In early 1935, a group of clergymen (including Canon Dick Shepherd from St. Martins-in-the-Fields, in London) and doctors (among them, the Royal Family surgeon, Lord Moynihan) founded the British Voluntary Euthanasia Society. This body's first public meeting was held at the headquarters of the British Medical Association on December 10th 1935. (It is interesting to note that, after the Second World War, December 10th became International Human Rights Day: for voluntary euthanasia is, for many, a human rights issue).
There are four stages of "Doctorassisted Dying". The first is the withholding or withdrawing of medical treatment from "hopeless cases" - a practice, once called "passive euthanasia", which is fully supported by the BMA as well as the General Medical Council, but is still opposed by a few pro-life groups. If someone has completed an advance directive (or ‘living will’) before the development of a terminal illness, stating the medical care they would like to receive if they become mentally incompetent, then this is very helpful to the doctors and family.
The second stage is often known as the "double effect". If someone is suffering a great deal from the symptoms of a terminal illness (such as severe pain), a doctor may give increasing dosages of a powerful drug, like diamorphine, officially to lessen the pain whilst privately knowing this can easily shorten the patient's life. This process, to "relieve someone's distress", is legal, although it allows doctors to perform "slow euthanasia", or "terminal sedation", without publicly declaring their true intentions (and it is hoped that the patient has agreed to this deceit).
Thirdly, doctor-assisted suicide can occur. Here, a doctor provides a prescription for a lethal substance (or, sometimes, the actual drug) to a terminally ill patient, who can take this whenever he or she wishes to do so. In the UK, at present, this is illegal, although it does occur, very privately.
Finally, voluntary and non-voluntary euthanasia - a doctor intentionally ending someone's life, with or without the patient's permission, usually by giving a single injection of a lethal drug — may be practised. This is also illegal at present in the UK, but does happen occasionally, very quietly (conservative estimates are that this form of doctor-assisted dying causes at least three percent of all deaths).
According to a BMA News Review survey in 1996, about half of all British doctors now want to see the law changed to allow voluntary euthanasia to occur, with strict safeguards.
In passing, it should be noted that the death of George V, in 1936, was an example of non-voluntary euthanasia. At noon, on the day he died, the King, who had been gradually slipping into a coma after a series of minor strokes, managed to sign a document permitting the appointment of a Council of State. But, it was realized that he was unlikely to live much longer. The family was consulted and agreed that his life would end that evening, but the King was not involved in this decision. Later, in a debate in the House of Lords on the possibility of a law to allow for voluntary euthanasia, the King's doctor, Lord Dawson (who had given the fatal intravenous injection) said that "there is no need for such a law, as all good doctors do if"?
Those who advocate legalised doctor-assisted suicide and voluntary euthanasia, like myself, also strongly support the good palliative care services we have in this country. The hospice movement has, over the years, developed very humane care for terminally ill patients, especially for those with cancer and AIDS. But even the best palliative care cannot relieve all the symptoms of terminal illness, unless terminal sedation is performed (which is a fairly common practice in many hospices today). I believe that legalised doctor-assisted suicide and voluntary euthanasia should become available Sof 59 May 2003 options within the provision of good palliative care services.
Legalised doctor-assisted suicide and voluntary euthanasia for terminally ill patients are available in some parts of the world today. Since 1981 these procedures have been decriminalized in the Netherlands, and they have been legal there since early last year. About four percent of all deaths in that country happen this way. Nine in ten Dutch doctors support these procedures for their patients. Strict guidelines are in place (there must be severe and persistent suffering, at least two doctors including a consultant must be involved, and the patient must be fully informed of their condition and the prognosis), and everything is carefully monitored. It is important to note that most ill people (at least two-thirds) who request voluntary euthanasia in the Netherlands are turned down by their doctors because they do not meet the criteria. In Switzerland, doctor-assisted suicide has been #5 -= strongest opponent, but the Islamic and Buddhist faiths also disagree with euthanasia. However, there are individuals within these religions, including some of their leaders, who fully support voluntary euthanasia.
The late Leslie Weatherhead, a prominent Methodist, once said, "I sincerely believe that those who come after us will wonder why on earth we kept a human being alive against his will, when all the dignity, beauty and meaning of life had vanished; when any gain to anyone was clearly impossible, and when we would have been punished by the state if we had kept alive an animal in similar conditions’.
The basic religious objection - at least among some Christians - is that suicide is forbidden. While the biblical texts do describe a number of cases of suicide (eight in the Old Testament, two in the Apocrypha and one in the New Testament), none of these passages offers detailed comment on the morality of the act, nor is there anywhere in the Bible an explicit discussion of this decriminalized for the past the Death of Chatterton (1856) by Henry Wallis ethical issue. Christian twenty-five years, and currently about 150 deaths a year occur this way. Doctor-assisted suicide was legalized in Oregon, USA, when in 1997 a state-wide referendum was adopted by a 60-40 vote. Again, strict guidelines are in place. Naturally, several American prolife organizations are watching very carefully what is happening there, but no major problems have been reported. Then, last year, in Belgium, a law allowing for voluntary euthanasia was adopted: the final parliamentary vote was 86 to 51 in favour - quite a decent majority. I hope that both those in support of doctor-assisted dying and those opposed to any of the I sincerely believe that those who come after us will wonder why on earth we kept a human being alive against his will, when all the dignity, beauty and meaning of life had vanished...
Inspired by the young | 8th century poet who committed suicide disapproval of suicide actually dates from the fourth century. Then, the church, encouraged by the arguments of St. Augustine, adopted strict prohibition against suicide precisely because it had become so popular among Christians. A vogue for martyrdom, and even collective suicide, had at that time begun to threaten the church. Any religion which preaches that life on earth is a vale of tears, a mere prelude to a better afterlife, would seem to be inviting its adherents to kill themselves unless it can offer a better reason for them to delay their departure for paradise. Declaring suicide a mortal sin was the churches’ solution! On an important ethical and religious issue like doctor-assisted dying, I believe it is necessary to personalize it. Many of us will have seen relatives or friends who have died slowly and in great discomfort. If we should develop four stages mentioned earlier, continue to observe carefully what is happening in Belgium, Oregon, the Netherlands, and Switzerland. Then they should ask themselves, if legalized doctor-assisted suicide and voluntary euthanasia can work well in these places, why not in the UK?
Public support for legalized voluntary euthanasia in this country is very strong: various polls in recent years have shown figures of 85 to 90%. "Organized Medicine" is cautious - a motion at the BMA annual conference, in 1997, against changing the law, added, at the end, "For the time being"!
The main religious opposition is from the Jewish and Christian religions, with the Roman Catholic Church the sof 59 May 2003 similar terminal illnesses, would we like to have the possibility of legalized doctor-assisted suicide or voluntary euthanasia for ourselves? If the answer is "yes", then we should support a change in the law to make this possible. Are we so different from the Belgians, the Dutch, the Swiss, or those who live in Oregon?
Dr Michael Irwin, a member of SoF, is a retired GP and is Chairman of the Voluntary Euthanasia Society (VES).