Opposition to the legalisation of assisted suicide is based on solid evidence and sound argument - as a majority of doctors concur
At 9:10am on Wednesday 9th October, a consultation of members of the Royal College of General Practitioners will close. The RCGP came back from a briefly held neutral stance in 2005, and we have already outlined why GPs must respond to the current consultation in defence of the College's stance against the legalisation of assisted suicide and euthanasia. It is important to remain constantly aware of how central the healthcare profession is in this debate
There is a small minority of doctors in this country (a quarter of one per cent belong to 'Healthcare Professionals for Assisted Dying') who think that medical practitioners should be licensed by the state to dispense lethal drugs to mentally competent, terminally ill adults who wish to kill themselves.
This is a policy opposed by the British Medical Association, the World Medical Association, the Association for Palliative Medicine, the British Geriatric Society and virtually every Royal Medical College including the RCGP and the RCP.
It is also contrary to every serious code of medical ethics that has ever been drafted including the Hippocratic Oath, the Declaration of Geneva, the International Code of Medical Ethics and the Statement of Marbella.
Advocates of legal change within the medical profession, like Sir Terence English, have commended Lord Falconer's 'assisted dying' bill, claiming that the bill has a 'narrow focus' which does not involve 'euthanasia' or 'disabled people' - only 'mentally competent, terminally ill adults'.
Tellingly, Sir Terence gave no arguments to support his position.
'Assisted dying' is a euphemism with no meaning in law but it means supplying lethal drugs to people who are terminally ill with the purpose of helping them to commit suicide.
The line between assisted suicide and euthanasia is very thin. Assisted suicide is helping someone to kill themselves. Euthanasia is killing them with or without their permission. The intention in both is the same and the acts are thereby morally and ethically equivalent regardless of the fact that they are illegal under different UK laws (the Suicide Act 1961 and the murder law respectively). Assisted suicide is simply euthanasia one step back.
But more than this, from a practical point of view one merges into the other. If a doctor places lethal drugs in a person's hands it is assisted suicide, but on his tongue it is euthanasia. If the doctor sets up a syringe-driver and pushes it himself it is euthanasia, but if the patient applies pressure or flicks the switch it is assisted suicide.
In one in seven cases of assisted suicide there are problems with 'completion' leaving the doctor to step in to finish the job, which is why legalising one inevitably legalises the other. There will also inevitably be those who claim that they are being discriminated against because they lack the capacity, even with assistance, to kill themselves, and so need someone to do it for them. This is why any law allowing assisted suicide only (and not euthanasia) would immediately be open to challenge under equality laws.
The reality is that assisted suicide is just another form of euthanasia.
Claiming that Falconer's bill is not for disabled people but only for terminally ill people is equally disingenuous. This is because almost all terminally people are also disabled, and many disabled people are either terminally ill, have life limiting conditions, or are susceptible to sudden unexpected and potentially life-threatening deteriorations in health.
Disabled people and people with terminal illness are simply not distinct groups but considerably overlapping categories. This is why every major disability advocates group in the UK - including Disability Rights UK, SCOPE, Not Dead Yet and UKDPC - are opposed to a change in the law. Paralympian Tanni Grey-Thompson, in passionately voicing these concerns, has recently called assisted suicide a 'chilling prospect for disabled people'.
Falconer's three criteria of 'terminally ill', 'adult' and 'mentally competent' are equally malleable and open to interpretation as argued in the recent critique by leading parliamentary think tank, Living and Dying Well.
Doctors acknowledge that estimating lifespans is notoriously unreliable, 'adult' is easily open to extension to 12 to 14 year olds using the concept of 'Gillick competence' and the experience in Belgium and the Netherlands shows that mentally incompetent people (babies with severe disabilities and adults with dementia) quickly get drawn into the remit of laws allowing euthanasia or assisted suicide. Assessing mental competence is a specialised skill that not all doctors have and it can easily be clouded by the presence of depression, which itself increases suicidal ideation.
It is for these reasons that in every country which has legalised any form of 'assisted dying' we have seen incremental extension - an increase in total numbers, a broadening of categories of people to be included and an increase in ending life through parallel means such as deliberate withdrawal of treatment, intentional morphine overdose or so-called 'terminal sedation'.
But the biggest problem with giving doctors the power and authority to end life, even with a patient's consent, is that doctors cannot be trusted with this kind of power.
Doctors are human and prone to financial and emotional pressure, but there are also some who sadly will abuse any power given to them. The recent experience of the Liverpool Care Pathway debacle, where some doctors and other health professionals abused what was essentially a good therapeutic tool through laziness, neglect or deliberate malpractice, underlines further why they should not be trusted with the even greater power to end life actively. Allowing doctors to have this power would make them the most dangerous people in the state.
Our current law is clear and right. By prohibiting all euthanasia and assisted suicide it acts, through the penalties it holds in reserve, as a powerful deterrent to exploitation and abuse. And by allowing some discretion to judges and prosecutors in hard cases it exercises this stern face with a kind heart. It does not need changing.
The first duty of Parliament is to protect its citizens and this is what the current law does. We cannot chip away at it without at the same time removing legal protection from vulnerable people and putting them under pressure to end their lives so as not to be a financial or emotional burden to others.