The choices confronting the terminally ill, and those caring for them, are the cause of fierce public debate. In the below piece written for OUPblog, Baroness Mary Warnock and Elisabeth Macdonald, authors of Easeful Death: Is There A Case For Assisted Dying?, respond to a recent UK YouGov Poll which indicated that the majority of Britons believe that there is indeed a case for assisted dying and euthanasia. If you’re in the vicinity and would like to hear the authors talk more about this subject, they are appearing today (Thursday 3 April) at the Oxford Literary Festival at 2.30pm.
A recent YouGov poll carried out in Britain has looked at public views on the role of assisted dying for the terminally ill or the chronically ill, as well as for those people surviving in a persistent vegetative state. The results were emphatically in favour of consideration being given to a legislative change in laws governing voluntary euthanasia.
76% of all adults in the survey either agreed or strongly agreed with the statement ‘Terminally ill people should be legally allowed help to die from medical professionals if they request it.’ Currently it is illegal in the UK for medical professionals to assist either terminally ill patients, or those with chronic incurable diseases, to die. However, medical professionals do have the legal right to help those in a permanent vegetative stage to die if their next of kin consents to it.
In discussing the concept of termination of life doctors frequently protest that such an idea is against all their training and instinct. On closer examination however is this really true? Doctors are trained to care for their patients and support them both physically and emotionally to the best of their ability. Doctors already make life and death decisions in difficult cases. In moral terms doctors could find the distinction between these cases and euthanasia, both based as they are on judgements as to suffering and value of life, more difficult to draw than first appears.
The development of palliative care as a speciality has facilitated the refinement of pain-management in both choice and delivery of effective medication. It is now very possible in most cases for pain, even when severe, to be well-controlled via the sustained administration of analgesia. Yet despite advances in palliative medicine there remain a small proportion of patients in the last days and hours of their lives whose symptoms persist uncontrolled or unendurable despite the best efforts of experts in symptom-control. These are the cases that trouble us most.
In our view, the concept of futility or pointless treatment needs to be carefully re-evaluated, especially in the modern hospital setting. That treatments can be given does not necessarily entail that they should be given. Where the likelihood of benefit is really infinitesimally small and the side effects and potential dangers of treatment (such as fourth line chemotherapy in advanced cancers) then a frank discussion should be held with the patient. It is very likely that the patient would choose to die relatively comfortably, (and often somewhat later) of their disease rather than dying of the unpleasant side effects and complications of futile treatment. Such decisions however, depend on the courage of both doctor and patient to face the true alternatives.
Often doctors make the judgment that they will not even offer this last resort of treatment and will save the patient the anguish of this decision. Others will question this paternalistic approach stressing the autonomy of the patient and their right to decide these matters for themselves. But we have argued that paternalism is not always bad. It may be the dying patient’s chief source of comfort, when he is too ill and tired to face making his own decisions
Young doctors recently trained and those currently under training have learned to place patient autonomy at the heart of medical practice. This generation of medical practitioners will probably find Advance Decisions and even a request for assisted suicide much more acceptable as part of professional practice. Medical training in itself is therefore, in our view, not a fundamental reason for the refusal of the medical profession to embrace assisted dying or euthanasia in appropriate circumstances if legislation can be effectively drafted and compassionately embraced.
In addition there is every good reason why geriatric medicine and palliative care training should form an important part of the medical curriculum. We are witnessing the expansion of an ageing population with attendant long-term problems of disability and chronic illness. Expertise in managing the last years and months of long life will be invaluable to most doctors and just as palliative care increases in its practice and importance, so also could the development of skills and decision-making guidelines for assisted dying and euthanasia if this is what society demands.
Baroness Mary Warnock is one of the UK’s most respected moral philosophers, with a long record for forming opinion and guiding legislation on moral issues; now an Independent Life Peer in the House of Lords, she is a Member of the House of Lords Select Committee on Euthanasia.
Elisabeth Macdonald provides a lifetime’s experience in clinical medicine. For many years a consultant Cancer Specialist at Guy’s and St. Thomas’ Teaching Hospitals in London, she has also worked in palliative care, and taught medical ethics.