Abortion and Euthanasia

John Crippen poses difficult ethical dilemmas on NHS Blog Doctor today which have set me thinking about these issues. Essentially they have a morbid connection as both involve doctors taking life. Interestingly I suspect many people would say that in an ideal world there would be no abortion but they would like to be able to choose when to die (and therefore by implication euthanasia). It is a bizarre manifestation of how much is not right with this world that I find myself arguing for exactly the opposite position.

I am absolutely and steadfastly against euthanasia. As a practising oncologist I have only once in my career had a patient ask me for an assisted death. I firmly believe that my whole reason for being a doctor is to ease suffering and to preserve life. If I took the step of deliberately ending another life, I feel that would diminish me. It would change the way I look at my patients - perhaps I would always be looking at them and wondering when was the time.

It is only a short step and a minor psychological derangement from there to Harold Shipman and I want no part of it.

I am moved by the stories of people who rationally and maybe appropriately decide that their life is not worth living, and therefore they call for euthanasia to be allowed in specific and defined circumstances. I sympathise with their individual cases and if they wish to commit suicide I would understand why- indeed although I cannot imagine it, maybe I would take the same way out myself. But I would never ask a doctor to kill me.

Aside from the moral position, with which many will disagree, what about the practicalities. This is what the Joffe Bill says, and like Dr Crippen I advise you to read it:

"Before the assisting physician can assist a patient to die the conditions specified in subsections (2) and (3) must be satisfied...

(2) The first condition is that the attending physician shall have—

(a) been informed by the patient in a written request signed by the patient that the patient wishes to be assisted to die

(b) examined the patient and the patient’s medical records and satisfied himself that the patient does not lack capacity;

(c) determined that the patient has a terminal illness;

(d) concluded that the patient is suffering unbearably as a result of that terminal illness;

(e) informed the patient of—

(i) his medical diagnosis;

(ii) his prognosis;

(iii) the process of being assisted to die; and

(iv) the alternatives to assisted dying, including, but not limited to, palliative care, care in a hospice and the control of pain;

(f) ensured that a specialist in palliative care, who shall be a physician or nurse, has attended the patient to inform the patient of the benefits of the various forms of palliative care,

(g) recommended to the patient that the patient notifies his next of kin of his request for assistance to die,

(h) if the patient persists with his request to be assisted to die, satisfied himself that the request is made voluntarily and that the patient has made an informed decision; and

(i) referred the patient to a consulting physician

(3) The second condition is that the consulting physician shall have—

(a) been informed by the patient that the patient wishes to be assisted to die;

(b) examined the patient and the patient’s medical records and satisfied himself that the patient does not lack capacity;

(c) confirmed the diagnosis and prognosis made by the attending physician;

(d) concluded that the patient is suffering unbearably as a result of the terminal illness;

(e) informed the patient of the alternatives to assisted dying including, but not limited to, palliative care, care in a hospice and the control of pain;

(f) if the patient still persists with his request to be assisted to die, satisfied himself that the request is made voluntarily and that the patient has made an informed decision; and

(g) advised the patient that prior to being assisted to die the patient will be required to complete a declaration which the patient can revoke."

Some of what I believe to be the most contentious passages are in bold, but in the end it comes down to this: what is unbearable suffering? I make the following predictions:

If this bill becomes law then the incidence of assisted dying in an area will be in inverse proportion to the quality of palliative care in that region.

Patients somewhere will be put under pressure to sign these declarations by unscrupulous doctors, nurses or relatives

Doctors and other healthcare professionals will end up in the dock for not fulfilling some of the criteria above.

Many more people will be put at risk by this act than the relatively few with genuinely intolerable symptoms who will benefit.

As with abortion, in 40 years this will become commonplace and doctors will be asking, as with abortion, why they have to go through the legalistic charade of signing all these documents and do so many healthcare professionals really have to be involved?

So, I urge all doctors to refuse to engage with this act. And for all of you who are wondering why you have to go through a legal process and why two doctors are needed to authorise a termination I would say this: for better or for worse you are authorising the ending of a life, all be it one which has not and may not ever have been born. It is right that there should be a legal as well as a medical authorisation for this, and it is right that as a society we should not regard the taking of life as a trivial medical process.

Don't get me wrong: Although my instincts are pro-life, in the current way of the world I absolutely support a woman's right to choose. But in allowing that right we must not forget what we are doing or ever stop asking if it is right that we are doing it.

Every unborn child deserves at least that