Tuesday, 17 September 2013

Stephen Hawking is a great scientist but his advice on decriminalising assisted suicide should be given short shrift

Scientist Professor Stephen Hawking has spoken out in favour of assisted suicide for people with terminal diseases (See Independent, BBC, Telegraph).

In an interview with the BBC, he said:

‘I think those who have a terminal illness and are in great pain should have the right to choose to end their lives and those who help them should be free from prosecution. 

But there must be safeguards that the person concerned genuinely wants to end their life and they are not being pressurised into it or have it done without their knowledge or consent, as would have been the case with me.’

Prof Hawking, now 71, was diagnosed with motor neurone disease (MND) aged 21 and told that he had just two or three years to live.

Following a bout of pneumonia in 1985, he was placed on a life support machine which his first wife, Jane Hawking, had the option to switch off, but instead insisted that he be flown back from Geneva to Cambridge.

He recovered from his pneumonia and went on to complete his popular science best-seller ‘A Brief History of Time’, which sold more than 10 million copies worldwide.

Somewhat ironically, he is living proof of the fact that doctors can be very wrong about prognoses (28 years out in Hawking’s case!), and that one can live a worthwhile life, full of meaning and purpose, despite having a serious, progressive, life limiting disease.

There have been three attempts to legalise assisted suicide in Britain since 2006 all of which have been defeated by substantial majorities. Two further bills, one in the House of Lords and one in Scotland are currently awaiting debate.

All of these bills contain the kind of safeguards Hawking has referred to but on each occasion in the past parliamentarians were not convinced that they would work and opted to reject them out of concern for public safety.

Their judgement was that any change in the law to allow assisted suicide or euthanasia would place pressure on vulnerable people – those who are elderly, sick, disabled or depressed – to end their lives for fear of becoming a financial or emotional burden. Such fears would be acutely felt at a time of economic recession when many families are struggling to make ends meet and health budgets are being cut. Moreover subtle forms of coercion within families are extremely difficult to detect, even by skilled health professionals.

We often hear from the pro-euthanasia lobby that they are only interested in legalising assisted suicide or euthanasia with so-called ‘strict safeguards’ – usually only for people who are ‘mentally competent, terminally ill adults’.

And yet the two major arguments they employ (autonomy - 'it's my right' - and compassion - 'my suffering is unbearable') can be equally applied to people who are neither mentally competent nor terminally ill.

There is thus a logical slippery slope operating, in that if you accept that assisted suicide or euthanasia is applicable for some under strict criteria, then it must follow logically that it will also be applicable for others outside these bounds.  Activists pushing for legalisation are obviously aware of this.

Any law allowing assisted suicide or euthanasia on any grounds at all would be ripe for challenge under equality and diversity legislation – hence the charge that activists are knowingly using the excuse of ‘robust safeguards’ to disguise the fact that they are actually working to an agenda of incremental extension: progressive legalisation by a series of imperceptibly small steps.

As I have previously argued, evidence of practice in those jurisdictions that have legalised assisted suicide and euthanasia (especially Belgium and the Netherlands) shows that the safeguards are illusory.

Lord Falconer’s bill, about to be debated in the House of Lords, uses a licensing system similar to that in the Abortion Act whereby two doctors certify in good faith that the necessary legal conditions apply.

But practice under the heavily 'safeguarded' Abortion Act demonstrates clearly why such a system involving doctors as the gatekeepers does not work in practice.

First, there has been a steady escalation in abortion since the change of the law in 1967 to the current situation where there are 200,000 abortions per year, accounting for one in five pregnancies. This is in spite of the law being 'heavily safeguarded' to allow abortion only in rare circumstances.

Second, almost all abortions currently fall outside the legal boundaries. 98% are carried out on grounds that continuing the pregnancy poses a greater risk to the mental health of the mother than having abortion, when there is no scientific evidence that this is ever the case. In most of these cases the real grounds are social inconvenience, failed contraception, economic difficulty or unwanted pregnancy.

Third, flagrant abuses of the law are not prosecuted. The current case of the DPP’s refusal to prosecute two doctors who authorised abortions on grounds of sex selection has attracted widespread criticism but no action. Similarly cases identified in 14 NHS trusts of forms authorising abortion being signed by doctors who had not even seen the women concerned have brought no action from the CPS, despite being in breach of the Perjury Act.

In addition there are other reasons to be suspect of such legislation.

First, we have already seen in the failures of regulation by the Care Quality Commission and other regulators over poor care in hospitals and care homes (eg, North Staffordshire) that abuses by healthcare staff will not be dealt with adequately until it is too late.

Second, if some doctors cannot be trusted with a clinical tool like the Liverpool Care Pathway, which was abandoned after a major enquiry due to widespread abuse, why do we imagine they can be trusted with authorising and administering assisted suicide?

Third, and this is probably what concerns me most, having assisted suicide as a healthcare option potentially saves a lot of money on care. This will inevitably make it an attractive option to families, healthcare managers and politicians who are wanting to cut costs. The danger of vulnerable people then being subtly steered toward suicide under such a system is very real and will be very difficult to detect. For a start, the key witness in each case will be dead and unable to give evidence.

We are best off with the current law, a blanket ban on assisted suicide and euthanasia but with discretion given to prosecutors and judges in hard cases. The penalties the current law holds in reserve provide a strong deterrent to those with an interest in another person’s death but allow flexibility for compassion. Most importantly it does not give doctors the power and authority ever actively to end life. We tamper with it at our peril. 

7 comments:

  1. I feel that the euthanasia lobby is trying so hard to mend a system that isn't broken that it is hard not to suspect ulterior and sinister motives.

    For centuries now, if not millennia, health professionals have blithely delivered effective analgesia to patients who are very ill indeed, scarcely worrying at all that this might shorten by a few seconds, minutes, hours, days or even weeks the mortal lives of those who benefit.

    They have squared this with their consciences, and appeased courts of law, by saying that the treatment that might have hastened slightly the deaths of those likely to die soon anyway, was not intended to cause death, but that death was an ethically tolerable and unintended side effect of the kindest possible treatment for the patients concerned.

    The health professionals have therefore worried far less than usual about the risk of killing patients, when the patients' prognoses are poor, so that they are each likely to die soon anyway from the illnesses that would cause them great pain but for the effective analgesia prescribed.

    Mankind has got so good at this lately, that an entire new hospice, terminal care industry has sprouted, becoming almost if not actually a new specialism. Yet it has been now, of all times in human history, when deliberate so-called euthanasia ought to be less tempting a genre of murder than ever before for doctor, patient and relatives alike, is when the most concerted effort of all seems to be afoot to decriminalise that crime. How illogical is that?

    I admit that I speak on this subject for the first time as somebody who isn't in pain, wants to continue living, and only knows about medical science what he picks up as general knowledge. But this comment expresses my sincere unease about the new pro-euthanasia movement accurately.

    There has almost always been judicial leniency towards "mercy killing" in every jurisdiction, in what Peter calls "hard cases". So far as I can see, never before has there been as little need to formalise this onto a statutory basis as there remains now, as far as I can see. Yet now in history is when the clamour for this has reached its crescendo? For what GOOD reason can this be? None, as far as I can see.

    "Thou shalt not kill. Nor should thou strive, officiously, to keep alive." Wise motto, but diabolical campaigning slogan. What evidence is there that anybody has been striving, officiously, during the past half century or so, to keep alive anybody who didn't stand a good chance of living to be grateful for a few more high quality years of life, because we wouldn't give up hope when they wanted to?

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    1. "What evidence is there that anybody has been striving, officiously, during the past half century or so, to keep anybody alive who didn't stand a good chance..."

      Terri Schiavo and Tony Nicklinson come to mind.

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  2. http://www.abc.net.au/4corners/stories/2013/09/16/3847237.htm

    Would love your thoughts on the story of this young man who wants to end his own life.

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    1. It doesn't give a lot of details about the illness, but it raises the same issues as most euthanasia stories. The sufferer doesn't feel that the medication he receives is sufficient to make his life worth living - and he's had 36 years to think about it! On the other hand, 'why can't a patient suffering from an incurable illness have the right to end their life?'. Define incurable illness? I have an incurable illness - it's called depression. My brother has a rare incurable illness that's currently dormant and can be controlled by drugs. People with cancer in recession are suffering from an incurable illness. My best friend was born with a hole in her heart. It's incurable and at one point she was in the hospital for dying children. She's now alive and well and has a great job working with children that she loves. As Peter has pointed out, Stephen Hawking has an incurable and very debilitating illness - but he's lived a good, long life and made academic achievements other academics couldn't dream of.

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  3. "Cannabinoids and nerve regeneration or neurogenesis"

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  4. They have squared this with their consciences, and appeased courts of law, by saying that the treatment that might have hastened slightly the deaths of those likely to die soon anyway, was not intended to cause death, but that death was an ethically tolerable and unintended side effect of the kindest possible treatment for the patients concerned.

    The health professionals have therefore worried far less than usual about the risk of killing patients, when the patients' prognoses are poor, so that they are each likely to die soon anyway from the illnesses that would cause them great pain but for the effective analgesia prescribed.

    ReplyDelete
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    ReplyDelete