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Assisted dying, trust in doctors, and palliative care

by
18 July 2014

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From Dr Sioned Evans

Sir, - I am writing as someone on the front line of specialist palliative care. I also happen to be a Christian and a clergy wife, regardless of which I would be taking this stance.

Much has been written about the moral and legal impacts of the proposed assisted-dying Bill for the terminally ill. I concur with all concerns regarding the risks to the vulnerable and the resulting shift in the moral compass of our society that a change in the law would inevitably bring.

Yes, there is room for improvement in how we care for the dying; and, yes, we need more education and financial support to improve this; but, no, we do not need medical staff to be trained to end lives, as proposed by a retired senior doctor in public health.

I have been humbled during my 21 years as a doctor by the trust that is placed in our profession. It seems we are among a diminishing number of professions who still have this trust bestowed upon us. I want to raise the concern I have regarding the impact this will have on that trust. Part of my work is to have sensitive conversations with patients and relatives about end-of-life care.

Under the current protection of the law, these patients and families and I know that a choice to accelerate death is not on the table. What if it were? How would that affect the dynamic? Would more patients feel that this is what they should do? Would they see me as "doctor death" and have an inherent mistrust of my motives? How can it be right that one of the options I have in my "medical bag" is a prescription to kill?

It has been said that the decision is a matter for Parliament, not for doctors. It is not, however, the MPs who will have the responsibility for prescribing the lethal cocktail, or, in the case of euthanasia, administering it? I cannot and will not kill someone. My motive for becoming a doctor was to cure, and, if cure was not possible, to provide comfort and relief. Would you trust your doctor in the same way, knowing that he or she had a licence to kill?

As doctors, could we truly reassure ourselves that the lethal dose we have just prescribed was justified because it ended someone's suffering? In the darkest hour of the night or deep in our conscience, could we really deny the truth that we had intentionally killed someone? This is a huge burden to put on the medical profession.

It seems incongruous, and a true irony, that the country that pioneered the modern hospice movement would be among a few countries in the world to legalise assisted suicide. We should note the cautionary tales within Europe, and that it is likely that before long there will be further legislation to expand the current proposed Bill, should it become law.

So, let us not train doctors to end lives, but teach them to be doctors who support a natural death and all the responsibility, care, and compassion that this entails.

SIONED EVANS
Associate Specialist in Palliative Care
Address supplied
 

From the Revd Stephen Cooper

Sir, - I have read Lord Carey's Daily Mail essay explaining his changed views on assisted dying, and listened to Bishop James Jones's Thought for the Day contribution to the debate. Apart from one minor passing reference, neither commented in detail about the safeguards that such legislation might require.

As Bishop Jones made clear, the argument made is between the "right to choose" and the relative sanctity of life. But above both of these comes the responsibility of us all, and of Government particularly, for the protection of the weakest and most vulnerable in society.

In this debate, the need of those who are frail, elderly, and perhaps easily confused for protection from exploitation and coercion from the venal and the selfish who are more interested in an inheritance or the avoidance of costly care bills is constantly put to one side by the proponents of assisted dying. It would be great to think that such things would not happen, but all too often this facet of human nature has not changed.

How would such protection be provided? By doctors? They have shown themselves incapable of sustaining safeguards over the long term under the 1967 Abortion Act, and, with the greatest of respect, there is no evidence that they would be any more capable of exercising judgement of motives and sustaining safeguards under assisted-dying legislation. The Court of Protection? It might seem to be an obvious choice, but the "behind closed doors" nature of its judgments means that the public has no way of either knowing whether fair judgments are being made, or learning from them.

The current system requires that, when someone takes the life of another out of compassion, the evidence for those motives is tested in open court to decide whether there was reasonable cause, and therefore a defence against unlawful killing. It remains the only way I have yet seen which provides the necessary level of protection of the weakest and most vulnerable in our society. It would not be an act of compassion to undermine this, which we would do at their peril under the proposed legislation.

STEPHEN COOPER
The Vicarage, Goosnargh Lane
Goosnargh, Lancashire PR3 2BN
 

From A. Wills

Sir, - I agree with your article "But what about terminal care?" by the Bishop of Dover, the Rt Revd Trevor Willmott (Comment, 11 July), which drew attention to the need for good palliative care at the end of life. Many people are concerned that they will have a painful and undignified death.

It has recently been reported that, since the Dr Harold Shipman case, not enough morphine is being given to relieve the pain of dying patients. Doctors can now fear being sued if the morphine given to relieve a terminally ill patient's pain happens to hasten their death. Some close relatives say that they remain traumatised after seeing their terminally ill loved one suffer greatly.

On 1 July, The Daily Telegraph reported that "Almost 100,000 terminally ill people don't get proper palliative care." This was found to be the case by the Royal College of Physicians, who say there is a lack of palliative care in hospitals, particularly at weekends and during the night. Hospices are experts in pain relief, and they make dying people comfortable, but there are not enough of them for everyone who needs one.

Can we wonder that there are calls for doctor-assisted help to die when this is the case? We serve a compassionate God; so Christians should try to secure palliative help for patients at the end of life.

A. WILLS
67 Dulverton Road
Middlesex HA4 9AF

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