Lord Joffe Bill on assisted suicide

Joffe Bill on assisted suicide, currently in the Lords

Every day, in NHS wards, the merciful doctors use such quantities of morphine to ease the pain of their patients that their respiration is suppressed

But I think it might be better than seeing increasing numbers of British people forced to take their lives in a foreign country

Assisted suicide is problematic, but better than months of agony


I don’t know if you caught the interview with retired doctor Anne Turner, 66, on the eve of her assisted suicide, but in a way it was one of the most horrifying pieces of television I have seen: the long discussions with her grown-up children; the flight to Zurich; the rendezvous at the headquarters of Dignitas. And then the camera just dwelt on that doorbell, and that anonymous Swiss block of flats, and the viewer was left to meditate on the enormity of what we were seeing.

Through that door, into that lift, had walked a sentient human being, and somewhere on the premises, and in complete conformity with Swiss law, her life was taken away. We marvelled at her composure, her determination and her dignity. I thought her children were stunning in their bravery, their reasonableness and the obvious love they had for their mother.

But it was when she was still in England that the BBC man asked the question we were all willing him to put. Dr Turner could walk, talk, have a meal. In her final hours with her family, she was still able to sing songs and to have a laugh. “With respect,” said the BBC man leaning forward, “you don’t look as though you are dying. Why are you doing this?”

And then Dr Turner explained her condition, and the fact of her inevitable and speedy decline, and her bitter experience of seeing her late husband suffer an almost identical degeneration, and her desire to end it while she was still capable of voluntary action; and I expect I am not alone in having risen from the sofa completely wrung out, and in a state of deep confusion.

For me, the frightening bit about assisted suicide is, of course, the possibility that I might change my mind. I see myself sitting in the pizza parlour for that final family meal, surrounded by the beaming faces of my many descendants, their expressions contorted into a finely judged blend of agony and supportiveness.

I see us all holding hands and singing songs and telling old family jokes; and then I become aware of this nagging voice at the back of my head, and the voice cuts through the pain and the despair and says, “I say, hang on a second. Am I really sure about this death option? What about life? Why don’t we give that a go – just for another day, hmmm?” But then I look again round the faces that have spent so long coming to terms with my decision or trying to talk me out of it; and I think: can I really back out now? Won’t they be irritated?

I am about to blurt out that I want to live, when I bite the words back, and reflect that any such decision would be a terrific bother, and probably pointless, in the sense that I would soon just change my mind again, and they would have to go to all the expense of finding the doctors and the solicitors and another dose of hemlock, and re-book their flights, so I might as well get on with it.

But then I look around at their tear-rimmed eyes and, just as I am about to say, actually, you know, on the whole, can we take a rain-check on this suicide business, someone starts making a speech of thanks for my life and many Daily Telegraph articles, and somehow I miss my moment.

I don’t want to be a burden, I decide; and there, surely, is the big risk in expanding assisted suicide, in the way of the Swiss. Not only are we living longer and longer: the sad fact is that a greater proportion of our last years are spent in discomfort and disease, and the cost of the medical interventions we require rises exponentially as we reach the end.

It is certainly possible to imagine that, if assisted suicide were legal in this country, then old, confused and pain-racked people could start protesting that they “didn’t want to be a burden”, and their exhausted and demoralised relatives could indeed begin to persuade themselves that this was the best solution.

That is the reason why many people will oppose the Joffe Bill on assisted suicide, currently in the Lords. I completely understand their reasons; and yet we should also be clear what we are saying to people such as Dr Turner, and the doctors who might be tempted to help them out of their misery.

Sorry, we say: you are physically incapable of taking your own life (an action decriminalised in this country in 1961), and therefore we must sentence you to whatever physical and mental tortures your mortal biology may send you, for the term of your natural life. If necessary, you must go on and on in unbearable pain, and any doctor who helps you to die will be liable to 14 years in prison.

That is what our law prescribes, and of course it is already held in systematic contempt. Anyone who has seen a relative die of cancer will know that doctors routinely advance death by days or even (who knows) weeks.

Every day, in NHS wards, the merciful doctors use such quantities of morphine to ease the pain of their patients that their respiration is suppressed, and quite right, too. No one would dream of depriving people of this final palliation of their suffering; but we should be in no doubt about what is happening. The doctors are taking an action that leads to the patient’s death. To put it bluntly, they are killing them.

What is the difference between that and assisted suicide? Only that assisted suicide takes place earlier, and with the patient’s consent. The closer I study Lord Joffe’s Bill, the more inclined I am to think it reasonable. It is full of restrictions – notably that death must be only a few months away at most; and all sorts of attestations are demanded from doctors and solicitors.

I can see all the disadvantages, and if the law were to be changed, then it would need careful review, to make sure that people were not coming under any pressure whatever to take their lives. But I think it might be better than seeing increasing numbers of British people forced to take their lives in a foreign country.

20 thoughts on “Lord Joffe Bill on assisted suicide”

  1. The Medical profession is based on the premise of maintaining life. However, life has a natural end and at this point it is our duty to make this as comfortable and painless as possible. With appropriate medical involvement it should never be the case that one is condemned to “go on and on in unbearable pain”, and I believe, for the most part, it is not.
    While it is important that people are not put through undue suffering at the end of their lives, which may involve the respiratory effects of pain relief, this is quite different to stepping in and ending them pre-emptively months in advance. Doctors, with some notable exceptions, do not kill their patients; diseases do.
    Far from being held in contempt the current law is widely considered necessary, both for the protection of patients and the integrity of the profession. Although clichéd, one particular aphorism should be held in mind; legislating for exceptions does not make good law.

  2. Anyone should be allowed to choose the manner of their death…but most of us have fate choose it for us.

    It is better that someone makes the choice and dies with dignity than they step in front of a train and traumatise many (i have seen the results of being hit by a highspeed train – and its astonishing how a body can be exploded like that).

    I have made it quite clear to all that know me…in the event of me becoming permanently incapacitated, kill me. My choice. And no one has the right to take that away from me.

    Doctors and nurses who help people die do so at the patients request, and evidently remember the part of the hippocratic oath “first, do no harm!”. Keeping someone alive when they don’t want to be IS doing harm.

    Finally, i recall a Boris rant on the subject of harrassment from the TV licensing bods – and how he didn’t actually have a TV…?

    ;o)

    Psi

  3. Dear Mr Johnson,

    I have to take issue with your conclusions in your column today, Thursday 26th January 2006. I have no doubt that doctors providing palliative care for people, with for example terminal cancer, do in fact speed the patients death in treating their pain and suffering, however the intention is the minimising of suffering and not the taking of life. Even when conducting the simplest operation are patients not asked to sign a waiver the intention is not for the patients to die but their life be improved/saved, but patients do die, operations do go wrong. What is important is that the doctor is trying to save/preserve life. Any act that legalised euthanasia would fundamentally change this underlying philosophy.

    I do not know your views on abortion but whatever they are you cannot disagree that the number of abortions since legalisation has exceeded even those imagined by the original supporters of the act. That the circumstances when an abortion can occur have been relaxed and the safeguards enshrined in the act circumvented almost at will. It has now become another means of birth control something that was never intended by the acts original authors I am sure.

    If mercy killings were legalised how long would it be before people, never intended to be recipients of this treatment, were killed. How long before Granny for example who is now a little Ga Ga and a bit of a nuisance was assisted to do the decent thing. How long before some of the patients who were very confused and maybe a little violent and expensive to keep, were encouraged to take the full syringe?

    What value does society place on our disabled and elderly? We already have a society where there are real concerns for the way people show respect for others. What are we saying to our young people? Surely it is Parliaments role and duty to defend the rights and improve the lot of its constituents not kill them off.

    I suggest that if euthanasia had been legal at the time Harold Shipman was operating, even with safeguards, it is likely that he would never have been convicted, however so long as the emphasis is placed on the preservation of life, real safeguards are already there.

  4. John:

    If the choice is the patient’s, what’s the problem? My grandmother lived to a ripe old age. Unfortunately, she suffered from alzheimer’s. During some of her periods of “lucidity” (the most torturous part of this vile condition – the realisation of how you are the rest of the time) she talked about how she had had a good life, and done things that other people may only dream about. Most importantly, she talked about how she had had enough, and how she wanted it to end.

    It took a further 5 years for her to die, her condition and quality of life spiralling downwards by the day, before her insides all just fell out and she died.

    I cared for a middle-aged man, who suffered from MS, up until his death. By the time I started looking after him he was already a quadraplegic. The amount of drugs he was made to consume on a daily basis was staggering – and appeared to be virtually useless. Formerly an active and intelligent man, his condition was a mental torture. Even speech was a major problem. He, too, frequently communicated his wish to die.

    Having seen these amazing and brave people being deprived of the dignified deaths they required, wanted, implored, i have to take issue with your supposedly “moral” position.

    I fail to see this aversion to death – EVERYTHING dies, it’s so inevitable. We wouldn’t let an animal suffer…but it’s fine for mum to die slowly, in agony, over months or maybe years?

  5. I couldn’t agree more Psimon and Boris. Death to many people is actually a comfort. With our ability to prolong life in a state where no pleasure can be obtained from the state of being, then why not allow assisted suicide.
    Yes is is utterly vital that it is regulated to the nth degree so that it cannot be used to hide a Shipman character, and if patient concent with adequate witnesses are required I cannot easily see how it could be used as an excuse for such butchery.
    People have a right to die with dignity, how they see that is entirely in their own eyes, to some it will be fighting for years against horrific suffering, but for many others, being allowed and indeed helped to die, in some comfort, with their faculties relatively intact would be a far more fitting way to go.

  6. I need to gather my thoughts on this, but feel a need to post. You see, my mother asked me to assist her to die.

    I said no.

    But when my father was in the hospital with his last illness, I communicated his desire for a DNR order (do not resucitate) with a clear conscience. It was, you see, not my right to interfere with his wishes, regardless of my feelings on the subject. It did take him some time to die, but I know it was in accordance with his wishes. Long before the body expired, the man I knew had left.

    I worry that when the medical field is monetized we will be running the numbers before having this kind of discussion, and I find that thought incredibly upsetting; it is, however, inevitable.

    Me? Plug me in, wire me up, I don’t care where you have to stick the tubes, just keep sticking them. As long as you can keep me alive, do it. And thank god I have never been in that situation, because everyone I’m related to says, “Oh, I know you wouldn’t want to suffer. We’ll have them pull the plug.” If you disagree with that, it’s worth having it tattooed on your body, because the orthodoxy of DNRs and assisted suicide is widespread.

  7. The sad thing is that morphine often isn’t readily available in nursing homes. It’s expensive and people do die in tedious agony.

    I can see both sides of the question. John Fitzgerald and Psimon were both very compelling in their argument. One wants to be able to die when in horrible pain or vegetative inertia but to do this without disturbing our (immensely important) taboos about death.

  8. I think there is an important distinction between seriously ill patients whose body is being kept alive by drugs, and those who stand a chance of recovery – or at least significant improvement to their quality of life – by medical treatment.

    There is something deeply unpleasant about stopping nature from taking its course on someone who is in permanent pain or distress through incurable illness. Far from being merciful, keeping such people alive always looks to me like a grotesque experiment designed to prove how science can overcome fate.

    Doctors are accused of playing God by wanting to end a near-spent life, but they are surely doing the same by holding medical jump-leads to a worn-out human battery.

    “Do no harm” must also mean “don’t prolong misery”. When my time comes, please pull the plug.

  9. Morphine is expensive???????

    Wha????

    Wow, things are different over there. In Canada, morphine is cheap and readily available. I can’t imagine a nursing home or hospital without it.

    I do think that if assisted suicide is legalized, it should be done with the consent of the physician in charge (so make sure your physician agrees with you on the issue) but should NOT be done by a physician. It’s appropriate for doctors to be in the business of prolonging life; the business of ending it is another line of endeavor entirely.

    Now, of course, we come to the question of perfectly lucid, perfectly healthy people who wish to be helped to die. What do we do with those?

    For myself, I refused to participate in helping my mother to die, even though I knew she was in terrible pain. There was a chance she could live, quite a decent chance, but she didn’t want to live with the pain and simply couldn’t imagine that they would be able to stop it. Through surgery, they were, but she never recovered; it had broken her. I still feel guilty about the decision I made, but while I feel terrible about what my mother went through, and that I disappointed her, I still believe that I did the right thing. Would I have interfered if she’d gotten someone else to do it? I would have lectured her and stood back; it was her decision.

    In the medical field, it’s sometimes very difficult to say “it’s going to be terminal”. If you authorize assisted suicide and an autopsy proves they could have lived, what then? It seems to me that you must legalize it for all, not just the seriously ill. After all, we’re still finding disorders that are debilitating and painful that were considered “all in their heads” a few years ago.

  10. Raincoaster: I hope that someone respects YOUR wishes if, fate forbid, you find yourself in the same predicament as your mother.

    It must be terrible to make your decision on your own fate, and be over-ruled by another.

  11. Mr Johnson, this morning I listened to my son-in-laws’ mother, Lesley Close, talking on BBC News 24 about her accompanying her brother, John, to Swizterland in order to enable Dignitas to help him take his own life. He suffered from motor neuron disease – a condition for which there is no cure and virutally no ‘palliative care’ and from which death follows a tortuous and degrading decline into pain the like of which most of us cannot imagine.
    Listening to Lesley patiently explaining (again) why she supported her brother and now actively supports Lord Joffe’s Bill on Assisted Suicide, I am left in no doubt that for a range of very specific situations there is a real need to revise the law and to enable sufferers the dignity of a death of their own choosing.
    This is not about euthenasia – which, by definition, is about others deciding when one should die. It is about giving those who are the sufferers of painfull and terminal conditions the right to determine at what point they may ‘bow out’.
    I sense from your article that you feel there are circimstances, such as those suffered by John Close, that fully justify the passing of this Bill and I very much hope that you will support it’s progress into law.

  12. Psimon:

    As I’ve said, I expect that my family will pull the plug, assuming that to be my wish. Even if I’m clear with them that it’s not, I expect they’ll convince themselves “she wouldn’t want to suffer like this”. They mean well, but we disagree on this.

    My mother’s wishes didn’t merely relate to her; she wished me to take an action I could not. I don’t think it was the right choice, but I would not have interfered if she’d asked someone else to do it. We can only control our own actions; in this case, we can only make our wishes known. If we truly reach a point where we are unable to take the action, and we can’t find anyone willing to carry it out, then yes, we’re pretty much stuck. This law would ensure that, even if family members couldn’t bring themselves to do it (how many “Dad died in his sleep last night” stories are only technically true?) there would be a qualified, capable professional available.

    Even I, who don’t support suicide in any form, can support that.

  13. Good to see an intelligent debate on this thorny issue, free from religious cant!

    For what it’s worth, I still vividly remember the last two years of my grandfather’s life. To watch a formerly active man, who had achieved so much in life by his own efforts, sit drooling in an armchair was heartbreaking – more so on the rare occasions when lucidity returned and he cried at the burden he had become to his loved ones.

    It strikes me as a cruel form of torture to allow people to suffer by continuing their lives when we have the means to release them. Especially when the attitude of society is so heavily influenced by the vociferous proponents of religions which few people actually practice.

    I certainly hope that we’ll have moved on enough so that somebody can legally give me the chop if and when the time comes!

  14. Not saying the Bozzer has no life, no. That what be foolish.

    I just noticed that in the article he talks about watching a horrifying bit of TV, on a BBC programme, but has previously stated he has no TV, and hence needs not a TV licence.

    Probably best to assume he saw the prog round at a friends house.

  15. We should all beware being blinded by the sanctimonious pontifications of the religious lobby, who seem to believe that they can command the moral high ground by simply invoking the words ‘sanctity of life’. We are, thank goodness, pre-eminently a liberal democracy now, not a medieval theocracy. Sacrificing individual choice, torturing some of the terminally ill, and inflicting agony and sometimes criminality on loving relatives, is not noble, but ignorant.

  16. One should beware the walking along the precarious tightrope between allowing a suffering person to die with dignity, at a time of their own choosing, and the next step: pushing that person over the edge, merely because their age of perceived usefulness is past.

    Life is precious until it is no longer perceived as such by its ‘owner’.

    Suicide, by its very definition, is an act for one person alone. The taking of another person’s life must always be regarded as the last taboo. This has to do with common law and public order, and should not be thought of in purely religious terms.

    If pain; suffering and quality of existence/ life, are considered, alone by the person concerned, as no longer being bearable, a loving, helping, hand should not be withheld, providing the desired end is overseen by two independent physicians.

  17. How I agree with Boris and Psimon. I myself suffer from MS and I live in constant fear of what I may become. I have seen people with this disease who are stone blind, unable to move a muscle, to eat, drink, talk, even to breathe without help. This is not a state which a slug or bluebottle should have to endure, let alone a human being.

    The Sanctity of Life groups are well-meaning, but totally ignorant and misguided. They speak of humans as being more important than animals. Okay, then why not allow them a peaceful and dignified end if that is what they wish?

    Medical technology is heading ever nearer to a position where it is going to be possible to keep many, if not most, people alive for years by the means of tubes and machines. Do the Sanctity of Life groups really believe this is what God intended? If He did, then this is not a God I want to follow.

    If I knew that, should I reach the point where life had no longer any value whatsoever, a doctor would be able to help me end things peacefully and painlessly, then I would be able to enjoy far more what limited quality of life is left to me now. What right do politicians, the medical profession or religious bigots have to deprive me of this comfort and security?

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