An easy death – whose job is it?

The vexed issue of ‘assisted suicide’ has surfaced again in recent weeks, thanks to the media reports of the elderly lady who starved herself to death, in the absence of any state-sponsored mechanism for achieving her desired end.

Some of these reports once again bemoan the fact that doctors are not allowed to assist people to commit suicide (I say ‘people’ advisedly, because they won’t all be ‘patients’ –  we actually need a name for those who wish to take advantage of any relaxation of the regulations around euthanasia, perhaps ‘departees’ would fit the bill?). Why is it always doctors who are put forward as the appropriate profession to pull the plug on those who have decided they have had enough? It’s no longer necessary to give lethal drugs by injection – and even if it was, you don’t need to be medically qualified to get a needle into a vein. ‘Ah’ you say, ‘even with orally-administered drugs, you still need a doctor to provide the prescription’. Well no, you don’t actually – nurses and other paramedical professionals are already authorised to prescribe and administer drugs under controlled conditions (see below).

Of course, it’s true that doctors will be involved in the treatment of many of the departees, because they will be suffering from terminal illnesses. They will therefore be responsible for their treatment, and for advising them on prognosis and on the options available for terminal care, but that doesn’t mean that they should be the ones to pull the metaphorical trigger should their patient opt for early release.

Then there are all the applicants who are either not suffering from any identifiable illness, or who have conditions which are non-terminal. It’s worth noting that the lady identified in the recent reports was complaining of back pain and fainting attacks, both of which are eminently treatable conditions, and which would not have qualified her for assisted suicide under the terms proposed by the supporters of a change in the law. To involve doctors in the killing of these people gives them the status  of state-sanctioned executioners.

Why does any of this matter? It matters because medical practice is based on trust between patient and doctor. Patients who are suffering need to know that their doctor’s one concern is to ease that suffering, something which is nearly always possible, but which occasionally requires doses of drugs that may hasten death. This is an accepted part of medical practice, and is qualitatively of a completely different order to the termination of those who have simply decided that they have had enough, regardless of the presence or absence of treatable disease. Patients need to know that their doctor will not be involved in any abuse of the assisted suicide legislation aimed at achieving their premature departure.

Because, however carefully any new law is drafted, it will be abused. If you don’t believe me, look no further than the 1967 abortion legislation. It was never the intention of David Steele and his colleagues to make abortion available on demand*, but that is what we now effectively have. The same will happen with changes to the law on assisted suicide, and the medical profession should refuse to be involved.

And they don’t need to be involved. If, after they have received any relevant medical treatment and advice, a person wishes to take advantage of relaxed regulations concerning  assisted suicide, their care would pass from the medical into the social sector. After receiving the appropriate counselling (which would hopefully be part of any new legislation) and filling in the necessary forms, they would then qualify for state-assisted suicide. This could be carried out in purpose-built (or converted) premises – I have always thought that ‘thanatorium’ would be a good name for these, although I suppose it might result in a premature end for the patients of short-tongued doctors who really intended to refer them to a convalescent facility.

For those wishing to die at home, there would be flying squads who could bring the necessary drugs and expertise to the departee’s bedside – I wonder how long it would be before someone (probably the Daily Mail) christened them the ‘angels of death’? And one of the consequences of qualification for the service would be that those drugs could be prescribed under an appropriate Patient Group Direction,  the legislation having added employees of the new service to the list of those authorised to administer drugs covered by a PGD. Then all that remains is for someone to hand the tumbler of poison to the departee, assisting them to drink it if necessary.

So there – job done! If society wants  assisted suicide, then society, through its politicians, must devise the necessary legislation and infrastructure. The proponents of a relaxation in the law must not be allowed to get their way and then wash their hands of any responsibility for or involvement in the killing  by offloading it on to the medical profession.

* I use abortion as an example of the ‘mission creep’ which can subvert even the best-intentioned legislation, I’m not expressing an opinion as to the desirability or otherwise of abortion on demand.


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