Many of us will, at some stage during our lives, face difficult decisions about death - our own, or someone close to us. If, like most people, we die in hospital, the best we can currently expect is that we die without pain. If suffering from a terminal illness we can hope that a doctor will respect our wish that he/she should withhold any treatment that would prolong life. We may even end up in the care of a doctor who is content to blur the lines between treating the pain and hastening the end. Very few of us will be able to exercise any further choice in the matter. Except in rare, and mostly unrecorded, cases, gone are the days when a family GP might "help out".

To the bishops of the Church of England - who still, perversely, retain a role in making our laws - this is as it should be. Led by the Archbishop of Canterbury, they are massing to extinguish a reasonable and long-overdue attempt by parliament to make humane sense of our last taboo. Lord Joffe's assisted dying bill - to be debated in the upper house today - is a modest and rational attempt to make sense of an area currently clouded by ignorance, fear, hypocrisy and uncertainty. The bishops want to keep it this way. They should be listened to with respect - and then ignored.

For some reason the British do not keep statistics about deaths involving so-called end-of-life decisions. If we are in line with other countries which do their homework it is likely that at least 20% of deaths involve "double effect" deaths - where the alleviation of pain may also involve the shortening of life. To some extent, many doctors are thus already participating in the humane hastening of death.

Lord Joffe would like to go further and enable an open and transparent conversation between the terminally or incurably ill, their relatives and carers and the doctors - the sort of conversation that is presently impossible. All alternatives - including hospices and palliative care - should be considered. The patient - a competent adult - must make a written, legally witnessed, declaration. There must be a cooling-off period and there is an opt-out clause for any doctor who feels unhappy or unwilling.

There is no doubt that such a measure has overwhelming public support. All surveys about doctor-assisted suicide show more than 80% of people in favour. Doctors themselves have - through a recent BMA vote - moved from a position of opposition to one of neutrality. A recent survey of 1,000 doctors found much more support for suitable legislation permitting assisted suicides than for the current position - where doctors face up to 14 years in prison for assisting a suicide. There have been many attempts since 1935 to reform the law on assisted suicides - but there has never before been such agreement between health professionals, lawyers and the general public as to how the law should be changed.

In the absence of reliable UK data it is worth looking at the evidence from such places as Oregon, where such a measure has now worked well for seven years. Attempts by President George Bush and the US attorney general John Ashcroft to frustrate the Oregon law do not meet with local support, any more than the bishops represent public opinion in this country. It is now time to move British laws onto a more open, sensible and humane footing.

http://oregon.gov/DHS/ph/pas/ar-index.shtml