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Assisted dying: a doctor’s reflections on Lord Falconer’s Bill

23 May 2014


From Dr Dewi Rees

Sir, - The lack of public interest in the Assisted Dying Bill would be remarkable if we had not gone through similar processes already. In Nazi Germany, there was no resistance to the kindly killing of the mentally ill which preceded the Holocaust and set the stage for euthanasia as it is practised today.

This was followed in the UK by the legalisation of suicide in 1961 - which had been a crime for many centuries - and, in the Netherlands, since the 1970s, by the practice of euthanasia and assisted suicide by Dutch doctors, a development that was not sanctioned by legislation but by decisions taken by the Dutch judiciary.

Because the incidence of such deaths was never properly determined, the Minister of Justice established the Remmelinck Commission, which published its findings in 1991. It reported that 2300 cases of active voluntary euthanasia and 400 cases of assisted suicide occurred each year in the Netherlands. It also found that about 1000 cases of active euthanasia, mainly involving disabled babies, took place annually without the patients' consent.

A further 22,500 deaths occurred each year from doctors' withholding or withdrawing treatment, mainly from elderly patients in nursing homes. Later, in 1994, the Supreme Court ruled that mental suffering per se was a sufficient reason for providing euthanasia. This meant that a physical or psychiatric illness was not a requirement, though the doctor who received the request to end this life should have the patient examined by at least two other doctors, of whom one must be a psychiatrist.

The 1967 Abortion Act was the next stage towards the acceptance of legislation for assisted suicide. The passage of this Act encountered little public opposition, and I supported it, expecting that few babies would be aborted; but I was totally wrong. I expected 1000 deaths in England and Wales, but the actual figure was 189,100 by 2009, established safeguards having been circumvented as abortion on demand became the norm.

I did refer one woman with rubella for termination before the Act was passed, and with my consultant's help and under his supervision performed a hysterotomy on another woman referred to us by a cardiologist for abortion. Once I realised the serious social implications of the Act, however, I refused to refer any other pregnant woman for termination.

Many years later, when I was a retired GP on a temporary assignment in a practice, I was surprised to be told by the senior partner that it was my duty to refer pregnant women for termination when they wished to have their babies aborted. I did not comply, but his attitude indicates the pressures put on people.

People who wish to end their own lives have the legal right to do so, but that is different from expecting someone else to do it for you. As a hospice doctor, I admitted the occasional patient who asked to be put down. The answer was always: "No, but we will look after you and keep you comfortable." Not one repeated the request, and they all seemed content with the care that they received. That was 30 years ago, and patterns of care have changed, but I remember taking about 20 Dutch doctors around the hospice, and was surprised by their apparent lack of interest in what we did; maybe they thought they had something better to offer patients.

Finally, I remember a colleague who, while working in the Netherlands, had agreed to end a patient's life. He went to the person's house and gave the patient a lethal injection. "Unfortunately," he said, "I botched the job and had to go back the next day to do it properly."

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