On Monday 25th November the UCL Medical Society hosted a debate between prominent supporters and opponents of assisted dying. Arguing for the motion ‘this house would legalise assisted dying’ were Lord Falconer, Baroness Jay, Sir Terence English and Professor Ray Tallis while on the other side of the house sat Lord Carlile, Baroness Finlay, Dr Peter Saunders and Robert Preston.
Lord Falconer’s Assisted Dying Bill
The debate began with Lord Falconer laying out the specific details and safeguards included in his Bill, as well as the personal experience which led him to support a change in the law. The former Lord Chancellor described what he saw as the inadequacies of the current situation where it is “currently lawful to take your own life but a crime to help someone achieve that”.
He spoke about the experience of Michelle Broad (whose husband Chris is the former England cricketer) who was forced to die alone so her husband would not be accused of any wrong-doing. This was made equally absurd when he pointed out that not even the opposition believe that people should be prosecuted for compassionately helping a loved one to die. He went on to say that, along with the Director of Public Prosecution’s guidelines on compassionate amateur assistance, there needs to be clarification around what a healthcare professional can do or even say to someone. Next month will see the Supreme Court rule on this very issue, and while this will bring much-needed clarity, it is obvious that Parliament needs to act and create a safe and workable law.
Lord Falconer’s opposite number Lord Carlile rose next to set out why he does not believe assisted dying should be made legal. He stated the “perfectly sensible law” we have now which does not allow people to help others commit suicide because “that is an unlawful act”. Lord Carlile also mentioned that a Government should never allow the deliberate killing of one citizen by another and that Lord Falconer’s Bill would not legalise assisted dying but euthanasia instead.
“Why should terminally ill patients go on suffering against their wishes?”
Baroness Jay was the next speaker to put forward a case for an assisted dying law, representing the “lay person” on a panel of medical and legal professionals as well as the majority of the public. She began by contrasting Lord Carlile’s stance on assisted dying with his reasons for support of equal marriage. The crux of his argument on equal marriage was that Parliament has a duty to lead as well as to follow, and asked what damage a same-sex marriage could do to another marriage; one could easily ask how a terminally ill person who wants the option of an assisted death affects those people who wouldn’t want it?
Baroness Jay asked why terminally ill people should be forced to go on suffering if that is not what they wish. She explained that it was not a choice between either palliative care or assisted dying but could be the best of both. “However we define compassion,” Baroness Jay said, “the suicide option is lacking in compassion”.
These words introduced the story of Dr Jacqueline Davis whose brother Kevin, suffering from terminal cancer, sent his wife away for the night on an errand and was found the next morning in a pool of blood at the bottom of the stairs after attempting to end his life. No one knows how long it took him to die. For Baroness Jay this made it clear that we cannot solely leave it to the courts or the medical profession, the end of her speech demanded that “Parliament must act”.
The second speaker for the opposition was Baroness Finlay, a leading figure in palliative care in the UK. Baroness Finlay explained that sometimes doctors can get a diagnosis wrong, and through her experience had seen people who overcame depression when they were first diagnosed with a terminal illness and wanted to live. She believed that what assisted dying really meant was physician-assisted suicide and pointed to the audience of medical students – “it is about you and me being part of a patient’s suicide.” As well as admitting that organisations such as Dignity in Dying worried her (in any role we may play once the law is changed), Baroness Finlay believed the current situation did not need changing.
Assisted dying not assisted suicide
Sir Terence English, DiD patron and steering committee member for HPAD, stressed the importance of focusing on assisted dying – helping someone to die who is terminally ill – rather than assisted suicide and euthanasia. He also re-iterated that the Falconer Bill was not for people who are disabled, mentally ill or suffering from a chronic illness. Sir Terence covered the ethics of the Bill and how it would work in practice – “doctors will not feel pressured to assist someone to die if it’s against their ethics or religion, but should be prepared to refer.” He finished by urging the next generation of healthcare professionals to “give the choice to those patients who want that control over their last few weeks or days of their life.”
Dr Peter Saunders, of the Christian Medical Fellowship, gave his speech which was focused on the idea of the slippery slope. Dr Saunders highlighted the concerns of how an assisted dying law would put pressure on vulnerable people to end their lives due to being a financial or emotional burden. Lord Falconer has stated repeatedly that an assisted dying law would only be for those who are dying; needless to say financial reasons would not be legitimate criteria for an assisted death. Dr Saunders repeatedly highlighted the situation in countries which do not have assisted dying laws, such as the Netherlands and Belgium (which have legalised euthanasia).
On Oregon, a place which does have an assisted dying law, he said there had been a 350% increase in assisted deaths since its legalisation fifteen years ago. It is worth noting that there was always going to be a slight increase from a low base in the first few years as awareness rose and more importantly the numbers of people having an assisted death (around 0.2% of the population of Oregon) have stabilised in the last five years.
Dr Saunders then said that “any law allowing assisted suicide or euthanasia will carry within it the seeds of its own extension”, we can assume that he is also talking about an assisted dying law even though the evidence in Oregon has proved that this is not the case. “If it ain’t broke, don’t fix it” was Dr Saunders’ mantra on the current situation, (even though Care Not Killing opposed the DPP guidelines in 2010). I was left wondering why someone is happy with people having amateur assistance to die and only being investigated afterwards, but is against defining the criteria to terminal illness (not disabled or elderly) and having upfront safeguards.
Assisted dying: reducing needless suffering, respecting patient choice and making people safe
Professor Ray Tallis, chair of Healthcare Professionals for Assisted Dying, introduced his own speech by saying he wanted to draw the audience back from Peter Saunders ‘apocalyptic’ presentation by reminding the audience that “this is not Belgium”. Professor Tallis’ main argument was that the case for a law includes reducing needless suffering, respecting choice and making people safe. He then ran through the opposition arguments in which a running theme was that there was no evidence for assertions such as the deterioration of the doctor/patient relationship or the slippery slope – “No appetite for extending conditions from assisted dying to assisted suicide in Oregon”.
As Chair of HPAD Professor Tallis was concerned with the perception of the medical profession on this issue, citing a poll in Pulse this month which showed the only a minority of GPs want professional bodies to oppose assisted dying – an indication that sweeping generalisations of specific groups does nothing for the debate. Professor Tallis ended with another HPAD member’s story: Dr Tess McPherson had to watch her mother, who wanted an assisted dying law, die slowly in pain.
The final speaker was Mr Robert Preston, the Director of Living and Dying Well, who gave a very considered talk on why he could not support the legalisation of assisted dying. He asked “how safe is safe” and worried that it would be a law “with irrevocable consequences if we get it wrong”. Mr Preston also mused on what could ever be seen as a clear and settled intent to end your own life.
Audience questions: “…it seemed to be clear for most that the current situation cannot continue.”
With the speeches finished it was time to hand over to the audience who evaluated and measured what they had heard in the preceding hour and a half. One of the first questions was asked of Robert Preston, implying that he didn’t seem to be displaying any objection to the idea of assisted dying, only the practical side of implementing a Bill. It caused some puzzled looks when the Director of Living and Dying Well admitted that he would support a law if a Bill could be safe for all and if the current law is shown to be not fit for purpose. Given that currently people are either being forced to travel abroad to have the death that they wish, attempting to end their life with botched consequences, or fearing prosecution of loved ones it seemed to be clear for most that the current situation cannot continue.
One of the major problems with the debate was that assisted dying had been conflated with euthanasia and assisted suicide. Sir Terence English pointed to the headline on the projector which read ‘this house would legalise assisted dying’ and said he wanted to specifically argue this. Professor Ray Tallis stated as Chair of HPAD that “we do not want to go further”. Lord Falconer stated on numerous occasions that his Bill was for the terminally ill only and that he would not support any extension. This was probably best summed up when Lord Joffe asked a question from the audience. He wanted to know what evidence there was from Oregon that showed an assisted dying law could not work safely, and why the opponents felt this law could not work in the UK. Lord Carlile, to the annoyance of the proposition and much of the audience, decided to pursue an answer on Holland and Belgium. The evidence against the Oregon experience was conspicuous in its absence.
A majority voted for the motion that assisted dying should be made legal
And finally the vote came, and a majority of the audience voted for the motion that assisted dying should be made legal. It was a great performance from a varied panel in front of a tough audience. Lord Falconer said that opponents were not against his specific Bill but against the Bill that they wanted to hear. “Listen to the arguments” was the plea near the end and I hope when the Bill is debated in the House of Lords this is the case.