Having Seen The Stark Realities

Ian Birrell writes:

This week sees a five-hour debate in Parliament that could lead to one of the most consequential laws this century when MPs hold a free vote on a Private Members’ bill to allow medically assisted suicide in Britain. The reform has previously been backed by Sir Keir Starmer, enjoys popular support and is often claimed to be progressive. It has been promoted by the admirable Dame Esther Rantzen, suffering terminal cancer, with her usual campaigning zeal. There are strong arguments on both sides of this moral minefield that merit respectful examination.

Yet there should be no delusions over the impact of unleashing state-sanctioned killing in our healthcare system. I would have preferred to write on almost any other issue this week, returning to work after the anguish of my own daughter’s death.

But I have investigated assisted dying in Europe and North America, as well as campaigned on patient safety and for the rights of citizens with learning disabilities, inspired by her. So it felt wrong to duck such a seismic proposed change to society. However the legislation is framed, however limited the intention, this reform would tip Britain over a slippery slope. Already some campaigners argue that the bill’s proposal to allow terminally ill adults with six months or fewer to obtain medical help to end their lives is too limited.

Experts expect challenges under human rights laws from patients whose terminal conditions leave them unable to take their own lives, rightly arguing this is discriminatory. There will be emotive cases of parents pleading that suffering children cannot access similar “treatment”.

We have seen elsewhere how the number of assisted deaths keeps rising after legalisation. And how rules can get widened over time – to include children, couples wishing to die together, old folks with dementia and young people suffering mental illness – despite initial promises to the contrary.

As one prominent ethicist said in the Netherlands, which pioneered reform in 2002, their desire to help patients suffering the most agonising of deaths led them to launch “something that we have now discovered has more consequences than we ever imagined”.

Legalised euthanasia frees a genie from the bottle, while fundamentally altering the nature of doctoring with its oath of first do no harm. It sends a message that killing is an acceptable form of treatment.

Yet we know doctors find it difficult to predict the timing of death with terminal illnesses – and that they, along with judges, are fallible humans who can make mistakes, be swayed by pressure or fail to detect coercion amid daily clinical stresses.

Some will become zealots for the cause – such as a former maternity specialist in Canada that I interviewed earlier this year who has assisted more than 400 deaths since they introduced euthanasia eight years ago. Canada exposes the danger – and political irresponsibility – of inserting such procedures into a struggling health system such as our own with its long waiting times, poor treatment outcomes and inadequate care support. I have spoken to patients pushed by doctors to accept medically assisted death when life-saving treatment was available – and to an analyst who warned British MPs euthanasia is used to cut healthcare costs. Almost two-thirds of their assisted deaths involve cancer – yet they have shorter waiting times and better outcomes for this disease than Britain.

The Health and Social Care Secretary, Wes Streeting, bravely opposes this bill on the grounds that it might harm existing services, while pointing out how the state of end-of-life care means the NHS cannot always deliver “a real choice on assisted dying”.

I have seen the incredible support offered in times of distress and pain by palliative care medics. Yet one in four patients fail to get such help – and as the palliative care doctor Rachel Clarke argues, it is “unconscionable” to offer citizens a choice to die if we fail to offer them also the care that can make life worth living. Studies show places that permit assisted death increase provision of palliative care significantly less than other states.

If Westminster really wants to demonstrate it is progressive, how much better to boost this brilliant branch of medicine pioneered in Britain – along with the shamefully underfunded hospice movement – to ensure decent end-of-life care for everyone. And perhaps our politicians might finally like to fix the overwhelmed social care system instead of continually sweeping it aside?

Then there is the issue of trust – and whether we can really have faith in politicians and regulators to protect sick, elderly or disabled people who might face pressure to end their lives after so many disturbing scandals revealing abuse of the weakest in society.

Bert Keizer, a Dutch practitioner of assisted dying, has said that British experts were right to be sceptical when Holland pioneered reform since their predictions came true. “Those who embark on euthanasia venture down a slippery slope along which you irrevocably slide down to the random killing of defenceless sick people” he wrote in a medical journal.

Bear in mind we live in a nation where several of the worst negligence scandals involved mass killing of elderly patients and the care system has been allowed to rot. A land that still locks up autistic people and citizens with learning disabilities in psychiatric hellholes with the connivance of doctors.

Meanwhile, there are confirmed cases abroad of people euthanised as a consequence of their autism or learning disabilities. And significant evidence – even from places such as Oregon praised for stringent protections – suggesting people choosing to die often feel a burden on families.

As an atheist and a liberal, my concerns over euthanasia are practical rather than ethical. But having seen the stark realities of assisted death abroad and reported on health scandals at home, I have deep fears over the consequences of introducing it here with our inept legislators, creaking public services and societal contempt for groups that might find themselves in the crosshairs.

Fix the NHS, fund palliative medicine properly, sort out social care – and then we can debate this issue with less fear.