Alan Fox asked me for my thoughts, as an ex-GP, on the question of euthanasia, assisted suicide and whatever. I can probably do no better than to link to the submission I made to the relevant House of Lords Select Committee in 2004. For completeness here’s a link to the 1982 article I quote there.
Just a couple of additional thoughts. The first is that, despite my submission, the House of Lords Committee agreed with my position that a change in the law would be against the public good, as has every parliamentary committee commissioned to investigate the issue. European Court rulings have also established that there is no such thing as a right to death. In an age ruled by the ethical concept of “autonomy” such judicial caution is noteworthy.
And yet the interesting thing is that the media campaigns continue unabated, and hard cases are always reported by the news as if it were only a matter of time before the old inhumanity gives way to what is “obviously” right. I think this teaches us mostly about how activists have discovered how to change national worldviews by stealth, rather than by any kind of intellectual or political process. It teaches us little about the morality of euthanasia.
My second thought is that Alan raised this issue in the context of pain relief. As my submission shows, this is far from being the core issue in the euthanasia question, but is the “poster child” of the campaign, since severe pain is understood by all of us to be a terrible thing, whereas other issues like “being too unhappy to live” or “being a burden on relatives” are morally more equivocal.
I was fortunate enough to meet Dame Cicely Saunders, founder of the hospice movement, twice at medical school. I started my career, therefore, with a clear idea of the most advanced insights on terminal care. Applying those insights in practice was most often hindered by professionals’ own inability to come to terms with death (basically). Surgeons used to taking radical action to save lives often felt emotionally compelled to distance themselves from their “failures” by tucking them up in a side room with the less-than-effective “Brompton Cocktails” when the pain got too much. There were psychological barriers against actually learning from the hospice movement’s approach.
Opposition also came from nurses – the clinical haematology team of which I was a houseman was, despite my lowly status, happy to initiate my regime of titrated 4-hourly opiates for a poor child dying of leukaemia. But the nurses on the ward, despite careful discussion, proved incapable of overcoming their own aversion to giving “addictive drugs” to a kid.
But times have changed, the hospice movement has burgeoned, and a whole new discipline of pain management has grown out of anaesthetics. Chronic pain teams usually exclude cancer from their remit (for the sake of workload), knowing that the terminal care guys have things pretty well covered. But their insights have filtered out and helped revolutionise the treatment of neuropathic pain, that intractable variety that resists the opiates so helpful in somatic pain.
For example, with the guidance of the pain consultants I became adept at managing neuropathic pain with drugs in the back clinic I ran during my last two years, and helped spread the methodology to GPs in the district served by the clinic. Terminal care doctors attended the same masterclasses as myself. The net result is that the management of pain has never, ever, been better and is advancing all the time. Bearing in mind that two centuries ago laudanum was all there was, the noteworthy thing is that whilst nobody then argued for euthanasia, pressure for it has increased in direct proportion to the effectiveness of pain treatment. That is evidence, to me, that it is the superficial appeal of the essentially unworkable liberal establishment’s dogma of moral autonomy, rather than pressing clinical need, which is driving the whole show.
Lastly, the hospice movement has shown beyond doubt that “bad death” has to do more with fear and ignorance than with symptoms. Making the time to engage with dying people, as people, can make their last days times of emotional healing, family bonding and completion. I met many people who learned what it is to be human when they were dying. I myself certainly learned much about life from the mystery of death. And it is a mystery, as I found when I led the funerals of my own family members – never have I seen ordinary people more serious about life.
I’ve not alluded much to theology, but it’s lurking behind a lot of what I’ve said here. The hospice movement was rooted in a profound spiritual truth, and was responding to a fear of death that arises from the same source. The ethical dilemmas for doctors, too, silently have the same unspoken assumption. And my own thought and practice has been acutely conscious of it. And that truth is that we are created in the image of God who gave us life, and will have to give an account of every human life taken to him.