British Doctor: We Must Help The Dying Not to Kill Them in Assisted Suicide

Bioethics   |   Steven Ertelt   |   Sep 3, 2006   |   9:00AM   |   WASHINGTON, DC

British Doctor: We Must Help The Dying Not to Kill Them in Assisted Suicide

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by Baroness Finlay
September 3, 2006 Note: Baroness Finlay of Llandaff is a professor of palliative medicine, based at Velindre Hospital in Cardiff. She was one of the leading opponents to a bill sponsored by Lord Joffe in the British House of Lords that would have legalized assisted suicide.

How do you define terminal illness? Lord Joffe’s Assisted Dying for the Terminally Ill Bill said it is someone with less than six months to live. But we, as doctors, cannot predict prognosis.

I have patients who I have honestly believed were dying and only had a short period of time left. But having got their symptoms under control and addressed other issues, they carried on for an enormously long time.

All the evidence, from people who look after these patients, is that we cannot predict prognosis.

Lord Joffe’s Bill also spoke of unbearable suffering. But the problem is that it doesn’t have any test about whether you can relieve that suffering or not.

If there’s no duty on the doctor to relieve it, you are forced to simply accept what the patient says.

Another problem is that unrelievable suffering is often not associated with terminal illness – the people whom I have seen who have been suffering the most, have either been extensively damaged by illness or accident or affected by bereavement.

Another issue to consider is that of coercion – the sense that patients are made to feel as though they are a burden and have a duty to die.

We know that we’re missing a huge tranche of people with depression associated with a medical illness, and we know that we can’t detect coercion.

In one case I dealt with, the family seemed to be so worried about the mother’s symptom control only up to her 65th birthday.

It later emerged that her life insurance policy expired on her 65th birthday and the family lost the money.

In another case when the husband got his wife home, he sat her up in bed and got her to change her will so she left him everything and nothing for the children. He turned up at her funeral with his girlfriend.

I couldn’t detect coercion in any of these cases.

What many patients want to know is that they are loved and that they are wanted – it’s quite common for patients to be surprised at the degree of concern from their family and friends.

Another major issue of concern is consistency and how we will be able to ascertain that the decisions of one doctor are consistent with another.

Holland has used the mechanism of self-reporting and we know there are a number of euthanasia deaths that are not reported in the system.

In Oregon, there is anecdotal evidence of cases of assisted dying outside the remit of its laws, but nothing has been done about it. Its own health department has said, in reports, that it has no way of verifying the figures.

In Holland, one in 32 deaths are now by euthanasia – that’s six times the road accident death rate. In the UK it would equate to four-and-a-half times the road death rate.

Something has changed in Dutch society and some GPs are saying that they are fed up with euthanasia and they are fed up with the pressure from families.

To read the rest of this editorial, go here.