Assisted Dying for the Terminally Ill Bill - A Submission to the Select Committee on Behalf of Affinity

 The text of the Bill can be viewed at www.publications.parliament.uk/pa/ld200304/ldbills/017/2004017.pdf

AFFINITY (formerly the British Evangelical Council, which was founded in 1952) is a network of evangelical Christian denominations, church groupings and independent causes. It is probably the largest association of exclusively Bible-centred churches in the United Kingdom, representing approximately 1,200 congregations.


1] OUR INITIAL RESPONSE
1.1] We are disappointed to see the reappearance of this Bill, an earlier version of which, as the Patient (Assisted Dying) Bill, was defeated in the House of Lords in June 2003.

1.2] Nevertheless, we recognise that there is a minority of people, plus a few organisations, who are persistently seeking to change the current legal safeguards and introduce some forms of euthanasia into the United Kingdom.


2] OUR BIOETHICAL PRINCIPLES
The best responses to any bioethical issue are based upon robust principles. Without such principles, responses inevitably degenerate into feeble subjectivity and utilitarianism. In the context of this Submission, our response is based on five principles:

2.1] All human beings are made in the image of God (Genesis 1:27). Therefore, all human beings have intrinsic dignity and value.

2.2] It is God who gives (Ecclesiastes 5:18), sustains (Psalm 54:4), and takes human life (1 Samuel 2:6). Therefore, to choose, or engineer, or bring about death, whether our own, or someone else’s, without divine sanction, is to usurp God’s prerogative (Psalm 104:29).

2.3] Since human life is a gift it involves stewardship, not ownership (Romans 14:12; 1 Peter 3:7). Therefore, sentiments such as, ‘It’s my body, I shall do as I please with it’, display excesses of personal autonomy that are entirely misplaced and unacceptable.

2.4] Innocent human life is not to be taken (Genesis 9:6). The Sixth Commandment (Exodus 20:13) reinforces this principle. Therefore, to destroy innocent human life is an offence against God’s holy law.

2.5] All human life demands special care (Matthew 7:12), particularly those who are weak and vulnerable (James 1:27; Zechariah 7:8-10). Therefore, such innocent lives are to be protected, not plundered.


3] OUR BIOETHICAL CONSEQUENCES
Based upon these principles of historic, orthodox, biblical Christianity, which are undeniably honourable, wholesome and beneficial, we,

3.1] seek to uphold and promote the utmost respect for all human life, from fertilisation until natural death.

3.2] are opposed to the deliberate taking of innocent human life, at any of its stages.

3.3] are opposed to all forms of euthanasia, whether it is carried out on the newborn because of some genetic disorder, whether the patient is elderly and judged to have a life not worthy to be lived, or whether it is defined in terms of deliberate acts or deliberate omissions. If the intent is to kill the patient, it is wrong. Such actions are callous and unworthy of any decent society.

3.4] are especially concerned by the current pressure to legalise some forms of euthanasia, particularly for the elderly, who are seriously or terminally ill. We regard this as a perilous slippery slope – voluntary euthanasia will undoubtedly open the door to involuntary euthanasia, as has occurred in the Netherlands (see, John Keown (1995). Euthanasia Examined, Cambridge University Press, pp. 261-296).

3.5] are also concerned about other issues associated with euthanasia, such as, the use of ‘quality of life’ assessments and ‘living wills’. The former tend to be too subjective and hedonistic, while the latter are inappropriate and only serve to encourage a climate of medically-assisted suicide.


4] OUR OPPOSITION TO THIS BILL
This Bill is a truly awful piece of proposed legislation. We are totally opposed to it, in both principle and in consequence. Some of our more important observations and objections are listed here:

4.1] The Bill is shocking to read – it sends a chill through the reader. Its ethos is contrary to all good medical ethics and practice. In particular, it is contrary to Hippocratic-Christian medicine, which, for over 2000 years, has specifically forbidden doctors to assist in deliberately bringing about the death of patients – “do the patient no harm” has been its enduring maxim. Noncompliant doctors have rightly, throughout the ages, been regarded as renegades.

4.2] If the Bill were to become law it would forever redefine, and hence, destroy the historic role of doctors and the whole healthcare profession as compassionate carers and life preservers. It would undoubtedly lead to the greater corruption of medicine. Not only would the illustrious record of medicine be abrogated, but also the crucial doctor-patient relationship of trust would be eroded, and the vulnerable would become fearful of even entering healthcare facilities.

4.3] The legalisation of any form of euthanasia, including assisted suicide, as envisaged in this Bill, would require that such procedures become ‘management options’, to be discussed with all seriously-ill and terminally-ill patients, who, because of their very vulnerability, could easily be pressurised into making inappropriate decisions. The subtle power of doctors should not be underestimated. Patients would become anxious and fearful of being burdensome, and thus ‘a duty to die’ would be engendered.

4.4] The Bill would be unworkable. Some of the safeguards, such as definitions of ‘terminal illness’, ‘within a few months’ (p. 2, lines 23, 27) and ‘made voluntarily’ (p. 3, line 8) are notoriously impossible to define and predict. They are subjective. Pro-euthanasia healthcare workers will simply ride roughshod over such supposedly protective measures. Furthermore, the history of medical bioethics demonstrates that once a permissive law has been enacted, its originally tight boundaries are soon expanded – consider, for example, the initial provisions and expectations of the 1967 Abortion Act.

4.5] The wording of the Bill provides huge scope for confusion. For example, the stark phrase, ‘… the patient wishes to be assisted to die’ (p. 2, lines 43-44), could be interpreted as helping the patient to die well, as in good palliative care (of which we would approve), but we fear that its intended meaning is that of bringing about death prematurely (of which we disapprove). Similarly, the term ‘suffering unbearably’ (p. 2, line 48) may be true of a patient on one day, or week, or month, but may not apply at a later day or period. It is well known that news of a poor prognosis can have a significantly depressing effect upon a patient (and relatives and carers), yet this can be temporary and often, maybe, weeks later, buoyancy can return.

4.6] The Bill states that the patient must be informed of ‘the alternatives’ (p. 3, line 5), including palliative care. This is insufficient and belittles the ways in which palliative care has transformed dying and death in recent years. Palliative care, which is simply the application of good medicine at the end of life, needs to be experienced, not merely discussed.

4.7] In addition to corrupting the medical profession, the Bill also insists that members of the legal profession are to be drafted in as collaborators (p. 3, line 38). Furthermore, the involvement and potential trauma for those who act as the ‘other witness’ (p. 4, line 1), in terms of future regrets, doubts and mistakes, will be too great a burden for most people to bear.

4.8] The Bill allows (p. 4, lines 25-29) for the so-called declarations to be revoked. But once signed, patients are sending a signal, albeit, perhaps unintentionally, to the healthcare team that they are requesting less than the best future medical care and treatment – a psychological barrier will have been irrevocably breached. And with what urgency will doctors inform their patients of their rights of revocation? A pro-euthanasia doctor would inevitably be lax in this area. And how will patients, judged to be on the borders of incompetence and therefore frequently confused, revoke their declarations? These alleged safeguards are illusory.

4.9] The Bill allows for conscientious objection (p. 4, lines 30-43), but what is the point of such a waiver, if the morally-sensitive doctor has to refer the patient ‘without delay’ (p. 4, line 37) to a pro-euthanasia doctor? And what if the ethos of the hospital is anti-euthanasia and one cannot be found? And will some hospitals become centres of excellence for the training and implementation of euthanasia to which patients will be transported? Perish the thought!

4.10] The Bill asserts that any healthcare professional who assists a patient to die will not have breached ‘any professional oath or affirmation’ (p. 5, line 22). This is rank hypocrisy. What about the Hippocratic Oath, or the Declaration of Geneva? Twenty-five years ago, Thomas Beauchamp and James Childress (1979) warned in their seminal book, Principles of Biomedical Ethics (Oxford University Press, p. 113), that, ‘Rules against killing in a moral code are not isolated moral principles; they are threads in a fabric of rules that support respect for human life. The more threads we remove, the weaker the fabric becomes.’ This Bill would shred that fabric.

4.11] The Bill describes the lethal chemical(s) used to bring about the death of the patient as ‘medication’ (p. 6, line 19). This is a deplorable misnomer and only fuels the argument that the Bill, and indeed, the whole issue of euthanasia, is unnatural, deceitful and offensive.

4.12] The Bill seeks to establish a monitoring commission in the hope that all cases of euthanasia will be documented and filed (p. 6, line 20). This, on the evidence from the Netherlands, will be a vain hope. There, such reporting increased from 30% to 41% by 1996 but, based on the latest 2001 figures, is still only 54%. In other words, the administration and monitoring of Dutch euthanasia, in spite of their professed ‘strict’ and ‘precise’ guidelines, remains a shambles.

4.13] The Bill includes (p. 6, line 22) the phrase ‘an attempt’ to assist to die. Is this a tacit recognition that assisted suicides are neither always successful, nor what are purported to be ‘deaths with dignity’? The Select Committee will no doubt be aware of the shocking account of the Dutch experience, reported by Groenewoud et al. (New England Journal of Medicine (2000) 342: 551-6), which showed that a quarter of doctor-assisted suicides in the Netherlands were botched, and that instead of merely ‘assisting’, nearly 20% of doctors had to act decisively to actually kill their patients. When such disasters occur, would the Bill allow doctors to cut the throats of their patients? And if not, why not, because the doctor’s intention would have consistently been to kill the patient? It is so obvious – the practice of assisted suicide always leads to full-blown euthanasia.

4.14] Section 15 of the Bill (p. 7, lines 3-6) is wholly unnecessary and disingenuous. It merely serves to unnerve the general public about end-of-life issues. Any good doctor will already be prescribing and administering the appropriate drugs, such as analgesics and sedatives, to relieve pain and distress – no change in the current law is required.

4.15] We recognise that the ‘greying’ of the population has increased the financial and personal costs of caring for the elderly. The economic arguments in favour of euthanasia are unassailable. The utilitarian says, ‘Why should we care, when it’s cheaper to kill?’ If euthanasia were to become public policy, the financial savings, and the freeing up of other resources within the NHS, would be huge. But so would the moral cost. The Bill would have a profoundly negative effect upon research and development into proper care – legalised euthanasia drives out palliative medicine. Instead of regarding the elderly and terminally ill as costly ‘bed-blockers’, and therefore expendable, we should be investigating and funding procedures and facilities to ensure that ‘their last days are not lost days’. No person has a life unworthy to be lived. To enable such patients to die well is not only the application of good Hippocratic-Christian medicine, but it is the fitting end of a person’s life, and a proper closure for the bereaved family. Euthanasia, of any sort, is counter to these civilized and important end-of-life events.


5] OUR CONCLUSIONS
5.1] The Christian gospel is the message of hope. We believe that in this life all human beings have the opportunity to be reconciled to their God and so live and die well. The people of God are entrusted with this gospel to demonstrate to all people how to live well and how to die well. Christians must therefore be in the vanguard by showing compassion towards all those who suffer, including the disabled and the dying.

5.2] We call upon all those in authority to oppose every form of euthanasia and instead to encourage legislation, resources and action that will support and cherish human physical, mental and spiritual life, at all its stages.

5.3] We are glad to learn that the Bill is opposed by many groupings within the medical profession, including the BMA and the Royal College of Nursing, and many disability rights groups, such as Disability Awareness in Action, and other organisations like, Age Concern and Help the Aged. We join them in our steadfast opposition to this Bill.

5.4] The end of life is always a complex and difficult time for patient, carers and families. It is the last of life’s great endeavours. The dying deserve the best care and attention. Medical treatment should be provided when it will be beneficial, and palliative care when it will not. Euthanasia must never be regarded as proper medical treatment. Killing the patient can never, ever be the right answer.

We welcome this opportunity to submit this response to the Select Committee on behalf of our constituency.

We sincerely hope that the Select Committee will conclude, as its forerunner, the Select Committee on Medical Ethics, did in 1994, not ‘… to weaken society’s prohibition of intentional killing.’ And that this Committee will again recognise that, ‘It would be next to impossible to ensure that all acts of euthanasia were truly voluntary, and that any liberalisation of the law was not abused.’

We trust that the Select Committee will resolutely oppose this Bill, and any other attempts to relax our current laws regarding the issues of dying and death.

Dr John R. Ling,
On behalf of Affinity,
August 2004.