Ten Reasons Why the UK Should Not Legalize Assisted Suicide
by Dr. Peter Saunders | London, England | LifeNews.com | 7/18/14 6:10 PM
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Lord Falconer’s
Assisted Dying Bill, due for a second reading in the House of Lords on 18 July, is purportedly based on the US state of Oregon’s
Death with Dignity Act (DWDA).
Dignity in Dying, the former Voluntary Euthanasia Society, who are
backing Falconer, claim that everything is wonderful in Oregon. But is
that really true?
In fact, far from being reassuring, the Oregon experience sounds a loud warning to the UK not to follow suit.
October 1997, Oregon enacted the DWDA which allows terminally-ill
Oregonians to end their lives through the voluntary self-administration
of lethal drugs, expressly prescribed by a physician for that purpose.
The Oregon DWDA also requires the Oregon Health Authority to collect
information about the patients and physicians who participate in the
Act, and publish an annual statistical report.
These annual reports are all available on the
Oregon government website and there is plenty of other relevant information in the public domain to draw on.
In order to qualify under the Oregon Act, a patient must be an Oregon
resident, 18 years of age or older, capable of making and communicating
health care decisions for him/herself and have been diagnosed with a
terminal illness that will lead to death
within six months.
It is up to the attending physician to determine whether these criteria have been met.
A similar law came into effect in the neighbouring state of Washington in 2009. Annual reports can be accessed
here.
So what can we learn about the Oregon/Washington model? Here are ten disturbing facts:
1. There has been a steady increase in annual numbers of people undergoing assisted suicide in Oregon
In 1998 there were 24 prescriptions written and 16 assisted suicide deaths. By
2012 these
numbers had risen to 116 and 85 respectively. This is a 380% increase
in prescriptions and a 430% increase in assisted suicide deaths in 15
years. The number of assisted suicide deaths in
Washington State, increased by at least 43% in 2013.
How would this translate to the UK? There were
56.6 million people in England and Wales in 2012 but only
3.9 million in
Oregon. So 85 assisted suicide deaths in a year in Oregon would equate
to 1,232 in England and Wales (14 times that of Oregon).
2. The Oregon health department is funding assisted suicide but not treatment for some cancer patients
Barbara Wagner had recurrent lung cancer and Randy Stroup had
prostate cancer. Both were on Medicaid, the state’s health insurance
plan for the poor that, like some NHS services, is rationed. The state
denied both treatment, but told them it would pay for their assisted
suicide! ‘It dropped my chin to the floor,’ Stroup told the media. ‘[How
could they] not pay for medication that would help my life, and yet
offer to pay to end my life?’ (Wagner eventually received free
medication from the drug manufacturer. She has since died. The denial of
chemotherapy to Stroup was reversed on appeal after his story hit the
media.)
Despite
Wagner and Stroup’s cases,
advocates continue to insist that Oregon proves assisted suicide can be
legalised with no abuses. But the more one learns about the actual
experience, the shakier such assurances become.
If AS were to be legalised in the UK end-of-life care would be likely
to worsen under financial pressures because it costs on average £3000
to £4000 a week to provide in-patient hospice care, but just a one-off
cost of £5 to pay for the drugs which would help them commit suicide.
Cancer treatments like chemotherapy, radiotherapy or surgery cost much
more. Do we really wish to place that temptation before families, NHS
managers and Health Secretaries in cash-strapped Britain?
3. Patients are living for many years after having been
prescribed lethal drugs for ‘terminal illness’ showing that the
eligibility criteria are being stretched
The Oregon and Washington laws, like Falconer’s proposed law, have
‘six months to live’ criteria. But doctors’ estimates of lifespans can
be wildly out. Consider Oregon resident, Jeanette Hall, who was
diagnosed with cancer and decided to ‘do’ Oregon’s law. Her doctor,
Kenneth Stevens, didn’t believe in assisted suicide and encouraged her
to be treated instead. It is now 14 years later and she is ‘thrilled’ to
be alive. This is
Dr Steven’s affidavit filed by the Canadian government in Leblanc v. Canada, now dismissed, discussing Jeanette. This is
Jeanette’s affidavit, also filed by the Canadian government in the same case.
The
Oregon statistics
record patients killing themselves up to 1,009 days after the first
request for lethal drugs – almost three years – showing just how hard
doctors are pushing the boundaries – and/or how bad they are at guessing
lifespans.
4. The vast majority of those choosing to kill themselves are
doing so for existential reasons rather than on the basis of real
medical symptoms
The main argument advanced for assisted suicide is unremitting pain. But the
Oregon data
show that those people citing ‘inadequate pain control or (even)
concern about it’ constitute just 23.7% of cases overall. So what are
the main reasons given for taking one’s life? In 2013 93% cited ‘loss of
autonomy’, 89% said they were ‘less able to engage in activities making
life enjoyable’ and 73% listed ‘loss of dignity’. These are not
physical but existential symptoms. But should lethal drugs be
prescribed to people who feel their lives no longer have meaning and
purpose?
The fact that almost a quarter of patients dying under the Act report
inadequate pain control or concerns about pain also shows that
palliative care provision in Oregon is unsatisfactory. But surely this
is an argument for better care rather than AS.
5. Many people in Washington and Oregon give ‘fear of being a burden on others’ as a reason for ending their lives
I have frequently argued that any change in the law to allow assisted
suicide or euthanasia would place pressure on vulnerable people to end
their lives for fear of being a financial, emotional or care burden upon
others. This would especially affect people who are disabled, elderly,
sick or depressed and would be most acutely felt at a time of economic
recession when many families are struggling to make ends meet.
This fear is again borne out by the American data. In
Washington
in 2013, 61% of people opting for assisted suicide give the fear of
being a burden to family, relatives and caregivers as a key reason. 13%
cited ‘financial implications of treatment’. In the same year in
Oregon the equivalent figures were 49% and 6%.
6. Fewer than three per cent of patients are being referred for formal psychiatric or psychological evaluation
In an article for The Telegraph,
former president of the Royal College of Psychiatrists Baroness Sheila
Hollins has voiced concern that proposals to license doctors to supply
lethal drugs to mentally competent, terminally ill patients fail to take
account of the complex process involved in assessing a patient’s mental
capacity. According to Baroness Hollins, assessing mental capacity
‘isn’t like checking the oil or water level in a car’ or ‘the sort of
thing that can be done in a single consultation, especially if the
decision in question – as it is in this case – is one with life-or-death
consequences.’
Commenting on the US State of Oregon, where
less than 3%
of cases were referred for a formal psychiatric assessment in 2013 she
writes: ‘Researchers have found that some patients who have ended their
lives under the terms of Oregon’s assisted suicide law had been
suffering from clinical depression. Depression impairs decision-making
capacity, it is common in elderly people and it is treatable. But in
some cases in Oregon it has not been diagnosed by the doctor
who assessed the patient’s capacity and prescribed lethal drugs.
Oregon’s law requires referral for psychiatric examination in cases of
doubt but in some cases that has not happened.’
7. A substantial number of patients dying under the Oregon Act do not have terminal illnesses
In Oregon in 2013 16.9% of those killing themselves under the Act did
not have cancer, heart disease, chronic lung disease or motor neurone
disease but were classified as having ‘other illnesses’. What were
these? A footnote in the
annual report
tells us that this ‘includes deaths due to benign and uncertain
neoplasms, other respiratory diseases, diseases of the nervous system
(including multiple sclerosis, Parkinson’s disease and Huntington’s
disease), musculoskeletal and connective tissue diseases, viral
hepatitis, diabetes mellitus, cerebrovascular disease, and alcoholic
liver disease.’
Many of these conditions might be considered life-shortening but it
beggars belief that all these cases were terminal (with less than six
months to live). These are in the main chronic conditions, again falling
outside the bounds of the Act. And yet the doctors went ahead and
signed the forms anyway – further evidence of how medical practitioners
cannot be trusted to keep to the legal boundaries.
8. It is virtually certain that there is underreporting of assisted suicide cases in Oregon
The Lancet recently published
a long awaited meta-analysis study which
indicated that in 2010 in the Netherlands, 23% of all euthanasia deaths
were not reported. Could similar under-reporting be happening in
Oregon? It is a virtual certainty.
Oregon officials in charge of formulating annual reports
have conceded ‘there’s
no way to know if additional deaths went unreported’ because Oregon DHS
‘has no regulatory authority or resources to ensure compliance with the
law’.
The DHS has to rely on the word of doctors who prescribe the lethal
drugs. Referring to physicians’ reports, the reporting division
admitted:
‘For that matter the entire account [received from a prescribing
doctor] could have been a cock-and bull story. We assume, however, that
physicians were their usual careful and accurate selves.’
So with an Oregon-type law like Falconer’s we can expect to see
steadily increasing numbers of assisted suicide cases year on year in
England and Wales, along with an unknown level of under-reporting.
9. Some doctors know the patient for less than a week before prescribing the lethal drugs
In order to assess whether a patient is being coerced or not, it
surely must be necessary for the prescribing doctor to know them
personally and understand their family situation. But in Oregon there
were patients who knew their doctor for less than a week before he/she
prescribed them the lethal drugs – further evidence of doctor shopping.
10. The presence of no independent witnesses in over 80% of cases is a recipe for elder abuse
In
Oregon in 2013
there was no doctor or other healthcare professional present at the
time of ingestion of the lethal drugs in 81% of cases. Also the duration
of time that elapsed between the request for the drugs and the actual
death ranged from 15 to 692 days with a median of 52 days.
During this time the drugs were kept at the patient’s home. But
without an independent witness how can we be sure that the drugs were
taken voluntarily and not administered forcefully or secretly by a
relative with an interest financial or otherwise, in the patient’s
death? If they struggled who would know? And any investigation into
possible foul play would have to traverse the substantial hurdle of the
key witness (the patient) being dead.
We know that in Britain, according to ‘Action on Elder Abuse’, there
are half a million cases of elder abuse annually, many of which involve
financial abuse by family members or close relatives. The Oregon law,
and by implication Falconer’s proposed law, is a recipe for elder abuse
of the very worst kind – killing for money.
Conclusions
The lessons from Oregon are clear. We should not go there. Keep Britain safe for vulnerable people.
LifeNews.com Note: Dr. Peter Saunders is a doctor and the CEO of
Christian Medical Fellowship, a British organization with 4,500 doctors
and 1,000 medical students as members. This article originally appeared
on his blog. He is also associated with the Care Not Killing Alliance
