20 Aug, 12 | by BMJ
As Tony Nicklinson’s case illustrates, there is clearly a desire among some patients with debilitating and incurable diseases, to end their suffering with the support of their doctor and relatives. To deny this right is to prolong the suffering of individuals and families—something I cannot condone. Nicklinson’s is the latest case in which appeals for the right to die have been rejected by British courts, and comes against the background of a long-running campaign for a change in the law. I sincerely believe, unbearable suffering, prolonged by modern medical technology/care, and inflicted on a dying patient against their will, is an unequivocal evil. To die with dignity is a basic human right.
For many years, surveys have shown a steady 75% plus support for assisted dying in the general population. I, like many in the profession, would like to see the law on assisted suicide amended to allow doctors to provide the choice of an assisted death only to those who are terminally ill, mentally competent, and who have expressed “a clear and settled wish to die”. I concede that a significant number of my colleagues in the profession would prefer to see no change at all as has been demonstrated numerous times at the BMA ARM.
The argument that palliative care, combined with psychological and spiritual support, can address all the problems of all dying patients ignores the clinical reality. Quite a few patients like Tony Nicklinson, despite receiving the best palliative care, still suffer beyond our imaginations. International experience also confirms that palliative care and assisted dying are not either/or options. Since 2002, assisted dying has been legal in Oregon under the Death with Dignity Act. Of the 50 states of the USA, Oregon has amongst the best palliative care and nearly 90 per cent of those seeking assisted dying do so from within those services.
I accept that assisted dying is not like any other clinical decision and if society is to offer this solemn choice it must build in safeguards that not only rectify the inadequacies of the current situation, but protect the vulnerable, the weak and all those—doctors and nurses included—who are involved in this incredibly difficult situation.
We must enact legislation to decriminalise acts of euthanasia and physician-assisted suicide, for the following compelling reasons:
- Prevention of cruelty and protection of human rights. To allow a terminally ill individual to end their life is the only humane, rational, and compassionate choice. The current prohibitions require a person with great physical or mental suffering to continue to endure suffering against their wishes, which cannot be right. The right to life and to a private and family life under the European convention on human rights should be interpreted broadly to include decisions about quality of life, including decisions about death if life is no longer one of quality.
- Regulatory control. The terminally ill are travelling abroad to countries where the right to end life in terminal cases is lawful. We cannot regulate the laws of foreign lands. We must make provisions within our laws to regulate this issue within our boundaries. We must not prosecute loved ones who assist a terminally ill individual to travel abroad to end their life lawfully for “encouraging or assisting” suicide.
- Ambiguity. The current law conflicts with the law as it is being enforced. If the laws were enforced, more than 100 people would have been prosecuted for accompanying loved ones abroad to end their lives. This uncertainty leaves all concerned, including physicians, unprotected.
- Discrimination. The ability of the wealthy to travel to countries where it is lawful for the terminally ill to end their lives treats the haves and have-nots unequally.
- Available safeguards. Many people are opposed to legislation that would allow “end of life” choices. But our concerns relating to abuses and protection of the vulnerable can be addressed by ensuring certain objective conditions are met prior to allowing a terminally ill individual to exercise the right to die:
- the patient must be terminally ill.
- the patient must be an adult.
- the patient must be mentally competent.
- the patient must be in severe pain.
- two independent physicians must be satisfied that the above conditions are present.
If we do not address this issue head on, we will have continued uncertainty and the unregulated practice of euthanasia, with the fear of prosecution hanging over the heads of all concerned. The goal of the medical profession should still be to save lives—but not at the expense of compassion and the right of the terminally ill to choose to end their lives with dignity. The availability of assisted dying would bring much comfort to not only Tony Nicklinson, but to others as well, even if they don’t actually use it, because it brings a sense of having some control.
Kailash Chand has been a GP for last 30 years and is now chair of the NHS Trust Tameside & Glossop. He is on the BMA council and he was on the general practitioner’s committee. He was awarded an OBE in 2010 for services to the NHS. He writes for the Guardian, and other regional and national publications on health matters.