the aegis of the Ministry of Justice, not theDepartment of Health. After all, what we are talkingabout here is not a form of health care but an

exception to the criminal laws which prohibit assistingsuicide and euthanasia.

A fundamental problem with the campaign forassisted dyingis that it assumes the existence of aperfect world a world in which all terminally illpatients know what they want without any trace ofdoubt or despair, in which all doctors have the skills

and time to conduct thorough assessments and in


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which all relatives are what the media like to callloved ones.

The real world just isnt like that. It is one thing forpeople like us to talk about assisted dying. We knowour rights and we know the law, and we areaccustomed to dealing with doctors and lawyers andto standing up for ourselves. We can look after ourown interests without much difficulty and we are notlikely to be coerced, either by others or by our ownemotions, into seeking to end our own lives againstour better judgement. But it is a mistake to read our

ways of thinking across to the great majority of peopleout there who are not familiar with the complexities ofmedicine and law and whose experience of living hasbeen all too often one of being done unto by personsin authority rather than of doing.

Doctors are busy people. They have neither the timenor, for most of them, the inclination to be landed with

the additional task of assessing patients for help withsuicide, much less for putting them down viaeuthanasia. And, while the majority of families areloving towards those of their members who are sick,some are not let is not forget that most elder abusetakes place within families. We have criminal laws,not because most people behave decently, butbecause a small number do not.

Yes, there are determined people who are seriousabout wanting assistance to end their livesprematurely and who may feel frustrated that the lawwill not allow them to have it. But there are manymore seriously ill people who are ambivalent, whomove from hope to despair and back again, who areafraid of what they future may bring or who are

worried about the burden that their illness is imposing


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on the families. It is to protect people like this, asmuch from themselves as from others, that we havelaws against euthanasia and assisted suicide.

It is sometimes wrongly asserted that the law as itstands is not clear. That is simply not true. One of thecountrys leading lawyers, Lord Carlile of Berriew Alex Carlile QC puts it like this:

I want to challenge the assertion that the present lawlacks clarity.

I suggest that the present law could not be clearerthan it is

You may be prosecuted if, first, there is enoughevidence to sustain a prosecution and, secondly, thatit is in the public interest for a prosecution to occur.What could be clearer law than that?

And not only lawyers and physicians oppose aweakening of the protection which the current lawprovides.

One of the most vociferous opponents of any changeto the law has been the Disability Rights Commissionand the organisations which campaign for disabledpeople.

Jane Campbell, who has spinal muscular atrophy,and is a Commissioner of the Equality and HumanRights Commission, and now Baroness Campbell ofSurbiton, says this:

Disabled peoples lives are invariably seen as lessworthwhile than those of non-disabled people.

Descriptions such as tragic, burdensome and even


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desperate are routinely used without objection.Unless one is extraordinarily strong, this negativityimpacts on the individual disabled person. If suicidewere a legally and socially acceptable option, toomany would succumb to this fate believing being putout of misery to be expected of them.. This Bill isdangerous and threatening. I and many other severelydisabled people will not perceive your support for itas an act of compassion but one founded in fear and

prejudice.

It is all very well for opinion pollsters to tell us that themajority of their respondents say they think the lawshould be changed to allow assisted dying. Butimagining what we would want if we were seriously illis not the same thing as actually being in thatposition. Physicians in palliative medicine, who workwith dying people day in and day out, report that

requests for help to end it allare rare and that, whenthey do occur, they are almost always a cry for helpand reassurance rather than determined demands forassisted dying. As with many emotive issues, suchas capital punishment, immigration and membershipof the European Union, Parliament has to take thewider and evidence-based view rather than simply toallow itself to be stampeded by opinion polls.

Here on Merseyside we are blessed by somewonderful hospices. I am a patron of Jospice andZos Place and a supporter of others. Good hospiceprovision and palliative care are the way to a gooddeath, not a law which would put public safety at risk.

Since 1967, when that illustrious Englishwoman,

Dame Cicely Saunders, founded St.Christophers


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Hospice in London, we have seen palliative care andthe hospice movement despite some geographicalvariations significantly expand to meet the needs ofthe seriously sick and dying. There are now 217hospices and palliative care units, 3,194 beds, and wespend 1.4 million daily throughout the U.K. onhospice care. You dont need a doctor to kill you todie with dignity and respect.

Shirley Williams Baroness Williams of Crosby putsthe argument succinctly:

I have visited a number of hospices and one of themost prominent was in Crosby in Merseyside where Iwas a Member of Parliament. It is amazing what hasbeen achieveda mood of happiness andcontentment reigns in many of them.

One of my correspondents who has been a palliative

care medical practitioner in the north of Scotland for23 years used the phrase, "It is easy for the right todie to turn into a duty to die". That is what lies at theheart of many of the objections that some of us wantto raise.All of us are acutely aware of hard cases; but we alsoknow that hard cases make bad law. And, as the 1994

Select Committee concluded, there would berepercussions for the whole of society were this lawwhich protects to be changed:

Individual cases cannot reasonably establish thefoundation of a policy which would have such seriousand 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


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extent which cannot be foreseen. We believe that theissue of euthanasia is one in which the interest of theindividual cannot be separated from the interest ofsociety as a whole.

Let me say in conclusion that this is not a black-or-white issue. I can see what the campaigners forassisted dyingare driving at, and they have somegood arguments on their side. With advances inmedical science, we are living longer but not alwayshealthier lives. But an assisted dyinglaw is not the

answer.

The law that we have is robustenough to determalicious or manipulative action but also flexibleenough to deal sensitively with genuinelycompassionate instances ofassisted dying. It is alaw with a stern face but a not unkind heart. We tinkerwith it at our peril.

For Defensive Use

Research shows that vulnerable people are not being

put at risk in Oregon

The research in question is methodologically flawed.To take one example, the researchers attempted toestablish whether elderly people in Oregon were moreprone to resort to physician-assisted suicide (PAS)than others. How did they do this? They set the lowerage limit for elderly at 85 years yes, 85! and they

compared death rates from PAS among the over-85s


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with PAS rates among wait for it! those aged 18 to64 i.e. the young and middle aged. They ignoredcompletely those aged between 65 and 84, whommost people would regard as elderly and who (as theofficial Oregon figures show) make up nearly twothirds of all PAS cases.

Or, to take another example, they established thatcollege graduates were over seven times morelikely to resort to PAS than non-college graduates.From this they concluded that legalising physician-assisted suicide did not put people of lower

educational attainment at risk. But it does not seemto have occurred to them that perhaps it might putbetter-educated people at risk!

Opinion polls show that most people favour a changein the law

The polls dont distinguish between those who feel

strongly about changing the law and others who knowlittle about the subject but feel it is not unreasonableto say Yes when asked questions such as whetherpeople who are suffering pain and distress shouldhave a choice to have help to die subject to strictsafeguards. The House of Lords select committeefive years ago received a postbag of over 12,000letters and emails on this subject. People who take

the trouble to write to parliamentary committees on asubject may be considered to have considered andstrongly held views. The balance of opinion here wasalmost exactly 50/50.

Most of us lead busy lives and draw most of ourinformation on this, and on most other, subjects fromwhat we read and see in the media. But the media

report the exceptional the handful of journeys to


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Switzerland for assisted suicide, the rare trials ofpeople accused of assisted suicide or euthanasia.They dont focus on what normally happens thatmost deaths are peaceful, that most relatives areloving and caring, that most people want good carerather than to kill themselves because normalitydoesnt sell papers or boost listening and viewingfigures. Acquiring our knowledge in this way isnecessary for most of us, but we need to be awarethat it carries a risk of distortion. And thesedistortions are apt to show up in what people tellopinion pollsters.

Research shows that doctors are already actingillegally by ending the lives of seriously ill patients, sowe should legislate and regulate the practice

The research, by Professor Clive Seale, also showsthat the incidence of illegal action by doctors inBritain is extremely low (professor Seales words)

and comparative studies by him show clearly that,where assisted dying has been legalised (e.g. inHolland), the rate of illegal action by doctors issignificantly higher than in the UK. Indeed, in one ofhis surveys Professor Seale comments that theargument that legalisation results in regulation cannotbe substantiated.

The Director of Public Prosecutions has made clearthat he will not prosecute in cases of assisted suicide

Not so. The DPP made clear in his prosecution policypublished earlier this year that nothing in it can beinterpreted as offering immunity from prosecution toanyone. He also made clear that the victims state ofhealth will not be regarded as a mitigating factor in

deciding whether or not to prosecute and that a


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doctors or nurses involvement in assisting suicidewill be regarded as an aggravating factor. Proposalsto legalise physician-assisted suicide for theterminally ill are therefore swimming 180 degreesagainst existing prosecution policies.

A significant minority of doctors supports a change inthe law, as the formation of Health Professionals forChange indicates. And the Royal College of Nursinghas also changed its stance to neutrality

Surveys of medical opinion regularly show that

around 7 out of 10 doctors are opposed to a change inthe law and that, of the minority who favour legalchange, some would be unwilling to participatepersonally in assisted dying. If we had such a lawhere, therefore, we would see the doctor shoppingthat is such an unhappy feature of the Oregon scene.

As for the RCN, its change of stance was based on

responses to a consultation by just 1200 out of amembership of 390,000 i.e. by 0.3% of the Collegesmembers. Nor has the RCN published any guidancefor nurses in the wake of the DPPs prosecutionguidelines: the BMA alerted doctors within a week tothe risks involved in assisting a patients suicide.

The Frances Inglis case shows that (in the words ofDignity in Dying) the murder law is not equipped forcompassion

Mrs Inglis was convicted of murder earlier this yearafter two attempts (the second successful) to end thelife of her brain-damaged son. She claimed she wasacting out of compassion but there had been no

request from her son to have his life ended. Mrs Inglis


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was convicted of murder but given the lowestminimum sentence possible 9 years imprisonment.The Court of Appeal confirmed the verdict butreduced the sentence to five years. If this is notcompassion, it is hard to imagine what would be. MrsInglis had ended her sons life without any requestfrom him to that effect simply on the basis that sheconsidered him to be suffering. Is Dignity in Dyingseriously suggesting that such acts should beoverlooked or met with a suspended sentence?

Documents

Lord Alton's Speech in Euthanasia Debate - 25/11/10 - Liverpool Medical Institution