Assisted living

Monday, June 20, 2016
Peter Williams


Peter Williams explains why the Labour-backed assisted suicide Bill had to be defeated

One of the greatest strengths of the conservative and Tory tradition has been its ability to harmonise concern for, and appropriately weight, the various goods that lead to human flourishing. Strong law, compassion for the vulnerable and disadvantaged, limited-and-judicious use of state intervention, and a respect for the free action of individuals and civic institutions have all characterised our policy prescriptions at different times. The Government should use every one of these various elements together in tailoring its approach to end of life care, and in doing so help remove any perceived need for physician involvement in the death of their patients.

When asked by fellow Conservative Fiona Bruce at Prime Minister’s Questions in June what his view was on the issue of assisted suicide, the Prime Minister answered that he opposed the Bill that had been proposed by former leading Blairite Lord Falconer of Thoroton, and that any “imperfections and problems” could be dealt with “sensitively and sensibly” without a new law that introduced that practice. This was a timely comment, as only around a week later the Labour MP Rob Marris won top of the Ballot for Private Members’ Bills, and announced he would introduce a Bill which went on to form essentially a copy of Falconer’s proposals.

All the most recent proposals for introducing assisted suicide into the UK are based on the system used in the US states of Oregon and Washington. On the premise that there exists a ‘right to die’, they have aimed to establish a process by which terminally-ill people who want to end their lives, had been prognosed as having six months or less to live, and who were mentally competent, would be enabled to do so through the provision of lethal drugs. Whilst being presented as very limited and innocuously moderate, such a system is profoundly dangerous, and if passed would compromise public safety and the welfare of vulnerable people.

As any doctor will attest, prognosing death for six months is a best guess, not a certain prediction. By enabling people to take their lives on the basis of such a medical opinion, it runs the risk not only of ending the lives of people who, wrongly prognosed, could have lived far longer and happier lives.

It would also create a situation foreseen by the Prime Minister when he stated his ultimate issue with assisted suicide: “I think the problem is the pressure that is then put on frail elderly people to take a decision that actually they might not want to go ahead with”. The reason why the law exists against assisting another to kill themselves, is that vulnerable people can be subjected to subtle pressure to end their lives by unscrupulous relatives, if not by medical staff who wish to empty a bed. Others might, simply by cultural inertia, choose to die because they feel a burden on others, as did 40% of those choosing to die in Oregon, and 59% of those choosing to die in Washington, according to the most recent figures. Such situations would far more often than not be undetectable by the paper-thin ‘safeguards’ given in the Bill, which constitute little more than a toothless procedural checklist.

Adopting the Oregon/Washington system would also lead to a manifold increase in the numbers of people choosing to commit suicide: if we apply the death rate from legalised assisted suicide in Oregon in 2014 to the number of deaths in England and Wales, we see that such a system would lead to over 1,500 such assisted suicides annually here (compared to the 20 or so cases that go through the courts).

Further, in establishing the principle that there is a ‘right’ to be assisted in killing oneself, Marris’s assisted suicide Bill would set the inexorable precedent for incremental extension of assisted suicide to others beyond terminal illness, and the introduction of euthanasia for others who are rendered incapable of killing themselves. That is why it is opposed by elderly and disabled groups such as the British Geriatric Society, Scope, the Disabled People’s Council and Not Dead Yet UK. For all the reasons given above, it is also opposed by leading medical organisations such as the Royal Societies of Physicians, Surgeons, and General Practitioners, the British Medical Association, and the World Medical Association.

These are just some of the reasons why assisted suicide is a prescription that profoundly threats public safety, and particularly vulnerable people. Why then, should the lobby for such a discredited and dangerous proposal so perennially persist in British politics? To an important extent, it is because assisting suicide is seen as a solution to the suffering caused by failures of end-oflife care provision that have become more clearly explicit over time, particularly in the last five years.

Despite the fact that Great Britain possesses possibly the best and most developed system of palliative care (the medical removal of suffering) in the world, thanks to the pioneering work of Dame Cicely Saunders and the Hospice Movement, it struggles with under-supply, limited application outside of a hospice setting, and sometimes poor organisation. An independent review commissioned by the Government reported in 2011 that of just over 470,000 people who die in England each year, some 355,000 require palliative care, yet only 171,000 receive specialist palliative care. It also found a postcode lottery of palliative care that led to gross inequities, with only 56% of Primary Care Trusts providing 24-hour community nursing.

This “unacceptable variation” and other similar problems were confirmed earlier this year both by a Commons Health Committee report, and by researchers at the London School of Economics, in a report commissioned by the cancer charity Marie Curie, which found that more than 100,000 people a year who would benefit from palliative care are not getting it, leaving them without the sufficient pain relief they need. Groups most likely to be so affected were the “oldest old” (aged 85 and over), people living alone, people living in deprived areas, and black, Asian and ethnic minority groups.

In May, a report by the Parliamentary and Health Service Ombudsman into complaints about end of life care found serious issues with the provision of that service. This included poor communication with families – tragically, meaning that some reported losing a chance to say goodbye to a dying loved one – and poor pain management resulting in unnecessary suffering of patients. The report also reported what the independent review, Health Committee, and LSE identified: poor planning and fragmented, uncoordinated care, often compounded by inadequate out-of-hours services.

In response to these structural problems, the pathway to proper reform is known, has been made clear, and could save money rather than lead to a greater strain on the public purse. The Commons report recommended access to palliative care in community settings and hospitals, as well as hospices. The 2011 review estimated that provision of more community-based services could reduce the number of hospital deaths by 60,000 a year, calculating that the annual saving to hospitals would be £180 million. The LSE report came to similar conclusions, finding that providing palliative community care to those that need it could improve the quality of life for thousands of patients and save millions in NHS money by preventing unwanted and distressing hospital treatment.

Meanwhile, Lady Finlay of Llandaff, a cross-bench peer, immediate former President of the British Medical Association, co-chair of end-of-life think tank Living and Dying Well, and one of Britain’s leading experts in palliative care medicine, has tabled an Access to Palliative Care Bill in the House of Lords that would ensure that all health and social care providers receive the necessary education and training in palliative care and are thereby enabled to provide a quality service for patients who need it. This would mean that the individual analgesic requirements of patients would become a priority and a duty for all medical professionals. It would also involve training all staff in how to handle the sensitive communications between themselves, dying patients, and their loved ones, so that needed psychological and emotional support is provided at all times. This would give the comforting sense of control back to people at one of the most uncertain times of their lives. In addition to this, Lady Finlay’s Bill aims to resolve problems such the access needed by healthcare workers to the essential palliative medication for patients at all times, and to the specialist advice needed to properly care for those with complex conditions.

All these changes would effectively create an efficient, humane, and universal system of palliative provision that would have the flexibility and trust essential to putting patient decisions about their treatment at the core of care. If this Government can support and accomplish such necessary healthcare reforms, complementing the crucial legal protections of vulnerable people, it would accomplish the necessary harmony between social compassion and legal strength that only a truly Conservative approach to the issue can provide.

By cementing British global leadership in the provision of end-of-life care and transcending the dangerous distraction of the assisted suicide debate, we could provide for the world a shining example of how, without endangering the vulnerable or compromising fundamental medical ethics, true dignity in dying can be achieved.

Peter D. Williams is Executive Officer for Right To Life and was part of Fiona Bruce MP’s team that defeated the Marris Bill.

This article was originally published in Crossbow, the Bow Group Magazine - Autumn 2015 on 11/11/2015. Published online 20/06/2016