We Need an Open, Objective and Rational Public Debate.

Blog | Zach Moss | 9th February 2012

This issue is far too important for it to be hijacked by those who trivialise it by basing their case on subjective scaremongering and innuendo. What is required is an open public debate in which objective, rational arguments from both sides of the divide are presented. This has not happened.

The main arguments put forward at the Synod were that changing the law will be the thin end of the wedge, resulting in a shift of the default position on the sanctity of life causing numbers requesting an assisted death to escalate over time; that protection for the vulnerable and disabled will diminish; and that quality palliative care provides an alternate solution.

Evidence from Oregon, where an assisted dying law has been in place for around 15 years, shows that Williams’ arguments are groundless. In Oregon, detailed records have been kept of patients requesting an assisted death: the basic facts are well documented and readily accessible. Additional information can be obtained from the Oregon Department of Human Services.

This and related evidence should be read with an open mind by all who are interested in helping terminally ill patients whose distress is not currently being addressed.

The Oregon data shows that:

Patients must request assistance to die on two separate occasions before their request is considered. This provides a vital safeguard for potentially vulnerable groups. The patient’s diagnosis and clinical condition must be consistent with them being terminally ill and confirmed by two independent physicians, one a consultant. As a generalisation, those requesting help to die are not frail, elderly or disabled: they are strong-minded, persistent and want to decide for themselves when and where to die;
The legalisation of assisted dying has not borne out Williams’ predictions of “disaster”. There was, as might be expected, a rise in requests for assistance to die in the first few years after the law was changed in 1997. But this has not continued and currently the percentage of deaths in Oregon under assisted dying legislation is identical to the current percentage of deaths in the UK resulting from a doctor’s decision to end a patient’s life at his/her request, approximately 0.2% of deaths;
The reasons recorded for requesting assistance to die reflect a loss of autonomy and dignity and a deteriorating quality of life, rather than failings in palliative care provision.

The status quo in the UK is patently inadequate to address the needs of dying patients. The current prosecution policy was established by the Director of Public Prosecutions to allay the fears of those who wish to help a loved one to escape an intolerable situation at the end of their lives. It achieves this to a degree but satisfies neither those who support a change in the law nor those who oppose it.

At times, arguments about assisted dying become confused with those about the adequacy and availability of palliative care services. Palliative care in the UK has been identified as providing the best end of life care in the world. But at the same time it is acknowledged by the National Council for Palliative Care, The British Medical Council and McMillan Cancer Relief that it is not able to adequately address the needs of all dying patients.

As a hospital doctor I saw patients who died peacefully and with dignity with family members and/or friends present. I saw others who died with neither peace nor dignity because it was deemed appropriate to make futile attempts to maintain life for a few hours or days longer. But this is not the issue here; there are legal means, if followed, whereby these situations can be largely avoided: The mentally competent can refuse further treatment and the relatives of those who have lost mental capacity can insist on the patient’s previously signed wishes being followed. The crux of the current debate is that assisted dying is sought by very few, who, usually because of present or anticipated loss of autonomy or dignity wish to have the opportunity to die at a time and place of their own choosing. Neither the best palliative care nor the legal system helps them to do this.

My fear about the Synod’s position is that it is more about the internal politics of an organisation embroiled in divisions about other contentious issues, seeking some form of unity on this one. In doing so I believe they fail to represent a majority of those with faith and furthermore turn their back on those terminally ill patients whose suffering is not relieved effectively through palliative care.

Comments below.