[The following consists of two submissions to the Falconer Commission -- the UK Commission on Assisted Dying -- kindly submitted by a reader in Scotland. The first is Isobel McLachlan's submission, and the second is a brief submission from her husband Colin, which expresses his agreement with the submission that his wife Isobel made to the Commission. Together they constitute a very eloquent appeal for reason and choice in dying, instead of the present status quo which was established long ago by religious beliefs which many people do not now share -- and even, of those who share them, a majority support a change in the law to permit assisted dying. Isobel's and Colin's submissions are also passionate testimony to the situation in life that so many people face, and from which our present laws, except for very few places on earth, provide no appeal, and to which they offer no alternative. Despite the idiocies of people like Damian Thompson or Allison Pearson, the Archbishop of Canterbury or the Pope, choice in dying is, as Ludwig Minelli (the founder of the Swiss organisation Dignitas) justly says, our last right -- not, mind you, the only right that is in need of recognition, but the last right that each of us can have, since, once granted, will be, when and if claimed, the last right that we will exercise as free persons. I wish to thank Isobel and Colin for letting their words stand here as a testimony to their love, their humanity, their courage and their good sense.]
I am 54 years old and suffering from Stage IV Breast Cancer. Although I have great faith in, and admiration for, the scientists & doctors who work tirelessly and with incredible ingenuity to produce treatments which give people in my situation a good quality of life for as long as possible, the fact remains the condition is incurable. I have, therefore, had to come to terms with my death in the not too distant future. In this I am resigned, as I can do nothing to change the fact. The manner of my death, however, is another matter and, over this, I strongly feel I can and should be able to exert a degree of control.
If we accept we all have the right to live, then, surely, we must automatically also have the right to die. If suicide is legal, then it is illogical for the assisted suicide of a terminally ill person to be illegal! If a much-loved pet is “put to sleep” to avoid suffering, how can a civilised society countenance human beings having no choice but to suffer?
As an atheist, I find it a disgrace that the views of an unelected minority can be imposed on us all, as happened in the House of Lords in the vote on Lord Joffe’s Bill, defeated with the help of the Bishops. Why, in a secular democracy, should the beliefs of one sector of the population be given such disproportionate weight? We must keep making the point, after all, that what we are suggesting will not take away anyone’s right to a natural death, we are simply asking to be allowed a choice. In every survey I have ever seen, the majority of the people in the country want the law changed.
The legislation I want to see is physician-assisted suicide, i.e. Voluntary Euthanasia. The reason is simply that doctors have the expertise to ensure a peaceful end. I have heard too many horror stories of dreadfully distressing attempts by family members trying to help a loved one die. A doctor takes an oath “to do no harm”. This can be interpreted as prolonging life at all cost. Weight must also be given, however, to the principle of providing relief from pain and distress, even if this results in the end coming slightly sooner for a patient. Let’s be honest, even the BMA acknowledge that there are doctors who have helped patients at the end of life, on purely compassionate grounds, and if the act were not illegal, I have no doubt there would be many more. I can understand that some medical professionals would not wish to carry out assisted dying and so there must, of course, be a means of allowing doctors to “opt out” if it gives them a problem of conscience.
I have written an Advance Directive stating my wishes should I be unable to communicate. If the law were to be changed to allow physician-assisted suicide, I would suggest that the Advance Directive could be altered/expanded to incorporate the change and allow a person’s wishes at end of life to be clearly and formally stated. As it stands, however, I can only instruct in the negative, i.e. withdrawal of treatment or, indeed, food & water, but cannot ask for positive help to end my life. This leaves me with the prospect of possibly dying of dehydration or starvation. This is the very antithesis of care. Is this the way a civilised society should be leaving people to end their days? Surely a compassionate act would be to help people slip away peacefully. With a law in place such matters could be discussed openly and, if my medical attendant would not be prepared to fulfil my wishes for religious or ethical reasons, I would be able to arrange to be placed under the care of one who would. Removing the uncertainty for medical professionals and, thereby, allowing frank discussion, can only be an improvement for all parties.
Opponents of a change in legislation tell us that good palliative care, and not euthanasia, is the answer. Firstly, in spite of what they may say, assisted dying and palliative care are in no way mutually exclusive. It is accepted that a point will generally come in the dying process when nothing more can be done. Surely then assisted dying is, in fact, the natural extension of palliative care. Secondly, can a guarantee be given to every dying person that a good level of care will be given? I don’t see how this could be possible. Whether it was provided or not can only be assessed after the event, which is of no use to the person on the receiving end. I, for one, want my final days to be, as far as possible, under my control, or that of my husband (who is of a like mind and supports me completely). Indeed, the assertion that pain can be controlled is a major worry for me. The World Health Organisation has developed a “Ladder of Pain”, which is a 3-step ladder for cancer pain relief. This goes from aspirin & paracetamol, through codeine, to strong opioids, such as morphine. On their website, it states that the regular administration of these will result in 80-90% of cancer patients being pain-free. This leaves 10-20% of us with the prospect of dying in severe, uncontrollable pain. As I have found that non-opioids & mild opioids do nothing to relieve my pain, and strong opioids cause very distressing side-effects, this WHO statistic, rather than reassuring me, leaves me terrified.
The question of “dignity” can also be a point of contention. I once heard a Palliative Care Nurse say that human dignity cannot be lost. As the concept of dignity is entirely subjective, how can she possibly make such a statement? Only the dying person can judge if his/her dignity is lost. As a strongly independent and self-sufficient person, loss of dignity is another of my major fears. Poor care, which I have seen and suffered first-hand in hospital, brings on loss of dignity all the more quickly. I have had more than 30 operations over my life time, for various medical problems as well as cancer. From this wide experience, I can say that it makes no difference what is in the Patients’ Charters, the reality is that hospital staff frequently fall short of the target always to treat patients with respect and ensure their dignity is maintained.
Another argument cited against the proposed change in the law is concern over the weak and vulnerable, where the elderly in particular may feel pressurised into taking this course of action. As well as there being no evidence whatsoever to show that this has happened in any of the parts of the world where assisted suicide is already allowed (indeed, the Oregon experience shows the opposite), any Law brought in here could, and most certainly,should incorporate the most robust safeguards to protect the weak & vulnerable. Anyone at this stage in their illness, however, will be well known to a number of medical professionals, so it seems highly unlikely that outside pressure would not be picked up on.
Procedures such as two doctors being involved, psychiatric assessment, and “cooling off” periods, which have all been suggested, answer what to my mind is the most nonsensical argument against such a law, which is that dying people can become depressed, and might just be having a bad day. Certainly for cancer, there is a well-recognised “dying trajectory”. I will be very aware, as will my palliative care doctor & nurses, when I have reached the final stage and will know that there will be no more “good days”. To deny us the right of choice on the basis we might just be “feeling a bit low” is insulting and patronising!
As far as who should qualify for assisted dying, in my opinion it should go without saying that the first to qualify would be the terminally ill. In fact, to anyone who would want to deny it for people in that situation, I would ask “Where is your humanity? Where is your compassion?” It should also be allowed for people with incurable and/or degenerative conditions. I can also see an argument for allowing it for any competent adult who has shown a voluntary, settled, clear, and informed wish to die. A change in the law to allow such assistance (even if, ultimately, we did not feel the need to make use of it) would be of enormous comfort to those of us approaching the end of our lives, giving reassurance that we will be allowed to die at the point – which only we can decide – when we can take no more.
If a change in the law is not going to come in time for me, I have to consider what other options may be open to me if I find myself in a position where I can no longer bear my suffering. I will not travel to Dignitas, for so many reasons. I find the whole situation that dying people in Britain are put in just incredible! We are supposed to be a civilised society, but we would have them go through the trauma of a long journey to a foreign country in order to receive compassionate assistance.
The only remaining option open to me is to rely on my husband to help me, should the need arise. Although he does not want to lose me,he would find it unbearable to see me suffer and do nothing. Anyone who knows us is well aware of my views and would see his assistance as an act of love and compassion. Under the DPP guidelines it is highly unlikely he would be prosecuted. Nonetheless, surely it is not unreasonable to expect legislation to formalise these guidelines and reflect the needs of the modern society in which we live.
Submission to Commission on Assisted Dying.
I wish to go on record as having read the submission of my wife Isobel McLachlan, with which I fully agree. I love her dearly, and when she dies shall miss her in ways I don’t even want to begin to imagine. Nonetheless, I will not see her suffer pain and indignity in her final days. It is internationally recognised that physical and mental torture is a major crime against humanity. It seems obvious to me that allowing a person to suffer while dying, when the means to alleviate that pain and distress are readily to hand, is tantamount to torture. I will not be a party to this torture, and will do what she wishes when the time comes.