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• Response to: Legalising Assisted Dying
  Alison Twycross
  Published on: 31 August 2017
• Legalising Assisted Dying
  Harriet M Copperman OBE, SRN
  Published on: 31 August 2017

• Published on: 31 August 2017

  Response to: Legalising Assisted Dying

  • Alison Twycross, Editor Evidence-based Nursing

  I would like to thank Harriet Copperman for her response to my recent editorial. I would like to respond to some of the points she has raised. Harriet says that: We should have the option of an assisted death. For many, just having that option would be sufficient to cope with their death. But a small percentage of people would want to be able to end to their life when it became intolerable. Suicide is not illegal any more...

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  I would like to thank Harriet Copperman for her response to my recent editorial. I would like to respond to some of the points she has raised. Harriet says that: We should have the option of an assisted death. For many, just having that option would be sufficient to cope with their death. But a small percentage of people would want to be able to end to their life when it became intolerable. Suicide is not illegal any more. We should therefore, with all the safeguards proposed in the Faulkner bill, enable those people to bring an end to their distress and suffering.

  However, the safeguards don't work. Supporters of Lord Falconer's Bill also argue that, if there are effective safeguards, we can give the right to die for those who wish to hasten their death while protecting those who do not. This argument was used in relation to the 1967 Abortion Act. Whatever one thinks about abortion, David Steel (who as an MP championed abortion reform in the 1960s) has pointed out that the 1967 Abortion Act was intended to stop back street abortions. There were warnings at the time about a slippery slope. And so it has proved to be: despite various safeguards, we now effectively have abortion on demand.

  We also need to listen to the warnings of people living and working in countries where euthanasia or assisted suicide has been legal for some time. The words of Theo Boer, a Dutch ethicist who supported the legalisation of voluntary euthanasia in the Netherlands are particularly pertinent. He cautions against legalising AS in the UK (http://bit.ly/1loFYgH). Professor Boer believes that the very existence of a law would progressively turn assisted suicide from a last resort to the norm. Data from both Oregon and Belgium lend support to such a view (Finlay and George 2011; Steck et al. 2013).

  Harriet Copperman also states "it is obvious now that with diminishing financial and professional resources and increased bureaucracy, that the goal of 'perfection' will never be achieved, and in my opinion specialist palliative care will become increasingly side- lined." This will become more likely if we legalise assisted suicide as is evident from cases in Oregon in the USA, were two cancer patients were refused funding for chemotherapy but were told that the State would pay for their AS.

  The bottom line remains that in matters of life and death, you cannot create freedom (to die) for the few without taking away adequate safeguards for the many.

  References

  Finlay, I.G. and George, R. Legal physician-assisted suicide in Oregon and the Netherlands; Evidence concerning the impact on patients in vulnerable groups - another perspective on Oregon's data, Journal of Medical Ethics, 2011;37:171-174.

  Steck, N., Egger, M., Maessen, M., Reisch, T. and Zwahlen, M. Euthansia and assisted suicide in selected European Countries and US States: Systematic literature review, Medical Care, 2013;51(10):938-944.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 31 August 2017

  Legalising Assisted Dying

  • Harriet M Copperman OBE, SRN, Retired nursing director of the North London Hospice Home Care Service

  Dear Editor,

  I began practising palliative care in the community in the mid 1970's and retired nearly 25 years later, having been involved with the care of thousands of dying patients. We were evangelical in our attempts to teach and spread the 'gospel of palliative care' to professionals, students and lay people, in the UK and around the world. We thought it was the answer to enabling people to have a good death....

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  Dear Editor,

  I began practising palliative care in the community in the mid 1970's and retired nearly 25 years later, having been involved with the care of thousands of dying patients. We were evangelical in our attempts to teach and spread the 'gospel of palliative care' to professionals, students and lay people, in the UK and around the world. We thought it was the answer to enabling people to have a good death.

  It was a large part of the answer, but not all of it. Alison Twycross points out that the need is to provide good end of care life so that people do not want/need an assisted death. I would have agreed with her in the past, but it is obvious now that with diminishing financial and professional resources and increased bureaucracy, that the goal of 'perfection' will never be achieved, and in my opinion specialist palliative care will become increasingly side-lined.

  Alison Twycross feels that good end of life care would be more likely were there, for example, better education about whether or not to administer antibiotics to someone who is terminally ill. That is actually an excellent example of how we have failed, after 50 years or so of trying to educate everyone appropriately, as Dame Cicely Saunders first taught about that topic in the 1960's. Incidentally, she always used to say "the patients are our teachers", and my addition to that was "while we learn they suffer"!

  The provision of palliative care (and pain control is probably easier to deal with than some other symptoms a patient may have) will never be perfect however much we would like it to be.

  We should have the option of an assisted death. For many, just having that option would be sufficient to cope with their death. But a small percentage of people would want to be able to end to their life when it became intolerable. Suicide is not illegal any more. We should therefore, with all the safeguards proposed in the Faulkner bill, enable those people to bring an end to their distress and suffering.

  Perhaps if we could really feel another's suffering, rather than just empathise, we might have changed the law years ago.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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