Suicide is not something to be encouraged or assisted
It may sound compassionate to embed assisted dying practices within health care. But it’s also dangerous.
The House of Lords is once again being asked to look at a Private Member’s Bill proposing so-called ‘assisted dying’. Words matter. They can inform or they can mislead. In this case it’s the latter.
Contrary to what the words might suggest, what’s being suggested isn’t that people should be given assistance as they die. That’s what doctors, and especially those of us who specialise in end of life care, do. What's being proposed is something radically different – that doctors should be licensed by law to supply lethal drugs to terminally ill people who appear to them to meet certain broadly-worded conditions. In law that’s assisting suicide and it’s unlawful.
Campaigners talk of strict safeguards. But what exactly are those ‘safeguards’? If we go by the previous Private Member Bills, they will be vague stipulations about what ought to happen in a perfect world – that someone seeking ‘assisted dying’ should have, for example, a “settled wish to die” and should be free from pressure. But what would be the minimum steps to ensure that these and other conditions were properly met? If we go by previous bills, none.
Are the lives of those who are dying less deserving of efforts to improve their quality, even if prognosis is short?
Who would be required to make these life-or-death decisions? The answer is doctors – because the people concerned would be terminally ill. Yes, doctors can diagnose terminal illness and offer an opinion (or best-guess ) on prognosis. But can, or should, overburdened doctors to be required to judge whether there is something in the patient’s life that might be influencing a request – like feelings of being a burden, or subtle pressure being exerted by others? No, they can’t assess it reliably.
Whatever the rights and wrongs of ‘assisted dying’ may be, one thing is clear. It is not part of clinical care. Most doctors who are caring for dying patients don’t want such powers. Therefore the minority of doctors outside this field, willing to assess requests for lethal drugs and engage in the practice, would be unlikely to have any in-depth knowledge of the people they were assessing or what is going on around the patient. These issues go well beyond the medical field, into areas in which doctors cannot make knowledge-based judgements. And there are no medical skills needed to prescribe a fixed-dose of lethal drugs.
It may sound compassionate to embed such practices within health care. But it’s also dangerous. We rightly trust our doctors not to do us harm, even if that means sometimes being refused treatments we think we want. Seriously ill patients often look to their doctors, not just for treatment, but for guidance. They are susceptible to subtle messaging. A doctor who agrees to a request for lethal drugs risks sending the message, however unintended, that in his or her opinion suicide is the patient’s best course of action.
There is also the fundamental issue of social policy. As a society, we rightly treat people who attempt to take their own lives with compassion. And, as a society, we are clear that suicide is not something to be encouraged or assisted. Yet how can we maintain that, while saying that some groups (for now, the terminally ill) should have their suicide assisted? Are the lives of those who are dying less deserving of efforts to improve their quality, even if prognosis is short?
We are told the numbers would be small, yet other legislatures have shown such deaths increase year on year, often with the law’s boundaries becoming ever slacker, rising rates of suicides and yet their palliative care remains patchy and inadequate. As observed previously – such legislation would change the moral landscape.
Baroness FInlay is a crossbench member of the House of Lords.