Assisted dying means a doctor’s best guess becomes a patient’s last day

15 November 2024, 14:38

The issue with the benign term 'Assisted Dying', is that it's a euphemism for a far grislier reality.

The term 'euthanasia' - literally "good death" - was adopted in the 1870s to refer to the intentional medical homicide of suffering patients through chloroform or other anaesthetics.

Since then, a long list of misleading labels have been applied by campaigners, from 'Easeful Death' to 'Medical Aid in Dying', all of which serve to obfuscate the unsettling reality of the issue - that administrating a lethal cocktail of drugs is fraught with long-lasting implications and the potential of trauma for all involved.

Instead, reassuring words like 'safety', 'choice' and 'protection' abound in MP Kim Leadbetter’s Private Member’s Bill, published on 11th November 2024, which is entitled 'Choice at the End of Life’, undoubtedly picking up on the phraseology of Dignity in Dying, the leading campaign organisation, who use the innocuous description “dying people deserve the choice to control the timing and manner of their death”, airbrushing out the messiness and emotional complexity involved in actually carrying out such an act, let alone the real possibility of vulnerable people facing coercion to die, should the Bill became law in the UK.

Sarah Wootton, Chief Executive of Dignity in Dying, assures us that “Safety is woven into the fabric of proposals for law change, introducing practical measures to assess eligibility, ensure rigorous medical oversight, and robustly monitor every part of the process.”

Kim Leadbeater claimed that the proposed legislation will give us the right to “see out our days surrounded by those we love and care for, knowing that when we are gone they can remember us as would like to be remembered,” phrases which sound uncannily like an undertaker's marketing pitch.

Philosopher Kathleen Stock writes: “At times, it can sound as if one is being offered a particularly relaxing spa treatment. With a pleasing ring of supportiveness, you are now being “assisted” in achieving something, rather than being killed by a doctor or killing yourself.”

The proposed Bill requires that doctors certify that the patient has less than 6 months to live in order to qualify for 'assisted dying'. But as a consultant with over 20 years of experience working for the NHS, the business of predicting how many years or months a person has left to live is notoriously unreliable - myself and my colleagues were frequently inaccurate with such predictions.

A person who is diagnosed with a ‘terminal illness’ can live on for years or die within days. With diagnostic errors, new treatments, spontaneous remission and random events, it is simply impossible to predict death with any certainty.

Why then, is this Bill assuming that busy doctors across the NHS, with a disparity of technical expertise, will be accurate in their prognoses every time?

And once lethal medication is prescribed, no one will ever know if a patient killed themselves unnecessarily, in the mistaken belief that they had only weeks left, when in fact they had years they could have spent with children, family, friends and spouses.

To allow this Bill to pass is to make extreme, broad-brush assumptions about life, death and terminal illness and to assume that vague prognostic timeframes are gospel truth rather than mere estimations.

The Bill requires doctors to prescribe and supply highly lethal and toxic drugs for the patient’s use alone. Yet, this is a situation that could so easily be weaponised by abusers, particularly in a society where we are still learning about and acknowledging the effects of coercive control.

Do we want a new supply of lethal drugs to be circulating in our community and accumulating in homes, potentially to be weaponised by anyone? The UK is already struggling with an increase in deadly and addictive street drugs, including Nitazenes, which can be up to 500 times more dangerous than heroin, according to The Lancet. The idea that lethal medical substances could added to this mix is a crisis we simply cannot afford.

Sir Keir Starmer and his colleagues have informed us that the NHS is broken, overstretched and failing. So why are we then adding the enormous and fraught responsibility of delivering death on request (as well the judging that those who wish to die 'have a clear and settled intention to end their own life which has been reached voluntarily, on an informed basis and without undue influence, coercion and duress'), to the NHS doctors, pharmacists and administrators who are struggling under a system so burdened people question its survival in its current form?

How can we possibly expect that doctors will have the bandwidth, time and energy to effectively fulfil the impossible task of ascertaining if someone is free from coercion when they make the decision to die?

Not to mention that 'undue influence' is a vague phrase in a fraught emotional context in which there may be subtle pressure and manipulation from loved ones and relatives.

Across the UK, the numbers of old and frail people are increasing, alongside the breakdown of traditional family support and community structures. Loneliness and isolation are worse than ever, especially for the most vulnerable in our society. Introducing the option of state-sponsored life termination into this challenging mix is nothing short of irresponsible.

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John Wyatt is an emeritus Professor of Neonatal Paediatrics and Medical Ethics. His book “Right to Die? – euthanasia, assisted suicide, and end of life care” is published by IVP.

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