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I still think that there is a very huge number of people who sink into dementia and mental incapacity who would really very much prefer to die, rather than continue in the state they are in. I think that’s something most of us dread more than any form of dying.

Thus said Baroness Mary Warnock, moral philosopher and ethicist, recently.

Her new book, written in collaboration with Dr Elisabeth Macdonald and entitled, “Easeful Death - is there a case for assisted dying?” has been reviewed as providing a readable exploration of the philosophical, medical and legal arguments for a change in the law covering assisted suicide and voluntary euthanasia. The book includes a chapter which is concerned with practical ways of inducing death, including a detailed examination of self-denial of food and fluid. “This may be a lengthy process, placing intolerable anguish on the family and professional carers.” The writers conclude that this is a legal but inhumane way to circumvent an intentionally inhumane law.

The last chapter of the book looks at some ways in which people’s attitudes to death are changing, and why. Since Darwin, it says, some of us have started to recognise that we “do not have a soul that is separate from our body” and therefore we have no need to maintain life in our disintegrating body for the sake of our soul. In addition, we now stay alive so long, and suffer so much for many years at the end of life that “we are forced to ask ourselves what all the extra years that people live are actually worth to the people that live them.”

Divided opinion
The issue of legalising voluntary euthanasia / assisted death has been debated, dismissed and resurrected three times in British Parliament in 2003, 2004, and 2005. On at least two of these occasions, the BGS has actively participated in the debate, strongly resisting any proposal to change current law on euthanasia. The subject continues to excite strong opinion, even among members of our Society, with one intellectual giant, Professor Ray Tallis, making an eloquent case for making the law more flexible, while another, Professor Peter Millard, leads a not overwhelming, but nevertheless significant majority which is vehemently against the notion.

During the 2005 offensive on the current law, the BMJ remained carefully neutral, saying that, “the question of criminal law in relation to assisted dying is primarily a matter for society and for Parliament”. The Royal College of General Practitioners came out against the proposed legalisation, while the Royal College of Physicians (London) was also neutral (the fact that Prof Tallis was Chairman of the RCP Comittee on Ethical Issues in Medicine, may have influenced this.)

A good death
Another book, released this year, tells of how Dr Rodney Syme, came to publicly break the law in Australia by providing Nembutal to suffering people who wished to die. His purpose in the book is to “dispel the unofficial conspiracy of silence within the medical profession, and to illuminate the black hole of misunderstanding and ignorance” by telling stories from his personal experience of assisting people with intolerable suffering to die. He wants doctor-assisted dying to be de-criminalised, and he wants people to know what happens at the end of life, so that they are better able to take control of their own dying.

Informed perspective
It goes without saying that physicians generally come to the subject of legalising euthanasia with a more “informed” perspective than the lay person - no disrespect to the millions of non-medical people who have cared for suffering, dying loved ones. Physicians have legitimate concerns, not only about the role that may be imposed on them as possible arbitrators on the logistics and participants in the administering of assisted death, but also, by virtue of the range of their experience with frail or dying people and their carers, they are aware of the “thin edge of the wedge” questions, including the likely pressures on vulnerable people who either consider themselves, or are considered, burdens on their nearest and dearest.

The fact remains that there is increasing world wide public pressure to review laws which criminalise euthanasia. There are 38 “right to die organisations” in 23 countries. Dignitas has assisted the suicide of over 700 foreigners since its founding in 1998 and “EXIT”, another organisation in Switzerland administering assisted death, claims over 50,000 members. Moreover, there is a small, but vocal number of physicians and intellectuals who provide equally eloquent and as informed an opinion in favour of assisted death as that of the majority against it.

Despite the fact that Dr Syme could receive a fourteen year prison sentence under Australian law, he prescribed barbiturates to dying patients. It was only when Steve Guest - a prominent journalist and government media advisor, suffering from terminal cancer of the oesophagus - asked him for help to end his life that Dr Syme decided to alter the focus of this book, and use it to actively provoke prosecution in order to try to change the law. Three years after Guest’s death, despite publicising the fact that he provided him with the barbiturates with which he ended his life, Dr Syme has not been prosecuted, nor has the coroner returned a verdict on Guest’s death.

He argues that in every case he has acted to palliate suffering, knowing that it was the patient’s intention to hasten their death. Parliament, he says, does not have the courage to legalise what he has been doing despite overwhelming public support for it. Perhaps, “it must be through our courts of justice that a defining decision will be reached. If a court accepts that physician assisted dying in appropriate circumstances is primarily an act of palliation, then the parliament may become irrelevant in finally helping those with terrible suffering to achieve a good death.”

Renewal of an old debate
The authors conclude that, as part of a more honest culture of reflection on ageing, illness and death, the public is now ready to embrace a more compassionate approach. “Debate in this area,” they urge, “should no longer be dominated by a minority of critical, often faith-led voices. Those who disagree have every right to voice their disapproval and not to participate, but they should not impose their convictions on the quiet majority.”

Article based on information provided by
FATE (Friends at the End)

BGS Newsletter, Oct 2008
Issue 18 ISSN 1748-6343 18