Assisted Dying for the Terminally Ill Bill [HL]

HOUSE OF LORDS Select Committee on the Assisted Dying for the Terminally Ill Bill Assisted Dying for the Terminally Ill Bill [HL] Volume III: Evidence— Individual Submissions Ordered to be printed 3 March 2005 and published 28 April 2005 Published by the Authority of the House of Lords London : The Stationery Office Limited £14.50 HL Paper 86-III ASSISTED DYING FOR THE TERMINALLY ILL BILL [HL] SELECTED INDIVIDUAL SUBMISSIONS The select committee received over 14,000 personal letters or other submissions from individuals in regard to the Assisted Dying for the Terminally Ill Bill. A brief analysis of these is given in Paragraphs 230-231 of HL Paper 86-I. This volume reproduces a small selection. CONTENTS Written Evidence Page Professor Margaret Battin 1 Dr Bert Broeckaert 6 Right Reverend Christopher Budd 8 Dr Jane Campbell 10 Dr Colleen Cartwright & Associate Professor Malcolm Parker 16 Nessa Coyle 21 Alison Davis 22 R George 30 Professor John Griffiths 37 Colin Harte 42 Raymond Hoffenberg 46 Professor Emily Jackson 48 Dr Bert Keizer 55 Dr Helga Kuhse 56 Henk-Maarten Laane 61 Ian Maddocks 67 Professor Roger Magnusson 70 Yvonne Yi Wood Mak & Glyn Elwyn 71 Baroness Masham of Ilton DL 80 Professor T S Maughan 81 Professor Charles F Mckann 82 NatCen 85 National Group of Nurse Consultants in Palliative Care 87 Professor Richard Glynn Owens 91 All-Party Parliamentary Pro-Life Group 93 St Christopher’s Hospice 96 Ms Karen Sanders 97 Professor John Saunders 101 Dr Richard Scheffer 103 A D Wade 107 Dr Ian R Williams 110 Dr Z Zylicz 113 Written Evidence Memorandum by Professor Margaret Battin of Utah University, USA My Background I am Distinguished Professor of the Department of Philosophy and Adjunct Professor of Internal Medicine at the University of Utah in the USA. I have authored, edited, or co-edited at least a dozen books, among them a study of philosophical issues in suicide, a collection on age-rationing of medical care, a study of ethical issues in organized religion entitled Ethics in the Sanctuary, and The Least Worst Death: Essays in Bioethics on the End of Life. I have been engaged in research on end-of-life medical decisions in the Netherlands and Oregon. In 2000, I was a co-recipient of the Rosenblatt Prize, the University of Utah’s most prestigious award. Summary of Submission 1. Palliative care and physician-assisted death — The question “What would you rather have, access to palliative care and hospice, or access to physician-assisted death?” presents a false dichotomy and does not fully address the needs, wishes, and realities of dying patients. — Opponents contend that legalization would undermine progress that has been made in improving palliative care and hospice. However there is dramatic evidence in both Oregon and the Netherlands that palliative care improves with the legalization of physician aid-in-dying. 2. The argument over physician-assisted death — In the past, debates about risks and benefits of legalization have been based on theory and conjecture. We now have empirical knowledge and data about the eVects of legalization in Oregon, and the Netherlands. — Opponents’ presentation of data from Oregon and from the Netherlands is incomplete and frequently filled with factual inaccuracies and distortions. — Many of the value-assumptions of those who oppose legislation are based in religious views. While religious commitments are to be respected, they should not be permitted to control social policy. 3. Addressing (and defeating) opposing arguments — Patient autonomy is actualized in physician-assisted dying. — Studies of physician practice show a measurable incidence of physician-assisted death whether legal or not. — In the vast majority of cases, assisted death is provided in the last week or last day before death would otherwise have occurred. — Already accepted methods of negotiating death oVer the patient few protections or safeguards. — The comfort provided by having the possibility of an easier death, even if one never actually uses it, can be enormous. — Society allows patients to make other end-of-life decisions—like refusing further treatment— without assuming that the patient is depressed. — No proposed statute for legalization would permit providing physician-assisted death without careful safeguards. — There is no evidence of sustained substantive abuse in either Oregon or the Netherlands. — There is a deep compatibility of excellent palliative care and physician-assisted death. 4. The philosophical debate over legalizing physician-assisted suicide — “Liberty” and “mercy” are fundamental principles of our society and are central to the case for legalization. — There is an ethical requirement for physicians to try to respond to autonomous requests from patients, and to not abandon patients. 2 assisted dying for terminally ill bill [hl]: evidence — The opposition claims killing is intrinsically wrong but accepts killing in self-defense, war and capital punishment. — The opposition cannot show that the principles or liberty and freedom, basic to an open, liberal, democratic society, should be overridden. 5. Conclusion — Physician-assisted death should be one of the last-resort options available to a patient who is facing a hard death. DiVerent people who are dying have very diVerent ideas and values about what would be, for them, the least worst death, and for some, an easier death with the assistance of their physician is vastly preferable to being allowed to die of their disease. — An open practice is better for patients, families and society. Below I outline more extensively, my arguments and reasoning 1. Palliative care and physician-assisted death 1.1 There is a growing consensus that palliative care is a core part of treatment to be oVered to all severely ill patients who are potentially facing death(1). However, challenging questions remain about how broad a range of choice patients may have in this process and about what limitations should be placed on the physician’s obligation to address patient suVering. Physician-assisted death has long been the focal point of ethical and political debate—a “hot-button”, divisive issue in a domain where there is otherwise considerable consensus. 1.2 If the question were, “What would you rather have, access to palliative care and hospice, or access to physician-assisted death?” most people would choose palliative care and hospice. Palliative care should be part of standard care for all severely ill patients, even those who are continuing active disease-directed treatment, and hospice should be the standard of care for all those who understand and accept that they are dying. I agree that access to physician-assisted death should not undermine processes and programs that promote comprehensive palliative care for patients and their families. 1.3 However, to frame this question in this way presents a false dichotomy: it serves the purpose of opposing access to physician-assisted death without fully addressing the needs, wishes, and realities of dying patients. I therefore prefer a more inclusive question: “What would you prefer, access to excellent palliative care and hospice by themselves, or access to excellent hospice and palliative care plus legal access to a physician-assisted death as a last resort if your suVering becomes intolerable?” 1.4 Both proponents and opponents of legalization of physician-assisted death can join together in support of improving access to and delivery of comprehensive palliative care for all severely ill patients. Both sides can also acknowledge and bemoan inadequacies in access to and delivery of health care services in general in the United States (and I therefore presume the UK), as well as end-of-life care in particular.(2) 1.5 However, as a proponent of legalization, I part company with opponents in my belief that it is not fair or justified to hold the question of legal access to physician-assisted death hostage to await the solution of these inadequacies. 1.6 Opponents of legalization contend that legalization of physician-assisted death-which they routinely demonize by using the term “physician-assisted suicide”—would undermine progress that has been made in improving palliative care and hospice. Not only is this not true, but there is dramatic evidence in both Oregon and the Netherlands that palliative care improves with the legalization of physician aid-in-dying. 2. The argument over physician-assisted death 2.1 In the past, debates about risks and benefits of legalization have been based on theory and conjecture. Even in the USA, the Supreme Court suggested when it addressed this issue in 1997 that “perhaps we should wait [on the question of legalization] until we know more.”(3; 4) Fortunately, we now have five years of empirical knowledge about the eVects of legalization in Oregon,(5-7) as well even more detailed empirical data from the Netherlands at various points over a 16 year period. Both of these data sets support the claim that a legal process can be contained; that little or no substantive abuse occurs. None is reported in Oregon, and much, much less than has been claimed in the Netherlands. Legislation is also associated with critical improvements in palliative care and hospice in both settings.(8) 2.2 Although “suicide” can be heroic and/or rational depending on setting philosophical and orientation(9; 10; 11), suicide in much writing is conflated with mental illness, and suggests the self-destruction of the person who is not thinking clearly or acting rationally. In most cases where a patient requests

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