In the first, Nigel Cox, a Winchester rheumatologist, was found guilty of the attempted murder of a patient with rheumatologist arthritis, after giving her a lethal injection of potassium chloride in August 1991. He was given a suspended jail sentence but later returned to work after a reprimand from the General Medical Council.
In the second, a House of Lords ruling gave permission for doctors at the Airedale General Hospital in West Yorkshire to remove a nasogastric feeding tube from Tony Bland. Tony, who had been suffering from persistent vegetative state as a result of prolonged asphyxia at the time of the Hillsborough disaster, died on March 3.
As a result of these cases , the House of Lords set up a committee , with Lord Walton as chairman, in February to consider the law related to euthanasia. It has been hearing submissions from interested parties and is expected to report in September or October this year. Judging by the precedent of the Warnock Committee on Human Embryology and Fertilization, its findings will probably be rubber-stamped into law, possibly as early as the summer of 1994.
As part of the political gamesmanship leading up to the Lords' committee's reporting, two further bills have been tabled in the upper house. The Termination of Medical Treatment Bill, seeking to make the Law-Lords judgement on Tony Bland applicable to all similar cases, was tabled in the House of Lords by Lord Alport on February 25 The Voluntary Euthanasia Society's Advance Directives Bill was introduced to the same house by Lord Allen on March 16. It effectively allows euthanasia by dehydration, starvation and heavy sedation. Finally, Mr Piara Khabra, MP for Ealing Southall, was to have tabled a ten minute rule bill legalising voluntary euthanasia the House of Commons on June 9, but it was withdrawn at the last minute. While it is unlikely that any of these bills will proceed beyond a first reading in the perceptible future, they nonetheless signal a rising demand for change.
On the positive side, the Department of Health, the Home Office, the British Medical Association and the Royal College of Nursing have all come out against any change in the law which currently regards intentional killing, for whatever motive, and assisting suicide as crimes.
However, across the North Sea reports are much more disturbing. According to the Remmelink Report, commissioned by the Dutch Ministry of Justice (a translation of which was published in the Lancet 1991; 338:669-74), nearly 2% of all deaths in the Netherlands result from euthanasia (BMJ 12 October 1991, p877), and of the estimated 3,300 cases per year over 1,000 are involuntary. The Dutch parliament became the first to sanction euthanasia officially on February 9 this year. The law takes effect next year but since 1973 doctors have been able to avoid prosecution by following a set code of practice.
The Royal Dutch Medical Association (KNMG) and the Dutch Commission for the acceptability of Life Terminating Action have just recommended in a new report that the active termination of the life of patients suffering from severe dementia is morally acceptable under certain conditions (BMJ 22 May 1993, p1364). The commission's two previous reports affirmed the acceptability of similar action for severely handicapped newborn babies (BMJ 28 November 1992, p1312) and comatose patients (BMJ 27 April 1991 , p984). It appears that Holland is moving rapidly down the slippery slope.
CMF is opposed to active euthanasia on the grounds that it is unnecessary (because alternatives exist), dangerous (because of abuses that inevitably follow legislation) and most importantly because it is morally wrong (violating the biblical prohibition on all intentional killing of innocent human beings).
Students are strongly advised to be well informed about the issues. A booklet containing reprints of six recent articles on euthanasia from the CMF doctors' journal is available free on request from the CMF Office.
Euthanasia - is it inevitable?
Recently, I attended a talk given by CARE (Christian Action Research and Education). They showed a video in which a reasoned view of euthanasia was given by supporters of both sides. I was particularly impressed by how many members of the general public felt that euthanasia should be available to any elderly person suffering from a terminal illness. They felt that it should be available for the following reasons:
- It is an individuals right to choose the manner and timing of his or her death.
- Everyone should be able to die with dignity.
- Euthanasia would prevent people dying in pain and distress.
CARE pointed out that dignity was a result of how society viewed death and not how that death occurred. Most forms of pain can be controlled these days, although this may involve a decrease in the level of consciousness. This may cause distress to relatives but the discomfort of terminal disease to the patient can be removed.
Although most people would prefer to uphold freedom for individuals, euthanasia includes giving doctors the right to administer medical treatment to a patient with the intention of killing that person. CARE argued that this would radically change the fundamental Christian principle, embodied in British law, of the sanctity of human life. This right could be very easily abused.
Euthanasia has been practised in Holland for nearly twenty years and was formally sanctioned earlier this year. It has been estimated by a government report in Holland (CARE video) that up to one third of all such killings were without the permission of the patient, even though strict guidelines have been laid down. Many elderly people there are afraid that their relatives may want to remove them from the scene; and others may feel obliged to ask to be killed because they have been told that it is better that they should die.
Throughout the Old Testament, the Jews are reprimanded for selecting against the weakest members of society (the widow and the orphan). I believe that a law in favour of euthanasia would also discriminate against the weak and the poor, especially the elderly, the disabled, those with 'learning difficulties' and the mentally ill.
I say the poor as well because I believe money will be the most important influence acting in favour of such a law. The Trust system favours anything that makes money and brings contracts into the hospital. Geriatrics is not a specialty which will bring contracts into a Trust hospital from outside its catchment area and therefore will suffer a shortage of funds. This has already started to happen. Acute services are gaining at the expense of chronic services. A terminally ill person may spend over ten months on a ward being in an unfit state to return home or without relatives or friends capable of looking after them. At £110 per day this costs the NHS over £33,000. Besides this, the Trust must find sufficient funds to give appropriate medical treatment, for example each unit of blood costs between £120 and £150 and several units may be required per week and in prostatic carcinoma, GnRH antagonists (eg Zoladex) cost £128 per month.
I believe that Trusts may have no choice but to put pressure on consultants in geriatric medicine to clear beds, and to be prepared to administer terminal treatment. This can easily be done by reducing the number of beds they have available, and by making sure that only those in favour of euthanasia are employed in the first place.
In obstetrics it can be difficult to get a consultancy post if you are not prepared to abort foetuses, even though the law upholds the right of doctors not to do so (how many anti-abortion obstetricians have you met?) Juniors' reputations precede them and another excuse can always be found for not employing someone. A similar situation would soon occur with old age medicine if euthanasia became law; and all specialties may be affected as terminal disease and chronic severe handicap can affect everyone.
Finally, like abortion, a law condoning euthanasia would be very difficult to reverse, because this would condemn anyone who was involved with an act carried out while the law was in force as murderers, morally if not legally. Therefore, the longer such a law is in force, the less likely it is to be reversed as more people would be guilty of having killed someone either directly or indirectly.
In conclusion, a law condoning euthanasia is a law which would select against the weaker members of society, and is also a law which could not be policed properly . It is one which could not be objectively evaluated and reversed if found to be inappropriate, and lastly is completely contrary to the law of God.
