- Stone of Morphie
[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.
Colin McLachlan
Thank you for posting this letter Eric.
It is so articulate & helpful in outlining the issues that our patients face. I don’t think this debate has advanced far enough in Canada.
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.
I think this is an important point but this sort of talk is not openly welcomed in palliative care circles here in Canada. Palliative care has distanced itself from this debate as assisted dying is seen as a threat or the diametric opposite to good palliative care. i.e. an easy exit may erode the will & resources to provide the more difficult to provide palliation of symptoms & pain. There may be some validity to this concern but the above quote addresses this concern so well and should prompt some meaningful debate.
As a physician involved in Palliative care, I am occasionally requested by patients to assist them in ‘ending it all’. Under Canadian law, I am not permitted to do this for them; however, there are many shades of gray in all this. We do at times provide what might, to an outsider, look indistinguishable from assisted dying.
For example: If the pain due to metastatic cancer becomes unmanageable by regional analgesic techniques and if the amount of systemic analgesia needed to keep the patient ‘comfortable’ starts to escalate to the point that they become very sedated. If their pain are still not well controlled, they may then require the addition of very heavy sedation to deal with their restlessness or air hunger. We effectively render these patients unable to eat or drink. The dying process can takes days to even a week or more with the family in attendance waiting for the inevitable & anxious to not miss the moment. In many cases, this leaves everyone anxious, exhausted and worn out at the end. It has always struck me as a little false & hypocritical to consider this a ‘Natural’ death when we are significantly influencing the process and possibly even prolonging the agony. Arguably, the only difference between what the Swiss clinic provides and what we provide is a shorter time scale and a more informed recipient. I am told that the difference is in the intent: i.e. there is a great deal of difference in that the goal is comfort & not hastening death. I’m not convinced.
To take active steps towards a more forthright and deliberate end is not a welcome topic for discussion – yet.
I see this as something that has to change.
-evan
Of course, irrespective of how eloquent this lady writes, the responses will remain the same: yeah, but . . . god . . . immoral to kill . . . . I don’t want it happen to me (so don’t opt for it) . . . someone, somewhere is doing something I don’t like so it should be illegal. It’s all vacuous, intellectually, ethically, emotionally.
Of course, in general this is true. However, in this case the submission was made to the Commission on Assisted Dying formed by Lord Falconer, who happens to be in favour of assisted dying. So, hopefully, since conditions in Britain are different than in Canada, where, although very few people have been convicted of an offence in a compassionate assisted suicide case, and the DPP in England has provided guidelines for prosecutors, submissions like Isobel’s will make a difference. It’s not going to change the churches, but the percentage of people in Britain in favour of assisted dying is considerably higher than in Canada, and greatly higher than the US, so perhaps their voices will be heard over the insistent voices of the religious however amplified by their privileged position in society.
Thank you for this. It is good to know that there are voices of reason in the palliative and hospice care community. I spoke to the annual meeting of the Canadian Hospice and Palliative Care Association in November 2007, in Toronto, and I was encouraged then by the response, but it does not seem to have been taken any further, and so I have been disappointed.
It is good to hear that some relief can be brought to the dying by the use of heavy sedation, and I agree with you when you say:
I was in a TV “debate” about assisted dying and Margaret Somerville, Canada’s radio and TV moralist, argued that palliative sedation was not assisted dying. I told her then that I thought her dreadfully wrong. In fact, she’s obviously wrong, and only her attachment to the Roman Catholic so-called “pro-life” position — which I call the Catholic Death Cult — prevents her from seeing this.
As Michael de Ridder says in his book Wie wollen wir sterben?, scarcely anyone dies naturally in our highly medicalised society. In fact, treatments are prolonged so long that a difficult death is very often unavoidable. Why the religious hang onto the myth of natural death is beyond me. After all, if we really held to the idea of natural death, very few of us would survive childhood, since merely prolonging life by technical means (medicine, surgery, emergency treatments, etc.) guarantees that death is not natural, but comes only at the end of a period of treatment and “unnatural” intervention. It is silly to speak of natural at all in the context of highly developed societies, a sad romantic regression that conceals what is really happening. The religious hang onto the idea in a manner that is strictly, from a Christian standpoint, idolatrous. In my view it is a hangover from times when the church was truly in charge, and kept a firm grip on society and its laws. Time to unclasp the dead hand of the past from our lives — which includes our dying.
I know that the US is not good when it comes to assisted dying, but the US is a big place with different attitudes and values in different regions. As an Oregonian, I ask you to remember that we really took the first step in the US, and now some other states are following. We have a bit more state autonomy in the US than the provinces in Canada do, but when Oregonians voted on the law for the second time, the Federal Gov’t tried to step in (John Ashcroft), but the Supreme Court found his arguments legally mistaken.
So, even though the rejection of assisted dying is higher in the US than other countries, we have our pockets of reason here and there.
Sorry Charles, I should have been more thorough. Yes, I do realise that there are pockets of reason in the US, and very thankful for them I am. But, overall, the US seems much more determined not to see assisted dying become the norm than even conservative Canada — although that doesn’t include the Canadian government which has decided to retreat to the first century. I think we still have a chance, even with Stephen Harper in charge of appointments to the Supreme Court, of see a change in the law take place in the next few months. I hope so, because that, at least, would respect majority opinion in this country. However, it will never get through this parliament, and even when the conservatives were in a minority, it didn’t stand a chance, because, like it or not, the churches have a stranglehold on this kind of decision. We need some way to bring and end to their supremacy in calling the shots about cultural change.