Friday, 2 July 2010

Royal Society of Medicine debate on assisted suicide

On Wednesday the Royal Society of Medicine (RSM) hosted a day conference and evening debate on the ethics of assisted suicide. Anthony Ozimic, SPUC's communications manager, was in attendance and has sent me some of his observations (some marked [AO]).

Lord MacKay, a former Lord Chancellor, was the day's first main speaker. He spoke about the findings of the 2005 House of Lords select committee on Lord Joffe's assisted suicide bill, which he chaired. The committee found that:
  • accurate prognosis of terminal illness is virtually impossible at a distance of months
  • disease can interfere with a patient's mental competence
  • Lord Joffe admitted to the committee that the definition of suffering in his bill was a subjective test (i.e. determined by the sufferer) not objective (i.e. determined independently).
Lord MacKay also said that: 
  • the suffering of a person requesting assisted suicide may arise not from illness but from non-physical causes (i.e. death of a life-long partner). The real reason for their suffering may therefore be hidden under another reason
  • opinion polls are not a good guide to public opinion due to knee-jerk answers to simplistic questions.
Professor David Albert Jones, a bioethicist, argued that:
  • there are two types of slippery slope, one empirical (based on observation of data) and one logical (based on connections between rational arguments)
  • acceptance of voluntary euthanasia concedes the idea that suicide or euthanasia is a benefit (i.e. good) for some people, that their lives are not worth living and that they are better off dead
  • to allow the (supposed) benefit of euthanasia to those who can consent (voluntary euthanasia) but deny that same benefit to those who cannot consent (non-voluntary euthanasia) would be to discriminate against those who cannot consent (i.e. the mentally disabled)
  • the legalisation of death on request will therefore threaten the vulnerable
  • doctors shouldn't offer patients things they don't think will be of benefit to the patient.
Professor Jones also cited evidence of the empirical slippery slope. Under the euthanasia regime in The Netherlands, there have been hundreds of reported cases of lives having been ended without request or consent. This practice is officially condoned and such deaths are not treated seriously as unlawful killing. There is a lack of outrage about this because it has been widely accepted that suicide or euthanasia can be a benefit.

Professor Bregje D. Onwuteaka-Philipsen, a Dutch pro-euthanasia academic, said:
  • in The Netherlands, cases of euthanasia deemed compliant with the law by euthanasia tribunals (comprised of an ethicist, a lawyer and a doctor) mean such cases are never seen by the public prosecutor
  • under the Dutch law, the qualifying criterion of suffering is not limited to physical suffering but can include psychiatric conditions
  • statistics suggest that there was a fall in the numbers of cases of euthanasia and assisted suicide between 2001 and 2005 and an increase in cases of pain alleviation. Prof. Jones said that he suspects that this means that euthanasia is being hidden under the guise of pain alleviation in the form of continuous deep sedation
  • statistics suggest that between 2001 and 2005 there was a big increase in the number of doctors who say that they will never perform euthanasia
  • 20% of euthanasia cases are not reported.
During the question-and-answer session, Dr Simon Kenwright of the Voluntary Euthanasia Society (now air-brushed as Dignity in Dying) said that in Britain "we already practise passive euthanasia through the withdrawing and withholding of therapy". I don't think his VES/DID colleagues will be happy about that admission. They deny that withdrawing and withholding of therapy (e.g. Bland, the Mental Capacity Act) can constitute euthanasia, and they now claim to oppose euthanasia!

Baroness O'Neill, a leading moral philosopher, said:
  • the ancient Greeks only spoke of communities, not individuals, as autonomous
  • Immanuel Kant, the 18th-century German philosopher, never spoke of autonomous individuals but only of autonomous principles (i.e. objective principles from independent, accepted sources)
  • autonomy today is deemed to be individual independence
  • there is no consensus today on the definition of autonomy, its criteria or limits
  • suicide is different from many choices in that it is irrevocable
  • she has received many letters from people saying that they will come under pressure if assisted suicide is allowed, because they are not in a position to be very independent.
Professor Paul Badham, an Anglican academic, made (what he claimed to be) a Christian case for legalising assisted suicide. He claimed that:
  • Jesus and St Paul were not martyrs but positively chose and actively sought death [AO: There is no evidence for this regarding St Paul; and Jesus' prayer to His Father after the Last Supper (Matt. 26:42) explicitly contradicts Badham's claim.]
  • many Christians before St Augustine's time followed the Stoics' belief in favour of suicide [AO: They were not Christians but Gnostics, who in the Middle Ages were known as Cathars or Albigensians. It says a lot about Badham's Christianity that he mistakes Gnostics for Christians.]
  • in the Old Testament the Fifth Commandment "Thou shalt not kill" had many exceptions [AO: There were and are no direct exceptions to the Fifth Commandment. As St Augustine explained the instances in the Old Testament to which Badham refers "by no means violated the [Fifth] commandment".]
  • St Augustine "added to the Fifth Commandment the words 'thyself or another'" [AO: St Augustine added nothing to the Fifth Commandment but in fact explained why those words were absent from it.]
  • Catholic opposition to assisted suicide is like the opposition by Christians to pain killers and epidurals and to the Catholic Church's ban on family planning [AO: The Catholic Church has never opposed pain killers, epidurals or family planning, though by "family planning" Badham probably means contraception and maybe abortion.]
  • the embracing of suffering in the life and teaching of the late Pope John Paul II contradicts a correct Christian understanding of medical treatment [AO: It's clear from this claim, as well as his claim about the deaths of Jesus and St Paul, that Badham both rejects biblical teaching on the value of suffering and simply doesn't understand many basic dynamics of human living e.g. resignation, opportunity, sacrifice.]
Michael Langrish, the Anglican bishop of Exeter, said that:
  • many people's experience of medical care is not of exercising autonomy but of being under the thumb of impersonal bureaucracy.
  • unlimited autonomy and choice do not address the needs of all human beings and therefore threaten to undermine the sanctity and dignity of all human beings
  • once a moral principle has been breached it often becomes to very difficult to police the boundaries.
He suggested four principles for approaching the debate on assisted suicide, in this hierarchical order:
  1. affirming life
  2. caring for the vulnerable (He argued that the danger to the vulnerable from allowing assisted suicide trumps any distress that may be caused by banning assisted suicide)
  3. building communities
  4. respecting individuals.
He also argued that:
  • allowing assisted suicide would contradict the government's suicide prevention strategy
  • examples of a bad death are not arguments for a bad law but a reason for good deaths and good laws.
Peter Carter, head of the Royal College of Nursing (RCN), tried unconvincingly to explain why the RCN has moved from a position of opposition to assisted suicide to a position of neutrality. Ominously, he told us that the RCN is consulting with a wider range of stakeholders on the issue. To me, this is officialese for saying that he's moving the RCN in the direction of endorsing assisted suicide.

Sir Graeme Catto, former president of the General Medical Council (GMC), also ominously explained that the GMC has moved beyond proscribing bad things for doctors to do, to advising doctors about how they can be good doctors. He gave his personal view in favour of allowing assisted suicide, saying that:
  • assisted suicide is not, or at least should not be treated as, primarily a medical matter
  • the risks entailed in allowing assisted suicide cannot be eliminated.
Ann McPherson, a doctor from Oxford, said that:
"I don't agree that every suicide is a tragedy. It can be a celebration, as a person can die with much more dignity."
Thus Dr McPherson argued that suicide is a benefit and that not to kill yourself may be undignified - thus neatly conceding Prof. Jones's arguments!

Baroness Jane Campbell, the disabled anti-euthanasia peer, argued that:
  • disabled people have to deal with fear and prejudice
  • it was said of her as a child that she would be better off dead
  • allowing assisted suicide contradicts suicide prevention. If one tries to commit suicide on one's own, society will try to prevent one, but if one seeks assistance, society wants to provide it
  • not one organisation of, or for, disabled people supports changing the law in order to allow assisted suicide
  • it's when disabled people aren't given the support they need that they start having suicidal thoughts
  • the law should not be changed because of a few people's perceived hopelessness.
Lord Joffe, the leading promoter in the House of Lords of assisted suicide, claimed that:
  • assisted suicide is a natural development of refusal of treatment which ends in death [AO: which is true where the intention is euthanasist e.g. as possible via the Mental Capacity Act.]
  • assisted suicide involves the provision of "life-ending medication" [AO: not medication but poison]
  • there is no evidence of abuse in The Netherlands under its assisted suicide and euthanasia law [AO: even though hundreds of patients have been killed without their consent or request!]
  • the director of public prosecutions (DPP)'s final policy on assisted suicide gives broader, not narrower, scope for assisted suicide by not specifying the deceased's disability as a factor.
Lord Carlile QC, the anti-euthanasia peer, said that:
  • the debate on Lord Joffe's bill had more speakers than any other debate ever in the House of Lords
  • coroners don't want to be involved in assisted suicide, and neither will judges, courts etc
  • nothing in Lord Joffe's proposals will protect weak and persuadable persons from vested family interests.
Professor Raymond Tallis, a retired physician:
  • spoke of "unbearable suffering prolonged by medical care" "inflicted on the patient" [AO: Yet medical care doesn't prolong or inflict suffering. Such results would be the antithesis of medical care.]
  • claimed that "respect for individual autonomy is a sovereign principle" [AO: Yet no legal system has ever regarded respect for individual autonomy as a sovereign principle. Human rights instruments (e.g. the European Convention on Human Rights) and national constitutions (e.g. the US Constitution) always make individual autonomy, and respect for it, subject to higher prior rights (e.g. the right to life) and common goods (e.g. protection of vulnerable classes). This is true even if sometimes courts interpret such instruments and constitutions in a contrary, false way (e.g. Roe v. Wade, in which the US Supreme Court declared abortion to be a constitutional right.)
  • admitted that well-off, middle-class, white, patients with strong personalities are over-represented in the cases of assisted suicide in the American state of Oregon [AO: This proves that laws allowing assisted suicide serve the vested interests of the strong, rather than helping the weak.]
Baroness O'Loan pointed out that:
  • there is no specialist palliative care, nor hospice system as we know it, in Oregon
  • article two (right to life) of the Human Rights Act needs to be the starting point in the consideration of assisted suicide
  • there is evidence of patients in The Netherlands choosing euthanasia out of fear of being left in pain, because of the lack of palliative care
A vote was held and the motion in favour of assisted suicide was rejected by a large margin.

Earlier this month the British Medical Association (BMA) issued a strong guidance statement warning doctors against any involvement, even indirect, in assisted suicide. Yesterday the BMA's annual representative meeting (ARM) passed a motion which points out that palliative care and other forms of patient support almost entirely eliminate requests for assisted suicide.

Comments on this blog? Email them to
Sign up for alerts to new blog-posts and/or for SPUC's other email services
Follow SPUC on Twitter
Join SPUC's Facebook group
Please support SPUC. Please donate, join, and/or leave a legacy