YESTERDAY, the Royal College of Physicians (RCP) announced that it would poll its members on their views on assisted suicide and euthanasia.
The poll, which will be done by email next month, is expected to report back in March.
Some will be disappointed that the President of the RCP has been bounced into this poll. I am not. It is right and proper for doctors to discuss and vote on important issues and there can be no more important issue than how we care for disabled people and the terminally ill.
But it’s highly unusual to declare a change in position, from opposition to neutrality, without consulting members, perhaps even unconstitutional.
The current laws on assisted suicide and euthanasia exist to protect the public, especially those who are sick, elderly, depressed or disabled, from feeling obliged to end their lives as we have seen in the handful of places that have gone down this dangerous path.
Of the places which allow doctors to kill their patient, most made the change very recently with the effect that the law has barely been implemented.
But in Holland, Belgium and the US states of Oregon and Washington, legal killing of patients has been going on for some time.
The Dutch law, passed in 1997, allows for euthanasia of mentally competent terminally ill adults. Since its introduction there has been a steady increase in the number of euthanasia deaths, which in 2017 accounted for more than four per cent of all Dutch deaths. Of the 6,585 cases reported in 2017, 169 were for people with dementia; 83 were for those with a psychiatric disorder; and 293 were for people with an accumulation of geriatric pathologies.
In one Dutch clinic, nearly seven per cent of those who successfully obtained permission for ending their life were categorised simply as tired of living, showing how the law has been extended way beyond its original purpose. Research found that nearly half (49.1 per cent) of those who wanted to die were also lonely.
Disturbingly, it has also become acceptable for disabled babies to be given lethal injections under the Groningen Protocol.
Similar legalisation in Belgium, passed in 2002 for adults, has followed a similar path. In 2014 it was extended to include children, while people have been euthanised due to depression, blindness and deafness, gender-identity crisis and anorexia.
Turning to the US, the model often pushed by those calling for a change in the law has been expanded to include a growing list of eligible conditions, while safeguards have been eroded.
In the first full year of the Oregon Death with Dignity Act, 27 people committed suicide using the Act. By 2017, the last year figures are available, 143 were recorded as doing so, representing an increase of 430 per cent. In the first full year of the Washington Death with Dignity Act, 51 people committed suicide using the Act. In 2017, 164 were recorded as doing so representing an increase of 222 per cent.
In 1998 there were five terminal conditions listed as causes of death in Oregon’s Annual Report on those helped to die, but in 2014, nearly one in 11 deaths were recorded as ‘other’. This included those with musculoskeletal and connective tissue diseases, diabetes, gastrointestinal diseases and liver disease, which are not generally considered terminal diseases. In 2017, deaths recorded as ‘other’, including arthritis, arteritis, sclerosis, stenosis, kidney failure and musculoskeletal systems disorders. Endocrine/metabolic diseases (e.g. diabetes) and gastrointestinal disease (e.g. liver disease) now have their own categories.
In Washington in 2017, three per cent of deaths were categorised as ‘other illnesses’ which were also described as ‘unknown illnesses’, making it impossible to establish whether or not the patient had a terminal condition.
Even more troubling are the reasons why people are choosing to kill themselves. In Washington figures from 2017 reveal 56 per cent of them said that they feared being a burden on family, friends/caregivers. Figures from Oregon were almost identical at 55.2 per cent.
Some people might be comfortable with, or even supportive of the right of those who feel they have become a burden to help to end their lives. But doctors and nurses who care for disabled people and terminally ill can never be amongst them. The elephant in the room is this – caring for people at the end of life is both expensive and hard and it is natural that they too may feel an element of burden.
I am hoping that members of the RCP will see these dangers and reach a similar conclusion. If they do not then how can the profession continue to see itself as caring?