Oxford Students for Life

Promoting a culture of life in the University and beyond

Tag: assisted suicide

5 Points of Controversy from Monday’s Debate

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Last Monday, November 9th, a panel of four experts – Dr. Peter Saunders, Dr. Kevin Yuill, Dr. Richard Scheffer, and Dr. Jacky Davis – came together to debate the motion ‘This House opposes the legalisation of assisted suicide’. After a forty-five minute exchange, the panel opened up for questions, most of which addressed specific claims repeated by each side throughout the debate. Both the proposition and the opposition relied on several key points to make their cases; here, we take a look at the ones that proved the stickiest.

‘Assisted dying isn’t suicide’

Dr. Scheffer began his opening remarks with this punchy assertion. ‘Nobody’, he claimed, ‘wants to die’. Unlike those who commit suicide, he argued, those who choose assisted dying don’t want to die, but are already dying and simply want to avoid a highly painful or undignified death. Dr. Davis affirmed this in her speech as well; the pair emphasised that assisted suicide ought to be considered a vital part of palliative care for the dying, and is not for the suicidal.

But this is controversial. After all, an audience member asked, what about nihilists? Why is the desire to live a criterion for being able to ask a doctor to help you die? And how is it possible to argue that those asking for legal drugs, to take themselves, don’t want to die? If assisted dying isn’t suicide, there’s very little that seems to distinguish the two; fundamentally, both are caused, at least in part, by a desire to end one’s own life. And after some grumbling, Drs. Scheffer and Davis admitted that this is true; at the very least, those who ask for assisted dying have formed a will to die by the time they actually do so.

‘Assisted dying laws undermine moral equality’

Dr. Yuill’s arguments hinged on this claim. Assisted dying laws, no matter how well-worded and safeguarded they may be, ultimately create two moral classes of people in society; those whose lives are worth protecting, and those whose lives are not. A terminal diagnosis and six-month prognosis, he argued, are just arbitrary criteria, which can be changed or thrown out once it becomes permissible to say that person A may not be given lethal drugs, but person B may. Those who wish to die may not believe their lives have value, but it is the duty of the law to afford every life value, and equal value at that. The opposition didn’t counter this point directly, but instead argued that assisted dying is about freedom, not equality.

‘It’s working in Oregon’

In the final round of questions, Dr. Saunders remarked that ‘it’s pretty clear we have different ideas about what’s going on in Oregon’. Oregon came up frequently in the debate, as assisted dying bills in the UK have been largely modelled off of Oregon’s assisted suicide laws. The opposition cited Oregon’s law as a perfect example of a restricted, safe, functional assisted dying law. The proposition, on the other hand, pointed out that only a fraction of those who die by assisted suicide in Oregon actually underwent the psychological evaluations that candidates for assisted dying are supposed to receive, showing that the safeguards aren’t really that effective. Moreover, they pointed out, in Oregon, health insurance for low-income people covers assisted dying, but doesn’t cover many forms of palliative care. It can be more expensive to keep someone alive than it is to kill them; Oregon is a sad example of this.

‘Assisted dying undermines and threatens the vulnerable’

Dr. Davis rejected outright the claim that assisted dying undermines vulnerable people. She cited an instance in which her patient came to her, saying she’d been told to oppose the law because it threatened ‘vulnerable people’, but she didn’t know who those people were supposed to be. The vagueness here is worth clarifying, which the proposition could have done more of. Still, they pointed out that in places where assisted dying is legal, the elderly, frail, lonely, and depressed often feel increased pressure to consider physician-assisted suicide, because a previously unthinkable option is suddenly on the table. Though many of those who would be in this position are, sadly, on the fringes of society, many have come forward to oppose assisted suicide; some of the strongest opposition to a change in the law has come from disability advocacy groups.

‘The law would be restricted, and safe’

Time and time again, proponents of assisted dying have emphasised that any change in the law in the UK would be heavily safeguarded, and that therefore a ‘slippery slope’ argument just doesn’t work. Drs. Scheffer and Davis both repeated this point. But the proposition responded that despite good intentions, advocates for legal assisted dying can’t deny that safeguards have failed in many places, and that once the law is changed, there’s no guaranteeing its application. While the law may have safeguards and restrictions, once the door to legal physician-assisted suicide is opened, there’s simply no way to make sure it’s not abused. Are we willing to risk it?

 

The audience wasn’t – a final vote passed the motion by a significant margin. While both sides made clear and strong points, the opposition couldn’t persuade those listening that any good assisted dying laws could do wouldn’t be outweighed by the tremendous risk we would take in passing them. Though both sides emphasised compassion and mercy for the dying, the proposition made a powerful case that legal assisted suicide would be a threat to public safety. The push for assisted dying isn’t a solution to our problems; it’s a symptom of them.

 

For those who want to learn how to defend the pro-life position against assisted suicide, come along to Hertford on Monday for an apologetics workshop. More details here and here.

Event Preview: “This House Opposes the Legalisation of Assisted Suicide”

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Legal assisted suicide, as proposed by the Marris Bill, was rejected by the House of Commons earlier this year after considerable media attention and public debate. 330 MPs voted against the bill, with only 118 in favour, in the first vote on the issue in nearly twenty years.

The Suicide Act of 1961 currently makes it an offence to encourage or assist a suicide or suicide attempt in England and Wales. Anyone found to have done so may face up to 14 years in prison. Many in the medical profession oppose the legalisation of assisted suicide, believing it would result in a transformation in healing ethic of their work, and that it must remain illegal ‘for the integrity of these professions and the public good’.

Many people, on both sides of the assisted dying debate, are motivated by compassion. But is it right to ask doctors to help end the lives of those they serve? In response to the Marris Bill’s defeat, Dr Peter Saunders said the law ‘protects those who have no voice against exploitation and coercion; it acts as a powerful deterrent to would-be abusers and does not need changing.’

What do you think? Want to know more about it?

Come along to Christ Church on Monday at 7:30, for what will be an interesting debate on the issue by four excellent speakers.

Proposing the motion will be Dr Kevin Yuill, senior lecturer in Culture at the University of Sunderland and author of ‘Assisted Suicide: The Liberal, Humanist Case Against Legalization’. He will be joined by Dr Peter Saunders, campaign director of ‘Care Not Killing’, former general surgeon, and chief executive of the Christian Medical Fellowship.

Opposing the motion will be Dr Richard Scheffer, a palliative care doctor, former hospice director, trustee for Compassion in Dying, member of Health Professionals for Assisted Dying and a board member for Dignity in Dying. He will be joined by Dr Jacky Davis, who is a consultant radiologist, co-chair of the NHS Consultants’ Association, executive member of the National Health Action party and a member of the National Health Action party.

Stay after the debate to have a drink and for a chance to meet the speakers!

What we’re looking forward to this year…

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The year ahead is an incredibly exciting one for OSFL. With a number of great events planned, and many more ideas still in the pipeline, we can’t wait to get started. As before, our work is going to focus on two main areas. Firstly we will be organizing events directed towards fostering discussion of life issues, and secondly we are committed to improving the lives of student parents on campus.

At the start of September the House of Commons emphatically voted against the Marris Bill, proposing the legalization of assisted suicide. In all likelihood the question won’t return to a commons vote until the next parliament at least, but given its prominence in the news we thought it appropriate to focus on this question for Michaelmas. For our main event of the term we have invited Dr Kevin Yuill, author of ‘Assisted Suicide: The Liberal, Humanist Case against Legalization’ and Dr Peter Saunders, campaign director for the Care Not Killing Alliance and formerly a general surgeon. They will be proposing the motion ‘This House opposes the legalization of assisted suicide’, against two representatives from Dignity in Dying, the leading campaign group in the UK supporting legalization.

At the end of the term, in the next installment of Life Chats, we are very excited to have Greg Jackson, former OSFL member and Student Support Officer for the Alliance of Pro-Life Students, presenting a session on assisted suicide apologetics. He will be tackling some of the thornier issues surrounding autonomy, suffering, and legalization.

Our first event of the term, however, is on a different topic. Philippa Taylor, Head of Public Policy at CMF, will be addressing us on the very delicate issue of foetal disability. In UK law abortion is only legal up until 24 weeks, unless the foetus displays “physical or mental abnormalities”, in which case abortion is legal up until birth. This poses numerous complex and sensitive questions, including potential discrimination towards disabled people, and we look forward to hearing Philippa’s talk on the matter.

With regard to student parents, there is a huge amount of work to be done and lots to build on from the excellent start made by the student parents sub-committee last year. Over the summer we had a very productive meeting with the newly elected Student Parents and Carers rep at OUSU, and look forward to working together as much as possible. Our initial focus is going to be on passing motions in the different college MCRs and JCRs, so that nappy changing tables are installed and high chairs are available in halls. Whilst doing this, we hope to raise awareness about the difficulties faced by student parents, by handing out information leaflets and running another student parent week, similar to the one held at the start of Trinity last year.

It is sure to be an eventful year, and one which we hope will make an actively positive contribution to student life at Oxford, whether that is through campaign work for student parents or by offering new perspectives on complex issues that affect each and every one of us. We always want to hear from you, and have been really encouraged by messages people have sent suggesting events. If ever you want to help out in any way, do not hesitate to get in touch!

For more information on events, including dates, timings, and venues, please visit our website or Facebook page.

Johnny Church is co-President of Oxford Students for Life

A medic’s reflections on palliative care and assisted suicide

How people die remains in the memory of those who live on.” – Dame Cecily Saunders, founder of the modern hospice movement.

During the last two months of my fifth year “Community Care” medical placement, I have had the precious opportunity to spend time with palliative care patients and physicians. It was an experience that not only gave me knowledge about this oft-forgotten kind of medical care, but also engaged my whole person, emotionally and spiritually, and left me with a new respect for the dying and those who care for them. I am thankful for the wisdom I gained from the experienced palliative care consultants, nurses, and chaplains at Sobell House hospice in Oxford, and Sue Ryder hospice in Nettlebed.

As a medical student, I have more opportunity than most to experience the hard realities of sickness and disease. But before this placement, I had spent little time with the dying, perhaps because I was more enthralled by the high tempo work of the emergency department, or the advanced interventions in cardiology.

Dr Adams, a wonderfully competent and compassionate palliative care consultant at Sobell House, taught me about the management of terminal patients: pain control, relief of nausea and constipation, and tending to emotional and spiritual needs. I learned about three of the big fears faced by the dying: fear of being in pain, of losing dignity, and of being a burden to loved ones. An elderly gentleman confided in me “I do love my family and I know they are all so busy, and I don’t want to burden them, so I hope I go soon.” I was told that it is not unusual to find patients concerned about becoming an unwanted burden on their relatives and carers.

Yet there were also those who took great delight in the time that they had left, and wished to stay alive as long as possible. “The thing that keeps me going is the only thing that makes me happy: spending time with my family”, one woman revealed. For some, a fear of the unknown in and after death, or a longing for forgiveness, was prominent. For others, a confidence in life after death brought peace. “I know where I am going”, reflected one man.

One of the most powerful lessons for me was the value of a good death. By a good death, I mean one in which a patient has had the chance to share memories with and say goodbye to loved ones, to set their affairs in order, to prepare themselves spiritually, and has been relieved from physical discomfort. Relatives, while grieving after a death, also shared their appreciation of the time spent together at the end. While many in our society may wish for a quick death, I think I would rather have this opportunity to spend my last days surrounded by family and friends, cared for by a team of experts.

Palliative care may begin to look very different to future medical students in the future. Next month MP Rob Marris will introduce a Private Members Bill into the House of Commons designed to allow doctors to assist in the suicide of patients with a terminal illness. At the moment, doctors are prohibited from killing and from assisting suicide, but under the proposed legislation they would be allowed to select a poison of their choice, advise the patient how to take the drug, and even insert an intravenous line for the drug to be given efficiently.

I’ve often heard people suggest that doctors currently use drugs to help people die, and that all is being proposed is regulation. But this is just not true: palliative care doctors use opioids and benzodiazepines to treat pain and anxiety, so that the precious last hours, days and weeks can be as valuable as possible. These drugs are used to improve one’s quality of life, not to end it altogether. The drugs used in assisted suicide, barbiturates in massive overdose, are completely different, designed to kill rapidly.

Of all the palliative care physicians that I spoke to, not a single one of them supported a change in the law on physician-assisted suicide. They recognise that the current law works, and that under the proposed law, pressure on terminally ill patients to end their lives may come from family members or medical professionals, but also may be self-imposed by those feeling they are a burden to others. I hope that the excellent work of the palliative care teams I joined can continue -without the threat of assisted suicide – for many years to come.

Josh Peppiatt is a 5th year medical student at Green Templeton College, Oxford

Assisted suicide would change the way we respond to despair

Nathan Verhelst, a trans man from Belgium, had struggled with mental illness since childhood. At the age of 44, after a series of crises, he took his own life. Sadly, that is not so uncommon. What was unusual were the circumstances. Verhelst received a lethal injection from a doctor, as part of Belgium’s standard bureaucratic procedure for those in ‘unbearable suffering’. The doctor explained that Verhelst’s suffering qualified as unbearable because after six months of counselling he was still suicidal. If that kind of reasoning makes you uncomfortable – if you wonder whether six months of counselling amounts to everything that might have helped Nathan Verhelst – then look away now, because it could be coming to the UK.

 
If Rob Marris’s assisted suicide bill is passed on 11 September, and survives the rest of its progress through Parliament, this country will become more dangerous for the elderly, the ill, the disabled and the depressed. So say the British Medical Association, Disability Rights UK, and the Royal College of GPs. At the very least, the principle of caution should warn against this bill.

Everyone can feel the pull of the case for assisted suicide. Many people are in physical and psychological pain; they say, repeatedly, that they would rather be dead than alive. Who could possibly be indifferent to their distress, and their hope that it might end?

 
We experience a stab of guilt, hearing their stories. And guilt is not the worst motive. If it prompts us to help the people at the margins of our own community, or prompts government to improve palliative care, guilt can do a lot of good. But it is a poor basis on which to pass a law which will change the fabric of society. This law will not simply abolish a category of suffering: it will create new ones. The evidence everywhere suggests that the main result of assisted suicide laws is to surround unhappy, lonely people with exit signs.
In Oregon, the supposed paragon of such a law, the chief effect has not been on those in physical pain. Less than a quarter of those receiving poison say they are worried about pain, or even the possibility of pain; the main reasons are ‘loss of autonomy’ (91%) and ‘decreasing ability to participate in activities that made life enjoyable’ (89%). According to a high estimate, over 30% of recipients in a single year may have had their judgment impaired by undiagnosed depression.

Still, to give Oregon its due, there is a fundamental difference from Britain. Oregon Right to Die, the body behind the law, were from the beginning moderates. Their intention, according to one of their leading figures, Eli Stutsman, was to ‘campaign for the right to die and against Dr. Jack Kevorkian in the same breath’. They were, if you like, doves rather than hawks.

The British right-to-die movement is different. It is a flock of hawks with some official doves fluttering around in the vanguard. The doves assure us that this Bill will go no further than Oregon’s restrictions: it will apply only to the terminally ill. (An elastic category in any case, as the disabilities campaigner Baroness Campbell has pointed out.) But the hawks are more articulate and more consistent in applying the logic of total self-determination. Baroness Warnock, a leading intellectual light of the movement, predicts a future in which ‘you’d be licensing people to put others down’. Polly Toynbee, one of Fleet Street’s most influential voices for a change in the law (and for further changes down the line), concedes the possibility ‘that the frail will be intimidated into hastening the end of their lives so as not to be a burden on their children’. She comments, in a disturbing foretaste of things to come: ‘Well, why not?’ The Economist recently proposed that the opportunity for taking poison be extended to people with depression. Well, in Belgium they are already living the dream. Euthanasia is up 25% on last year, and the law becomes ever less discriminating in its effects.

There, as Rachel Aviv reported in a must-read article for the New Yorker, euthanasia has taken away people with ‘autism, anorexia, borderline personality disorder, chronic-fatigue syndrome, partial paralysis, blindness coupled with deafness, and manic depression’. This is scarcely the picture painted by the likes of Dignity in Dying.

In 1931, the great psychologist Carl Jung noted that many of his patients suffered from ‘the senselessness and aimlessness of their lives… I should not object if this were called the general neurosis of our age’. If anything, that diagnosis is truer today. Suicide is the biggest killer of young British men, and the UK is incubating a crisis of loneliness and mental illness. Usually, we try to build hope and solidarity against despair. But Belgium has discovered an alternative. “If the patient’s energy is gone,” one euthanasia doctor tells Aviv, “then it is not humane to say, ‘Well, maybe if you go to a hospital that specializes in your problem for two more years it will help.’ I think we have to respect when people say, ‘No – that is enough.’” Sorry, doctor, but running out of energy is a symptom of depression: a lot of people feel that they have ‘had enough’, are useless, and would be better off dead. It makes all the difference whether they are listened to and given support to carry on. In some places, that seems to be going out of fashion.

The testimony of doctors suggests that when suicide becomes institutionalised, a society becomes anaesthetised to the preciousness of human life. One Dutch doctor recalled the first time he administered euthanasia. The first case was ‘terrible’, he said. His team agonised all day before carrying it out. The next one, he said, was much easier. ‘The third case’, he concluded, ‘was a piece of cake’. That is a report from the bottom of the slippery slope, and it turns out to be quite a short slope. Assisted suicide will weaken the bonds of society. It will nudge towards the edge exactly the people we should be hauling back from it. One day we might be asked if anybody tried to stop it.

 
To write to your MP, go to http://notoassistedsuicide.org.uk/

Dan Hitchens is a former President of Oxford Students for Life.

Protecting the vulnerable: a report on Tanni Grey-Thompson’s talk

“Excuse me, are you Tanni Grey-Thompson?” She’d been off the train two minutes when a woman stopped us on the station platform and, with the kind of fluster you reserve for meeting your heroes, explained that Grey-Thompson had long been an inspiration. Her reputation having gone before her, the talk on Tuesday was well-attended by an audience with mixed views on the Falconer Bill for the legalisation of assisted suicide, which began its Committee Stage in the House of Lords last Friday.

Grey-Thompson is known in Parliament for her work on disabled rights, welfare reform and campaigning for women in sports. It is the issue of assisted suicide that has prompted the biggest reaction she’s seen as a peer, though. “We’ve had more mail on this than on anything else, ever.” She says, incredulous, that normally people write to her asking for social care, help, housing. Now they write asking for the right to die. It’s too drastic a solution, she argues. “We don’t have a perfect system. We need to talk about palliative care in this country, about hospices, about social support,” before we make death the answer.

The first issue she addressed was the polarised presentation the issue often receives in the media. Grey-Thompson highlighted the real complexity of the issue and her concerns about the potential for confusion created by the manipulation of language. Talking about ‘medicine’ for a procedure that kills; the use of ‘assisted dying’ over ‘physician assisted suicide’ to convey the idea of a passive ‘slipping away’, rather than the less palatable recognition that this is involving a doctor in someone’s death. Nor is the simple dichotomy sometimes presented, between supporting assisted suicide and wanting people to suffer, one that makes sense in Grey-Thompson’s eyes. “I’ve never met someone opposed to assisted suicide who wants people to be in pain.” She worries that those behind the Bill expect it to be passed on principle (the very good principle of limiting suffering), planning to “deal with the sticky bits” afterwards. We need to ask practical questions about assisted suicide now, she urges: “who, when, what and how”.

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The audience arrives at the Blue Boar Lecture Theatre

The Bill endangers the lives of the vulnerable, Grey-Thompson argues. Research carried out by Scope reports that 70% of disabled people are concerned about pressure being put on people to end their lives should this bill pass. It is the same Mary Warnock, Grey-Thompson’s childhood hero for her defense of the right to mainstream education of those with special needs, who suggests that those suffering from illness or disabilities may have a ‘duty to die’ for the sake of society. Where hospice care is a postcode lottery and beds in NHS hospitals may be scarce and expensive, it’s not difficult to imagine this kind of philosophy becoming normalised were assisted suicide to be made legal. One of Grey-Thompson correspondents contacted her recently to say that her local authority have taken all her support away, leaving her with the option of going into a care home at the age of 43. ‘I might as well die,’ she wrote.

The Bill’s safeguards are inadequate and unclear. Grey-Thompson thinks the six-month life expectancy condition an arbitrary limit, and worries that many disabled people would fit into that category. There is a lot of detail missing, particularly about the role of the doctor in the procedure – the conscience clause, for example, is unclear. In Oregon, the model for Falconer’s proposals, the GP must have known the patient for 12 weeks, a period Grey-Thompson thinks too short. The ‘cooling-off period’ once the decision is taken would be of just 14 days. Most disturbing is the prospect of such a fundamental change in the doctor-patient relationship, which would leave the system open to abuse. Doctors make very difficult decisions concerning the end of life all the time, Tanni points out, but such a change in the end they aim at is “moving the goalposts” too dramatically. Once it is legitimate for a doctor to participate in someone’s death, the opportunity is there for subtle pressure: an expectation could be quietly established that someone will choose assisted suicide, based perhaps on a subjective judgement of their ‘quality of life’. And on top of this, if the Bill gets through, she’s worried about the floodgates opening to more radical options. In Belgium and the Netherlands, where even children can be euthanised, the number of people opting to die in this manner is soaring.

Tanni talking

Her speech was peppered with poignant anecdotes from her own experience, and from that of those who write to her. We heard about the disturbing reaction of a doctor when she fell pregnant, who gave his opinion that “People like you shouldn’t have children.” Grey-Thompson’s response was characteristically tongue-in-cheek: “What, people from Wales?” She’s got thick skin – she’s needed it. Despite – perhaps in the face of – letters that say things like “I hope your daughter dies a long and painful death”, Tanni’s resolve to oppose the Bill has only been strengthened. The key positive step she proposes is the scrutiny of palliative care, hospices and social support networks. She pointed out the absurdity of spending huge amounts of money on preventing suicide, whilst at the same time funding plans help people do so with more ease. Grey-Thompson thinks it unlikely that the Bill will make much headway this year: the Commons won’t want to touch such an issue just prior to a general election. The reports from the Committee stage will hopefully clarify some of the grey areas the current draft Bill skirts around, but we can’t hope for assisted suicide to be made ‘safe’: giving doctors the power – and the responsibility – to help kill their patients is ground too dangerous on which to legislate.

(Amy Owens)