Leader 

Moving to a more open system

Leader: Slowly but surely Britain is moving to a more rational position on a patient's right to die.
  
  


Slowly but surely Britain is moving to a more rational position on a patient's right to die. Currently the law remains locked into an illogical contradiction under which death can be accelerated by doctors withholding a drug, but the pursuit of the same end by administering a drug remains illegal. The law, which rests on intent, should recognise this inherent contradiction. Withholding treatment is just as much a death-dealing procedure as active intervention. The courts, which have given doctors the go-ahead to accelerate death in a succession of rulings on individual patients undergoing insufferable pain, have rightly refused to make more sweeping judgments on the grounds that this is an issue for parliament. But until recently parliamentarians were reluctant to act. It was left to doctors, who grapple daily with this ethical dilemma, to bring relief to these patients. But the first authoritative study of medical decisions, which we reported yesterday, suggests there are far fewer actively helping the terminally ill to die than earlier believed.

A decade ago a survey of 300 doctors published in the British Medical Journal found almost half had been asked by patients to take active steps to end their lives. Of this half, almost one-third had complied. But the survey was too wide-ranging and probably included the withholding of treatment. Yesterday's study was much more specific. Extrapolating from a survey of 870 doctors, the study suggests that there were fewer than 3,000 deaths last year (0.5% of the total) where there was active intervention by doctors to accelerate the death of the terminally ill, compared to 177,192 (nearly a third of the terminally ill) where treatment was withdrawn to achieve the same end. Even so, as the Voluntary Euthanasia Society noted, the research confirmed that some doctors were in fact breaking the law, admittedly for compassionate reasons, and deliberately helping their patients to die. As these columns have long argued, a more overt system would be more honest, more accountable and assuredly less likely to be abused simply because it could be properly monitored.

Parliament now has an opportunity to act. A new bill, the assisted dying for the terminally ill, introduced into the Lords by Lord Joffe, is due to receive its second reading shortly. This is the third - and much revised - version of earlier bills by the peer. It includes extensive changes as a result of a 150-page report by a select committee of the Lords last year. It is now restricted to "indirect assisted dying" - meaning the doctor's role is limited to writing out a prescription or providing an oral barbiturate to allow a patient a peaceful death. The new approach reflected the procedure in Oregon, that has been in operation since 1997, and only this week was upheld by the US supreme court. The Lords select committee, which supports the Oregon approach, held 10 evidence hearings in the US state where it learned the system was free from abuse and working well. The bill will be restricted to patients who are terminally ill with six months or less to live, suffering from unbearable pain, are mentally competent, and have made persistent and well-informed requests to die. It includes 20 safeguards to protect vulnerable people including an assessment by two independent doctors as well as consultation with a palliative care expert to explore alternatives.

But, alas, the alliance of nine major faiths that was against the last bill, is likely to remain opposed even with the extra concessions. These religious opponents have every right to believe in their strict interpretation of the sanctity of life, but no right to impose their belief on others. There is no doubting what society wants. Over 80% in a succession of polls have supported the principles of the bill. It is time parliament ended a medical practice which requires too many terminally-ill patients to inch towards death through a torture chamber.

 

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