I was asked by a medic friend of mine what my views on Physician Assisted Suicide are. This was sparked off by a debate that the Medical School he attends was holding on the subject with speakers coming from a variety of areas within and out with Medicine. It gave me the idea to write about this subject, so, here are my views on the matter. Feel free to challenge me if you do not agree with what I am saying.
The bottom line is that I do not agree with any form of assisted suicide, regardless of whether it is a friend, relative or doctor. Just for your information, I don’t want this to turn into a post or debate about this particular subject, but I am also against abortion.
End of Life care has been changing in the developed world. As our understanding of medicine has grown we have been able to better understand how to use medication and other techniques to ensure that those whose life is knowingly coming to an end through illness and disease are as comfortable, pain free and dignified as possible.
It is my belief that rather than debating euthanasia we should be focusing our efforts on further developing the palliative care system. Systems such as the Liverpool Care Pathway are the way forward when dealing with the terminally ill and we should never be satisfied with the system we have. We should always be striving to improve them and to better understand how to treat people in the last months, weeks and days of their life.
Sadly, not a huge amount of research or funding goes into End of Life Care. I suspect this has something to do with the fact that End of Life Care is usually associated with older people. While a large proportion of the NHS budget (around half) goes on treating elderly patients, the levels of research into and funding for the research is minuscule compared to the funding and research into other health issues. If we continue to keep funding levels where they are then we will never be able to have the advances that may be possible in this area.
Often when discussing or debating this issue I am asked about the withdrawal of medication by medics and it is often put to me that such actions are tantamount to physician assisted suicide. These are points that are fairly easy to refute.
Firstly, medicine’s first priority is often curing. This means that more often than not the medication that patients are on when the decision to withdraw is taken is there to prolong life and o try and cure any illnesses. The withdrawal of the medication is simply allowing nature to take its course. Euthanasia is a deliberate act to bring about a person’s death by administering lethal doses of medicine.
The same applies to the switching off of life support. When such a decision is taken it is often the case that the body had died long ago and the vital organs are simply being kept alive by machines; in other words preventing nature from taking its course.
It’s a really complicated issue and I could keep writing on it for hours, but such a lengthy piece wouldn’t be suited to a blog entry. I feel that what I have written tells you my stance on it and points to why I have adopted that stance on the issues.
Feel free to challenge me on any of the above or to ask me questions should you wish to know more about where I stand on these matters.
prout de jure 
From a medical practitioner’s point of view, yes, I can see that that is a very logical way to look at things. How would you reconcile it with the right of the individual to decide what happens to them? Presumably physician-assisted suicide is only likely to occur when the patient honestly does not want to be alive any more. It’s a huge, important and serious decision. Obviously the greatest of efforts should go into persuading them out of it. But despite all this, if a person is convinced that they would honestly prefer to die, given that ordinary suicide isn’t a crime because what happens to an individual is ultimately a decision of their own, would you see that the lacking the wherewithall to die in a time and manner of their own choosing precludes them from having the choice to do so?
There is a rather large difference between someone deciding to end their life and carrying this decision out and taking this decision and then seeking the help of another person to end your life
In reality there is no great difference at all, only a question of discrimination. Suicide is not illegal, however this is not extended to those who are too disabled or unwell to be able to end their own lives.
So the question is this: Why should a disabled person not be afforded the same opportunity as a physically fit person to take their own life if they so wish? The ECtHR copletely skated over this issue when it heard the case of Pretty v UK by spinning some line about the general tenure of the legislation being to deter people from committing suicide. This is patently nonsense as if this was the case suicide would be illegal.
Although I understand your wish for brevity I feel that this post gives no actual reasons as to why you are opposed to physician assisted suicide (PAS), other than you feel that better end of life care is an alternative (positions which are by no means mutually exclusive).
Secondly, your ‘simple to refute point’ on withdrawl of care and feeding is so contorted that you are in danger of going round and round in circles before you disappear in a puff of smoke.
The difference between PAS and withdrawl is a semantic fudge to allow doctors to end life in a way which assuages the fears of the public, and soothes the conscience of doctors.
This position is explicitly recognised by the law lords in the case of Bland. What is the moral difference between the person who holds a young child’s head under water and the one who see’s a child slip and allows them to drown?
Your argument about letting nature take its course is similarly flawed. Again this is a way for people to protect their consciences from the truth that their actions are ending the life of another. That person is alive until you make the decision to end it.
Again let us consider the moral difference between removing a feeding tube of a totally dependent patient and refusing to feed a small child who is unable to provide for themselves. Where is the difference?
There is much more to say but it is late and I am up early for the BVC tomorrow.
Best
BoB
I’m with bar or bust on this one, Oliver:
I couldn’t agree more. Is the withdrawal of medicine not also a deliberate act (or omission). It’s the deliberateness which is the crucial point here, rather than whether the conduct is classified as being positive or negative.
I was actually trying to cite:
“The difference between PAS and withdrawl is a semantic fudge to allow doctors to end life in a way which assuages the fears of the public, and soothes the conscience of doctors.”
Oh well.
I must say that I disagree. There is a massive difference. With PAS a doctor has to physically give a lethal dose of medicine. While doctors no longer take the Hippocratic Oath it still forms the foundations of ethical medical practice, doctors giving a lethal dose of medicine is something that the Hippocratic Oath tells doctors not to do. Even simply prescribing a lethal dose goes against what the Hippocratic Oath stands for.
Ultimately my views on the subjects of euthanasia (and abortion) are biblically based. This blog entry was purely about my own personal beliefs and convictions rather than about what the law has said, what it does now say and what it may say in the future. I had no intention and still have no intention on getting involved in a complex legal debate over the legalities and such like (certainly not in this particular entry). I am vigorously opposed to the attempt to legalise euthanasia in Scotland. To put it simply, I am against euthanasia because it is my belief, as a Christian, that it goes against what is contained within the Bible.
I disagree with the removal of feeding tubes. When I speak of treatment, I mean medication aimed at cure. Removing feeding tubes is essentially starving the person to death. When referring to “nature taking its course” I mean that we stop attempting to cure a person who is in the final stages of a terminal illness and instead focus on pain management and ensuring the patient is as comfortable as possible. Continuing feeding through tubes in patients who are unable to feed themselves for whatever reason is not treating the illness, but falls under the bracket of keeping the patient as comfortable as possible.
Injection of drugs, removal of medication…tomato, tomato…if it helps you sleep at night then fine, continue holding onto non-existent distinctions. I could go into the fact that palliative care is often only a prolonged form of PSA but you seem to want to close down the debate on this subject.
I respect your views which are obviously deeply held, however theological arguments really only hold water when you live in a theocracy.
Personally I am on the side of respecting autonomy and the value mercy and kindness involved in respecting the wishes of a dying person.
In your opinion they are non-existent, wasn’t aware that your opinion was more superior to mine.
I’m sure you probably could argue that point, but the ability to argue a point doesn’t mean to say it is correct, at the end of the day there isn’t really one correct answer (as with most moral questions)
Well the thing is that I have expressed valid arguments based upon facts and the rulings of judges, as well as being able to deal with reality, where as you are the one who has been putting forwards ‘mere’ opinion. Never mind old chap, ignorance is bliss I suppose.
I can indeed argue that point, as have many others which is why this debate is happening as more people agree with making PSA available. This probably due to the fact that people are forming more logical and mature responses to death and end of life decisions.
This was never meant to be a legal debate. It was never meant to be about what the law has said, does say and ought to say on the matter. It was purly a meant to be a discussion on the moral side of the issue, which is complex enough without adding in court judgements which are limited to a particular jurisdiction of the UK rather than the UK (this being a matter of Criminal Law). It is possible that in Scotland euthanasia will be legal by the next Scottish Parliament election if Margo Mcdonald MSP gets her Bill through, while euthanasia remains illegal in the rest if the UK. It is this that has caused mecto raise the issue on my blog.
My personal opinion is based entirely on biblical principles such as that life is God given and by extension only God has the authority to decide when that life should end. Also the teachings of Jesus about loving our neighbour means that we as a community should be looking after those who are terminally ill and their friends and family through effective end of life care ensuring dignity and as little pain as possible during the final part of our lives.
I am quite capable of forming personal opinions and having seperate legal opinions. There are many things in the law that I do not agree with, nut this does not prevent me from firming a legally based opinion on the same set of circumstances that differs from my personal opinion – that’s part and parcel of going into the legal profession.
This blog isn’t an academic work, primarily it’s a personal blog with my rantings, ravings and personal opinions. Sometimes I’ll post more academic things, but those posts stand out a mile when compared with my normal content as they are littered with authoritative sources backing up my points and opinions.