The law must protect, doctors must care, and euthanasia undermines both

The following article was published by Mercatornet on July 13, 2017

A British palliative care pioneer talks to MercatorNet about the campaign for assisted suicide.

By Carolyn Moynihan

Baroness Ilora Finlay

There is not much you could tell Professor, the Baroness Ilora Finlay about death and dying – outside of a war zone, perhaps. The Welsh doctor and Member of the British House of Lords (since 2001), was the first consultant in palliative medicine in Wales back in 1987 and set up the hospice system there. In 1989 she introduced the Diploma in Palliative Medicine at Cardiff University where she still teaches. She co-chairs Living and Dying Well, a think tank to examine the evidence around euthanasia and assisted suicide.

Over the decades Professor Finlay has cared for thousands of people at the end of their lives, and in opposition to the growing euthanasia movement has become an internationally recognised champion of the need for good palliative care for all those diagnosed with a terminal illness.

In 2005 she served on the House of Lords select committee on the Assisted Dying for the Terminally Ill Bill – an exhaustive inquiry into assisted suicide that resulted in the UK parliament rejected the bill. She was also a prominent opponent of a similar bill introduced in 2014 (that was also rejected).

Recently she visited New Zealand where a private member’s euthanasia bill (not the first of its kind here) is now before parliament. David Seymour’s End of Life Choice Bill would allow terminally ill people with six months to live, or people with a "grievous and irremediable" condition – that is, the chronically ill -- to ask a doctor to help end their lives.

Mental capacity and vulnerability

“It’s very similar to the law in the Netherlands,” she told me during an interview in Auckland. “It could even be wider in its effect.” For one thing the Seymour bill does not have an explicit requirement for mental capacity.

“It only states that the person concerned must ‘have the ability to understand’ the nature and consequences of assisted dying. There’s no requirement to ask whether a person at this moment is thinking straight, whether their judgement is unimpaired.

“This would make people with learning difficulties extremely vulnerable. A person with Down syndrome, for example, could ‘understand’ from what they hear and see around them what euthanasia ‘means’ and say yes to it when they have not really understood at all.”

The latest official reports from The Netherlands show that 1 in 26 of all deaths there come about through euthanasia or physician assisted suicide, with an increase of 15 percent year on year. In the words of one of the original promoters in The Netherlands, euthanasia is becoming “the default mode of dying” there.

The majority of doctors remain opposed

You would expect Britain, where Dame Cicely Saunders founded the hospice movement 50 years ago, to be good at looking after the dying. In The Economist’s Quality of Death Index 2015, the UK ranked first out of 80 countries for palliative care, followed by Australia and New Zealand.

But is the medical profession there standing firm in its opposition to euthanasia?

“All the professional colleges in the UK as well as in most places around the world remain opposed, as do the majority of doctors,” says Professor Finlay. “Even in Oregon, where they changed the law, two-thirds of the doctors don’t want to be involved. I met with the New Zealand Medical Association whose chairman is absolutely clear that this is not a role for doctors.

“And indeed it is not the place of doctors to sit in judgement on who is or is not eligible for assisted dying, and then be part of the process of bringing about the person’s death deliberately with lethal drugs, when what they should be doing is getting on with looking after patients and caring for them, helping them maintain their dignity and keeping them comfortable, irrespective of what has happened to them.”

Being in control is not most people’s priority

One of the cultural forces driving the euthanasia movement is the desire of some people in prosperous countries who have always had “choices” and been in control of their lives, to remain in control to the end.

How much do people who actually are terminally ill care about being in control of everything?

“I’ve looked after thousands of dying people,” says Professor Finlay, “and what they want is to feel better than they do at the moment, to live better during whatever time they have left. It has often struck me that people who were adamant when they were well that they would want euthanasia or assisted suicide, when they are ill suddenly change their minds and are desperate to carry on living. When they face the reality of losing life they want everything done to help them live as fully as possible.

“The demand for euthanasia is coming, by and large, from those who are not in the last stage of illness, whereas those who are in the last stage are actually being looked after very well. People are frightened of things that, with good care, will probably not happen to them: that they might lose their mind, become breathless, that pain will become unbearable.”

The grey wave and the cost factor

There’s another kind of fear behind the “demand”, too – fear of the cost of caring for an ageing society. How are we going to care for all the people living longer lives but needing help?

“That’s a really interesting question. What the research shows is that if you look after people well, if you provide palliative care early, and you help them live as well as possible, their depression is lower, hopelessness is lower, the quality of life is higher – so paradoxically they live longer, but the costs are not higher. Because you are helping people maintain independent living and carrying on.

“If you look at the statistics for Oregon, for example, the peak age group for assisted suicide requests is 65-80, it’s not among the 80-plus year olds. And people in their 80s are generally much fitter today than they were.”

Are we up to this kind of care?

Can we, though, count on having enough professionals who want to do this kind of care, with its extra demand for empathy, understanding and personal skills? Are we cosseted Westerners up to it these days?

“Oh yes, we are completely up to it. There’s no problem about people wanting to go into specialist palliative care at all. It is one of the most competitive fields of medicine in the UK.

“I think, also, that there is an awareness that we need to be putting more into care, helping people make decisions, helping them understand that they can refuse treatment. Nobody is being forced to stay alive, nobody is being forced to suffer, as people campaigning for Euthanasia claim.

“However, there is always a power differential in the doctor-patient relationship, and we do need to train doctors to listen to what people need, to help them plan in advance and to modify their wishes as they go along.”

Fragile families and loneliness

Fear of death and requests for assisted suicide may be partly driven by changes in the family. Small families, distant families, broken families, families burdened by big mortgages so that both spouses have to work full time – these trends mean that someone who needs support because of old age or a degenerative disease will often not be able to find it in their family.

“Loneliness is a big killer. There certainly is evidence that it shortens your life expectancy, and both loneliness and the fear of it is a major problem in society today.”

Whatever the problem, the answer is not suicide, not killing. But how should opponents of euthanasia focus their case? Professor Finlay strongly emphasises the proper role of the law.

Prime focus: the law must protect the whole population

“First, you have to ask those wanting to change the law, does the law we have now not work? Laws have to protect the whole population, not just a few, so if we change the law, will more people be protected? Or will you be removing protection from people? All the evidence I have seen shows that these laws cannot protect everyone. The process becomes quite arbitrary: here is a suicide we will try to prevent; here is one we will assist. But why?

“You can’t be neutral. The law is written in a way that will involve you. People who think, ‘I’ll leave that to someone else to deal with,’ are deluding themselves. I think if you object to euthanasia and assisted suicide you have a duty to say so, to collect your thoughts and express them sensibly.

“This, by the way, has nothing to do with religion. It is not a question of what you believe -- people on both sides have their beliefs. Your arguments have to be based on evidence. Sometimes the evidence used is not very strong – you get stories going around that might or might not be true.

“But here is a story that comes straight from the most recent full report from Holland’s monitoring committees. There were three young women who were each severely psychologically disturbed. And in all three it could be traced back to abuse in childhood or early teens. Yet they were allowed to be euthanased because they were so disturbed.

“I have a real problem with a society that says, we will kill the victim with a lethal injection, but the perpetrator is out there, free.”

Carolyn Moynihan is deputy editor of MercatorNet.