‘ Assisted Dying’ A Christian Perspective

1. ‘Assisted Dying’ A Christian Perspective St Michael's, Blackheath Peter Saunders Chief Executive, Christian Medical Fellowship Director, Care Not Killing Alliance

2. Background • Christian Medical Fellowship - 4,000 Christian doctors/ 1,000 medical students • Care Not Killing - ~40 organisations

3. Definitions Euthanasia is where someone intentionally kills a person whose life is felt not to be worth living Euthanasia can be voluntary, non-voluntary or involuntary

4. Euthanasia does not include... • Stopping or not starting a medically useless treatment • Pain relief when the intention is to kill the pain but not the patient (double effect) • Refusal of medical treatment by a competent patient

5. Definitions Assisted suicide is where someone (eg. a doctor) helps someone else to end their own life

6. The Law in the UK • Suicide Act (1961) It is a crime to ‘encourage or assist’ another person’s suicide - up to 14 years • Murder Act (1965) It is a crime intentionally to take the life of another person even for compassionate motives – mandatory life sentence

7. Discretion in sentencing • Stephen Marshall – Murder (36 years) • Frances Inglis – Murder (9 years) • Kay Gilderdale – Assisted suicide (12 month conditional discharge)

8. British National Media • Pro-euthanasia BBC, Channel Four, ITV The Times Guardian Independent Daily Mirror • Anti- euthanasia Daily Telegraph Daily Mail

9. Well publicised Dignitas cases • Anne Turner • Craig Ewart (MND) • Daniel James (Tetraplegia) • Sir Edward and Lady Downes

10. Celebrity support • Baroness Warnock • Joan Bakewell • John Humphrys • Terry Pratchett

11. Baroness Warnock

12. Martin Amis

13. Philip Nitschke

14. Ludwig Minelli of Dignitas

15. Dignitas • Body bags in elevators • Deaths in car parks • Cremation urns • Profiteering (Soraya Wernli) • £10,000 per case

17. Select Committee Conclusion - 1994 'We concluded that it was virtually impossible to ensure that all acts of euthanasia were truly voluntary and that any liberalisation of the law in the United Kingdom could not be abused. We were also concerned that vulnerable people - the elderly, lonely, sick or distressed - would feel pressure, whether real or imagined, to request early death.’ (Lord Walton of Detchant, February 1994)

18. Attempts to change UK law • Lord Joffe (3 bills from 2003-2006) – lost 148 to 100 • Lord Falconer (Amendment to Coroners and Justice Bill 2009) – lost 194 to 141 • Debbie Purdy case (2009) – stalemate • End of Life Assistance (Scotland) Bill (Margo MacDonald) (2010) – lost 85 to 16

19. Joffe’s 3rd bill defeated 148-100 • The arguments that convinced Parliament • Public safety - A change in the law would place vulnerable people under pressure to request early death – therefore it should not be changed for a few persistent cases • Palliative care - Requests for euthanasia are extremely rare when patients needs fully met – therefore we need better care

20. Falconer defeated 194-141 • Public Safety - A change in the law would place vulnerable people under pressure to request early death – therefore it should not be changed for a few exceptional cases • Palliative Care - Requests for euthanasia are extremely rare when patients needs are fully met – therefore what we really need is good care • No need - The current law is clear and right – it deters abuse and allows mercy in hard cases

21. Opposing a change in the law • Gordon Brown • Jack Straw • Ed Balls • David Cameron

22. Opposing a change in the law • Lord Carlile • Lord MacKay • Lady Butler-Sloss • Lord Brennan

23. Opposing a change in the law • British Medical Association (BMA) • Royal College of General Practitioners (RCGP) • Royal College of Physicians (RCP) • Association for Palliative Medicine (APM)

24. Opposing a change in the law • Baroness Jane Campbell • Over 30 disability rights leaders • RADAR • UKDPC

25. Debbie Purdy • Primary progressive Multiple Sclerosis • Sought judicial review of DPP to refuse ‘clarifying’ Suicide Act • High Court and Appeal Court hearings lost but • House of Lords hearing won 27 July 2009

26. The DPP Guidelines • Keir Starmer • Draft/interim Guidelines issued 23 September 2009 • Consultation ended 16 December 2009 • Definitive guidance published 25 February 2010

27. DPP Guidelines – prosecution less likely if… • Victim had a settled wish to commit suicide • Assistance was of a minor nature only • Assister co-operated fully with the police • ‘Assister’ was ‘wholly motivated by compassion’ • PD James – ‘a murderer’s charter’

28. DPP decisions thus far • Caractacus Downes – no prosecution • Michael Irwin (former VES chair, SOARS) – no prosecution • Libby Wilson (FATE) – no prosecution

29. End of Life Assistance (Scotland) Bill • Dutch Bill - Assisted suicide and euthanasia • Wide scope – Terminal illness and disability • Means undefined – injection, gas, hanging, bullet… • No independent medical opinion/conscience clause • No reporting; No penalties

30. Commission on Assisted Dying • Conceived by Dignity in Dying and financed by Terry Pratchett • Administered by ‘Demos’ and Chaired by Lord Falconer • 9 of 11 commissioners in favour • Reported 5 January 2012 recommending assisted suicide for mentally competent adults with <12 months to live

31. Arguments for Euthanasia • Compassion - ‘Death with Dignity’ • Autonomy - ‘Right to die’ • Economics - ‘alternatives too expensive’

32. Compassion – ‘death with dignity’ • Are the symptoms untreatable? • Have all referral avenues been sought? • Are the symptoms medical?

33. Autonomy – ‘a right to die’ • Rights for patients imply reciprocal duties for doctors • Many ‘free’ requests for euthanasia are not freely made • Rights granted to some undermine rights granted to others

34. Economics - we can’t afford it ‘As soon as he goes beyond 60-65 years of age man lives beyond his capacity to produce, and he costs society a lot of money...euthanasia will be one of the essential instruments of our future societies.' (Jacques Attali, L'Avenir de la vie)

35. European demographic time-bomb • Low fertility rates and an aging population • 3/2 working to dependent becomes 1/1 by 2060

36. Economics • 70% of elder abuse occurs in families • 12% of elder abuse is financial abuse • 30 to 50 per cent of total lifetime health care expenditures occur in the last six months of life • £5,000 for chemotherapy; £1,000 for palliative care; £5 for a glass of barbiturate • Do we want assisted suicide/euthanasia to be a ‘healthcare option’?

37. Barbara Wagner

38. Arguments against euthanasia • Unnecessary - there are ethical alternatives • Dangerous - exploitation and the slippery slope • Morally wrong - contrary to all historical ethical codes

39. Unnecessary - use ethical alternatives • Palliative Care • The Hospice Movement • Psychosocial and Spiritual factors

40. Palliative Care • Mum wanted to die, but convincing her to live gave us both a gift beyond measure... (Baroness Ilora Finlay; Daily Mail 19 March 2010)

41. Dangerous - exploitation • Request as a symptom of suffering • Request by coercion (by ‘loved ones’ or ‘victims’) • Request out of felt duty • Suicide contagion • Incremental extension

42. Oregon One third die ‘for fear of being a burden’ < 5% psychiatric evaluations; 1 in 6 depressed Self-reporting with no surveillance 1,000 British deaths per year with an Oregon-type law

43. The Netherlands and Belgium The Groningen protocol for disabled babies 8% of all deaths by ‘terminal sedation’ 21 dementia patients euthanized last year Organs taken for transplant 13,000 British deaths per year with a Dutch-type law

44. Misguided Compassion? 'My underlying motive was the desire to help individuals who could not help themselves...such considerations should not be regarded as inhuman. Nor did I feel it in any way to be unethical or immoral...I am convinced that if Hippocrates were alive today he would change the wording of his oath...in which a doctor is forbidden to administer poison to an invalid even on demand...I have a perfectly clear conscience about the part I played in the affair. I am perfectly conscious that when I said yes to euthanasia I did so with the greatest conviction, just as it is my conviction today that it is right.’ (Karl Brandt, 1947)

45. The first mercy killings • 1925 survey shows parental support for childhood euthanasia • Karl Brandt kills baby Knauer at the University of Liepzig in 1939

46. Early German Euthanasia • Binding and Hoche – ‘Life unworthy of life’ • Voluntary euthanasia - ‘I accuse’ • Tiergartenstrasse 4 (T4) • 6,000 disabled children by 1940 • 70,000 elderly and mentally ill by 1941

47. Death Camps and Genocide • T4 operation stopped and staff redeployed • 24 main death camps and 350 smaller camps in operation by 1943 • 6 million Jews

48. 23 Doctors at Nuremberg

49. Could it happen again? ‘The beginnings at first were merely a subtle shift in emphasis  in  the basic attitude of  the physicians.  It started  with  the  attitude,  basic  in  the   euthanasia movement  that  there  is such a thing  as  a  life  not worthy  to  be lived. This attitude in its  early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to  be included in this category was enlarged to  encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all  non-Germans.’ (Leo Alexander. NEJM 1949; 241(2): 39-47)

50. Slippery Slope requirements • Favourable public opinion • Willing doctors • Economic pressure • A law allowing it