Wednesday, 8 May 2013

Don’t be fooled by Lord Falconer’s ‘modest’ assisted suicide proposals


Lord Falconer has finally announced that his long awaited assisted suicide bill will be tabled in the House of Lords next week on Wednesday 15 May.

It is then that we will finally see the full text of the bill which will then proceed to second reading (debate stage) sometime in June, or possibly in the autumn.

According to the BBC and Telegraph the bill will be based on the Oregon model – assisted suicide for mentally competent adults who have less than six months to live.

The timing has been carefully planned. On 13 and 14 May the Court of Appeal will be hearing the case of Paul Lamb, a 57 year old man with quadriplegia, who is seeking permission for a doctor to kill him by means of a lethal injection.

Off the back of media coverage of this case, Falconer, who is being backed by Dignity in Dying (the former Voluntary Euthanasia Society), will argue that his proposal is modest in comparison.

Lamb is not terminally ill and wants a doctor to give him a lethal injection (euthanasia).  Falconer however is only asking for people who are terminally ill to have the right to receive help to kill themselves (assisted suicide).

This model, he will argue, will be safer for vulnerable people and will have ‘upfront safeguards’ to stop abuse.  

According to House of Lords calculations in 2005 a Dutch-type law (such as Lamb is seeking) would mean 13,000 euthanasia deaths a year in Britain, but an Oregon-type law (like Falconer’s) would mean only 650.

Falconer is thereby attempting to position himself as the reasonable middle ground between those who wish to keep euthanasia and assisted suicide illegal and those who want extensive decriminalisation.

We should not be fooled by this ploy and the situation in Oregon is already ringing loud alarm bells.

Members of the House of Lords should note that statistics released just earlier this year (full report here) show that the number of assisted suicide prescriptions and deaths in Oregon, once again, increased in 2012 and has now reached an all-time high. 

There were 59 assisted suicide deaths in Oregon in 2009, 65 in 2010, 71 in 2011 and 77 in 2012; a 30% increase overall in just four years. 

The number of prescriptions for assisted suicide was 95 in 2009, 97 in 2010, 114 in 2011 and 115 in 2012; 115 in 2012; a 21% increase since 2009.

Overall assisted suicides have gone from 16 in 1998 to 77 in 2012, an overall increase of 381% (see chart above).

This pattern of incremental extension is similar to that seen in 
the NetherlandsSwitzerland and Belgium, other countries that have changed the law.

A major factor fuelling this increase is suicide contagion - the so-called 
Werther effect. This is particularly dangerous when assisted suicides are backed by celebrities as they are here and given high media profile as they are frequently by the BBC. 

The Oregon numbers may not seem large but we need to remember that Oregon has a very small population relative to the UK and that they may well be an 
underestimate as they are based on physicians' self-reporting. 

But for argument's sake let's simply take them at face value. How would they then translate to Britain?

Back in 2006, and based on Oregon’s total of 38 assisted suicide deaths in 2005, 
the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain. 

But as the numbers in Oregon have since doubled to 77 the UK equivalent would now be 1,300.

We should learn from the Oregon experience and be resisting these moves. 

Any change in the law to allow assisted suicide (a form of euthanasia) would inevitably place pressure on vulnerable people to end their lives so as not to be a burden on others and these pressures would be particularly acutely felt at a time of economic recession when many families are struggling to make ends meet and health budgets are being slashed. Especially when fears about the NHS are actually fuelling support for assisted suicide. The so-called right to die can so easily become the duty to die.

And once legalised there will inevitably be incremental extension as we have seen in Oregon, Switzerland, Belgium and the Netherlands. Legalisation leads to normalisation. New hard cases will brought to bring pressure to widen the existing criteria to allow extension to ‘Gillick competent’ minors, people without mental capacity who ‘would have wanted it’ and those who are ‘suffering unbearably’ but are not terminally ill.

I have previously blogged about 
the shroud of secrecy which surrounds assisted suicide practice in Oregon, the worrying trends in neighbouring Washington state, which enacted a similar law more recently and the way the Oregon law steers people toward suicide. 

Also deeply concerning are reports of 
depressed patients being killed without being treated, doctor shopping, deaths taking place without witnesses present (raising questions about elder abuse) and the fact that 44 of the 77 who died last year (57%) said that they were concerned about being a burden on family, friends and caregivers. 

The lessons are clear. Let’s not go there.

The best system is what we have already – a blanket ban on both assisted suicide and euthanasia which provides a strong deterrent to exploitation and abuse whilst giving discretion to both prosecutors and judges to temper justice with mercy in hard cases.

Under this the number of people going to the Dignitas facility in Switzerland to end their lives remains a trickle of about 15-20 per year.

So let’s keep that system in place and concentrate on providing the best possible care to people who are dying. Let’s major instead on killing pain without killing the patient.

23 comments:

  1. You disgust me, Peter. You advocate the status quo, a heartless, cruel and unregulated regime where patients with ALS, cancer and all manner of untreatable diseases are forced to commit suicide prematurely or endure torture until their last breath.

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    1. No one is forced to commit suicide and Falconer's bill will not help people who are suffering but have more than six months to live. What specific change in the law are you suggesting?

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    2. My suggestion is for England to stop pretending that there is a difference (moral or otherwise) between self-starvation and a lethal dose of barbiturates.

      https://www.facebook.com/photo.php?v=452680511482811

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    3. So are you suggesting that everybody who wants to starve themselves to death should be able to have a lethal injection?

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    4. Why not? It'd be quicker, more humane, and no different morally.

      No one starves themselves to death unless they want to die in the first place. The same applies for those who ask for respirators to be disconnected.

      If you think there's a real, tangible, moral difference, please, enlighten me. I'm all ears.

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    5. The difference between allowing someone to die of natural causes and killing them should be obvious.

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    6. Except that by allowing someone to stop eating and drinking, society is giving tacit approval to their suicide.

      Along the same lines, patients on dialysis may commit suicide AT ANY TIME by refusing treatment. The law doesn't interfere. Likewise, it shouldn't get in the way of other rational suicide choices.

      Depression can be treated in most cases. It's different from situations where NOTHING can be done (such as ALS and end-stage cancer). In some cases, chemotherapy can be worse than the disease it is intended to cure.

      Also, if I were you, I would hold off on judging those who are depressed until you have experienced unrelenting depression for at least a fortnight. It might teach you some compassion and empathy.

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    7. What makes you assume I have no experience of depression? That's quite a huge assumption to make about somebody. Perhaps you should try being a little less judgmental yourself. Assuming that everybody who doesn't see things your way is lacking in compassion and empathy (which you regard yourself as having oodles of?) is fairly arrogant, wouldn't you say?

      But to get back to the point. Yes, passive actions such as not eating properly etc. have historically not been treated as suicide. When suicide was a crime, self-starvation didn't count. Neither did drinking yourself to death. Simple loss of will to live any longer was not considered self-killing. There had to be some active act of violence against the self - like drowning, jumping off a tall building or hanging. Simply losing the will to live didn't count as a crime.

      Current law still follows the same principle. A bit of a legalistic answer I know, but we are talking about the law.

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    8. Because studies show that 90% of people who have seen a friend or loved one request euthanasia support a change in the law to make it legal.

      http://dwdv.org.au/Bulletins/Bulletin-03-2008-03-17.html

      You can download a copy of the survey there.

      As for your comments on depression, if you had truly experienced it, you wouldn't dismiss depression as something so "easily treated."

      "Self-starvation didn't count as suicide"? Yet another instance of the law being an ass and lagging behind the moral paradigm of its age.

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    9. I didn't say anywhere that depression is easily treated. Depression can be very difficult to treat and very difficult to live with. Nobody really knows what causes it, and some people struggle with it all of their life.

      I can very well understand why some people want euthanasia. Suffering is a terrible thing to experience and, in some ways, and even more terrible thing to watch because we feel so powerless - especially if it's someone we love. However, suffering is a big part of life and comes in many forms - mental as well as physical. Once we go down the road of killing to relieve suffering (as opposed to letting someone go) where will it end?

      I'm sorry if I'm being a bit acerbic in my comments. It rubs me up the wrong way when people accuse other people of lacking in compassion for not agreeing with them on a morally very difficult subject like euthanasia. I'll try to be a little more gracious, because I do have some sympathy with your opinions - just not the way you're expressing them.

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    10. Where will it end? With informed consent and irrelievable suffering. With terminal sedation, the patient is essentially dead (because they will never experience life again) for several days or weeks before biological death. The problem with terminal sedation is this: The doctor is in control and is not permitted to ask their patient for consent (because that could be construed as asking for euthanasia).

      Thank you for the explanation. Anyone who says "Compassion means suffering with others" is lacking in compassion. It really is that simple. If you don't understand the meaning of compassion, how can you possibly be compassionate? It's impossible, obviously.

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    11. Yes, but how do we define 'informed consent'? Can somebody who's seriously depressed be considered in their right mind to make such a decision? How do we define 'irrelievable suffering'? How can we know that someone will certainly die in several days? What length of time before death is going to be the set number - days, weeks, months, years? This is my problem with your position. I understand the reasoning behind it (to end suffering). I just don't see how it can work in practice.

      I don't remember saying anywhere that 'compassion means suffering with others' (though there is a section in the Bible that says to do that, but I don't imagine you have a great deal of respect for what the Bible says). What is your definition of compassion?

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    12. If they're depressed, we should attempt to treat the depression for six months or so. Not setting a limit for the treatment of depression or anything else makes them guinea pigs for the psychiatric profession. It's that simple.

      Your other concerns can be addressed by asking the patient directly. It would certainly be a better solution than relying on individual doctors, nurses and their consciences. Very few angels of mercy ask for another doctor's opinion (that I am aware of).

      My definition of compassion is being empathetic with those in suffering, and willing to respect their wishes. If that includes assisted dying, so be it.

      "Suffering with" is actually the etymology of the term. It may have been acceptable when morphine was yet to be developed, but it certainly isn't useful today.

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    13. Well, yes, I agree that just standing there watching someone suffering when you could make them more comfortable is not compassionate. And we should respect people's wishes in terms of not wishing to be resuscitated, choosing to discontinue treatment etc. I just draw the line at actually administering a lethal dose of poison. This is because I have known 'terminally ill' people go on to live for another 30 years. We just don't know for sure when someone's going to die.

      There are some things that morphine can't fix. I think you can still suffer with people in many ways. The main problem for the elderly in our society, I think, is actually loneliness.

      (I'm assuming you were talking about terminally ill patients suffering from depression, not that we should give depressed people six months before we just finish them off!)

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    14. But you have conceded that self-starvation is acceptable. The only difference between that method of self-deliverance and a lethal injection is time.

      Loneliness is tragic, but we cannot force people to spend time with their elders any more than we can force them to become doctors or volunteers in third-world countries.

      Yes, I was referring to terminal and incurably ill patients with depression.

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    15. There's a huge difference, Winston. A lethal injection has to be administered, or, at least supplied, by another person.

      Also, what about the mentally disabled? Very soon people are going to start asking why mentally able people can choose and the mentally disabled cannot, which will lead to euthanasia without consent because somebody else has decided that a life is not worth living.

      You're repeating the same arguments over and over again. It seems to me you're simply too closed minded to see the problems.

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    16. And what do you know? Peter just put up an article on euthanasia and disabled babies.

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    17. There is no difference except time. No matter how you contort your logic, that fact won't change.

      For the mentally disabled, it should be handled on the same basis as everyone else - informed consent.

      Voluntary and involuntary are two polar opposites. One is compassion, and the other is murder. It really is that simple.

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    18. To me your logic seems a bit contorted if you think that not force feeding someone to keep them alive is the same thing as giving them a lethal injection. But I guess we'll have to agree to differ. :)

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    19. If you think self-dehydration is anything other than indicative of a will to die, your capacity for reason has been eviscerated.

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    20. I'm obviously failing to get my point across. Perhaps you'd like to watch this debate where physicians explain:

      a) that medical diagnosis is not an exact science (sometimes 'terminally ill' people get better.

      b) that the 'will to die' is a very subjective and changeable thing. that when people suffer they often experience fluctuations between hope and despair. Even very ill people who attempt suicide are later glad that they did not die, but had a little more time to experience life. Should we rob people of those last precious moments?

      There simply is nothing objective to hang this piece of legislation on.

      http://www.youtube.com/watch?v=zA5Jiuxf4cg&feature=player_embedded

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    21. 1. Why would ANYONE opt for self-dehydration if they lacked a will to die?

      2. Following that argument, no one except doctors should be able to make decisions for patients, because there is always the chance for error. Welcome to IngSoc.

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  2. Also depressed people often lose interest in eating and generally don't take care of themselves. Should we give all depressed people a lethal injection? What about women suffering from postnatal depression? Though, I suppose that's the fault of pro-lifers as well because, as a number of pro-choice people have pointed out, abortion prevents postnatal depression.

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