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Submission to the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill (2004)


Submission to the House of Lords Select Committee
on the
Assisted Dying for the Terminally Ill Bill

The Linacre Centre for Healthcare Ethics



September 2004

Resume



1. Introduction

The Linacre Centre for Healthcare Ethics[1] is a research institute under the trusteeship of the Catholic Trust for England and Wales. We publish material, run conferences and provide speakers on a range of bioethical issues, and also offer advice and information to individual health professionals and patients. We welcome the opportunity to contribute evidence to the Committee on the Assisted Dying for the Terminally Ill Bill, and would be pleased to respond to any questions the Committee may wish to raise on this evidence, or on related issues.

2. Respect for life





2.1 Suicide Act 1961

[2] In its prohibition of assisting suicide, the Act is a central component in the network of laws protecting the vulnerable.

3. Defences of euthanasia



3.1 Autonomy





3.2 Welfare

There is, in short, a wish to set some limits on patient autonomy and the presumed right to die.[3]



4. The Netherlands

[4] and its extension to those who are unable to consent, such as infants and young children.[5] Indeed, there is now official toleration of non-voluntary euthanasia, in that (for example) euthanasia of children is required to be reported. In 2001, 100 out of 1088 deaths of babies under one year of age involved the giving of drugs with the explicit purpose of ending life.[6]

Three major Government-ordered studies of euthanasia and other end-of-life decisions have been carried out in the Netherlands, where euthanasia was accommodated for many years by court decisions before being legalized by statute. These studies show a far from reassuring picture with regard to observance of guidelines, including the requirement that the patient give consent.[7] [8]

4.1 Compliance with guidelines

When we read that 900 patients were deliberately killed without their request in 1995 (a figure which rose to 980 in 2001) we should remember that this figure, alarming as it is, does not include 1,537 cases where palliative drugs were given with the explicit, unrequested aim of hastening death.[9] If we include this group of cases, it becomes clear that more than a third of those actively killed were killed non-voluntarily. Even excluding this group of cases of active non-voluntary euthanasia, one in five of those actively killed were killed without their request.[10] If we turn to euthanasia by omission, there were as many as 18,000 such cases in 1995,[11] [12]

4.1.1 Reporting

It is often said that euthanasia will be better controlled where it can be freely reported.[13] [14]

[15] Such cases, both the 1990 and 1995 studies revealed, were virtually never reported.[16] [17]

[18] Most striking of all, in both the 1995 study[19] and the 2001 study,[20] the authors suggest that it is the patient who is responsible for avoiding termination of his life: if he does not wish euthanasia, he should say so clearly, orally and in writing, well in advance.

5. Palliative care

What then, should the terminally ill patient be offered in place of euthanasia, which the Dutch experience over many years has shown to be impossible to contain? Euthanasia in the Netherlands has been linked to poor palliative care, though such care is improving. Thankfully, the hospice movement in the U.K. is particularly strong; however, efforts must certainly continue to extend high quality care to all who need it.[21]

[22]



6. Conclusion

[23]



Notes

[1]
[2] [of the 1961 Act] [to commit or attempt to commit suicide]
[3] Few would argue that patient autonomy should be an overriding consideration in medicine generally. A doctor would not normally amputate a finger, or assist a patient in self-amputation, merely because this was requested.
[4] [Medical Decisionmaking at the End of Life: The Practice and the Review and Verification Procedure] (Utrecht, 2003), p.104, Table 10.2). 29% of doctors consider this an acceptable motive for assisted suicide (Ibid, p.107).
[5]
[6] Van der Wal, van der Heide et al., p.121.
[7]
[8] [on withholding/withdrawing treatment with the explicit intention/purpose of hastening death]
[9]
[10] Keown, op.cit., p.128. The larger figure includes assisted suicide.
[11] See note 8.
[12]
[13]
[14]
[15]
[16]
[17] P.J.van der Maas, J.J.M.van Delden and L. Pijnenborg, Euthanasia and Other Medical Decisions Concerning the End of Life (1992), pp.101-2.
[18] Hendin, op.cit., p.234.
[19] [Euthanasia and Other Medical Decisions Concerning the End of Life: The Practice and the Notification Procedure] (The Hague, 1996), p.237.
[20] Van der Wal, van der Heide et al., p.201.
[21] It is also important to safeguard the hospice movement itself from any euthanasiast influences. To avoid the deliberate hastening of death - as opposed to the acceptance that death will occur - is central to the hospice ethos.
[22]
[23]