Oxford Students for Life

Promoting a culture of life in the University and beyond

Tag: end of life

Freshers’ Fair Adventures

Ben Conroy shares some of his expertise on representing Oxford Students For Life at the annual Freshers’ Fair.

The Oxford Fresher’s Fair is an experience. With around 3,500 new students passing by your stand over the course of the fair, (minus anyone who sleeps through their slot) and a couple of hundred other stands to compete with for their attention, it gets intense.

I’ve now done one fair as a participant and two behind the stand, and these are some of the main tips that I’ve learned from the experience.

Invite people to talk.

It’s good to have both a hawker’s cry and an introductory pitch. The first one is for getting people to come to the stall. We use some variant of “human rights, life ethics and free flower seeds!” (you can’t give out food or sweets at the Oxford fair and we like the “seeds of life” symbolism). Once you’ve made eye contact, give them a quick pitch for what exactly your society’s about and why they should come to your events. It also helps to have a cool-looking stand!

You’re there to invite people to a conversation, not start one.

It can be tempting to engage people in debates about the issues at the stand: but that’s a waste of both their time and yours. They have a load of other stands to go through, and you have a lot more people to talk to – they’re walking past all the time. You want to invite people to sign up to your mailing list, come to events, and chat to them there.

But be willing to have a brief chat.

You can have all sorts of interesting brief conversations with people if the opportunity presents itself (when they’re writing down their name and email for example). I had a great chat this year with someone about our shared appreciation for CS Lewis, while another person offered to help the society fundraise. Interactions can sometimes get weird: during my first shift this year one guy left our stand only to come back with a bunch of flowers for my stand partner and fellow committee member before vanishing again. It’s also great to develop a rapport with the people on the stands around you – it’s a long day at the fair and you can use some stallholder solidarity.

Be unapologetically pro-life, and unapologetically civil.

The unofficial Oxford Students for Life motto is never more appropriate than at Fresher’s Fair. We’re totally up front about being the University Pro-Life society and what we stand for, but we’re also keen to emphasise that we welcome people of all views on abortion, assisted dying etc. to our events. We almost never get anyone actively hostile (the worst is usually a “not interested” or a grumpy look), and several times someone who initially seemed sceptical ended up enthusiastically signing up.

On that note…

Have an event people of all views will be interested in.

Our first event this term was a talk by Ryan Day of Alliance Defending Freedom on the theme “Whose Life Is Worth Living”, discussing, among other things, some of the ethical issues raised by the tragic Charlie Gard case. That’s an issue that doesn’t cut along standard pro-life and pro-choice lines, and we had a lot of interest in it from people of all persuasions on the stand. Later on in the term we have a discussion of conscientious objection for medics that also drew interest.

Have fun!

If your university has a fresher’s fair or something like it, it’s an excellent opportunity to talk to so many people about your society and pitch yourselves and your events. And you never know what might happen: the conversation I had with the OSFL team as a fresher was instrumental in getting me to join the committee and spending the next two fairs behind the stand.

Ben Conroy is in his third year, studying PPE at St John’s.

5 Points of Controversy from Monday’s Debate


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.

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”.

Tanni arrivals 2

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)


‘This Bill is about me’: Baroness Campbell’s speech at yesterday’s Lords debate

The Falconer Bill was debated yesterday in the House of Lords. (A good report is here.) The speeches were about half-and-half for and against the Bill. Many peers spoke from their own personal experience, including Baroness Jane Campbell, who has spinal muscular atrophy. The full text of her speech is below.

My Lords, I have fought for autonomy the whole of my life. I have fought for that for myself and for others. I do not want this Bill.

First, I must declare a very important interest. This Bill is about me. I did not ask for it and I do not want it but it is about me nevertheless. Before anyone disputes this, imagine that it is already law and that I ask for assistance to die. Do your Lordships think that I would be refused? No; you can be sure that there would be doctors and lawyers willing to support my right to die. Sadly, many would put their energies into that rather than improving my situation or helping me to change my mind. The Bill offers no comfort to me. It frightens me because, in periods of greatest difficulty, I know that I might be tempted to use it. It only adds to the burdens and challenges which life holds for me.

However, it is not just about me. My story is echoed by the majority of disabled and terminally ill people in Britain today. Many of them are outside this House, protesting against the Bill. I urge your Lordships to go and talk to them. Many more will have written to your Lordships. Supporters of the Bill argue that there is a hard and fast distinction between terminal illness and disability. I can tell you absolutely that there is not. We, the folk this Bill claims to serve, know that. The Bill purports to offer choice – the option of premature death instead of pain, suffering and disempowerment – but it is a false choice. It is that of the burglar who offers to mug you instead. That is not choice. Pain, suffering and disempowerment are treatable – I have to believe that – and they should always be treated. My long experience of progressive deterioration has taught me that there is no situation that cannot be improved.

I have spent my life developing ways to prevent people in vulnerable situations feeling powerless and burdensome. They do get cajoled and do feel a burden, especially when they are at home with no one to come and assist them to go to the toilet and to have dignity. I have seen this transformation when people have been helped. Those whom society once saw as totally dependent have become active and valued human beings. I am afraid that assisted dying will bring back outdated beliefs that devalue disabled and terminally ill people, when we have tried so hard to get away from them. Small wonder then if some succumb to those beliefs and see premature death as the only answer. Small wonder if family, friends, doctors and others see it as their duty to support that goal. It appears easier, cheaper and quicker – and it is.

The Bill is motivated by fear and pity but as the greatest French novelist Balzac observed,

“pity is death to us – it makes our weakness weaker still.”

Death is seen as a release from pity, for both giver and receiver, but there are far better ways of responding. We must put our energy into providing the best support, be it medical, social, practical or emotional, to disabled people and terminally ill people. We are nowhere near there yet. Helping people to live with dignity and purpose must surely be our priority. Disabled people and terminally ill people do not deserve pity. They deserve so much better. The Bill has become a runaway train, and the more frightening because of that. Please let us pause and find ways to reflect further. The Bill is not the answer.

The very wording of the Falconer Bill reveals its implications for the vulnerable

About the author: A former OSFL committee member, Greg Jackson is currently studying for an MA in Ethics.

For those of you who have not yet had a chance to read Lord Falconer’s Assisted Dying Bill, here are some of its key phrases.

To begin with ‘assisted dying’: The phrase is a euphemistic attempt to make it seem as if what is here described is a part of the practice of palliative medicine. All it really amounts to is assisted suicide under certain conditions – conditions that we may fear will expand in the future, perhaps without limit.

Much of the Bill’s wording, when looked at closely, gives cause for real concern.


a person is terminally ill if that person –

(a) has been diagnosed by a registered medical practitioner as having an inevitably progressive condition which cannot be reversed by treatment (‘a terminal illness’); and

(b) as a consequence of that terminal illness, is reasonably expected to die within six months. 2 (1)

As a previous blogpost explained, this is an unworkably vague criterion. But in any case, why is the cut-off at six months? Why is it only these people that are to be given lawful assistance in ending their own lives? This is surely discriminatory. The law, in effect, is putting these people in a category which is not worth protecting, and therefore is failing to recognise the equal worth of such people. The Assisted Dying Bill, were it to succeed, would be telling people in this category that society has given up on them; that they are no longer valued enough for the law to be concerned with their protection to the extent that it is concerned with others’. At the time when they need hope more than ever, the law is telling them that their case is hopeless.

‘[the [patient’s decision must have] been reached voluntarily…without coercion or duress.’

3 (3) (c)

One may wonder how such a thing could ever be accurately determined. After all, ‘coercion and duress’ can be extremely subtle forces, difficult to detect. We cannot simply rely upon the patient’s word that he or she is not under coercion or duress. Financial and familial pressures can exert a powerful influence on all of us, but perhaps even more so on the sick and the dying, and such pressures can remain virtually impossible to detect. Surely some terminally ill people will end up making this decision against their own will.


‘…the attending doctor and the independent doctor must be satisfied that the person making it has been fully informed of the palliative, hospice and other care which is available to that person.’

2 (4)

Here as elsewhere, we see the enormous trust that the Bill places in the medical profession. It relies upon the medical profession policing itself. Who else, after all, is going to determine whether a patient kills themselves in accordance with the criteria set out in the Bill? While we can assume that the majority of medical professionals are upright and conscientious individuals, can we trust that each and every medical professional will fully inform a patient of other options?

Furthermore, the Bill undermines the grounds upon which our ordinary trust in the medical profession is based. People look to doctors for cure and care, and they entrust themselves to them in the confidence that doctors are dedicated to those ends. But if doctors are not dedicated to these ends then a relationship of trust with them is no longer possible.


The attending doctor of a person who has made a valid declaration may prescribe medicines for that person to enable that person to end their own life.

4 (1)

The Bill refers to ‘medicine’ used to end one’s life. But this is a clear abuse of the term – ‘medicine’ being, of its nature, directed towards treatment and healing. In this case the lethal drug is not directed towards treatment and healing, but rather towards the death of the patient.

‘the attending doctor and the independent doctor, having separately examined the person and the person’s medical records and each acting independently of the other, must be satisfied that the person…has a clear and settled intention to end their own life which has been reached voluntarily’. 3 (3) (c)

The Bill makes no requirement whatsoever that the person who seeks to end their own life need undergo psychological assessment – which is not a small matter. There is no procedure to assess whether or not the patient is suffering from depression or some other psychological condition that will affect their decision-making capacity. All that is necessary is that two physicians determine that the patient ‘has the capacity to make the decision to end their own life’, and one might legitimately wonder how that might be determined as well. Again, the Bill places an awful lot of trust on the medical profession to police itself in these matters, yet as said, this Bill undermines the very foundations of that trust.


‘The Secretary of State may issue one or more codes of practice’.
8 (1)

And ‘the Secretary of State may specify in regulations’ what experience a doctor needs (3 (7)); ‘The Secretary of State may by regulations specify’ how the ‘medicines’ are to be administered (4 (7)); ‘the Secretary of State shall consult such persons as the Secretary of State thinks appropriate’ (8 (2)). A lot of the Bill’s implications are left to unknown circumstances.


Much has been made of the safeguards in the Bill, yet in addition to the issues that we have noted, legislation that permits assisted dying can never have adequate safeguards because the essence of such legislation is to make respect for the lives of the dying dependent upon the strength of their will to survive. The Bill represents society losing hope. And it detracts our efforts away from palliative care, a holistic solution which recognises the true value of the sick and the dying.


You can still email peers and ask them to oppose this dangerous Bill.

Why doctors oppose Falconer: a medic explains

The author is a medical student currently at Oxford University.

The major organisations representing UK medical professionals have raised their voices in resounding opposition to Lord Falconer’s assisted dying bill. But why? Do they not care about suffering patients? While their position may continue to strike Lord Falconer’s supporters as odd, it turns out that, given their specialized knowledge about care at the end of life, they have very good reasons for opposing the bill.

The medical profession has always understood itself as a healing profession – and intentionally facilitating someone’s death is strikingly contrary to that goal. As put by the Royal College of Physicians: ‘Assisting suicide has been clearly and expressly outside our duty of care since Hippocrates and must remain so for the integrity of these professions and the public good’. The RCP is pointing out that assisted suicide is not medicine and if a physician is asked to participate in assisting a patient’s death, the request must be denied.

Treating assisted dying as ‘just another medical procedure’ threatens the integrity of the profession, insofar as the profession aims at health. Hippocrates included an explicit prohibition on the provision of deadly drugs for precisely this reason. If an explicit commitment to healing patients is lost, medicine is at risk of losing its way as a profession. It is the unwavering commitment to the health of her patients that gives the doctor a privileged position in society and the trust of her patients.

Consider also that the modern hospice/palliative care movement began in the late 60s – less than 50 years ago. Since that time palliative care has become much more widely available, physicians have refined it as an art, and they know that it will continue to improve. In a recent conversation, a palliative care physician told me that in his experience patients who express an interest in dying ‘if things get bad’ are afraid more than anything else. Once he explains that he will not be shy in using medications – pain relievers and others – to alleviate their symptoms, their fear subsides and they stop enquiring about being helped to die.

Medical professionals are resolved to continue to improve palliative care as an art so that the fears that often drive patients to ask about assisted dying can be better quelled with the promise of effective palliation. It is crucial that, while physicians realize that even with the best palliative care some may still be resolved to pursue suicide, ‘helping their patients to die’ is off the table, as it is out of the scope of their profession. Instead, their focus is on getting better at relieving pain and other symptoms and caring for their patients attentively at the end of life.

Moreover, while the bill attempts to build in protections for the vulnerable – based on prognosis, depression screens, etc. – doctors know better than anyone that these simply are not effective enough to provide reliable protection. Whatever the rationale for identifying having 6 or fewer months to live as the point at which a patient may choose assisted suicide, doctors know that providing a prognosis is more like predicting what Germany’s goal total will be over the course of the World Cup than it is like calculating how long it will take for a drug to be cleared from circulation. There are too many variables for it to be reliably precise.

A number of studies have reinforced this – and the further away one gets from the end of life the less accurate predictions tend to be. Whether or not the expected time remaining should be treated as important, physicians approach their estimates with humility and realize that it is shaky at best to base policy on them.

Even more importantly, doctors realize that they cannot reliably do what the bill asks them to do – screen out depressed patients. Depression comes with an impaired sense of judgment and often feelings of despair. Those who are depressed are ‘not themselves’ and thus, when they have suicidal ideation, it is our duty to protect them from themselves – not to facilitate self-harm. The legislation tries to combat this danger through screening, but screening for depression is not at all like measuring cholesterol, blood pressure, or blood sugar. The screening tests are based on patient responses and while somewhat reliable in patients who do not have an agenda, a depressed person set on gaining assistance in committing suicide could easily dupe the test. It would only require fairly basic knowledge about depression. Physicians – psychiatrists in particular – are aware of this and realize that even the best screening methods we have are unable to correct for this. As such, doctors are very much justified in pointing out that, even if it tries, the bill cannot reliably protect those with mental illness – thus making the legislation unsafe.

As we have seen, physicians have very good reasons for opposing Lord Falconer’s assisted dying bill. They recognize their profession to be one of healing and are unwilling to undermine its integrity by permitting the medicalization of suicide and codifying it in law. Their objections are also based on a strange mix of confidence and humility – confidence in their ability to improve palliative care and humility in recognizing their own limitations. Physicians realize that they are being looked to not only to irrevocably alter their profession, but also to ensure safeguards that they simply cannot provide.


Keep Britain safe for the elderly and ill. Here’s how to write to the House of Lords.

5 things to know about the Falconer Bill

Lord Falconer’s Bill will come before the House of Lords for its second reading on the 18th July. Here are 5 things to know about the Bill:

(1) The Bill was put together by an independent Commission. The Commission on Assisted Dying was set up in 2010, chaired by Lord Falconer, and funded by Sir Terry Pratchett and Bernard Lewis. It aimed to investigate the “circumstances under which it should be possible for people to be assisted to die” and to “recommend what system, if any, should exist to allow people to be assisted to die”.

(2) The Commission itself has not been free from criticism. It was set up in response to two independent Parliamentary Select Committees, who examined the issue and concluded that no change in the current law was necessary. Around 40 leading medical, ethical and disability rights organisations boycotted the Commission’s call for evidence submissions due to a perceived bias in the way the Commission was set up and how it intended to conduct its research. The British Medical Association passed a motion in June 2011 disputing the Commission’s claim to impartiality and independence.

(3) The Bill in its current form aims to change the existing law so that terminally ill adults are provided “at their request with specified assistance to end their own life.” This is only possible where the person fulfills certain conditions: they must have a “clear and settled intention” to end their own life; they must be over 18 and have resided for more than one year in the UK; their illness must be confirmed as ‘terminal’ by a registered medical practitioner because it cannot be “reversed by treatment” and as a consequence of that illness the person is “reasonably expected to die within six months.”

(4) There are many arguments against the Bill. The Bill is clear in expressing the criteria required to be eligible for assisted suicide, but fails to provide guidelines on how to assess whether any of these criteria have been met. This poses a serious threat to the safety of vulnerable members of society. Evidence can be found in Oregon, where assisted suicide has been legal since 1998, of the dangers of not ensuring that psychiatric assessments are used to rule out judgment impairing mental conditions. A 2008 British Medical Journal paper concluded that Oregon’s law failed to protect mentally ill patients since cases of clinical depression had passed undiagnosed.

Another problem with the criteria in the Bill is that patients are required to have a terminal prognosis of six months or less. However a terminal prognosis is extremely unreliable, and the Royal College of GPs have said when estimates are being made for people living a matter of months, the “scope for error can extend into years.” The Bill would also have a very negative effect on clinical practice, since it would directly undermine patients’ right to life and medical care. Baroness Campbell wrote last year that the existing law rests on “the principle that we do not involve ourselves in directly bringing about the deaths of other people”. She argued that the Falconer Bill tries to replace that clear principle “with an arbitrary and permeable one.”

One of the greatest problems with this Bill is the false assumption that the value of life diminishes closer to death. The value of life never diminishes, and so the challenge is for us to offer support and love to the terminally ill so that they may have true ‘dignity in dying’, rather than try to provide a false dignity through control over the time and manner of death.

(5) The Bill will come before the House of Lords on the 18th July for the second time, the first of which was at the start of June. The second reading is the first opportunity for the members of the Lords to debate the main principles and purposes of the Bill. After that it goes through a couple of different stages where amendments can be made before a third and final reading in the Lords. All this takes place before the Bill can reach the House of Commons, Royal Assent and be passed. Now is therefore the time to write to Peers to make sure all the arguments for the case to keep the current law are heard, and to express your concerns and hesitations with the Bill.


Who could possibly be against assisted suicide? Well, all of these people…

It is hard to doubt the good intentions of Lord Falconer, whose assisted suicide bill is being debated in the Lords on 18 July, two weeks from today. It is even harder not to be moved by the personal accounts of people who want to die, and their carers. But there is another side to this – one which has received less media coverage, but has convinced many of us that the Falconer Bill is extremely dangerous to public safety. When all is said and done, the Bill proposes to add ‘death’ to the services offered by the NHS and other health providers. And it creates a category of ‘lives not worth living’, which seems likely to expand over time. Baroness Warnock – as distinguished and respectable a supporter of assisted suicide as you will find – has said:

‘If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service… I think that’s the way the future will go, putting it rather brutally, you’d be licensing people to put others down.’

No wonder that a striking number of people and organisations, of many different kinds, have come out against assisted suicide.

Firstly, doctors. The British Medical Association’s crystal-clear policy, held consistently since 2006, is that assisted suicide threatens lives, weakens the ethos of the whole profession, and neglects the care which can be offered to patients in distress. The Royal College of Physicians is ‘firmly opposed’ to assisted suicide, arguing that ‘our duty of care is to work with patients to mitigate and overcome their clinical difficulties and suffering. It is clear to us that this does not include being, in any way, part of their suicide.’ The World Medical Association calls assisted suicide ‘unethical’; The Royal College of GPs reaffirmed its opposition in February.

The psychiatrist Baroness Sheila Hollins has argued that safeguards for a ‘clear and settled intention’ are practically impossible to implement. She adds: ‘Fear about dying calls for better palliative care services, a field in which Britain is already a world leader, and for a public that is better informed about the realities, rather than the scare stories, about death and dying.’

Secondly, people with disabilities. A recent statement signed by the respective leaders of Disability Rights UK and Scope warns: ‘We are deeply concerned that a change in the law will lead to disabled people – and other vulnerable people, including the elderly – feeling pressure to end their lives.’ The great Paralympian Baroness Tanni Grey-Thompson, another signatory to the statement, comments that reading the Falconer Bill sends ‘a chill down the spine’. As Baroness Jane Campbell and Richard Hawkes of Scope have both noted , Belgium’s child euthanasia laws are themselves a warning about the slippery slope.

Thirdly, parliamentarians. The Scottish Parliament voted against assisted suicide in 2010. The House of Lords rejected similar legislation to the Falconer Bill in 2009 and 2006.

Lord Winston, speaking in 2006, pointed out: ‘We cannot predict how people may feel about the future and to take that view is ultimately the most presumptuous thing that we can do.’

David Cameron is opposed: ‘My worry has always been about whether people will be unfairly pressurised.’ Nick Clegg, whose mother is Dutch, is also against changing the law: he remarks that the euthanasia laws in the Netherlands have ‘created a permissive culture, where people start going beyond the letter of the law.’

Fourthly, faith communities. The fullest statement came in a 2005 letter signed by the national leaders of the Buddhist, Sikh, Hindu, Anglican, Catholic, Evangelical, Muslim, Jewish and Greek Orthodox communities. Assisted suicide, they wrote, would ‘radically change the social air we all breathe by severely undermining respect for life’. And this is not only a conservative concern: the prominent liberal Anglican Giles Fraser has written movingly in his Guardian column against a new law.

Fifthly, legal experts. An exhaustive report by Lord Carlile, Baroness Butler-Sloss and Lord Brennan has concluded that changing the law is unsafe. In the words of Butler-Sloss, ‘The law is there to protect us all. We tinker with it at our peril.’

Finally – and this should count very heavily – there are all the voices of the terminally ill and the vulnerable, and their families and carers. Just read some of the comments on this petition against the Falconer Bill:

‘As a disabled person, the thought of starting on that slippery slope towards a right to die, rather than a right to live, is terrifying.’

‘This is literally a matter of life and death – changing this law could well lead to people like me being euthanized because someone else has decided I am terminally ill, and I’m so brow beaten that I agree with them to stop being a “burden”.’

‘I have just reached eighty, and can feel the pressure that I would be more use to some, if dead!’

If we won’t listen to the voices of the experts, we must at least listen to those who are frightened of coming under pressure to end their own lives.

Go here to write to members of the Lords about the bill.