Euthanasia and assisted suicide: the background

History

The early church doesn’t seem to have given the matter a great deal of thought, until martyrdom became common. Then voluntarily giving up one’s life became praiseworthy; Ignatius of Antioch wrote on his way to death in Rome, “I write to all the churches, and I bid all men know, that of my own free will I die for God… Let me be given to the wild beasts, for through them I can attain unto God.” Relinquishing life started to be seen as a proof of spirituality. Some martyrs (especially women) killed themselves to prevent dishonour, and were venerated for it.

Then St Augustine wrote strongly against ending one’s own life voluntarily, basing his argument on the Ten Commandments: “Nay, the law, rightly interpreted, even prohibits suicide, where it says, You shall not kill…. We understand that commandment simply of man. The commandment is, You shall not kill man; therefore neither another nor yourself, for he who kills himself still kills nothing else than man.” Augustine’s view became the standard for Christians down through the centuries.

When mercy-killing went on, it was regarded as uncivilised behaviour. This description comes from around 1550 in England:

“There is also another merciful treatment that they are accustomed to use on sick people, as follows; when anyone is given up by doctors and there is no remedy for his illness, the nearest relatives take a pillow, put it on the patient’s throat and sit on it, thus causing him to be suffocated this is done by the father to the son as well as by the sons of the father, and, as they have full faith in the doctor’s judgement, that the patient cannot be saved from suffering in any other way they think to please God by freeing him from pain, this kind of merciful action is not to be found among all sorts of people, but only among those of low standing in certain parts of the country remote from the sea, where some barbarous customs still persist owing to their being little contact with the outside world.”

With the rise of modern medicine, however, doctors had increasing power to make decisions that would “manage” the deaths of their patients. We know now that Lord Dawson administered drugs in 1936 to hasten the death of King George V.

Lord Dawson's notes assert that he had been told by Queen Mary and the Prince of Wales - the playboy son who was to become Edward VIII and, less than a year later, would abdicate and become the Duke of Windsor - that they did not want the King's life needlessly prolonged if his illness was clearly fatal. There is no indication that the King himself had been consulted.

Ten months later, in a House of Lords debate, Dawson described euthanasia as a “mission of mercy” best left to the conscience of the doctor. ''One should make the act of dying more gentle and more peaceful even if it does involve curtailment of the length of life,'' he told his fellow peers. ''That has become increasingly the custom. This may be taken as something accepted.'' (New York Times)

In the last few decades, there has been a rising demand for assisted suicide. Dr Jack Kevorkian, “Dr Death” who claimed to have helped 130 patients die, and Dignitas, the Swiss organization providing assisted suicide, have become famous. There has been a constant stream of seriously ill people demanding the right to die, a development probably hastened by the demise of religious belief in the Western world, and the growth of attitudes which say: it's my life, nobody else's, and afterwards I believe there's oblivion, no judgment by a God to whom I’m accountable.

Recent developments:

- France has passed legislation in 2015 allowing doctors to place terminally ill patients in a “deep sleep” until they die

- Child euthanasia without any age limit became legal in Belgium in 2014. In The Netherlands, it’s technically illegal for anyone under 12; but in practice, if doctors follow the “Groningen protocol”, they will not be charged, and infant euthanasia is happening

- In Oregon, there has been a marked upturn in the number of deaths from 2013 onwards - an 80% increase in deaths over 2014 and 2015. Those seeking death are "doctor shopping", moving around to find doctors willing to give them death-bringing drugs; one doctor issued 27 lethal prescriptions in 2015.

- Also in Oregon, some people who were supplied with drugs because they only had 6 months to live, then went on to live for another three years before taking them

- In the Netherlands, euthanasia accounted for 1 in 26 deaths in 2015 (the same percentage would amount to 20,000 deaths in the UK). There is evidence of “legislative drift”: increasing numbers of people are being granted euthanasia for conditions such as psychiatric illness or dementia.

2. What does public opinion say?

Both sides of the debate claim that polls support their position. For example…

Sarah Wooton, chief executive of Dignity in Dying, says 79% of disabled people support a change in the law. The figure she quotes is from a poll commissioned by her organisation in which YouGov surveyed 1,036 disabled people. It's potentially confusing because a survey from the disability charity Scope reports a quite different story: "70% of disabled people are concerned about pressure being placed on other disabled people to end their lives prematurely, if there were a change in the law." (BBC)

Some of the most significant polls recently are:

YouGov poll May 2016 of 1764 adults:

Just 7% of British public agree with the BMA’s opposition to assisted dying
84% of people believe its position should change
a third of people (32%) think that the BMA’s opposition to assisted dying will damage the relationship terminally ill people have with their doctors.

Populus poll April 2015 of 5000 adults

82 per cent of the public support a change in the law.
There is support for assisted dying from 80 per cent of Christians, 83 per cent of Jews and 91 per cent of Hindus. (Support was lower among Muslims, 38 per cent, while 50 per cent of Sikhs were in favour.)

A poll of 1000 GPs in England and Wales commissioned by Dignity in Dying and conducted by medeConnect in May 2015

Doctors are split on this issue. 34% of GPs are supportive of a change in the law on assisted dying and 20% are neutral
56% of GPs think that representative bodies such as the BMA should adopt a neutral position on assisted dying.

Ipsos MORI poll June 2015 of 2000-2200 adults in each of 15 countries

In 13 of the 15 countries surveyed, more than half of online adults say that doctor-assisted dying should be legal. The exceptions were:

• Poland, where 48% say it should be legal and 29% say it should not

• Russia, where 47% say it should be legal and 32% say it should not

Belgium (86%) has the highest proportion of participants saying that doctor-assisted dying should be legal, followed by France (84%) and the Netherlands (81%).
In Great Britain 70% of participants say that it should be legal, whilst 13% who say it should not be legal.

3. What's happened where legislation has taken place?

In Oregon, one in six people talk to family and friends about assisted dying, but just one in 50 go on to speak to their doctor and begin to be screened for suitability. One in 500 actually end their life.

In the Netherlands and Belgium, which in 2002 legalised voluntary euthanasia for the terminally ill and in cases of hopeless and unbearable suffering that cannot be alleviated, things were different. In 2013 in the Netherlands, euthanasia accounted for 2.9% of deaths.

A 2005 report by the Department of Human Services in Oregon analysed the end-of-life concerns of all who had actually obtained a medically assisted death between 1998 and 2004. The major concerns were losing autonomy (87%), being less able to engage in enjoyable activities (84%), losing dignity (80%) and losing control of bodily functions (59%). Astonishingly, relief from pain or concern about pain were cited by only 22% as a reason.

Who dies at Dignitas? A survey of cases between 2008 and 2012 yielded these results: total non-Swiss cases 611; 268 Germany, 126 UK, then France with 66, Italy 44, USA 21, Austria 14, Canada 12, all other countries 8 or less. Ages ranged from 23 to 97. Women were predominant. Most common reason for wishing death: neurological disease (e.g. paralysis, Parkinson's, Motor Neurone Disease, multiple sclerosis). This accounted for nearly half of all cases - followed by cancer and rheumatic diseases. 1 in 3 had multiple conditions.

Currently one Briton a fortnight travels to Dignitas in Switzerland, while a further 300 terminally ill people are ending their own lives behind closed doors at home.

4. What has been the attitude of Christians?

Generally Christians have opposed euthanasia and assisted suicide. But recently there have been high-profile changes of mind. Archbishop George Carey and Desmond Tutu have made their support known for assisted dying. However, all major Christian denominations take a negative stance, although some have started to reconsider their position.

Other well-known people who have changed their mind include Brian Rix of MENCAP, which has opposed euthanasia for years; and Stephen Hawking, who once maintained that “it would be a great mistake” but now says, “To keep someone alive against their wishes is the ultimate indignity.”

5. What is euthanasia anyway?

Four things need to be distinguished:

Voluntary euthanasia (where a doctor is involved in actively terminating someone’s life)
Physician-assisted suicide (where a doctor supplies the drugs but a patient initiates death)
Assisted suicide (where someone else, a non-medical person, helps)
Assisted dying (where mentally competent, terminally ill people take prescribed medication to end their lives)

Dignity in Dying support option (d) at the moment.

6. What’s happened in Britain recently?

Key years have been:

2006. This is when the Voluntary Euthanasia Society changed its name to “Dignity in Dying” and Lord Joffe put forward a bill in the House of Lords proposing physician-assisted suicide - although Lord Carlile claimed in debate, “Everybody in your Lordships' house knows that those who are moving this bill have the clear intention of it leading to voluntary euthanasia. That has always been the aim and it remains the aim now." The bill was blocked in the Lords by 48 votes. The Christian Medical Fellowship and several other bodies (mostly Christian or concerned with disabled rights) formed a network and lobby group called Care Not Killing.

2009. The End of Life Assistance Bill was put forward by Independent MSP Margo Macdonald (who had Parkinson’s Disease); it was defeated in the Scottish Parliament by 85 votes to 16. Debbie Purdy argued in court that the law was not clear about whether her husband would be prosecuted for aiding her suicide; as a result the Director of Public Prosecutions issued guidelines to clarify when no legal action would be taken.

2013. Another End of Life Assistance Bill failed in Scotland, but this time support for it had doubled.

2014. Lord Falconer’s Assisted Dying Bill was held up by amendments and ran out of time before the end of parliament. After the election, Falconer suggested his proposals would have more of a chance if they were taken up by an MP in the Commons.

2015. MP Rob Marris came first in the Private Members' Bill ballot) and revived Falconer’s bill as the Assisted Dying Bill 2015. It lost: 118 for, 330 against.