Euthanasia and Assisted Euthanasia and Assisted Suicide Suicide

Peter SaundersPeter Saunders

God and Bioethics God and Bioethics Dublin, 8 April 2009Dublin, 8 April 2009

DefinitionsDefinitions

Euthanasia is the intentional killing of Euthanasia is the intentional killing of a person whose life is felt not to be a person whose life is felt not to be worth livingworth living

Euthanasia can be voluntary, nonEuthanasia can be voluntary, non--voluntary or involuntary voluntary or involuntary

DefinitionsDefinitions

PhysicianPhysician--assisted suicide (PAS) is assisted suicide (PAS) is where the doctor prescribes a lethal where the doctor prescribes a lethal medication, but the person medication, but the person administers the dose himself or administers the dose himself or herselfherself

Euthanasia does not include...Euthanasia does not include...

Terminating or not initiating a medically Terminating or not initiating a medically useless treatmentuseless treatment

Proportionate pain and symptom treatment Proportionate pain and symptom treatment when the intention is not to kill but to care when the intention is not to kill but to care (double effect)(double effect)

Refusal of medical treatment by a Refusal of medical treatment by a competent patientcompetent patient

Arguments for EuthanasiaArguments for Euthanasia

Compassion Compassion -- ‘Death with Dignity’‘Death with Dignity’

Autonomy Autonomy -- ‘Right to die’‘Right to die’

Economics Economics -- ‘alternatives too expensive’‘alternatives too expensive’

Compassion Compassion -- death with dignity?death with dignity?

Are the symptoms untreatable?Are the symptoms untreatable?

Have all referral avenues been sought?Have all referral avenues been sought?

Are the symptoms medical?Are the symptoms medical?

Autonomy Autonomy -- a right to diea right to die

Rights for patients imply reciprocal duties for doctorsRights for patients imply reciprocal duties for doctors

Many ‘free’ requests for euthanasia are not freely Many ‘free’ requests for euthanasia are not freely mademade

Autonomy is not absolute and rights must be balanced Autonomy is not absolute and rights must be balanced with responsibilitieswith responsibilities

Rights granted to some undermine rights granted to Rights granted to some undermine rights granted to othersothers

Economics Economics -- we can’t afford itwe can’t afford it

‘‘As soon as he goes beyond 60As soon as he goes beyond 60--65 years 65 years of age man lives beyond his capacity to of age man lives beyond his capacity to produce, and he costs society a lot of produce, and he costs society a lot of money...euthanasia will be one of the money...euthanasia will be one of the essential instruments of our future essential instruments of our future societies.'societies.'

(Jacques (Jacques AttaliAttali, , L'Avenir de la vie)L'Avenir de la vie)

Arguments against euthanasiaArguments against euthanasia

Unnecessary Unnecessary -- there are ethical there are ethical alternativesalternatives

Dangerous Dangerous -- exploitation and the exploitation and the slippery slopeslippery slope

Morally wrong Morally wrong -- contrary to all historical contrary to all historical ethical codesethical codes

Unnecessary Unnecessary -- use ethical alternativesuse ethical alternatives

Palliative CarePalliative Care

The Hospice MovementThe Hospice Movement

Psychosocial and Spiritual factorsPsychosocial and Spiritual factors

Dangerous Dangerous -- exploitationexploitation

Request as a symptomRequest as a symptom

Request by coercionRequest by coercion

Perceived duty to requestPerceived duty to request

The slippery slope to involuntary The slippery slope to involuntary euthanasia (Holland, Germany)euthanasia (Holland, Germany)

Slippery Slope requirementsSlippery Slope requirements

FavourableFavourable public opinionpublic opinion

Willing doctorsWilling doctors

Economic pressureEconomic pressure

A law allowing itA law allowing it

Arguments against PASArguments against PAS

It’s technically euthanasia by intentionIt’s technically euthanasia by intention

Places pressure on patients to request itPlaces pressure on patients to request it

Introduces a ‘slippery slope’ to euthanasia Introduces a ‘slippery slope’ to euthanasia

Involves problems with ‘completion’ (15%)Involves problems with ‘completion’ (15%)

Impossible to policeImpossible to police

Will undermine development of palliative careWill undermine development of palliative care

Euthanasia in the Bible Euthanasia in the Bible

AbimelechAbimelech -- ‘death with dignity’ ‘death with dignity’ (Judges 9:54(Judges 9:54--57)57)

Saul Saul –– ‘put out of his agony’ ‘put out of his agony’ (2 Samuel 1:1(2 Samuel 1:1--16)16)

Biblical PrinciplesBiblical Principles

All human beings are made in the image of God All human beings are made in the image of God ((GnGn 1:27)1:27)

Taking the life of innocent human being is Taking the life of innocent human being is forbidden forbidden –– even on request (even on request (GnGn 9:6; Ex 20:13)9:6; Ex 20:13)

Scripture only sanctions the killing of ‘guilty’ Scripture only sanctions the killing of ‘guilty’ human beings in specific circumstances (capital human beings in specific circumstances (capital punishment, holy war, selfpunishment, holy war, self--defence) defence)

RatsachRatsach and and PhoneuoPhoneuo -- ((Ex 21:12Ex 21:12--1414; ; LvLv 24:1724:17--21; 21; Nu 35:16Nu 35:16--3131; ; DtDt 19:419:4--13)13)

Biblical PrinciplesBiblical PrinciplesThe third way between either allowing to die in The third way between either allowing to die in pain or giving a lethal injection (John 8:1pain or giving a lethal injection (John 8:1--11) 11)

Bearing one another’s burdens (Gal 6:2)Bearing one another’s burdens (Gal 6:2)

Carrying the cross Carrying the cross –– ChristChrist--like compassion for the like compassion for the sufferingsuffering

Death is not the end Death is not the end –– euthanasia could be the euthanasia could be the greatest spiritual disservicegreatest spiritual disservice

The Law in the UKThe Law in the UK

Suicide Act (1961) Suicide Act (1961) Assisting suicide is a crimeAssisting suicide is a crime

Murder Act (1965) Murder Act (1965) Intentional killing even for Intentional killing even for compassionate motives is a crimecompassionate motives is a crime

Ethical CodesEthical Codes

Hippocratic Oath (600BC)Hippocratic Oath (600BC)

JudeoJudeo--Christian EthicChristian Ethic

Declaration of Geneva (1948)Declaration of Geneva (1948)

International Code of Medical Ethics (1949)International Code of Medical Ethics (1949)

Statement of Marbella (1992)Statement of Marbella (1992)

Hippocratic OathHippocratic Oath

‘I will give no ‘I will give no deadly medicine deadly medicine to anyone if to anyone if asked nor asked nor suggest such suggest such counsel’counsel’

23 Doctors at Nuremberg23 Doctors at Nuremberg

Declaration of Geneva 1948Declaration of Geneva 1948

‘I will maintain the utmost respect from ‘I will maintain the utmost respect from human life from the time of conception; human life from the time of conception; even against threat I will not use my even against threat I will not use my medical knowledge contrary to the laws medical knowledge contrary to the laws of humanity’of humanity’

International Code of Medical Ethics International Code of Medical Ethics (1949)(1949)

‘ a doctor must always bear in mind ‘ a doctor must always bear in mind the obligation of preserving human the obligation of preserving human life from the time of conception life from the time of conception until death’until death’

Statement of Marbella (1992)Statement of Marbella (1992)

‘assisted suicide, like euthanasia is ‘assisted suicide, like euthanasia is unethical and must be condemned unethical and must be condemned by the medical profession’by the medical profession’

The international sceneThe international scene

US (Jack Kevorkian)US (Jack Kevorkian)Australia (Philip Australia (Philip NitschkeNitschke))HollandHollandBelgiumBelgiumLuxembourg Luxembourg Switzerland (Switzerland (DignitasDignitas))

Netherlands Netherlands -- NVE is widespreadNVE is widespread

3,200 cases of VE3,200 cases of VE400 of PAS400 of PAS900 of NVE900 of NVE

2,000 of palliation with Explicit intention of 2,000 of palliation with Explicit intention of ending life (EIEL)ending life (EIEL)

18,000 of wd/18,000 of wd/whwh with EIELwith EIEL90 neonates, 290 neonates, 2--5 psych pts 5 psych pts = >24,500 total with EIEL= >24,500 total with EIEL

(1995 figures)(1995 figures)

Netherlands Netherlands –– Cases are underreportedCases are underreported

Only 41% of 3,200 VE cases are reportedOnly 41% of 3,200 VE cases are reported

Netherlands Netherlands -- ConclusionsConclusions

The soThe so--called called ‘‘strict safeguardsstrict safeguards’’ have have largely failed: largely failed:

ie. VE only, prosecution for Nie. VE only, prosecution for N--VE, No VE if VE, No VE if palliative care available, all cases openly palliative care available, all cases openly

reported and properly scrutinised.reported and properly scrutinised.

Oregon Oregon

Death with DignityDeath with Dignity Act passed 1997Act passed 1997

401 deaths thus far401 deaths thus far in 11 years in 11 years

Most common reasons Most common reasons -- loss of dignity (92%), loss of dignity (92%), autonomy and participation in enjoyable activities autonomy and participation in enjoyable activities

Less than 5% have psychiatric evaluations but one in Less than 5% have psychiatric evaluations but one in six are depressed six are depressed

Reliance on doctorsReliance on doctors’’ selfself--reportingreporting

House of Lords’ Select Committee House of Lords’ Select Committee Report Report 17 February 199417 February 1994

No change in the law to No change in the law to allow euthanasiaallow euthanasiaCompetent patients may Competent patients may refuse treatmentrefuse treatmentDevelopment of Palliative Development of Palliative Care ServicesCare ServicesResearch into pain relief and Research into pain relief and symptom controlsymptom controlTreatmentTreatment--limiting decisions limiting decisions notnot to be determined by to be determined by resource availabilityresource availability

Select Committee Conclusion Select Committee Conclusion -- 19941994

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

(Lord Walton of (Lord Walton of DetchantDetchant, February 1994), February 1994)

Motor Motor NeuroneNeurone Disease (MND) Cases Disease (MND) Cases (1997(1997--2006)2006)

Annie Annie LindsellLindsell

Diane PrettyDiane Pretty

Reginald CrewReginald Crew

Anne Turner Anne Turner

The The JoffeJoffe Bill Bill

Three ‘Three ‘JoffeJoffe’ Bills in three years ’ Bills in three years –– 20032003--2005 2005

First ran out of time First ran out of time

Second led to Lords’ Select Second led to Lords’ Select Committee ReportsCommittee Reports

Third came to the vote Third came to the vote

The House of Lords’ Report (2005)The House of Lords’ Report (2005)

140 witnesses in four countries140 witnesses in four countries

Over 60 formal written submissions Over 60 formal written submissions

Over 14,000 letters and eOver 14,000 letters and e--mailsmails

8 hour debate on report on 10 October 2005 8 hour debate on report on 10 October 2005

74 Lords spoke 74 Lords spoke –– evenly dividedevenly divided

The 2006 Assisted Dying BillThe 2006 Assisted Dying Bill

Assisted suicide but not euthanasiaAssisted suicide but not euthanasia–– The ‘Oregon’ model with ‘Netherlands’ regulationThe ‘Oregon’ model with ‘Netherlands’ regulation

England and Wales onlyEngland and Wales only

Nurses’ involvementNurses’ involvement

Worrying definitionsWorrying definitions–– ‘terminally ill’, ‘unbearable suffering’‘terminally ill’, ‘unbearable suffering’

Bringing together…Bringing together…

Human rights groupsHuman rights groups

Professional groupsProfessional groups

Healthcare providersHealthcare providers

Faith based organisationsFaith based organisations

Concerned individualsConcerned individuals

Common AimsCommon Aims

Promoting more and better carePromoting more and better care

Opposing assisted dyingOpposing assisted dying

Changing public opinionChanging public opinion

StrategyStrategy

Website Website –– www.carenotkilling.org.ukwww.carenotkilling.org.uk

Slogan Slogan –– ‘‘Care Not KillingCare Not Killing’’

Resources Resources –– leaflets/DVDs/papersleaflets/DVDs/papers

SpokespeopleSpokespeople

EvidenceEvidence--based researchbased research

MembershipMembership

18 Core organizations18 Core organizations

30 Associate organizations30 Associate organizations

Core MembersCore Members

ALERTALERTAssociation for Palliative Association for Palliative Medicine of Great Medicine of Great Britain & IrelandBritain & IrelandBritish Council of British Council of Disabled PeopleDisabled PeopleCARECARECatholic Bishops Catholic Bishops Conference of England Conference of England and Walesand WalesCatholic UnionCatholic Union

Christian Medical Christian Medical FellowshipFellowshipChurch of EnglandChurch of EnglandEvangelical AllianceEvangelical AllianceHeythrop Heythrop InsituteInsituteLawyersLawyers’’ Christian Christian FellowshipFellowshipLIFELIFERADARRADARRight to LifeRight to LifeSPUCSPUC

The argumentsThe arguments

Requests for euthanasia are extremely rare Requests for euthanasia are extremely rare when patients needs fully met when patients needs fully met –– therefore we therefore we need good palliative careneed good palliative care

A change in the law would place vulnerable A change in the law would place vulnerable people under pressure to request early death people under pressure to request early death –– therefore it should not be changed for a therefore it should not be changed for a few persistent casesfew persistent cases

The Early CampaignThe Early Campaign

VES VES rebrandsrebrands itself as itself as Dignity in Dying Dignity in Dying –– 23 23 January 2006January 2006

Dr Anne Turner dies in Dr Anne Turner dies in Switzerland Switzerland –– 24 January 24 January 20062006

Care Not Killing officially Care Not Killing officially launches launches –– 30 January 200630 January 2006

The early campaignThe early campaign

www.carenotkilling.org.ukwww.carenotkilling.org.uk launched on 30 January launched on 30 January 20062006

Over 500,000 leaflets printed and distributedOver 500,000 leaflets printed and distributed

Over 15,000 copies of the DVD Over 15,000 copies of the DVD ‘‘Doctors speak on Doctors speak on assisted dyingassisted dying’’ distributeddistributed

Major Public debate between Dignity in Dying and Major Public debate between Dignity in Dying and Care Not Killing Care Not Killing –– 13 March 2006 (Panorama)13 March 2006 (Panorama)

MP Brian Iddon named as CNK chairman MP Brian Iddon named as CNK chairman –– 28 March28 March2006 2006

Activity 2006Activity 2006

Major letter writing campaign to Peers and Major letter writing campaign to Peers and MPs MPs –– April 2006April 2006

102,363 people in three weeks sign petition102,363 people in three weeks sign petition

Major media campaign launched Major media campaign launched –– 7 May 20067 May 2006

RCP reverses its position and opposes a RCP reverses its position and opposes a change in the law change in the law –– 10 May 200610 May 2006

Friday 12 May 2006Friday 12 May 2006

Patients, doctors and disabled people speak out on Patients, doctors and disabled people speak out on media against bill media against bill –– 99--11 May 200611 May 2006

Faith leaders unite against billFaith leaders unite against bill

Demonstrations outside parliamentDemonstrations outside parliament

Peers turn out in force to oppose bill Peers turn out in force to oppose bill

Bill defeated by 148Bill defeated by 148--100 at 2nd reading on 12 May100 at 2nd reading on 12 May

BMA reverses positionBMA reverses position

British Medical Association votes overwhelmingly British Medical Association votes overwhelmingly to oppose euthanasia to oppose euthanasia –– 29 June 200629 June 2006

Against voluntary euthanasia Against voluntary euthanasia –– 65%65%

Against physician assisted suicide Against physician assisted suicide –– 65%65%

Against nonAgainst non--voluntary euthanasia voluntary euthanasia –– 94%94%

The current positionThe current positionJoffe’sJoffe’s Bill has suffered an overwhelming defeat Bill has suffered an overwhelming defeat and the law remains unchanged and the law remains unchanged

The medical profession is united against The medical profession is united against euthanasia and assisted suicide euthanasia and assisted suicide –– RCGP, BMA and RCGP, BMA and RCP all have reversed position in last 18 months RCP all have reversed position in last 18 months to join WMA, RCN, APM and other royal colleges to join WMA, RCN, APM and other royal colleges

Public opinion polls remain in Public opinion polls remain in favourfavour of a change of a change in the law although it depends what question you in the law although it depends what question you ask ask

What has happened since?What has happened since?

Dignity in Dying has regrouped Dignity in Dying has regrouped –– 12 12 staff and over £1million turnover staff and over £1million turnover

New Cases to change public opinion New Cases to change public opinion

New assaults on the law New assaults on the law

The new threat The new threat

VES (Dignity in Dying) growing in strength VES (Dignity in Dying) growing in strength and confidence and confidence

More wellMore well--funded court cases funded court cases

More high profile suicides More high profile suicides

More pressure on Parliament More pressure on Parliament –– PAS as PAS as part of ‘end of life care’part of ‘end of life care’

Dignity in Dying Dignity in Dying

New CEO New CEO –– Sarah Sarah WoottonWootton

>£1 million turnover >£1 million turnover

Slick media machineSlick media machine

Dignity in Dying Spokespeople Dignity in Dying Spokespeople

Debbie Purdy Debbie Purdy Edward Turner Edward Turner Sophie Sophie PanditPanditLesley Close Lesley Close Brian Pretty Brian Pretty Kelly Taylor Kelly Taylor WynWyn Crew Crew

Recent cases Recent cases

Craig Ewart Craig Ewart

Daniel James Daniel James

Peter and Penelope Duff Peter and Penelope Duff

Other recent supportive figures Other recent supportive figures

Philip Philip NitschkeNitschke

Baroness Warnock Baroness Warnock

Joan Joan BakewellBakewell

John John HumphrysHumphrys

Terry Terry PratchettPratchett

Debbie Purdy Debbie Purdy

Primary progressive Multiple Primary progressive Multiple Sclerosis Sclerosis

Seeking judicial review of DPP Seeking judicial review of DPP to refuse ‘clarifying’ Suicide Act to refuse ‘clarifying’ Suicide Act

High Court hearing lost High Court hearing lost

Appeal Court hearing lostAppeal Court hearing lost

Appealing to House of Lords Appealing to House of Lords

Recent Events Recent Events

Sky Real Lives Sky Real Lives –– Craig Ewart Craig Ewart

Panorama Panorama –– Margot Margot MacDonald MacDonald

A short stay in Switzerland A short stay in Switzerland ––Ann Turner Ann Turner

Euthanasia Euthanasia –– Current threatsCurrent threats

Assisted dying amendments to Coroners and Assisted dying amendments to Coroners and Justice Bill Justice Bill

Margo MacDonald’s End of Life Choices Bill Margo MacDonald’s End of Life Choices Bill

Possible Private Members’ Bill in Lords or Possible Private Members’ Bill in Lords or Commons Commons

Coroners and Justice BillCoroners and Justice Bill

First Reading First Reading –– 14 January 2009 14 January 2009

Second Reading Second Reading –– 26 January 200926 January 2009

Committee Committee –– 3 February 3 February -- 10 March 200910 March 2009

Report Report –– 23, 24 March 2009 23, 24 March 2009

Third Reading Third Reading –– 24 March 2009 24 March 2009

Coroners and Justice Bill Coroners and Justice Bill

Clauses 46Clauses 46--48 tighten up Suicide Act 1961 to 48 tighten up Suicide Act 1961 to prevent ‘internet’ suicides prevent ‘internet’ suicides

Under the Suicide Act 1961 it is an offence to Under the Suicide Act 1961 it is an offence to “aid, abet, counsel or procure” the suicide of “aid, abet, counsel or procure” the suicide of another person another person

The CJ Bill would The CJ Bill would make illegal “acts capable make illegal “acts capable of encouraging or assisting suicide”. of encouraging or assisting suicide”.

Patricia Hewitt Amendment Patricia Hewitt Amendment

Exempting from prosecution Exempting from prosecution acts “done solely or principally acts “done solely or principally for the purpose of enabling or for the purpose of enabling or assisting a person to travel to assisting a person to travel to a country or territory in which a country or territory in which assisted dying is lawful”. assisted dying is lawful”.

Media circus 20 March Media circus 20 March

Not reached at Report on 23 Not reached at Report on 23 March March

Hewitt Amendment Problems Hewitt Amendment Problems

Scope to include nonScope to include non--terminally ill terminally ill

Elasticity of the term ‘assisted dying’ Elasticity of the term ‘assisted dying’

Act would both encourage and discourage suicideAct would both encourage and discourage suicide

Places British citizens at mercy of overseas law Places British citizens at mercy of overseas law

Vulnerable people placed under pressure Vulnerable people placed under pressure

Hewitt Amendment Problems Hewitt Amendment Problems

Current Swiss suicides not representative Current Swiss suicides not representative –– we we would see very different cases with law change would see very different cases with law change

Malicious encouragement Malicious encouragement vsvs compassionate help compassionate help distinction spurious distinction spurious

Establishment of precedent for assisted suicide Establishment of precedent for assisted suicide

Law is already working Law is already working –– ‘stern face and kind heart’ ‘stern face and kind heart’ (justice and mercy) (justice and mercy)

Danger of assisted suicide as ‘therapeutic option’ Danger of assisted suicide as ‘therapeutic option’

Coroners and Justice Bill Coroners and Justice Bill –– Where to now?Where to now?

House of Commons House of Commons –– 26 January 26 January –– 24 24 March 2009 March 2009

House of Lords House of Lords –– 27 April27 April

Royal Assent Royal Assent -- ?Autumn 2009 ?Autumn 2009

‘‘End of Life Choices’ Bill Consultation End of Life Choices’ Bill Consultation

Margo MacDonald MSPMargo MacDonald MSP

Consultation closed 8 March Consultation closed 8 March

Report and draft bill awaited Report and draft bill awaited

18 signatures needed to 18 signatures needed to proceed proceed

Until 2011 to complete Until 2011 to complete process process

Private Members’ Bills Private Members’ Bills

House of Commons House of Commons (Evan Harris) (Evan Harris) –– chance chance lost with ballot in lost with ballot in December 2008 December 2008

House of Lords (Lord House of Lords (Lord Warner) Warner) –– not enough not enough time left this time left this parliamentary session parliamentary session

What can Christians do?What can Christians do?

Get informed Get informed

Pray Pray

Join Join Care Not KillingCare Not Killing

Write letters to Peers Write letters to Peers -- www.writetothem.comwww.writetothem.com

Educate others Educate others –– students and churches students and churches

Get involvedGet involved

What can Christians do? What can Christians do?

The key issue is availability and willingness to The key issue is availability and willingness to put your head above the parapet put your head above the parapet

‘Whom shall I send and who will go for us?’ ‘Whom shall I send and who will go for us?’ And I said ‘Here am I, send me!’ (Isaiah 6:8)And I said ‘Here am I, send me!’ (Isaiah 6:8)

Get involved Get involved