An open letter to Robert Buckland MP: The Assisted Dying Bill

Dear Mr.Buckland,
 

We are writing this letter to once again urge you to reconsider your position on the Assisted Dying Bill which is due to be voted upon on September 11th 2015. Several of us from Swindon Humanists have discussed or corresponded with you about this before, and we fully understand and agree with your statement that it is entirely possible for people to hold widely different but defensible opinions regarding assisted dying. We do however believe strongly that supporting the Bill is the right option, which is also where the vast majority of public opinion lies.
 
We would firstly like to remind you of just some of the many arguments in favour of this position:
 
1) Having the option of assisted dying can provide reassurance to people who are in the final stages of a terminal illness; that they will be able to call a halt to their suffering if they so wish – even if they don’t actually come to do so in the end.
 
2) Without the option of an assisted death, people may well end up dying sooner than they would otherwise do, especially in the cases of those travelling abroad as they will have to be fit enough to make the journey, possibly alone, and this clearly means they would have to do so long before the true final stages of their life.
 
3) Not having the option of assisted death forces some people to attempt suicide, sometimes unsuccessfully, sometimes alone to ensure their family cannot be prosecuted, and sometimes in long, drawn out ways such as starving themselves to death.
 
4) Voluntary and non-voluntary euthanasia is already practiced in the UK, but it happens outside the law and therefore without any safeguards. In 2009 Professor Clive Seale published research which found that a ‘significant minority’ of doctors reported making decisions that they think will hasten the death of a patient. In 9.8% of those cases patients verbally expressed a request for the end of their life to be hastened. There should be real transparency about this which should start by having the law reflect the reality.
 
5) It is quite clear from polling data and the fact that the DPP has not thought it in the public interest to prosecute a single person who has helped someone travel abroad to have an assisted death, that the current law does not reflect societies standards of compassion.
 
6) Just as abortion and homosexuality, both legalised in 1967, are not compulsory, the legalisation of assisted dying would also not make it compulsory. No one is forcing it on anyone else, but opponents are forcing their views on those who would choose it for themselves.
 
There are of course also many arguments against, but we firmly believe they either fail to address the Bill itself or are contradicted by evidence:
 
1) If this Bill is passed it would lead to further steps to enable a wider set of people to access assisted dying, or that it would inevitably lead to the legalisation of assisted suicide or euthanasia.
 
The analogy of a ‘slippery slope’ is a bad one, because even if this Bill is passed, and even if campaigns then started up to extend it, the same process would have to be gone through to amend the law again. Considering it has taken 80 odd years since the first assisted dying Bill, and we still don’t have one, despite public opinion, I think the idea that that system would then allow a headlong rush in the opposite direction is faintly ridiculous. And it isn’t an argument against what is in the Bill.
 
The evidence available to us to address this argument is that in the 18 years assisted dying has been legal in Oregon (the Death With Dignity Act of 1994, which the current Bill to be voted upon is closely based) there have been no calls to extend the law beyond terminally ill, mentally competent adults. So to date, the slippery slope has been considerably more sticky and less steep than feared. Also worth noting is there has been a steady but small increase in the numbers of DWDA deaths over those 18 years, from 16 in 1998 to 71 in 2013, however as a proportion of deaths in the state this equates to roughly 0.2%, a figure that has remained steady for the last several years.
 
2) Allowing assisted dying would harm investment, development and access to palliative care.
 
Oregon statistics show that the vast majority of people who have an assisted death were in receipt of hospice care; showing both that the option is clearly there and that palliative care alone is not a complete solution in all cases. The claim that palliative care would suffer if assisted dying is legal is, in the case of Oregon, shown to be false as Oregon has among the best palliative care of the fifty states in the US and the proportion of people dying in hospice care has more than doubled since the Death With Dignity Act was introduced. Further to that evidence, a 2011 report by the European Association of Palliative Care came to this conclusion:

“The idea that legislation of euthanasia and/or assisted suicide might obstruct or halt palliative care development thus seems unwarranted and is only expressed in commentaries rather than demonstrated by empirical evidence”.

3) Vulnerable people may be consciously or unconsciously coerced into ending their lives for the benefit of others.
 
We think this is undoubtedly the argument that we would consider the most important. Again, there is evidence we have that may help us to address it. But the first response to this argument would simply be to say that in hospitals here, and in foreign clinics, people already get assistance to die and there are little or no safeguards in place to address this specific concern. Surely it would be better to bring those situations within the law and apply those important safeguards and, if you believe the safeguards in the Bill are not sufficient, to assist in improving them rather than rejecting the entire Bill at this early stage.
 
A report published by the Journal of Medical Ethics in 2011 looked at assisted dying in Oregon and also the Netherlands, specifically at evidence concerning the impact on patients in ‘vulnerable groups’, assessing the concern of a ’slippery slope’, predicting abuse of people in vulnerable groups. From Oregon it looked at all the annual reports and three independent studies and from the Netherlands it looked at four government commissioned studies of end-of-life decision making (from 1990 – 2005). Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.
The results of the study were that the rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS.
 
In 9 years in Oregon, a total of six persons with AIDS died under the DWDA; although the numbers are small, persons with AIDS were 30 times more likely to use assisted dying than those who died of chronic respiratory disorders. So there would seem to me to be a good reason there to look deeper into the possible causes of that highlighted risk. However, the conclusion of the Journal of Medical Ethics report states that where assisted dying is already legal, there is no current evidence for the claim that legalised physician assisted suicide or euthanasia will have disproportionate impact on patients in vulnerable groups.
 
4) It devalues human life and violates the sanctity of human life.
 
This argument surely depends on how you value human life to begin with. As long-time campaigner Baroness Mary Warnock said in a debate “being alive is not something to value in itself” and by that she means it’s the quality of that life and how that life is lived that matters, not the brute fact of being alive. The use of the term ‘sanctity of human life’ is common from religious opponents to assisted dying and while they make the same valuable arguments as anyone else, solely religious or theological arguments are not relevant. The majority of people in the UK are not religious. It would be wrong to impose a solely religious or theological view on those who don’t subscribe to that way of thinking. As an example of the type of view that should never be imposed, here is a quote from Pope John Paul the second. In 1995 he said:

“According to Christian teaching, suffering, especially suffering during the last moments of life, has a special place in God’s saving plan; it is in fact a sharing in Christ’s passion and a union with the redeeming sacrifice which He offered in obedience to the Father’s will”.

 

However, as mentioned earlier, polling of religious people shows they largely reject the official position of their churches and in fact many religious officials speak out in favour of assisted dying. Even the former Archbishop of Canterbury, Lord Carey, changed his mind from opposition to support in advance of the House of Lords debate in July of this year. In that debate he said:

“As to those who chide me – and they have – by saying that my argument and change of heart are light on theological backing, let me tell them what my theology is all about. It is about accompanying those very sick and dying people to that place where they feel most abandoned […] and where they need us to be with them to help find peace of mind and to help them on that journey. If that is not theology of the best and purest kind, I do not know what is.”

 
6) The Bill would help to devalue disabled people. This argument was made very strongly in the House of Lords debate in July by Baroness Campbell and Baroness Grey-Thompson, both of whom are disabled. While we understand how important it is that disabled people are not discriminated against in any way, the Bill does not deal with people with disabilities. As polls show that the majority of disabled people are in favour of assisted dying, they appear to be ignoring the opinions of the group they wish to represent.
 
We at Swindon Humanists accept the difficulty of this debate that is so clearly not a black and white issue, but we feel that both from an empirical standpoint and a moral one, the right choice is to support the Bill. We very much hope that you will consider these arguments once more and agree (as your fellow Conservative and Swindon North MP Justin Tomlinson does). As Professor Raymond Tallis says:

“Unbearable suffering, prolonged by medical care and inflicted on a dying patient who wishes to die, is unequivocally a bad thing. From this it follows that not doing (or, worse still, prohibiting) what has to be done to prevent this is unacceptable cruelty. “

 

Yours sincerely,
 

Swindon Humanist Committee:
Neil Davies
Jo Garton
Belinda Neal
Fred Pound
Nikki Dancey
Andy Bentley
Andrew Whitford
Chris Eley