20 Oct

Why the 2015 Assisted Dying Bill failed to persuade a majority of MPs

Posted By Politybooks

The 11th of September this year saw the first vote in around twenty years on physician-assisted dying (PAD). MPs voted 330 to 118 against the assisted dying bill introduced by Labour MP Rob Marris (see BBC for details). 74% of MPs voted against the 2015 bill, and a near-identical 72% opposed the last bill of its kind in the House of Commons in 1997. Currently, PAD is legally available in a number of other countries. Under the proposed legislation, a terminally ill person could have requested physician assistance in ending their life. A high court judge would have had to agree that they had full mental capacity, and that their wish to end their life was voluntary, settled and informed as established by a written declaration signed by two doctors.

Although there were calls for the issue to be put to a referendum with some polls suggesting public support ran as high as 80%, specific polling questions elicited a different result. In a ComRes poll of 2,055 British Adults in July 2014, pollsters asked:

Would you still support the Assisted Suicide Bill if…?

a) People may feel pressurised to end their life so as not to be a burden to their loved ones (47% supported, 28% opposed).

b) There has been a steady rise in assisted suicides in places where it is legal (58% supported, 21% opposed).

c) End of life care may worsen when it costs £3-4000 a week for hospice care, but £5 for the lethal drugs. (59% supported, 15% opposed).

d) Major disability rights groups oppose a change in the law (63% supported, 12% opposed).

e) Majority of doctors oppose it, including the BMA and Royal College of GPs. (65% supported, 42% opposed).

Overall, 42% of those who supported the bill in principle changed their mind on one of the practical considerations above. This may explain why parliamentarians are more conservative on reforming the law than the public; implementing it is different to supporting it in principle.

Following on from the previous post in which the arguments in favour of physician-assisted dying were listed, here we explore, in more detail, several of the arguments raised in opposition to the bill…

Concerns were raised about the risks posed to vulnerable people who would have felt under pressure to end their lives so as not to be a burden to family, relatives, or caregivers in a society short on resources. This was the case that GPs and specialist organisations such as The British Geriatric Association made (whose 2,750 members include many doctors and nurses). They raised concerns that many requests to end life come from the patients’ families and not the elderly person themself: ‘Often such requests are then forgotten if such degrading symptoms as urinary and faecal incontinence, depression and unremitting pain are relieved.’

A 2015 study of 80 countries by the Economist Intelligence Unit found that thanks to the NHS and the hospice movement, UK palliative care was ‘second to none’.

The concern here is that legalising assisted suicide could lead to a diminished motivation to invest in world-class palliative care which is expensive. Maintaining high standards of palliative care through proper investment and accountability may be seen to protect those who have no voice against exploitation and coercion, or provide security against a cost-benefit analysis of healthcare that puts a lower value on their lives.

Hard cases make bad law and legalising PAD could turn out to be a can of worms. The Assisted Dying Bill offered such strict safeguards against abuse that with 500,000 people dying in England and Wales each year, there could be thousands of disputed cases before high court judges every year.

Hippocrates’ oath which established a code of medical ethics and a long tradition of professionalism among doctors, stated, ‘Nor shall any man’s entreaty prevail upon me to administer poison to anyone.’ There is a sense that a PAD bill that would allow doctors to prescribe patients drugs which bring about their death would be contrary to the ethics of clinical practice and go against the aim of improving a patient’s quality of life. It is why the Royal Medical Colleges and the British College of GPs opposed the bill. The legalisation of physician-assisted suicide would either create a class of medical professionals who specialised in the role of physician-assisted suicide, or place pro-euthanasia doctors into this role. Would a frail elderly patient taking up a bed with chronic or terminal conditions, feel as secure in their trust of a doctor known to regularly assist in suicides, as opposed to one who is known to be opposed to euthanasia?

Recalling his time as a young doctor in Glasgow Royal Infirmary, Dr. Liam Fox, the former Defence Secretary, said in the parliamentary debate: ‘I very often would be sitting with a dying patient and there is a very strong temptation to end their suffering. I believe anything that increases this pressure on doctors is an ethical trap which I do not want to see.’ He added that the principle of ‘double effect’ – in which strong medication given to reduce pain also hastens a patient’s death – was, ‘very, very different ethically and morally from giving a patient something that is primarily designed to kill them.’ And where patients are unable to administer life-ending medication themselves, doctors themselves may have to administer this. One doctor spoke of how, though he sought to act in a patient’s best interests, he recognised that doctors who become numb to suffering and exhausted after long shifts, may be tempted to put an unconscious patient who was terminally ill, in pain, and without relatives, out of their misery. Of course the strict safeguards should prevent this, but the present law is explicitly clear and avoids ambiguity for unscrupulous doctors to exploit.

Washington State’s own 2014 report stated that 59% of those who died under its assisted dying legislation self-identified as feeling a burden. Where a person seeks assisted suicide citing ‘feeling a burden’, their choice is not freely made. People who feel a burden are among the most vulnerable in society and often need encouragement to live. It is also harder to assess the mental capacity of a patient to end their life. For example, depression can be hard for doctors to recognise in terminally ill patients. This bill would put them at risk, and safeguards cannot adequately account for the motives for seeking assisted suicide. Added to this, it is also difficult to judge life expectancy and prognoses, for the timescale of a terminal illness are often wrong. The Marris Bill relates to patients with less than six months to live, but the Royal College of GPs has said that when predicting death more than a week or two in advance, ‘the scope for error can extend into years’.

What is your own view?

Are parliamentarians more conservative in their ethics than the general public?

We live in a representative democracy, but should we have more of a direct democracy on ethical questions such as PAD?

Are these reasons adequate to justify the denial of PAD to those who wish for it?

Did religious leaders have a disproportionate lobbying power in this debate, as some secular voices have claimed?