We all want to have a ‘good death’ – but assisted suicide is not the solution
PARLIAMENT will soon be debating whether to pass a law that would allow people to be helped to die by being given lethal drugs.
I am very concerned that, whatever the best intentions of the advocates of this, the risks are great.
In countries where assisted dying has been legalised, there has been a huge increase in the number of people who die this way.
In the Netherlands, a 29-year-old woman with mental health problems drank poison given to her by her doctor in an assisted suicide.
In Canada, one in 20 deaths is now by euthanasia, and a very high number of these are for social reasons.
In most countries, the law started with the premise of limiting assisted dying to those with terminal illness and a limited life expectancy.
But then the interpretation gets ever- wider — in Canada and Oregon, some with anorexia have had euthanasia.
‘How can this be policed?’
There are already proposals for people with mental health issues — and no other issues — to be offered euthanasia.
Disabled people can have their lives ended for principally social reasons.
Although the expected proposals in the UK will be linked to those with just six months to live, such life expectancy is impossible to predict with certainty.
There is no systematic monitoring of the quality of assisted dying in countries where it is legal, and little or no assessment or oversight of the advice or counselling provided by the doctors involved.
How in practical reality can this be policed?
Would the doctors who provide lethal drugs be the same as those offering palliative or end-of-life care?
Would they be required to offer it as an option to all?
That’s a conflict that is hard to manage, no matter what the law says.
Assisted suicide is often painted as a painless way to die. But in the countries where it has been legalised, death is not always as easy or painless as some suggest.
The drugs used have never been properly evaluated.
In Belgium, the cocktail of drugs used contains one that causes complete paralysis, meaning that, for some people, in their final moments there is no way of communicating discomfort.
Paralysis can lead to death by asphyxia — imagine silently suffocating but being unable to ask for help.
And yet we don’t hear or read enough about the reality of death by lethal drugs.
The concept of a good death is something we should be proud of.
Dame Meg Hillier
Crucially, the UK has been the pioneer of support for people who are in pain and dying.
I have the privilege of representing St Joseph’s Hospice, which has been caring for the dying since 1905 and which was formative in the work of hospice pioneer Dame Cicely Saunders.
My own father was an early pioneer in delivering palliative care in the 1970s, when the hospice movement was still young.
The concept of a good death, with care and pain management led by expert teams of nurses and doctors, is something we should be proud of.
Professional and holistic support for the dying person and their family about how to manage illness, death and its aftermath is essential.
I have seen this at first hand with an elderly relative supported in his final days in a hospice.
My concern is that if the assisted dying bill is passed, many vulner- able people will be encouraged to accept it as their best option.
Many of the current advocates are articulate and capable.
People fear pain but, even more than that, they fear dependence — not being in control of what is happening
Dame Cicely
But if the same trusted doctor is placed in an advisory position as well as treating patients, many will feel under pressure — particularly the less literate, those with poor understanding of English or where family relationships are complicated.
One in five people in the UK over 65 is affected by abuse — mostly financial or emotional neglect.
Many people with disabilities, including paralympian Tanni Grey-Thompson, are concerned that many of the reasons advanced for assisted dying describe situations which disabled people live with every day of their lives.
As she has said: “Allowing this practice . . . introduces a value judgment that some people — disabled people — are ‘better off dead’.”
At the heart of palliative care is much more than how and when you die.
As Dame Cicely said: “You need to be alert to the whole person. Isolation is what people fear most of all when they are dying.
‘Ensure support’
“People fear pain but, even more than that, they fear dependence — not being in control of what is happening.
“Palliative care aims to give the patient as much control as they can have in the rest of their lives by relieving pain and the other symptoms, and give them the freedom to go on being themselves.”
We have well-established and world-beating care for people who are dying.
The Health Secretary, Wes Streeting, himself acknowledges the state of palliative care in this country is not yet in a place where we can be sure people will not effectively be coerced by the lack of support available.
I agree. If people are not getting this support, the answer is not to give them lethal drugs but to ensure that top-quality care and support is there for patients when they need it most.
It is a tragedy if this is not provided at the moment — but not an argument to enable assisted dying as a cheap and convenient alternative.
- Dame Meg Hillier is Labour MP for Hackney South and Shoreditch.